Inspection on 04/09/07 for Bystock Court

This inspection was carried out on 4th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bystock Court 13/09/06

Bystock Court 10/01/06

Bystock Court 09/08/05

Bystock Court 06/01/05

Bystock Court 13/07/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Bystock Court Old Bystock Drive Exmouth Devon EX8 5EQ Lead Inspector Clare Medlock Unannounced Inspection 4th September 2007 10:00 Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bystock Court Address Old Bystock Drive Exmouth Devon EX8 5EQ 01395 266605 01395 222689 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Devon Sheltered Homes Trust Mrs Lynda Brenda Lockwood Care Home 41 Category(ies) of Learning disability (41) registration, with number of places Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 41. 13th and 14th September 2006 Date of last inspection Brief Description of the Service: Bystock Court is a home, which is owned by a registered charity, Devon Sheltered Housing Trust. The day-to-day operation of the home is carried out by Devon Community Housing Society (DCHS). Bystock Court is registered to provide accommodation and personal care for up to 41 people with learning disabilities. Out of the 41 rooms, one is used to provide short-term care. Although the home does not admit people over retirement age, some of the residents have chosen to continue to live there after their retirement. The main building is an impressive large period house set in extensive grounds on the outskirts of Exmouth, Devon. There are 41 single bedrooms and a range of communal areas including lounge, dining room, ballroom, craft room, games room, laundry and kitchen. There are two semi-independent flats, each with three en-suite bedrooms, a lounge and kitchen. Within the grounds are a range of buildings including a small farm, greenhouses and a paper shredding business. Residents are encouraged to participate in the running of the home and work in units according to their interests and abilities. The home also provides a range of education and leisure activities. Fees paid by people living at the home at the time of this inspection ranged from £375 - £635 per week. These fees do not include the cost of clothing, Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 5 toiletries, transport, hairdressing, chiropody charges and other personal items. The CSCI report is displayed on a notice board in the home. The Statement of Purpose, Service User Guide and brochure can be requested from staff at the home. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on Tuesday 4th September 2007. Prior to the inspection, the homes manager sent a detailed annual quality assurance assessment. This told us what the home had achieved in the last year, what problems they have and what plans they have for the next year. In addition to this, we received twenty questionnaires from people living at the home, nine questionnaires from staff, questionnaires from two health care professionals and fifteen from relatives of people who are living at the home. All of the information provided has helped us gather a picture of what life is like at the home. On the day of inspection we looked around the home, grounds and outlying buildings. We spoke in detail with four people who use the service and more generally to many more during the inspection. We spoke with six members of staff, the administrator and the general manager at the home. We looked in detail at what it was like living at the home for four people. We looked in detail at their records, care plans, bedroom and what they did during the day. This is referred to as case tracking, and helps us to understand the experience of people living in the home in more detail. We also looked at records. These records included care plans and records kept on people who use the service, staff recruitment files, diaries, medicine charts, accident records, maintenance records, finance books, staff training records and complaint folders. What the service does well: Many aspects of life at Bystock Court are very good. The home way people are admitted to the home is a careful and considered approach. Staff ensure that enough trial visits and short stays are offered before the trial period starts. This means that the person moving into the home knows if it is the right place for them to be but also allows other people at the home to see if the admission would affect them. The information given to people, their families and care manager is detailed and offers information about life in the home. The home also obtain a lot of information about the person who is planning to move into the home. The home provides an excellent range of work, education and leisure opportunities to suit all interests and abilities. Emphasis is placed on providing fulfilling work opportunities. Within the grounds there is a working farm, paper Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 7 shredding unit, productive greenhouses and gardens. In the house there are also opportunities to work in the laundry, kitchen or the craft workshop. People are able to make decisions about which activity, work or opportunity they wish to attend and can come and go as they please. Incentives and encouragement is offered to all residents. People are protected by the home making sure that risk assessments have been carried out on activities to ensure that people are safe but also supported to take responsible risks. People who use the service go out into the local community regularly. They attend a range of social, leisure and sporting facilities including swimming, horse riding, pubs and clubs. Residents are able to keep good contact with friends and families. Transport is provided by the home if required. The food is popular at the home. Menus are balanced and varied. Good choices are provided to ensure all likes, dislikes and dietary needs are catered for. The dining rooms are bright and well furnished. Meal times are a sociable time for the people who live at the home and a chance to meet new service users attending the day care facilities. Health and social care professionals are satisfied with the care provided. Staff are very knowledgeable about the social, personal and healthcare