Inspection on 23/10/08 for Byways

This inspection was carried out on 23rd October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Byways 06/11/07

Byways 01/08/06

Byways 24/10/05

Byways 05/05/05

Byways 07/12/04

Byways 07/07/04

Byways 30/03/04

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 29/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Byways 80-82 London Road Warmley South Glos BS30 5JL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Odette Coveney     Date: 2 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Byways 80-82 London Road Warmley South Glos BS30 5JL 01179612426 01179709301 max@aspectsandmilestones.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Jeffery Parry Type of registration: Number of places registered: Aspects and Milestones Trust care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 8. 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 category: Learning disability (Code LD) Date of last inspection Brief description of the care home Byways is a care home that provides accommodation and support for eight people with learning disabilities and additional needs. Aspects and Milestones Trust, a non profit making Trust, operate it. The home is situated in Warmley, five miles from the centre of Bristol. It is approximately a twenty minute walk from a range of shops and the local bus service. The property is a two storey; extended detached house situated in good sized well-maintained gardens that are fully accessible. The home provides single rooms with wash hand basins. There is ground floor accommodation for two service users. All other bedrooms and a staff sleeping in room are situated on the first floor. There is a passenger lift between floor levels. All areas of the home are accessible to Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 8 Brief description of the care home service users. Hallways and corridors are spacious and doors have a clear opening width to accommodate wheelchairs. The home has assisted bathroom facilities and a separate toilet on each level. One Bathroom has a shower. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of this visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 Framework. This focuses on outcomes for those who use the service and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. The home’s last Key inspection was carried out in November 2007 and a rating of adequate was given, this was due to there not being a permanent registered manager in post. This situation has not changed and further information about this can be found within the management section of this report. This unannounced Key Inspection was conducted over 1 day (7hrs) by one CSCI Care Homes for Adults (18-65 years) Page 6 of 34 inspector and following this visit a meeting was held with the management of this service in order to look at the issues identified at the site visit. The management demonstrated a commitment in meeting the requirements which had been set. Prior to the visit some time was spent examining documentation accumulated since the previous inspection, including the Annual Quality Assurance Assessment (AQAA). This information was used to plan the inspection visit. There are seven people living at the home and three of these were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The home’s policies and procedures were also used to confirm the findings. The views of the manager, the area manager, staff were gathered through face- toface discussions. People living at the home do not use verbal conversation as their main form of communication and we observed during our visit that people were calm, relaxed and appeared to be at ease in the home. Surveys received by us prior to the visit from people living at the home did not outline any areas of concern. What the care home does well: What has improved since the last inspection? What they could do better: In order to ensure that individuals needs are fully kept under review and are known to all it is required that care plans and risk assessments are reviewed and updated as needed. In order that staff are administering epilepsy medication when it is needed it is required that the home contact an individuals general practitioner and the dispensing pharmacist in order that clear information is obtained about when the medication should be given following a seizure and furthermore the homes policy pertaining to this must be reviewed and updated if needed. In order to ensure that water temperatures at the home are safe, checks should be completed on a regular basis and records of these checks should be maintained. In order to demonstrate the ongoing commitment from Aspects and Milestones Trust in providing a well maintained home in which individuals live it has been required that the area identified within the environmental section of this report is given attention. Care Homes for Adults (18-65 years) Page 8 of 34 In order to demonstrate that money held on behalf of people who live at this home is safe, it is required that the home improve upon the the security of money held at the home. In order that those living at the home have full information in a format which is suited to them it is recommended that consideration be given to producing the minutes of residents meetings in a pictorial format. In order to ensure that a stable, consistent manager is in post. It is required that the permanent manager submits an application to us in order that we can determine their fitness. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users have their needs, hopes and goals assessed and recorded before they move in to the home so that staff know how best to support them. Evidence: Byways is registered with us to provide residential care for eight people who have a learning disability.There have been no new admissions since the last visit to the home. There is currently one vacancy at the home at this current time. The Statement of Purpose was in place and this was found to be fully comprehensive and contained all of the relevant information required. The Statement of Purpose contained the aims and objectives of the home and spoke of treating individuals with dignity and respect, to promote independence and encourage individuals to make choices with aspects of their lives. There is a clear process to ensure that the service is able to meet the assessed care needs of prospective people moving to the home. There is an admission procedure, Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: which is included in the statement of purpose and full assessments of needs are undertaken, people can come for introductory visits and overnight stays in order to determine if Byways is suitable in order to meet their assessed needs. The care files reviewed during previous site visits have showed evidence of pre-admission assessments to enable staff to develop personalised care plans of individuals and these record how the needs were to be met. Contracts or licence agreements which outline the terms and conditions of the placement were not reviewed at this site visit and therefor will be reviewed by us when we next visit the service. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those living at the home have a plan of care and associated risk assessments in place, however these require review in order to ensure that they contain sufficient, detailed information. Individuals at the home are supported to make decisions which affect them, however some improvements are needed to ensure that these are fully recorded and evidence the involvement, where possible with the service user. Evidence: Each individual has a great deal of information recorded about them with evidence to show that this information that has been gathered over a period of time. We saw that each person had a day to day support folder containing personal care statements about how individuals wanted to be supported in this area, folders also contained information about their preferred methods of communication and information which was considered to be essential. The essential information contained things staff needed Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: to know, information that was important to the person they were supporting, information was person centered and individualised. We saw that staff had attended signalong training to ensure that they can communicate with people in their preferred style. We noted that one person who has lived at the home for sometime had returned to Byways from hospital, this had occurred a few days prior to our site visit. We spoke with the manager and staff who were able to inform us in detail about the level of care and support that this person needed and demonstrated to us that they knew this person well, however it was evident that this person had not had his needs reassessed by the home prior to them returning to Byways. The persons needs had increased and they now required additional assistance with their pressure area care, care with feeding and drinking and this person was also spending long periods of time having bed rest alone in their room. We reviewed the care and other associated documents for this person and found that these had not been updated to reflect the support needed. It is required that the registered person must ensure that the service users plan is kept under review, this is to ensure that staff have clear and accurate information in order to direct their practice. We visited this person in their room. The person looked comfortable, however we noted that their call bell was tied up on a chair and was not within the persons reach to call for staff assistance. This person is frail and may not use the bell, however there was no evidence to show that this had been evaluated or discussed or that any decision had been made to ensure the safety of this person. It is required that call bells should be available for individuals use. Whilst at the home we saw that within people records Mental Capacity Act Statements were in place, however for one person we could see no evidence of who had been involved within the decision making process, the document was not dated or signed. Following the visit the home provided evidence that the last pace of this statement was missing and forwarded it to us to show that it had been in place. Improvements should be made to ensure that all required documentation needed to support people at the home are in place and are available when needed. We will review this area at our next visit to the home. Those living at the home are involved in regular care plan review meetings and can make their views a known about their view of life at the home and how they are supported, records of these reviews were seen by us at this visit. We saw in records at the home that staff enable those who live at the home to take reasonable risks. However we noted that not all assessments for general day to day activities had been updated. These included making a hot drink, road safety, support Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: with eating and assistance needed following a fall. These must be updated to review whether the risks are still relevant or whether there have been changes to the identified hazards previously recorded. We noted that when we were talking about those who live at the home staff we observant in ensuring that the office door was shut in order that conversations could not be overheard. The home have clear statements in respect of confidentiality and privacy, these areas are also covered with staff within their induction and also within their National Vocational Qualification training. Care Homes for Adults (18-65 years) Page 15 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Byways are supported well in order that they have opportunities to be part of the local community. People at the home engage in appropriate leisure activities and have opportunities for personal development. Evidence: On the time of out visit people were being supported by staff to participate in a number of activities, one of the individuals went shopping, another person attended college, another person attended a day service. We also saw a small group of people doing some artwork and people appeared to be engaged with what they were doing and appeared to enjoy themselves. We also saw a number of peoples art and craft work on display around the house. Those living at the home participate in the local community by attending social events at the community centre and visiting the local pub and shops. Staff support people at the home to maintain relationships with others. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: One of the people living at the home visits and stays with their parents for weekends, the home take this person and collects them. At the time of the visit the atmosphere at the home was calm and relaxed. We noted good positive staff communication with individuals living at the home, communication was tailored to the specific needs of people living at Byways and each person was approached in the way most appropriate to them. This was very positive and individuals were treated with respect. At the time of the visit the atmosphere at the home was calm and relaxed. Staff from the home support people who live at Byways to access to social and leisure resources. Activities provided by the home and in the wider community includes the following: church, swimming, disco, shopping, attending college, music, art & drama, cookery, walks, and meals out. The home strives to maintain regular contact with individuals’ family members. Care plans provide details of individuals personal and family relationships. There are many photographs of those who live at the home and their families in peoples bedrooms. During the visit individuals were observed moving freely around the home. All had access to communal areas and their bedrooms. It would appear that daily routines within the house are flexible, and people are supported to maintain their level of independence and make choices. We saw examples of this within individuals care plan, within minutes of review meetings and within individuals daily diaries. We saw that regular meetings take place at the home with the people who live there, we saw minutes of these meetings and saw that all are consulted and encouraged to participate in the process. In order that those with differing communication needs are fully supported it is recommended that the minutes of residents meetings are produced in a more accessible format. The kitchen was seen to be clean and tidy, fridges and cupboards were well stocked. The staff try to ensure the menus are nutritionally well balanced and varied, so that those living at the home are provided with a balanced diet. An Environmental Health Officer visited the home in January 2008 and the home were awarded four stars for health and hygiene within the kitchen area. The kitchen area appeared well managed. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are supported in a manner they prefer with physical and emotional needs being met. People are supported well with their health and are able to access specialist services when needed. Medication given at the home must correspond with the instructions given by individuals general practitioner in order to ensure that this is being administered correctly. Evidence: We saw in peoples files that they had in place personal care statements, these outline clearly to staff and others how people wish to be supported with this area of their care. We saw in daily notes, correspondence and care plans that people have access to a wide range of healthcare services. Services include primary care such as chiropody and access to a GP as well as specialist services when needed such as speech and language therapy, physiotherapy and occupational therapist. People are also supported with their emotional needs by a clinical psychologist who reviews people on an annual basis Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: and liaises with individuals GP to ensure that medication is also monitored and kept under review in the best interests of people who like at the home. We reviewed medication at this home. We saw that medication is held securely and saw that staff who are responsible for medication at the home are trained to undertake this task. There are no people at the home who are able to deal with their own medication and all are supported by staff in this area. We saw photographs in place with medication records and further saw that each person had a medication folder about their medication and health needs. We reviewed the medication records for three people and were concerned to see discrepancies about when epilepsy medication should be given to one person at the home. The records stated that the medication should be given for seizures less than three minutes, the bottle stated that the medication should be given for seizures less than three minutes, however, the homes policy states that the medication should be given for seizures over three minutes. This is a potential hazard and instruction in this area is not clear. Is is required that the home confirm with the individuals general practitioner and the dispensing pharmacist in order for clarification. Records and the homes policy must be amended accordingly. This is to ensure that the medication identified during our visit is being administered correctly and in line with the instructions from the general practitioner. Care Homes for Adults (18-65 years) Page 19 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are clear policies and procedures at the home to respond appropriately to any complaints which may be raised. Staff are trained in adult protection and are aware of their responsibility in this area. Money held at the home on behalf of people who live at Byways is well recorded and accounted for, however improvements are needed to improve security in this area. Evidence: The home have clear complaints policy and procedures and these are discussed with staff during their induction training. We saw in individuals files that they have a pictorial copy of the complaints policy. No concerns were raised to us during our visit to the home. Staff told us that checks are undertaken three times a day of monies held on behalf of individuals at the home. They also told us that at the last check earlier that day that all monies held were accurate and balanced with records in place, demonstrating that effective auditing processes are in place. Whilst we were at the home we observed that a member of staff left the box containing individuals money on a dining room table. This was left for a long period of time, we pointed this out to the manager who assured us that the money was being Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: dealt with and would not be left unattended. We returned to this same area forty five minutes later and the money box was still on the table, the manager spoke to the staff member who had left it there, however they did not seem to think that it was an issue. We told the manager that this was not acceptable and she moved the box and put it in a locked cabinet. It is not acceptable to leave individuals money where it could be taken. The home must ensure that money held on behalf of people living at the home is