Inspection on 26/05/09 for Bywell House

This inspection was carried out on 26th May 2009.

CQC found this care home to be providing an Poor 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bywell House 07/05/09

Bywell House 10/03/09

Bywell House 05/03/08

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Random inspection report Care homes for older people Name: Address: Bywell House 2 Longfellow Road Worthing West Sussex BN11 4NU zero star poor service 10/03/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lesley Webb Date: 2 7 0 5 2 0 0 9 Information about the care home Name of care home: Address: Bywell House 2 Longfellow Road Worthing West Sussex BN11 4NU 01903236062 01903236062 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hazelwood Care Ltd care home 20 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 20 20 The maximum number of service users to be accommodated is 20. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home Bywell House is a care home registered to accommodate up to 20 older people in the categories dementia, (DE), and mental disorder (MD). The property is a detached building situated in a residential area on the outskirts of Worthing. The town centre and seafront are within walking distance and there are local shops and other facilities nearby. Buses and mainline trains are easily accessible. Care Homes for Older People Page 2 of 14 1 0 0 3 2 0 0 9 Brief description of the care home People living at the home are accommodated in twenty single bedrooms, which are located on the ground and first floors. A vertical lift provides access to each floor. Communal accommodation consists of a lounge and a dining area, which are located on the ground floor. There is an enclosed garden to the front and side of the property for people to use. This service is privately owned by Hazelwood Care Ltd. The Responsible Individual who acts on behalf of the company is Mr. Manvinder Singh. The fees for this care home currently range from four hundred and eighty five pounds to five hundred and thirty five pounds per week. Care Homes for Older People Page 3 of 14 What we found: The reason for this inspection was to assess compliance with three Statutory Requirements Notices (SRN). The first for medication originally consisted of four elements. We carried out a random visit on the 7th May 2009 and found two elements having been met and two unmet. The unmet elements being Have a system in place at the Home to ensure that all medicines are safely and securely stored, so that service users do not have access to medicines that have not been prescribed for them. Have a system in place to store medicines according to the manufacturers instructions and at the correct temperatures. This will ensure that medicines will not deteriorate and become ineffective. The second SRN was for staffing and consisted of eight elements. These being To have systems in place to ensure that all staff working at the home have the required knowledge, skills and competencies to undertake their roles. To make arrangements for all staff, including those who are cooking and cleaning, to have suitable training in working with people with dementia to ensure that all staff have an in-depth understanding of the challenges and abilities of service users with dementia. To have a system in place to ensure that all staff have an in depth understanding as to the reasons service users should always be afforded respect autonomy and choice. To have a system in place to ensure that all staff undertake training in food hygiene, moving and handling, infection control, health and safety and safeguarding adults. Have a system in place to ensure that new members of staff receive the appropriate induction training. To have systems in place to ensure that staff do not start work at the home prior to all of the required checks being completed. To have a system in place to ensure that all staff must have two reference, one being from their previous or most recent employer. To have a system in place to ensure that when staff are employed to work at the home on receipt of a pova first check, whilst awaiting a CRB check, the member of staff must be supervised at all times by a member of staff who is appropriately qualified and experienced to supervise the new worker. The third SRN was for risk management, care planning, staff practises, meals and moving and handling. It consists of eighteen elements. These being - Care Homes for Older People Page 4 of 14 To have a system in place to ensure that medical advice is sought whenever any change in a service users condition takes place, or when a service user complains of pain following a fall. To ensure risk assessments are carried out on all service users who are at risk of falling. Risk assessments must be carried out on all service users who require help with moving and handling. Risk assessments must be carried out on the use of commodes for transporting service users around the home. Risk assessments must be undertaken in respect of the use of the hoist in areas of the home with limited space. To have a system in place to ensure that when a service user requires moving and handling, that this task is carried out in a safe and an appropriate way using the correct equipment. To have a system in place to ensure that there are sufficient numbers of wheelchairs available for use in the home, in order that those service users who require help moving around the home will have their needs fully met. To ensure that there is a written policy in place to guide staff on what is acceptable and what is not in relation to the care provided at the home. To have a system in place to monitor staff practise to ensure that the staff are following the policy and are affording service users respect, dignity and choices at all time. To review procedures and care practises in the home to make sure that the dignity and choices of the service users are promoted through routines. To have a system in place to ensure that all service users have clear individualised care plans that detail all of the service users identified needs, and that all sections of the care plans are fully completed, signed and dated by the person who completed the plan. To have a system in place to ensure that care plans provide staff with clear guidance as to how they are to meet the service users identified needs. To have a system in place to ensure that service users care plans are reviewed and updated at least monthly, and that the plan is signed and dated by the person who undertook the review. To have a system in place to ensure that service users receive a bath as detailed in their care plan. To have a system in place at the home that will ensure that there are sufficient and robust infection control measures, to include implementing sanitising policies and procedures for commodes and toilets, ensuring that all areas of the home are kept clean. To have a system in place that will ensure that all staff at the home use protective Care Homes for Older People Page 5 of 14 equipment including aprons and gloves when needed. To have a system in place to ensure that service users are provided with a varied, wholesome, appealing, nutritious and balanced diet. To have a system in place to ensure that