needs of all people living at the home. The management, recording, storage and administration of medicines are good at the home. Staff have received training on the safe administration of medicines. People who use the service and their families know how to make a complaint, and felt able to speak to staff or the manager if they have any problems or concerns. The home has been generally well maintained. All equipment has been serviced and maintained regularly. Good systems are in place to ensure all areas are kept clean. The laundry is well equipped and runs smoothly. There are good recruitment procedures in place to ensure all necessary checks are carried out before new staff are confirmed in post. Staffing numbers have been increased and are usually sufficient to meet the needs of the residents. The ethos of the home is generally good with the senior managers providing an open style of management. Relatives are happy with the care that their relatives receive and are generally happy with the communication at the home. What has improved since the last inspection? Information provided for people who live at the home and their families has improved. The Statement of Purpose and Service User Guide have been Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 8 reviewed and updated. The complaints process has been written using line drawings and symbols to help understand the text. The home have also produced a booklet, which explains how people are helped to make decisions. These improvements provide people more information which explains what they can expect from Bystock house. The budget for maintaining the house has also improved with the result of refurbishment of two bathrooms, new flooring and carpet, more redecoration and plans to complete refurbishment and modernisation of two further bathrooms. Corridors have been decorated, lighting improved and new pictures displayed to decorate the home. The management has also improved at the home. The homes manager has now registered with the Commission for Social Care Inspection. The general manager supports her. Together they are beginning to improve staffing, supervision and training at the home. What they could do better: The main priority for the staff at the home will be to ensure that all care that is given is ‘person centred’ rather than being done because it is easier for staff or just practice that has been accepted over the years. The focus of running the home must always be in the interest of the person living there and any practices, which are service led and institutionalised, must be challenged. Whilst the ethos of the home is generally good, it is sometimes let down by poor attitudes of a small number of staff. These attitudes must be challenged in order to improve people living at the home and also to keep them safe. Staff must ensure the way they speak with each other and with people who live at the home is respectful at all times. Staff must attend protection of vulnerable adult training to become aware of what can be classed as abuse. Staff should also be confident to report any practice, which is unacceptable to the senior managers. Activities at the home are very good. This could be improved by ensuring that they all encourage people to participate in activities and must make sure that their work practices do not affect or restrict the quality of life and choices of the people that live there. Staff should make sure that opportunities are open for everyone and consider that people may wish to have a change from time to time to vary the activities in which they participate. Communication between staff must also improve. Officers in charge should ensure they are organised during their working day and give clear directions to support workers. Instructions should be consistent so all staff are aware of how to consistently care for each person. Support workers must also be effectively supervised and instructed to ensure they are aware of how to safely care for the people living at the home. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 9 Staff must continue to receive induction before they work. The managers should ensure this induction is delivered in a way that is meaningful and not rushed and should make sure it is relevant to the role. Training programmes must be continued with the focus on ensuring all staff have up to date training in both mandatory subjects but also areas that are relevant to the care that is given. Records must also be improved at the home. Assessments must be completed in enough detail to be used to form the initial plan of care. Staff should make sure they ask all questions to ensure care continues to be person centred. Care plans must be well organised and used as a working document on a daily basis. Care plans should be a document that is relevant, clear to follow and easy to monitor changes. Care Records should be reviewed at least every six months or more often where changes occur. By ensuring records are improved will make sure communication is improved and will make sure that any changes in condition result in all staff knowing how to plan and deliver the right care or treatment. Care plans should reflect the care that is given and the knowledge of staff. When care plans are improved and used as a working document communication will improve. Staff will not rely on informal verbal communication and care can be tracked and changed when needed. Improving the standard of record keeping will also be evidence of what care has been provided and will act as a reference when planning long term care. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards looked at included 1,2,3,and 4 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The admission and assessment procedure ensures that people are able to decide whether the home is where they want to live. Improvements to the way this process is recorded would ensure care planning could be more person centred. EVIDENCE: People living at the home told us they liked living at the home and had ‘come to stay before moving into the home. This process varies on the needs of the person. One person said they had to ‘fight’ to come to the home as it was close to their parents. Another person said they came to the home for a few days and met her friend who was also living at the home. Another person explained that they had used the day care and had chosen to come to the home. Staff told us the process of admission varies depending on each person. The statement of purpose, Service User Guide and brochure provide information for prospective clients who are arranging the admission for people at the home. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 12 Nineteen out of twenty people who returned questionnaires responded that they were asked if they wanted to move into the home and were given enough information to decide if it was the right home for them. One person said ‘I stayed for a week to decide if I liked it’. Case tracking showed us that the records used for the assessment and admission process shows that staff get information from other sources including parents, families and health and social care professionals. The pre admission records still lack some detail regarding religion, specific healthcare needs. This means that detail on the person either relies on this information being passed on verbally or being missed which may result in care not being provided or being person centred. Staff at the home collectively have the skills to communicate effectively with people who use the service. The staff group have a variety of skills which help to provide the specialist services that are provided. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards inspected on this occasion include: 6,7,8 and 9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care Plans are not always well managed or person centred and do not reflect, or support the care that is given and sometimes restricts the choices people make. EVIDENCE: Each person living at the home has a set of records. Additional information are stored in various places. These include the daily monitoring records, handover book homes diary and other records. The organisation and storage of these records was ‘piecemeal’ and difficult to manage on a daily basis. Although each individual had a care plan, the development and review of the plan is variable. The plan includes basic information necessary to deliver the resident’s care but is not detailed or person centred. The care plan is not used as a working document and does not consistently reflect the care being delivered. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 14 Care plans are meant to be reviewed at least six monthly at the home or more often when changes occur. However, three of the four plans inspected had not been reviewed in that time scale or been updated to reflect the change in care planning. The plans did not show clearly how specialist and detailed care would be met. Staff told us that care plans are not always used as a daily reference. Staff also told us that care is communicated during ‘handover’ sessions and any changes are communicated verbally. Care plans for those people that can become aggressive or challenging were not clear of how behaviour can be avoided or give guidance of what works and does not work. An example in one plan stated that the word ‘No’ was not to be used but no guidance was seen as to methods, which could be tried. Staff told us in situations like that they ‘did their best’ or ‘copied other staff’ with how they dealt with situations. This lack of clear guidance has the potential to place people who use the service and staff at risk. We looked at one person’s records and there were five different documents to show that they could become aggressive, confrontational, kick out, hit out, become anxious, have mood swings or swear at staff. Staff also told us that the storage and management of records was disorganised at times. The care plans are kept in the staff room which staff told us is not at the centre of the home. Staff told us that this means that sometimes they forget to record information or when they are writing in care plans they feel isolated from the rest of the home and do not have access to an external telephone line. Staff spoken to were extremely knowledgeable about the people who use the service. Some information given by staff was either not recorded at all or not recorded in detail and used to start a plan of care. Information regarding people living at the home was found in many books, folders and care plans. This piecemeal system is service led and not person centered. It also relies on staff remembering to read the separate records and relies heavily on verbal communication, which may mean care is not provided, followed up or reviewed. It also means that care cannot easily be audited to ensure care has been given. Questionnaires were received from health care professionals. These asked: Does the care provided support individuals to live the life they choose? One commented: ‘Staff would benefit from training in person centred planning’ People who use the service told us they have a link worker, who ‘help them’ with life at the home and who ‘sort things out’ if it is needed. It was clear that link workers had been linked with gender as a consideration. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 15 People who use the service told us that they like living at the home. Two people told us they did not like doing much at the home and that was OK with the staff. One person explained that they liked doing a bit of gardening. Other people who use the service told us they liked working on the farm with the goats and horses. A tour of the premises confirmed that there are outbuildings where people can assist it they want to. One staff member told us that people who live at the home are able to come and go as they wish and that others are very keen and are working all day. People who use the service were sent questionnaires about life at the home. They told us they were able to make decisions about what they did each day. One response was ‘I chose what work I do and what food I eat’ The annual quality assurance assessment stated that a booklet has been introduced which explains how people can make decisions. Relative questionnaires contained a comment, ‘From time to time he is offered the opportunity to take part in recreational activities, which he declines. It is always accepted that this is his choice and his wishes are repeated. These matters are then discussed at the annual review.’ Observation confirmed that people who use the service are offered opportunities regarding the running of the home. These roles include laundry services, kitchen services, cooking and gardening. The residents who live in the self contained flats are supported and encouraged to plan what food they eat, shop for and cook the food, and clean the two flats within the home. Some people are able to come and go as they please in line with risk assessments; others are encouraged to join in activities with prompts. People who use the service told us they are never forced to do something they do not want to do. Meetings for people who use the service are held on a regular basis. Staff do not attend these but an outside advocate comes to chair the group and feeds back information to the manager. Comprehensive risk assessments have been carried out on all activities where the home considers the resident may be at risk of harm. These show how the home supports residents to lead active lives with appropriate safeguards where necessary. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15,16,17 were inspected on this occasion Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The wide and varied choice of work, education and leisure opportunities mean people of all interests and abilities have access to leading a fulfilling life. By ensuring that some opportunities are not restricted would ensure that people have more choice and more opportunities to maintain links with the community. EVIDENCE: People who use services are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home has sought the views of the residents and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 17 The grounds are extensive, and within both the house and the grounds there are a range of work opportunities and activities. There is a working farm with sheep, cattle, goats, chickens, ponies and guinea pigs. Those residents who are interested in farming are employed in all aspects of animal care and maintenance of the farm. The paper shredding business is popular with people who use the service. One person said that they enjoy working there and like the staff. The business supplies bedding for animals. People help shred, pack and deliver the bales of paper to local businesses and customers. Staff and people living at the home maintain the gardens and greenhouses. They produce plants for sale throughout the year, and residents who like gardening were seen busily working in these areas. On the day of inspection a group of day care Service Users and people who live at the home were off to a ‘mencap’ sale to sell the plants. Some people who live at the home choose to work within the house. Some work in the kitchen, some in the laundry, and some in the craft workshop. One person proudly showed us the workshop and also showed us the art and crafts that were on sale. The home was decorated in works of art that had been produced by the people living at the home. People who use the service told us about their jobs at the home. One person explained that she enjoyed working in the kitchen and wanted to work in the café if it opens. Another person told us that staff help them clean and tidy their room but they were not forced to do anything they did not want to do. One questionnaire highlighted that a person may like to collect the eggs occasionally rather than always doing the same activity. There was no evidence to show that staff had regularly asked people if the activity they were doing was reviewed on a regular basis to check they were happy to continue this. People who use the service were sent questionnaires about life at the home. They told us that they make decisions about what they do each day and can chose what they do during the day, evening and weekend. Some of the comments showed that people go on trips, watch TV and go Shopping. One comment stated that one person would like to go out more in the summer An external advocate holds the residents meetings. Findings and requests are then fed back to the manager. Recent requests have included proving new transport, which has been arranged. A people carrier has been purchased for transporting people and a smaller car for individual journeys. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 18 The annual quality assurance assessment stated that staff have organised and booked a holiday for the people living at the home. The manager told us that staff at Bystock have a commitment to enable people who use services to develop their skills, including social, emotional, communication, and independent living skills. The manager explained a plan to incorporate a café area at the home to improve community links and provide opportunities for people living at the home to take part in valued employment and activities. During the inspection staff were seen prompting people and encouraging them to join in the activities and roles at the home. People told us they were not forced to do things in the home. Staff told us that people were free to come and go as they chose. Observation confirmed that people living at the home socialised with day care service users whilst performing some activities. People who use the service have the opportunity to develop and maintain important personal and family relationships. During the inspection several people were on holiday with their families. Relationships can be developed between the people living at Bystock. Staff intervention is provided to ensure both people are happy to the relationship to develop and both give their consent. Examples were discussed at the inspection and appropriate intervention has taken place. People told us about the friends they have and that their families can visit or telephone whenever they chose. Where appropriate, people who live at Bystock House are involved in the domestic routines of the home, they take responsibility for their own room, menu planning and cooking meals in the two flats, making sure that they are able to enjoy the food they prefer and like. The manager is in the process of ordering a karaoke machine for residents after a request by them. Another person told us they have a TV in their room but it would be nice to have another video player in the games room. One person told us they liked their room and that they had a key to keep their things safe. They also had a box where they kept their money. People who use the service were asked for extra comments. These included that they like living at Bystock and it is a nice place to be. One person said they were happy in their home. Relatives were asked how they thought that the home could improve. Comments included: The care home could provide more trips at weekends, and My relative should be encouraged to go about more and Life seems much easier for staff if the residents stay indoors and It would be nice if the egg collection could be offered to all residents, not just the same ones. Staff told us sometimes it depended on which senior member of staff was on duty whether some trips and outings were encouraged or not. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 19 People at the inspection talked about bowling clubs, art clubs and classes, trips to the pub, trips to the shops. Attending community social events, community fairs to sell produce and visits to see family Forty-one people can live at the home at any one time so routines are necessary to ensure the smooth running of the home. Mealtimes are an occasion where choice is provided. At mealtimes the room has a lively atmosphere with lots of friendly conversation. There is also a quieter room where some people who live at the home prefer to eat their meals. There is a self-service ‘carvery’ system that enables people who live at the home to choose what they want to eat. There is a strong emphasis on healthy eating, and menus have been carefully drawn up to ensure people who live at the home have good variety and choice. Fresh fruit and vegetables are purchased locally. People who live at the home are consulted regularly on the content of the menus and adjustments are made accordingly. People who live at the home talked about how much they enjoy the meals. One person said he was able to ask the chef to cook him specific food he liked. Another person told us the food was good as she helped prepare it! On the day of inspection the staff and people who live at the home were holding a fun day, which involved a BBQ and afternoon of games. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 20 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): On this inspection we looked at standards 18,19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The management of a person’s health, personal care and medication in the home is good. Recording of events would improve communication and the care planning process. EVIDENCE: All staff spoken to during the inspection were extremely knowledgeable about the personal and health care needs of the people they cared for. This knowledge was not reflected in the records kept in the home. People living at the home said they could get up and go to bed when they wanted. One person explained this was after he had finished watching a TV programme. Some records explained personal preferences of when people wanted to be woken if they had not got up on time. Staff told us the personal care needs varied depending on the capabilities of the person. Staff explained that some people needed prompts or gentle encouragement whilst others needed more time and full assistance. Staff spoken to were knowledgeable Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 21 about the dislikes and likes of the people at the home and how they used gentle persuasion to encourage self-care. People living at the home were dressed in a way that reflected individual style. One member of staff explained that people are able to choose their own clothes and special shopping trips are arranged t buy specially requested items of clothes. Everyone living at the home looked well cared for, and were clean and tidy. Relative questionnaires asked: Do you feel that the care staff meets the needs of your relative. All but one ticked always. One ticked usually. Comments included: ‘She always appears well dressed, clean and well cared for whenever we visit’, and ‘He does not like being away from Bystock’ and ‘They care for his health and hygiene needs’. Two questionnaires contained specific details of health needs of the people living at the home. Both explained that they had been informed about the problem and that it had been dealt with quickly and efficiently. Whilst looking at records one of these incidents was recorded but not highlighted as a care need. Information had been passed on verbally between staff. This relies on staff remembering to pass on the information to all staff caring for that person and may lead to information being forgotten and care not being given. Staff told us that residents go out to get their haircut, visit the dentist and GP. A chiropodist visits regularly for which people are charged a small fee. People living at the home all had access to a local GP (General practitioner). Staff told us that the person visits the GP surgery unless a home visit is required due to ill health. These visits are then done in the person’s bedroom. Staff were knowledgeable about the healthcare needs of the people they cared for but this knowledge was not always reflected in the records kept in the home. Other specific health care needs, for example blood tests because of medication, however were well recorded. Feedback from a local GP was positive. Comments included: Bystock provide a supportive, caring and empathetic approach When asked how the service at Bystock could improve, the comment was: Communication between staff occasionally could be better The management of medication was good in the home. The home uses a blister pack system of administrating medications. Medicines are held in secure cupboards in a room on the ground floor. These are separated into three cupboards, one for each floor. Staff said that residents prefer to go to this room to collect their medications rather than staff take medicines to them in their rooms. Staff told us that a small number of experienced and trained staff administer the medications with one member of staff being appointed for Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 22 the overall management of medications. Records were well maintained. The cupboards were found to be neat and orderly. A secure refrigerator is available for any medicines that have to be kept cool. The home have a new locked cupboard in case the home are holding controlled drugs. The staff at the home have a well-organised receipt and returns system at the home and have been visited regularly by the pharmacist to provide advice and support to the staff. There are letters on file from each resident’s GP setting out the medicines that they allow staff to give to the person without a prescription. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 23 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 22 and 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The complaints at the home are managed well but the way a very small number of staff speak to some residents is disrespectful. There are clear vulnerable adults policies available, however these are not always used which places people at risk. EVIDENCE: The home have a complaints procedure in place, which has recently been reviewed to make it more accessible. The manager explained that this has involved the use of line drawings and symbols to assist people reading documents. The Manager explained it is a trial, as they did not want to make the process more complicated. All questionnaires received from people who live at the home said they knew who to go to if they were unhappy. These people were listed as their link worker, the manager or other staff at the home. The Commission for Social Care Inspection have not received any complaints regarding Bystock court since the last inspection. Previous complaints received by the home have been dealt with appropriately. Questionnaires received from relatives showed that they all knew how to make a complaint. Comments included: I have never had reason to complain, and, Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 24 complaints are very few and far between, however the management and staff are always available and address and problems and/or misgivings swiftly. Questionnaires sent by people who use the service showed that staff treat them well and listen and act on what they say. The home and DCHS (Devon Community Housing trust) have strict policies on how allegations of abuse should be referred and dealt with. All staff spoken to knew to report any allegations of abuse to the homes manager or general manager and said they would report to senior managers at DCHS if the abuse was from the in house manager or was not referred correctly. People at the inspection said they liked the home. All but one person said staff were kind, spoke to them nicely and were fun. One person said that some senior staff shout at them. This was supported by a comment on a questionnaire received from a person living at the home said that a senior member of staff shouts at them and their friend. This was referred to Devon County Council to look at. Staff questionnaires and staff spoken to confirmed that some senior staff could speak to people disrespectfully at times. These comments had not been communicated to the manager despite policies being in place. This was fed back to the general manager who gave assurances that this will be dealt with as a matter of importance. Not all staff had received training in the protection of vulnerable adults training. The administrator was arranging this training at the time of inspection. Workshops had been held in house on the subject of professional boundaries, which staff had said were interesting. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 25 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,26,27, elements of 29 and 30 were inspected on this occasion. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The clean and well-maintained home provides people with a comfortable place to live. The planned improvements to the bathrooms will improve the home for the people who live there. EVIDENCE: Bystock Court is a large period style three-storey house situated on the outskirts of Exmouth. New housing estates have been built in the surrounding area in recent years. The grounds and exterior of the building have been well maintained. Inside the home the communal rooms and bedrooms have been well maintained and attractively decorated. The entrance hallway, dining rooms, sitting rooms and ballroom are bright, comfortable and well furnished areas. The entrance hall, downstairs corridors, and two bathrooms have been re Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 26 decorated and lighting improved. New carpet was fitted to the stairs and landing approximately a year ago and non-slip flooring outside of the kitchen. People living in the home each have their own bedroom, which is decorated and fitted to individual tastes. All furniture seen on the day of inspection was in a good state of repair and domestic in style. There are also two self-contained flats within the home providing more independent accommodation for residents. Art work displayed in the dining areas and corridors brightened the home. Staff told us that residents were able to vote for the pictures. The most popular choices were purchased, with additional artwork by people who live at the home being displayed. During the tour of the building the manager explained that funding had been agreed and quotes have been requested for the refurbishment of the three remaining bathrooms, which will also provide an additional ensuite for one of the people living at the home. Two people showed off their room. One explained he had additional storage space in the loft for more of his possessions. Another person proudly showed their large flat screen TV and posters. Another person was waiting for the delivery of their new bed. All floors of the home can be accessed by stairs with the exception of a small set of stairs which have a stair lift for those who need wheelchair access. The majority of people at the home are fully mobile. The people with mobility restrictions have bedrooms on the ground floor. All areas of the home that were seen were clean, tidy and free from offensive odours, which is an improvement since the last inspection. People living at the home help regular cleaning staff. Laundry facilities are managed on site. Whilst these are not domestic in style they are appropriate for the size of the home. Gloves and aprons are available for all staff and dissolvable bags are used for the very small amount of soiled laundry that is occasionally produced. Staff spoken to all told us that they had received training in infection control and this training was mandatory. Questionnaires received from people who live at the home confirmed that they thought the home was always clean and tidy. Comments received from relatives included ‘She has a cosy room that is always clean and tidy’ and ‘It would be good to encourage more independent living, smaller units where residents can experience a more homely feel in day-to-day living. E.g. smaller more intimate dining areas, remove long corridors and bedroom arrangements. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 31,32,33,34,35 and 36 were inspected on this occasion. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Induction and training are sometimes inadequate, which means staff do not always have the skills and knowledge to perform their roles in a safe and effective way. Poor consistency of methods of working and lack of supervision may mean that staff are sometimes unaware of their roles, which may place people at risk. There are sufficient numbers of staff to meet the needs of the people who live at the home. EVIDENCE: Staff told us that they have a job description, which lists their day-to-day roles and responsibilities. Staff also told us that they have received an induction although this seems to be a paper exercise rather than meaningful. Staff also said follow up support was disorganised with them learning by the mistakes they made or watching and copying other staff. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 28 Staff also told us that the day-to-day organisation at the home was sometimes confusing. Staff told us that senior support staff were sometimes disorganised and the way things happened depended upon which staff that were on duty. Questionnaires sent to staff contained comments that showed that the organisation of workload was sometimes disorganised. Comments included; ‘because everyone follows different rules, you can never get a straight or satisfactory answer. We need to follow the same rules then there won’t be constant confusion, miscommunication and conflict’ and ‘there is a lot of conflict in the majority of staff so everyone does different things’ Staff questionnaires also contained comments, which show that staff do not always act in the best interest of the people who use the service. Comments included ‘Some staff have been here for years and they do not always put the resident first’ and ‘The residents are sometimes spoken to disgustingly- this is only by a few seniors and most of the staff are great.’ Feedback from healthcare professionals was generally good. However, one comment included that Staff would benefit from training in person centred care planning. Bystock Court, inevitably because of its size has a somewhat institutional feel, which may prevent some staff from promoting individuals independence. Staff spoken to said there tended to be enough staff on duty but mealtimes were chaotic at times with the additional day care service users eating at the home. Staff told us agency usage was low and the turnover of staff was low. Staff questionnaires showed that supervision and induction in the home was sometimes poor. Comments included ‘I have only been observed when I first started here and that was by a fellow support worker and never manager or officer in charge’ and ‘I answered yes to induction but it was very basic and there was too much information at once. Then I was expected just to get on with the job. It was very frightening and if it were not for a few wonderful support workers I would have been a real mess. Training and induction here is terrible’ and ‘Training is a little too late and I need relevant training in autism, downs syndrome and mental issues. I feel that if we had more grasp of these conditions we could do more for the service users.’ Training records were well organised. Mandatory training is a priority and was more organised with existing staff having received recent training or training sessions being booked. However, specialist training in areas such as challenging behaviour and understanding learning disabilities were out of date. The manager has arranged recent workshops on professional boundaries which staff have found useful. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 29 Supervision in the home is beginning to improve. Staff told us that the manager conducts supervision of senior staff and then senior staff supervise support workers. Questionnaires received from staff confirmed that senior staff have received supervision but not all support workers have received this yet. Staff also told us the format has changed and direct questions about whether staff have witnessed abuse to the people living at the home. Staff recruitment is generally good at the home. New staff have been recruited to increase staffing levels. Staff files are well organised. However one file did not contain evidence that a CRB (Criminal Records bureau-police check) had been performed. This information was provided by the end of the inspection. None of the files inspected contained evidence that a recent photograph had been obtained. All files contained at least three references, forms of ID, application form and record of interview. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 30 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 38, 39, and 42 were inspected on this occasion. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Bystock Court is a well managed home and a safe place to work and live. EVIDENCE: Since the last inspection Lyn Lockwood has been registered as manager with the Commission for Social Care Inspection. She is responsible for the day-today management of the home. Andrew Scott is employed as a General Manager with responsibility for overseeing the services, facilities and all work units. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 31 Feedback regarding the management of the home was received from people who use the service, relatives, health care professionals and staff who work at the home. This feedback was positive. Comments showed that the General Manager and home manager were very supportive. Comments included ‘ From day one Andrew and Lynn have been very supportive open and accommodating. They have great ideas and really want to push the home forward for the good of the residents’ and ‘There is definitely enough support there if I need it’ Staff told us they have support worker meetings once a month Relative questionnaires were also positive about the management of the home. Comments included ‘We have every confidence in the team at Bystock’ and ‘There is excellent communication with relatives with plenty of notice given regarding meetings events etc.’ and ‘The care and support given to my cousin, in my opinion has been first class. They are an outstandingly dedicated, caring and professional group of people.’ Negative comments were included but these related to communication about the organisational communication. One questionnaire stated ‘Despite several requests to DCHS (the trustees) for information on the future of Bystock on the proposed amalgamation with the Guinness Trust no response has been received’ Staff told us that there are several meetings held at the home. ‘Resident’ meetings are held and ‘chaired’ by an outside representative. Relative meetings are also held. Staff told us that the management of the home had improved and both managers had an open door style of management. This was evident during the inspection where the general manager was interrupted many times by people living at the home. The manager was seen to deal with interruptions with patience and respect. Humour and friendly banter was shared between staff and residents. The general manager was ‘told off’ by a person living at the home who explained that the manager had failed to lock up the horses properly. All staff spoken to confirm that new ideas can be suggested at any time to the managers and ideas listened to and acted upon. The manager completed an annual quality assurance assessment explaining what has improved in the last year and what was planned for the next year. The organisation that runs Bystock Court also performs audits on a regular basis. Relatives and people who live at the home are invited to attend annual care plan reviews and therefore have some input into the provision of care. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 32 The home was generally well organised. The majority of records were well maintained. Records for gas safety, water temperatures for the prevention of legionella, portable electrical supply tests, fire safety checks, environment risk assessments and accident records were seen and were up to date and well recorded. Training records showed that mandatory training records were well organised and training had either been booked or organised. A tour of the building showed that cleaning products were stored appropriately. A recent environmental health inspection did not make any recommendations. The cook uses the food standard agency programme ‘safer food better business’ but also keeps cleaning schedule records and fridge temperatures. The maintenance man told us that staff have a book where they write any general repairs that are needed and then he also conducts the routine work such as testing fire equipment, water temperatures and other safety checks. Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 x 26 3 27 2 28 x 29 3 30 3 STAFFING Standard No Score 31 2 32 1 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x x 3 3 x x 3 x Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 34 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (2b) Requirement Timescale for action 01/01/08 2. YA23 12 (4a) 3. YA23 13 (6) 4. YA32 12 (5b) 18 (c) The Manager must ensure each person has a care plan which is reviewed at regular intervals or when changes occur so staff are aware how they can meet the needs of the person The Manager must ensure that 01/01/08 all staff speak to people who live in the home in a respectful manner so that people are treated with dignity The manager must ensure all 01/01/08 staff are aware of what is classed as abuse and how they can report any allegations to ensure people are kept safe at all times The manager must ensure: 01/01/08 • All staff employed at the home have attitudes and characteristics to ensure they are approachable and good at communicating. • All staff employed at the home have the skills, training experience to care for people with learning disabilities So that people are kept safe and treated with respect and dignity Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 35 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA2 Good Practice Recommendations Staff should record the religion of prospective new residents and determine their preferred denomination/place of religion, so care can be planned which meets the person’s needs. The manager should ensure the assessment is recorded to show that information is obtained to provide the basis for person centred care. The care plans should be organised in such a way that they are person centred, easy to read and used to plan, deliver and review care. The manager should make arrangements to enable people to engage in activities, offered regular choice and ensure staff do not restrict this without clear explanation The manager should consider the request from a person living at the home to purchase a video player for the games room. The manager should continue with the planned programme of refurbishing the bathrooms to ensure people live in a pleasant environment The manager should ensure that officers in charge give consistent advice and instructions and that support workers know what their role is The manager should ensure that the induction programme is not rushed and is meaningful to the role that is to be started The manager must ensure that support workers receive supervision sessions. 2. YA2 3. YA7 4. 5. 6. 7. 8. 9. YA13 YA14 YA27 YA31 YA35 YA36 Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bystock Court DS0000021897.V345709.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!