stored securely. We have been informed by the home since our visit that the staff member concerned had been spoken with about their lack of apparent responsibility in this area and the homes local policy on storage of money had been updated and that this would be an agenda topic for the forthcoming staff meeting to be held on November th 2008. Care Homes for Adults (18-65 years) Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are suitable for their intended purpose, the home is accessible, safe and well maintained. Evidence: Byways is located in the semi rural area of Warmley. The home is in keeping with the local community. It is situated within a residential area and has some local amenities such as a community centre, pub, post office and shop within walking distance. There is a regular bus service which can take people to the local shopping area of Kingswood or into Bristol City town centre. During our last visit to the home, two requirements and three recommendations were made in respect of improving the environment for those people who lived at the home. These were that the ceiling on the top of the landing be repainted, arrangements should be made for the cleaning of the fan in the first floor bathroom, and consideration to be given to the redecoration of the ground floor toilet area and the kitchen. The home have responded well and all of these issues have been addressed and dealt with as needed. However, during our last visit we also recommended that consideration be given to the replacement of the carpet in the entrance hall, we recommended this as the carpet was looking tired in areas. This recommendation had Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: not been met, we were told that an air conditioning unit for the lounge had been purchased instead as it was felt that those living at Byways would benefit more from this. We were told that the air conditioning unit had been well used at the home. Following our visit the area manager confirmed to us that finance were in place and the entrance hall carpet would be replaced. We will review this at our next visit to the service. Upon arrival at the home we saw an old mattress leaning up against the side of the house which appeared to have been there for some time, this is unsightly and it is recommended that this be removed. We were informed when we met with the manager of the home following our key site visit that this had been removed. The home has a separate lounge and dining room for peoples use, these areas were found to be comfortable, bright, airy and clean and free from offensive odour. We saw people making good use of all of these areas. During our visit we viewed a number of rooms and found these all to be single occupancy and all personalised to reflect individuals tastes and style. All rooms had furnishings of good quality. We noted that in one persons room they had a restrictor to a drawer unit, making it difficult for this person to take out their own clothes when they wanted to. We were informed by the manager that the restrictor had been in place for a while and that due to the behaviour of the individual concerned the decision had been made, in their best interests, by the home to limit their access. The manager agreed that this should be reviewed and a decision to be made as to whether the action was appropraite and should continue. During our visit we randomly tested the temperature of water from baths. We also checked the water from a shower and were concerned to find that the water was extremely hot and potentially dangerous, we were assured by two staff members that this shower is not used by anyone at the home. However this area still remains a potential risk. Following our site visit we received confirmation from the manager and area manager that a risk assessment for this shower had been completed, this determined that this area is not required for use by service users and the water had been turned off. The home are reminded that should individuals wish to use this facility it must be made available to them and be safe for use. We saw that the home have very effective systems in place in order to prevent the risk of infection and cross contamination. We saw in bathrooms that the home had in place plastic aprons and gloves for use, it is recommended that these items are stored more discreetly in order not to impinge on the homely environment which has been created at the home. Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: Care Homes for Adults (18-65 years) Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those living at the home benefit from being supported by staff who are well trained. There are sufficient numbers of staff employed at the home to support those who live at Byways. Evidence: At the time of our visit there was the manager and three support workers on duty, these were to support the four people who were in the home at the time of our visit. The manager confirmed to us that at night there is a member of staff awake on duty and another member of staff who is on the premises on cal and is available if additional assistance is needed. The levels of staff in place at this current time is consistent to meet the needs of those living at Byways. We reviewed a number of staff files during this site visit in order to evaluate what training staff have undertaken since our last visit to the home. We saw that staff have undertaken core training such as manual handling, first aid and basic food hygiene. We also saw that staff have also undertaken specialist training in areas such as dealing with difficult people, working with advocates, managing teams and individuals, managing performance of staff teams and supporting those who have autism. The Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: manager was able to provide evidence that all staff have received sufficient amounts of training, training which is appropriate to their role. Staff also told us that they feel well supported by the organisation and that training is provided when requested and when a need had been identified. We saw that regular staff meetings take place at the home and staff are supervised on an individual one to one basis, this provides an opportunity for staff to discuss their role and responsibilities and to look at areas of further personal development. Care Homes for Adults (18-65 years) Page 26 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those who live at Byways