service users are offered a choice of meals. Before our visit we received a written response from the Responsible Individual informing us that all elements of the SRNs have been acted upon. The outcome of this visit is as followsIn relation to the medication SRN we reviewed the two outstanding elements and found that a bedroom has been decommissioned and is now used to store all medication, including prescribed creams and ointments. The manager informed us this change has taken place as the temperature in the previous room used to store medication could not be reduced. This resulted in medication being stored in temperatures above those recommended by the manufacturers. We looked at the medication administration records for all residents. The prescribed creams and ointments for all residents were now seen to be stored correctly. Records are in place that detail daily monitoring of the temperature in the medication room. These evidence medication is now being stored in line with manufacturers instructions. We viewed staffing rotas for the previous four weeks. In the majority of cases a qualified first aider has been identified on each shift and this is highlighted. We did note that neither the deputy or managers hours are detailed on the staffing rotas. We talked to the manager about this who said she would ensure this information is included. We viewed the recruitment records of five staff, including the three newest people to commence working at the home. All contained records including two references, application forms, two forms of identification, verification of training undertaken and POVA first disclosures. Three did not include evidence of a full enhanced CRB disclosure. The manager informed us two of these staff are in the process of completing their induction and all three do not have any direct contact with residents. We talked to the manager about employing staff before a full CRB disclosure has been obtained, directing her to our website where guidance can be found and also to guidance published by the Department of Health. We spoke with one of the members of staff currently undertaking their induction. They also confirmed they have no direct contact with residents and that they are supervised at all times. Induction records on file evidence that new staff receive guidance over a four week period and that this covers care planning, residents, policies and procedures, health and safety, care practises and health and safety. None of the staff files contained a recent photograph of the individual. The manager said that she would arrange for these to be put in place. We spoke to four care staff on duty. All demonstrated understanding of dementia, how Care Homes for Older People Page 6 of 14 this can affect residents and the actions they should take as a result. For example one person explained, Behaviours can change, moods, can get confused then can be alright, remember past but sometimes not present. Sometimes we have to orientate, they can forget they had dinner, or where the bathroom is. Staff also demonstrated understanding of safeguarding residents and their responsibilities, health and safety and promoting residents dignity and choice. For example with regard to safeguarding one person explained This is protection of adults from abuse. If I saw abuse I must inform manager or senior, if manager go higher, CQC or police or if manager not paying attention take further. With regard to promoting residents rights to dignity and choice one member of staff explained, If helping with personal care make sure door closed, offer choice with clothes, explain process of washing before doing, show respect when talking to them. Training records that we looked at evidence eight care staff either having obtained or who are in the process of completing National Vocational Qualification level 2 and one who is booked to start this shortly. In addition to this one person has completed level 3 and three others are in the process of completing this. Thirteen staff, not including the deputy or manager are employed at the home. Nine have undertaken health and safety training, eight first aid, eleven moving and handling, five infection control, twelve protection of vulnerable adults, six food hygiene, eight tissue viability and continence promotion, ten nutrition and diet, eight medication and nine dementia. We were informed that dates have been arranged for staff to undertake all training they have not yet completed. This information was also detailed on a training schedule. Records detail three staff having received fire training and one training as a fire marshall. The training schedule details training has been arranged for October 2009. We asked the manager about systems that are in place to ensure staff receive training and this regularly updated. She informed us she is not involved in this, that a manager from another home owned by the company that owns Bywell House arranges training and that she is not aware how she monitors training needs. The manager informed us she would like to take over the responsibility of monitoring and arranging training for staff at the home. Staff informed us that two staff meeting have taken place since February 2009 when the manager commenced working at the home. Records confirm these taking place on the 18th March and the 27th May where topics were discussed including respect for residents, activities, roles and responsibilities, accountability, confidentiality, records, care plans, infection control and meal times. All staff that we spoke to said they found the staff meetings useful. We spoke to the manager about support and supervision of staff. She informed us that individual supervision sessions have recently started, with six staff having participated in a session. When asked what systems are in place to monitor all staff receive regular supervision she informed us none but said this would be implemented. The manager and staff that we spoke to informed us that the previous practise of using Care Homes for Older People Page 7 of 14 commodes to transport residents around the home has now ceased. We were informed the commodes known as sani chairs have been removed from the home and three wheelchairs purchased. There are currently ten residents living at the home. We were informed that none require hoisting but that two mobile hoists are available if this were to change. Records are in place that details daily checks undertaken by staff for the hoists, wheelchairs and profiling beds. Health and safety risk assessments are not in place for equipment used to move people. We talked to the manager about this who said she thought it was sufficient for equipment to be documented in residents care files. We explained that health and safety legislation requires assessment of risk not only for residents but for staff and the environment. We directed her to the Health and Safety Executive for further information. We witnessed two staff assist a resident to sit at a dining table using a moving and handling belt. Staff carried out this assistance safely, offering encouragement to the resident throughout the process. We looked at a policy that has been implemented since our last inspection that guides staff with regard to acceptable care practises