CARE HOMES FOR OLDER PEOPLE
Chy Byghan Sunny Corner Lane Sennen Penzance Cornwall TR19 7AX Lead Inspector
Paul Freeman Announced 20 June 2005 09.30 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 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 Older People. 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. Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Chy Byghan Address Sunny Corner Lane Sennen Penzance Cornwall TR19 7AX 01736 871423 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Rosemary Deane & Mrs Jacqueline Brown Mrs Rachel Mary Vaughan Care Home 19 Category(ies) of 19 OP (old age), 6 DE(E) (Dementia over 65) registration, with number of places Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 17 March 2005 Brief Description of the Service: Chy Byghan is a registered care home providing accommodation and personal care for up to eighteen older people. Up to six of the residents may require care because they experience confusion. The home also provides day care for up to three older people.The home is detached and is located in the village of Sennan, approximately 11 miles from Penzance. It is situated slightly off the main road and has car parking space.The building consists of two storeys, with most of the accommodation provided on the ground floor. Several of the residents bedrooms have french doors that open directly onto an outside patio. All the bedrooms currently have single occupancy but two rooms can be shared if required. The home provides a comfortable sun lounge, a smaller second lounge and a well-decorated, spacious dining room.The registered providers live in the care home and in conjunction with the registered manager are involved in the running of the home on a day-to-day basis. Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection took place over eight hours. The Inspector looked over the building and at a number of records and documents. Before the inspection the providers completed a pre inspection enquiry document that gives up to date information about the home. Ten of the residents, three relatives, six of the staff, the provider and registered manager were spoken to. The Inspector found the requirements and recommendations set at the last inspection had been worked upon. The ownership of the care home changed in March 2005 and the new providers Mrs Brown and Mrs Deane reside at the care home. The previous owner Mrs Vaughan has been appointed as the registered manager. Residents commented this was a positive arrangement and there had been no changes or interruptions to the services and facilities provided. What the service does well:
Each resident is provided with a written contract by the home where they fund their own care. If funding is provided by a statutory agency the resident is given terms and conditions of residency by the providers. This explains the arrangements at the home that are not included in the statutory agencies contract. The providers meet with all prospective residents and undertake an assessment of their needs. The providers also consult relatives and the other professionals involved. This makes sure the home have a good picture of the residents’ needs and satisfies all parties that the needs can be met by the home. Residents commented the home have positive arrangements in place to make sure their health needs are met. Reliable and robust arrangements have also been established to store and administer medicines. Where it is safe to do so residents are able to administer their own medication. Residents commented they were very satisfied with the meals provided. The kitchen is well organised and the staff that undertake kitchen duties are suitably trained. The residents describe the meals as “homely” and said they are provided with choice and a varied menu. Residents commented they are confident that any concerns or complaints are dealt with appropriately and efficiently. A suitable policy and procedure is in place and residents said there were no barriers to raising concerns with the providers or staff. Sufficient staff are on duty to meet the needs of residents and positive arrangements are in place for staff to develop their skills through training. A
Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 6 good team spirit is evident amongst the staff group and staff commented they are well supported by the owners and registered manager. The home is well run and organised and residents are regularly consulted to make sure their needs and choices are accommodated wherever possible. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 3 Satisfactory arrangements are in place to assess prospective residents and make sure the home is able to meet their needs. Residents are provided with a suitable contract or terms and conditions of residency where funding is provided by a third party. EVIDENCE: The new owners have reissued written contacts where residents fund their own care or terms and conditions of residency where funding is provided by the Social Services Department. The new providers have made no fundamental changes to the terms and conditions at the home. The providers assess each prospective resident before they move to the care home. This makes sure the providers are satisfied they are able to meet the needs of the prospective resident. The assessment details the needs of the prospective resident and where necessary the most suitable means of providing the care and support required by the person. Relatives or the residents’ representatives are also provided with the opportunity to be involved in the assessment process. Professionals involved with the resident are also consulted. This ensures the providers have a clear understanding of the residents’ needs, preferences and choices.
Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 The care planning arrangements need further improvement to provide a comprehensive picture of the residents needs. The plans are regularly reviewed but the records of the review need to be more detailed to make sure up do date information is available. Positive arrangements are in place to meet health needs and administer medication. EVIDENCE: Each resident has a care plan that informs the staff of the needs they have and the best way of providing the care and support they need to meet their needs. Where residents are unable to direct their own care more information is required in some instances to make sure the care provided is safe and occurs in the most satisfactory manner. The care plans are regularly reviewed with the residents but the records of the review need to be more detailed. This will ensure that everyone at the care home has up to date information about the care and support required. The home has continued to develop and improve the care planning arrangements. Staff commented they found the plans to be informative and helpful in their work. Residents were positive about the care provided and manner in which the staff undertake their duties. Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 10 Residents also said their health needs were well catered for. The records indicate that staff are alert about residents’ health and services are promptly accessed when required. Satisfactory arrangements are in place for the storage and administration of medicines. The staff that have responsibilities for medication have been suitably trained and residents are able to administer their own medicines when it is safe to do so. Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 A varied menu is provided that is nutritionally balanced and takes accounts of residents’ needs, preferences and choices. EVIDENCE: Residents commented they were very satisfied with the meals provided and the choice they were given. A varied menu is available that provides satisfactory nutrition. Home baking and cooking play a central role in the food provided. The kitchen is well maintained and organised and suitable health and safety measures are in place. Three cooks are employed across the week and care staff prepares the afternoon teas and suppers. All staff working in the kitchen have been suitably trained. Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Satisfactory arrangements are in place to deal with any complaints or concerns raised. The adult protection policy and procedure needs to be improved to make sure that every reasonable step is taken to protect residents. EVIDENCE: The home or Commission has received no complaints. Satisfactory arrangements are in place to deal with any complaints or concerns raised. The residents commented they were confident that any issues of concern are dealt with appropriately and promptly by the providers. The policy and procedure in place to protect residents from abuse needs improvement to make sure it reflects the Department of Health guidance ‘No Secrets’. In the last year there have been no concerns about abuse. A satisfactory whistle blowing policy and procedure is in place for staff. This gives staff with the opportunity to raise any issues of concern with a third party and provides additional protection for residents. Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 No concerns noted. EVIDENCE: The environment was not assessed but no concerns were noted. The setting is evidently well maintained and a good standard of hygiene occurs. Residents commented they were very satisfied with the facilities provided. Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 Sufficient staff are on duty to meet the needs of residents and satisfactory arrangements are in place for staff to participate in training opportunities. This will further develop the service provide by the staff. EVIDENCE: The home have a stable staff group and no staff have left during the change of ownership of the home. The staff commented there had been no disruption to their work following the arrival of the new owners. Two staff are on duty for waking hours and one staff member is awake each night. Additional staff are provided when this is required and the owners provide an on call service at all times. Domestic staff are on duty each to maintain the good standards of hygiene and cleanliness provided. Residents are very satisfied with the care and support they receive and commented that staff respond quickly and efficiently to any requests they make. A range of staff training is provided and this includes the NVQ qualification and other training around the key tasks staff are required to undertake. Staff members have an individual training programme that is based upon their professional needs. The staff said there was a good team spirit and mutual support. They were also very satisfied with the support and guidance provided by the managers of the home. Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 15 Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 37 and 38 The home is well run and organised and the owners have a positive leadership approach. Some of the records are not satisfactory and need to be improved to make sure that residents’ needs are met. Measures are in place to provide a safe and hygienic environment. The arrangements for assessing risk also need to be improved. EVIDENCE: Residents commented they found the new owners to be very approachable and helpful, and they responded positively to any issues they raise. The staff said the home continued to be run in an efficient manner and there were regular opportunities at staff meetings to share information or raise any concerns. Regular meetings are also held with residents and the owners regularly consult with the people at the home on an individual basis.
Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 17 The records provided at the home need to be improved in certain areas. Other than the care plans the residents daily records are not always sufficient to clearly record the events that have occurred and any action taken by the staff. There are however some good examples of record keeping. The home have a range of measures in place to promote a safe and hygienic environment. The arrangements to assess risks to individual residents need to be improved. The assessments must provide clear guidance to staff about the steps they need to taken to minimise any potential risks. Potential risks must also be taken account of during the assessment of prospective residents. Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 x x x x 2 2 Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 19 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 7 Regulation 15 Requirement For service users that are unable to direct their own care, care plans must be developed in a manner that clearly records the nature of the care or support required. A record detailing the contents and conclusions of each review must be made The policy and procedure for adult protection must be developed to reflect the Department of Health Guidelines ‘No Secrets.’ Service users daily records must detail events, and incidents or concerns, the action taken and the outcome of the action. Risk assessments must be completed on each occassion the safety or welfare of the service users could be compromised. Any action required from the risk assessment must be included in the service users care plan. Timescale for action 30.10.05 2. 3. 7 18 15 13 30.9.05 30.9.05 4. 37 12 and 17 30.10.05 5. 38 13 30.8.05 6. 38 13 30.8.05 Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 20 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 11 Good Practice Recommendations Service users wishes following death should be discussed with each individual or their representative and a suitable record made where appropriate. Chy Byghan D52-D04 S62587 Chy Byghan V222151 200605 Stage 4.doc Version 1.20 Page 21 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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