Care Home: Bay Tree Court

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What the care home does well The staff keep exceptional records on each individual in the home. These are very detailed and are kept up to date with the help, if possible, of the person concerned. This ensures that peoples needs, expectations and views are sought at all times and current needs can be managed by the staff. Staff ensure that they follow the Company guidelines and use all records according to their procedures and if a person is a short or long stay admission to the home. There are robust drug administration processes in place and people appear to be having medication as prescribed. Care is taken to ensure the views and instructions of other health professionals are followed and written down. There is a varied program of activities of both a group and individual nature and people are encouraged to pursue their own hobbies. Food is prepared in a clean and safe environment and menus checked for their nutritional content, to ensure people receive a balanced diet suited to their individual needs and well being. The environment is clean and safe and adapted, in some areas to meet peoples needs. All garden areas are accessible to wheelchair users and people are encouraged to help with the vegetable plot, raised beds and greenhouse. A robust system of staff recruitment is in place to ensure they are safe to work with people in the home and they are then trained to do their individual jobs. There are always sufficient staff on duty to ensure the needs of everyone can be met through a 24-hour period. The quality assurance program also far exceeds that laid down by the National Minimum Standards and ensures the Company is aware of peoples views and needs and checks are made to ensure they are not put at risk of harm from living in the home. What has improved since the last inspection? There were no outstanding requirements from the last visit, but the home has shown us where they have sought to make improvements through their auditing processes in the home, to enhance the lives of those living there. What the care home could do better: There are no requirements or recommendations needed from this site visit. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bay Tree Court Normanby Road Scunthorpe North Lincolnshire DN16 2AR     The quality rating for this care home is:   three star excellent 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: Theresa Bryson     Date: 2 3 0 6 2 0 0 9 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. that people have said are important to them: They reflect the things 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 Older People 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 Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Bay Tree Court Normanby Road Scunthorpe North Lincolnshire DN16 2AR 01724855410 01724853735 baytreecourt@schealthcare.co.uk 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) : Southern Cross Healthcare (West) Limited care home 34 Number of places (if applicable): Under 65 Over 65 34 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 34 The registered person may provide the following category of service only: Care Home only, Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category, Code OP, maximum number of places 34 Date of last inspection Brief description of the care home Baytree Court Care Home provides care for 34 service users under the category older people. It is owned by the larger company Southern Cross Ltd and has the full support of a head office and regional team. The Regional operations manager makes regular visits. It has sister homes in near by Grimsby. The home is situated on the very edge of the main town thoroughfare of shops in Scunthorpe and bordering a residential and hotel area and small industrial estate. The home is purpose built and has gardens to the back and sides. All areas are accessible for wheelchair users and there is ample car parking space. The home has on display informative information leaflets about the Care Homes for Older People Page 4 of 26 Brief description of the care home home, to enable people to make informed choice. The home will accept service users who are paid at the local authority fee level rates and also those privately funded. Care Homes for Older People Page 5 of 26 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This site visit took place over one day in June 2009. Prior to this a number of surveys were sent to people living in the home, health professionals and staff. A number were returned. We also looked at the service history for this home and what they had told us about themselves and any incidents which had occurred since we last visited. They sent us their Annual Quality Assurance Assessment (AQAA) which told us how they are planning their service provision and lots of other statistical information. During the course of the site visit we spoke to a number of people living there, some relatives, other visitors and staff. We also looked at a number of documents and records, including those held on their computer data base. Care Homes for Older People Page 6 of 26 Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. People are fuller assessed prior to admission to ensure the home can meet their needs. Evidence: The latest admissions care plan was tracked as part of the care planning process. All information had been completed according to the timescales set in the procedures for staff to follow. This gave an holistic picture of this person and staff were able to develop a fuller care plan from this initial information. People spoken to said how well informed staff were on their admission to the home, which they found very comforting. The manager or deputy manager completes the pre-admission assessment to ensure people understand about the home and what services it can provide and also to see if the home can meet their needs and will fit into the family home. There are two types of plans, one for normal long stay admissions and one for short stay admissions, both were checked and found to have been completed. Care Homes for Older People Page 10 of 26 Evidence: The home does not give intermediate care and therefore Standard 6 is not applicable. Care Homes for Older People Page 11 of 26 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Excellent record keeping is in place to ensure peoples current needs are recorded and staff know how to meet them at all times. Evidence: During the course of the site visit four care plans were tracked in depth. These had been exceptionally well written and showed regular evaluations of peoples needs and reviews of risk assessments when required. There was excellent follow through when incidents had occurred and full use was made of the Company documentation to show that staff understood the necessity to keep accurate records. For example when one person had a problems with elimination this was detailed in their care plan, observation charts were completed and a bowel movement assessment also completed. This ensured the person was comfortable at all times and did not have a loss of