and dignity and choice. This appears detailed and informative. On both days that this visit took place we observed staff treating residents with dignity and respect. For example residents were spoken to using their preferred names as detailed in their care plans, residents requiring assistance were given this discreetly and at the residents pace. We viewed the care files of five residents. All have been reviewed and a new format put in place. The new format is organised with information easily obtainable. All files that we looked at contained care plans for identified needs that have been reviewed and signed and dated by the person completing them. Plans were seen to be in place for needs including communication, bathing, skin needs, mobility, personal choices, and mental health. All included instructions for staff such as the number of staff required for assistance, equipment required, preferences and choices. Residents files contained risk assessments for areas including falls, nutrition and skin. We noted that in some instances these have not been completed in full. We discussed this with the manager who agreed to review and amend where needed. Residents files also contained evidence of regular weight monitoring, health care intervention and personal care such as bathing. We could find no evidence that residents have the opportunity to undertake a hearing test. One residents file that we looked at identified this a need. We talked to the manager about this who agreed to arrange as soon as possible. We viewed the accident records that have been completed since our last key inspection. In the main these detail any injury sustained as a result of an accident but also that appropriate medical intervention has been sought. Care Homes for Older People Page 8 of 14 This visit took place over two days. During both staff were observed to use personal protective equipment when carrying out tasks such as cleaning spillages and when assisting with personal care. Personal protective equipment seen to be sited in various places around the home including at the entrance to the kitchen, laundry, bathrooms and landing near residents bedrooms. As a result of our last full key inspection the Health Protection Agency visited the home and made several recommendations. At this visit we were shown infection control policies that have been implemented that now include sanitising procedures for commodes and toilets. The manager informed us that all beds and commodes in residents bedrooms have been replaced. We also noted that the emergency call system and the rotting window frame in bedroom 1a have been replaced and the lounge decorated. All areas of the home that we saw were clean and free from offensive odours. On both days of our visit we sat and ate lunch with residents in the dining room. Since our last key inspection tables have been rearranged to give more space and linen table cloths and napkins are now provided. Fresh fruit was seen to be readily available to residents on both days. A sign is now on display on the patio doors that lead to the dining room informing people they cannot be used at meal times. Staff and visitors were seen to respect this. At both lunch times staff assisted residents discreetly, residents were offered choices of orange or blackcurrant juice and tea and coffee. Residents were able to choose from two meals. Plate guards were brought to tables before meals were served and put on for those residents who required this tool. The majority of residents appeared to enjoy their meal. For those who did not staff offered a third alternative. The atmosphere at lunch time was relaxed. Residents were heard to laugh and join in conversations with other residents and staff. We viewed residents individual meal records. These demonstrate that residents are offered choices everyday and that alternatives are given when the two main options that day are not wanted. We did note that on some occasions records have not been completed. We talked to the manager about this who agreed that if a resident refuses all meals offered this should also be recorded for monitoring purposes. We spoke to the cook who informed us only fresh products are used and that all cakes and puddings are home made. She also told us that since our last key inspection and that by the Environmental Health Department two new freezers and a fridge have been purchased and the dishwasher has been replace. What the care home does well: What they could do better: Nutritional screening tools and assessments if used, must be completed in full. Care Homes for Older People Page 9 of 14 The manager and deputy must record the hours they work on the staff rota. A recent photograph of staff must maintained with their records. Priority must be given to ensuring all staff receive fire training and that a system is implemented that monitors staffs training needs. Health and safety risk assessments must be completed for any equipment used for the moving and handling of people. Hearing tests must be arranged for residents where this has been identified as a need. All of these and the changes in the home will be monitored at our next key inspection. 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 2. Care Homes for Older People Page 10 of 14 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 12 16 In line with Regulation 22/05/2009 16(2)(m)(n) the registered person must ensure activities are offered that are varied, flexible and meet the expectations, preferences and capacities of residents. This must happen to ensure residents have to opportunity to lead full and active lives. 2 19 16 In line with Regulation 16(2)(c) the registered person must ensure all residents bedrooms have working lights, hot running water and furniture in good working order. This must happen to ensure residents needs are met. 22/05/2009 3 26 16 In line with Regulation 16(2)(j) the home must consult and act on any recommendations made by the Environmental Health Agency with regards to the kitchen. This must happen to ensure the kitchen is fit for the purpose of preparing meals for residents. 10/06/2009 Care Homes for Older People Page 11 of 14 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 4 33 24 Quality monitoring systems must be undertaken on a regular basis, including obtaining the views of people. This must happen to ensure residents receive a consistent and safe service. 10/06/2009 5 38 13 In line with Regulation 13(4) 25/04/2009 the registered person must ensure detailed risk assessments are in place for the use of bed rails and that these include instructions on safety checks that must be carried out and recorded when used by residents. This must happen to reduce the risk of harm to residents. Care Homes for Older People Page 12 of 14 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, 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 38 13 In line with Regulation 13(4) 26/06/2009 the registered person must ensure risk assessments are completed for any equipment used to move or handle residents. This must happen to reduce the risk to residents and staff. 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 Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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