benefit from the ethos and management of the home, however the manager must be registered by The Commission in order that we can assess their fitness. The health, safety and welfare of those who live at Byways is promoted and protected. Evidence: The manager in post is Ms M Silcock, Ms Silcox had only been in post at the home for one week when we did our site visit. Ms Silcock told us that she has achieved a National Vocational Qualification at Level four in management, that she is a positive response and manual handling trainer and also that she has obtained a registered managers award. Ms Silcock informed us that she had completed a CRB application with us and was in the process of completing her application to register with The Commission. There has been no registered manager in post at this home for over a year and although arrangements have been in place to support those who live and work at the home these arrangements have been temporary. We made a requirement Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: at our last site visit that the home must make suitable arrangements in order to have a registered manager in post. This requirement has not been met by the home and is now a repeated requirement, if action is not taken by the Trust to comply with the requirement enforcement action will be taken by us. It should be noted that Ms Silcock fully participated with our visit, she had a good understanding of the needs of individuals who live at Byways and demonstrated a good understanding of her role and responsibility in managing a care home and teams. Prior to our visit to the home we received from the previous, temporary manager a completed annual quality assurance assessment. (AQAA). This AQAA had been fully completed and contained a great deal of information about how the home are meeting the National Minimum Standards that are set for care homes for young adults,. The AQAA also told us what the home believes they do well and what their plans are for the forthcoming twelve months ahead. The home told us that they plan to look at ways of improving advocacy for people who live in the home, and to continue to identify appropraite leisure, social opportunities for individuals both at the home and in the community, we look forward to reviewing progress in these areas at our next visit to the service. The home has a number of policies and proceeds in place, these direct staff and ensure continuity of service and a consistent approach. We saw that the home had in place all of the required policies and procedures such as admissions processes, complaints, whistle blowing, medication and health and safety policies. We reviewed the local policy on pressure care as one of the people in the home is being supported with this aspect of their care. The local policy was reviewed in July 2006, however, there is no mention of individual waterlow pressure care assessments or that individuals may require equipment. This policy must be revisited and updated in order that it is clear and robust to fully support people in this area. We reviewed fire records and saw that the home are completing the required checks on equipment and emergency procedures. We saw that staff have received sufficient amounts of fire training and contractors visit in order to maintain the fire detection systems in place. We talked to staff about water temperatures at the home and the hot water temperature levels needed to ensure people were safe. We noted that the home do not maintain a record to show that temperatures of water are undertaken. It is required that these checks are completed and a record maintained to evidence that people are not at risk in this area. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: We saw that the home had a public liability insurance certificate in place, demonstrating that appropriate insurance cover is in place for those who live at, visit and work at the home. Care Homes for Adults (18-65 years) Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 37 8 (1) a Arrangements are made for the registration of a permanent manager of the service. 08/01/2008 Care Homes for Adults (18-65 years) Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 The registered person must ensure that the service users plan is kept under review. This is to ensure that staff have clear and accurate information in order to direct their practice 23/12/2008 2 7 12 The registered person shall ensure that the home is conducted so as to make proper provision for the welfare of those who live at the home. call bells should be available to people in order that they can request for staff assistance and may be used in an emergency. 23/12/2008 3 9 13 The registered person must ensure that unnecessary risks to service users are identified and where possible eliminated. 23/12/2008 Care Homes for Adults (18-65 years) Page 31 of 34 Risk assessments in place should be reviewed in order to ensure they contain accurate information. 4 20 13 The registered person must ensure that suitable arrangements are in place for the recording and handling of medication. This is to ensure that the medication identified during our visit is being administered correctly and in line with the instructions from the general practitioner and the homes policy that is in place. 5 23 13 The registered person shall 23/12/2008 make suitable arrangements to ensure that those living at the home are prevented from harm. The home must ensure that money held on behalf of people living at the home is stored securely. 6 42 13 The registered person shall 23/12/2008 make arrangements to ensure that any activities that service users participate in are reasonable practicable free from avoidable risks. Records of hot water temperatures would show that staff are monitoring water temperatures and that appropriate action would be taken should any risks be identified. 23/12/2008 Care Homes for Adults (18-65 years) Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 4 16 24 30 40 Minutes of residents meetings held at the home should be produced in a more accessible format. Mattress at the side of the house should be disposed of. Aprons and gloves could be stored more discreetly at the home. Local Policy on pressure areas should be revisited and updated to include information about pressure area assessments and the use of equipment. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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