dignity for what could be a distressing condition. Another person had problems maintaining adequate nutrition levels and staff had completed a risk assessment and also used a malnutrition screening tool. This was written into their care plan and staff recorded intake of food and recorded weight frequently. This ensures that staff are Care Homes for Older People Page 12 of 26 Evidence: monitoring this person very frequently and enabling them to maintain an adequate diet for their health and well being. Each individuals care plan now has a separate entry for mental capacity and deprivation of liberty in case this is required to be used at any time. This ensures that staff make informed decisions regularly and all information is immediately to hand, should the need arise. On the main notice board a section had been reserved to up date people living in the home and visitors as to who the Dignity Champion was in the home, so they could go to them for any special advice. Accident records were also checked and again excellent follow through and record keeping for each incident. The staff follow a check list to monitor falls and record incidents on a report sheet. In some cases a body map record is made and observation record. Relatives are informed, where applicable and all follow through either internally and/or with other health professionals is recored. The manager completes an audit monthly to pick out trends. each audit can also have an action plan if necessary. The management team ensure that any incident which needs to be recorded and sent on a Regulation 37 form to CQC is completed promptly. The care plans were legible and stored safely and accessed on a need to know basis only. When speaking to staff they appeared to have a through understanding of how all the documentation fitted together and stated they do refer to it daily. Both people living in the home and relatives who were spoken to stated they had had input in the care planning process, which was seen to be documented. A senior member of staff helped the inspector check some drug administration records and storage facilities. A mid day drug round was partially observed. Safe practice appeared to be in place and staff had a good knowledge base on certain medications when challenged by the inspector. The storage areas were secure, clean and tidy and good records were kept of all medication transactions. The home completes audits on a regular basis and any action is recorded and followed through the next time. Staff were observed during the day assisting people with personal care, at meal times and with social activities. also in interaction with other health professionals who were visiting the home and by telephone. on each occasion, each staff member was calm and appeared to have the correct information to hand to help each individual. 9 people who live in the home were spoken to and 3 relatives and 2 other visitors. All made very positive comments about the attitude of staff and how well they were being looked after. Making such comments as definitely looked after well and couldnt wish for better. One person said I love them all. A visitor remarked how staff help them when procedures took place with people living there so they were not distressed and said staff are brilliant. This was also reflected in the surveys returned to us prior to the site visit by people living there and other health professionals. Care Homes for Older People Page 13 of 26 Care Homes for Older People Page 14 of 26 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. 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. There is a varied program of activities to ensure peoples social, religious and cultural needs are met and food is prepared in a clean environment. Evidence: The social needs assessments were tracked as part of the care plan process but also separate activities records were checked alongside information displayed on notice boards and when speaking to people living in the home. Each person had a working/playing care plan which alongside the social needs pen profile was up dated regularly. This gives staff an understanding of peoples individual needs and tastes and covered not only social interaction but their religious and cultural needs. The person employed to facilitate social activities also keeps their own records, which we were informed all staff can access. There was a notice board in place detailing future events and a calender to keep people informed of more national events such as the Queens birthday or the start of Ramadan. When we were in the midst of speaking to some one resident in the home the person asked the inspector to brake off as they said I help organize the ladies for morning dominoes and its nearly time to start Later some people were seen to be playing in one of the sitting room areas. Another person explained, after it had been observed by us, that they and another resident enjoy Care Homes for Older People Page 15 of 26 Evidence: crosswords but as one of them had failing sight one read the question and they both decided on the answer. These events had been facilitated by staff when it was realized some people had similar interests after the care planning process had been completed. A person living in the home who was spoken to explained to us how they take part in chair exercises with others and how staff encourage them in one of their hobbies of collecting.Some others spoken to described the entertainers they had and also how some times I just like to read ,which staff helped them by obtaining books. There was also evidence in one part of the garden that people were being encouraged to grow some simple vegetables and maintain the raised flower beds. The kitchen area had been awarded a 3-star rating by the local Environmental Health Officers in December 2008 and hoped to have this reviewed this year. A tour of the kitchen showed that food was being prepared in a safe and clean environment with adequate safety checks being completed and documented on a regular basis. There was a varied menu in place and the Company completes statistics detailing nutritional information for each menu cycle. For example how much calcium or vitamin c is in each menu. This ensures the management team can see whether a balanced diet is in place to help peoples health and well being. Staff were observed during the day assisting people at breakfast and lunch and with snacks and drinks. They did so in a relaxed manner and gave encouragement where necessary to ensure people eat a balanced meal. The dining rooms on both floors were bright and airy and clean. Care Homes for Older People Page 16 of 26 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Robust systems are in place to ensure people can raise concerns and know these will be dealt with in confidence and promptly and they are protected from harm. Evidence: There had been no complaints sent to us since the last key inspection. The complaints log which was seen at the site visit last recorded concerns raised in 2006/07 and each had full information on how the incidents had been dealt with at the time. People living in the home were able to tell us that they had every confidence in the management team in dealing with concerns, should the need arise. They also were able to explain where this information was held. Staff were also able to detail the complaints and safe guarding adults policy and their records showed they had received up to date training in this topic. There was currently a safe grading investigation being undertaken for a person living in the home, but this did not directly involve the home or its staff. The management team have kept us up to date on all aspects of this case to ensure we can make a valued judgment as to whether the correct action has been taken. Care Homes for Older People Page 17 of 26 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, 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. 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 live in a safe and comfortable environment suited to their needs. Evidence: A tour of the home took place during the site visit. All areas were very clean and showed attention to detail, such as flower displays, tidy bed areas and all rubbish being removed quickly. Since the last visit the dining room and lounge area attached had been redecorated making it light and airy. Each bedroom area had a knocker on the door and could be locked with a key, which is offered to all people living there. A couple had taken this option but the home does have a master key for emergency purposes. Some bedroom areas had also been refurbished, some painted and some with wall paper. One person living there detailed how it had been made possible for them to choice their own wall paper. There was ample evidence that people had been allowed to bring in furniture and belongings from home and this, some said, had helped them settle into the home. All safety certificates were checked and all had valid dates. Where specialist equipment was in use such as low profile beds, bed rails and hoisting equipment a risk assessment was seen to be in place for each individual which was evaluated regularly. All areas are accessible for wheelchairs, including the garden, which had a new raised Care Homes for Older People Page 18 of 26 Evidence: decking area, with seating and a vegetable plot, raised beds and a greenhouse. All areas of the home were hazard free and care was taken to ensure it was light and well maintained.The manager was able to identify new pieces of equipment which had been purchased such as easy chairs and where repairs to some major equipment like a bath had now been completed. Care Homes for Older People Page 19 of 26 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. 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. A robust recruitment and training program ensures staff are safe to work with people resident in the home. Evidence: During the course of the site visit 9 staff were spoken to and others returned surveys which had been sent out by us prior to this visit. many made positive comments about working at the home and all expressed how the training was helping them do our jobs. Staff spoke about helping each other out regardless of the department needing help and pull together to ensure peoples needs and expectations are met. Staff attitudes when observed by us during the full day were calm and encouraging to people living there. When asked about individual people they appeared to have a good knowledge base of peoples needs and risks. They expressed that it would be helpful to have a floating person on the care rotas, especially in the morning to help them answer call bells and have some more quality time with individuals. The rotas were checked and there appeared to be an effective process in place to check the dependency levels of people living there and ensure sufficient staff were on duty to meet everyones needs. 4 staff personal files were tracked in depth and there was sufficient evidence to support that adequate safety checks had been made prior to their employment Care Homes for Older People Page 20 of 26 Evidence: commencing and they were not putting people at risk. The staff training program for the home was extensive and showed that not only were all mandatory training topics up to date but also some more specific topics had been tackled since the last inspection visit. There was written evidence to support that staff had covered topics such as palliative care,dementia, diabetes and equality and diversity.This ensures that people are being looked after by staff trained to do their jobs and cover all the current topics of illnesses presented by the people living there. The Company produces a guide to the percentage of staff which should have reached certain training target levels, for example 100 of care staff completing manual handling training but a lesser proportion of care staff to have completed medication training. This is produced on a regular basis for the managers of each home and keeps them focused to ensure training topics are booked. Care Homes for Older People Page 21 of 26 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A robust quality assurance system is in place to ensure the building is safe to live and work in and that peoples needs, views and expectations are met at all times. Evidence: A long discussion took place during the site visit with the manager on how the Company support structure works. The manager has an open door policy for people to approach her but also has a weekly surgery in case individual want to discuss items important to them on a more formal basis. People spoken to who live in the home told us that all Company personal were approachable and they had every confidence matters would be dealt with in confidence. The Company has a very intense quality assurance scheme in place. This not only covers six weekly residents meetings, but staff group meetings and surveys being sent out. A selection of minutes of meetings were seen and showed a variety of topics covered and opportunity for people to put across their own view points. Action plans are made where necessary. A further set of auditing processes take place in the home, including care plan audits, medication Care Homes for Older People Page 22 of 26 Evidence: audits, health and safety audits to ensure peoples needs and expectations are being met and the home is a safe place to live and work. The auditing and consultation processes in use are far above that expected from the National Minimum Standards. We also looked at the computer records for the personal allowances of people living in the home to ensure the money was being used for their benefit and all transactions appeared to be correctly recorded. This also applied to the residents comfort fund and all transactions and total balances appeared to be accurate. Company personal from head office check these records on a regular basis to ensure staff in the home understand the importance of accurate recording and that those recordings are correct. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 24 of 26 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 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 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!