Care Home: Bay Tree The

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What the care home does well This home provides a good level of care in a homely and comfortable setting. Care is based on a thorough knowledge of each person, good assessments and plans of care which are regularly reviewed. Good risk assessments help people to be as independent as possible. People are assisted with their health care in a caring and friendly manner. Complaints are quickly dealt with and people are protected from harm by well trained staff. The home is clean and well maintained. There is a good ratio of staff to people, and staff are well recruited. The home consults people about practice and makes sure suggestions are acted upon. People made positive comment about The Bay Tree, some examples are: `The staff can`t do enough. They are all so kind and friendly.` `The food is really wonderful and the staff are always bright and encouraging.` What has improved since the last inspection? The way in which the home deals with medication has improved to ensure people living at the home are protected by safe medication administration. Staff all received infection control training and almost all staff have now received abuse awareness and safeguarding training so that the people living at the home can be protected from risk of abuse and harm. What the care home could do better: The home could audit medications which are kept in packets, so that a running total can be kept. This is to ensure people receive their correct medication, to reduce the risk of errors and so that the home has an accurate record of what medication they have in stock. Key inspection report Care homes for older people Name: Address: Bay Tree The Station Road Robin Hoods Bay North Yorkshire YO22 4RL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Karen Ritson     Date: 2 3 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 23 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 23 Information about the care home Name of care home: Address: Bay Tree The Station Road Robin Hoods Bay North Yorkshire YO22 4RL 01947880718 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Thomas Edward Dobson,Mrs Jean Dobson care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Bay Tree is a detached Victorian building set in its own ground in village of Robin Hoods Bay. There are three floors, with the residents occupying the first two floors and the proprietors the top floor. A shaft lift provides access to the first floor but due to the lay out of the building several bedrooms and one bathroom have restricted access due to there being two or three stairs. The Bay Tree is located close to all the village amenities although access to public transport is limited because of the location. The front garden is well maintained and is enclosed. Seating is provided for use by the residents if they want to. At the rear of the building there is a veranda for use by the residents. The home has a statement of purpose and service user guide, which provide information about the scope and nature of the care and facilities on offer. These, with Care Quality Commission reports, are available on request at the home. The fee charged is between £365 and £385 per week; however, this may vary with the degree of assessed need or if a service user occupies a double room as a single. Chiropody, Care Homes for Older People Page 4 of 23 Over 65 18 0 0 1 1 2 2 0 0 8 Brief description of the care home hairdressing and newspapers are not included in this fee and these are charged at cost. Care Homes for Older People Page 5 of 23 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: two star good 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: The inspection for this service took twelve hours. This includes time spent gathering information and examining documentation before and after a site visit and in writing the report. The site visit took place on 23rd October 2009 between 9.30 and 15.30. Information for this inspection was gathered from the following: A tour of the premises, observations of care throughout the day of the site visit, speaking with people, case tracking people on the day of the site visit, examining policies, procedures and records kept at the home, examining information regarding the home on the file kept by CQC, considering comments made by relatives, health care and social services staff. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations -but only when it is considered that people who use services are not being put at significant risk of harm. Care Homes for Older People Page 6 of 23 In future, if a requirement is repeated, it is likely that enforcement action will be taken. All key standards were looked at during this inspection. The manager was available throughout the day of the site visit. Care Homes for Older People Page 7 of 23 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 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 23 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 23 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. Peoples needs are well assessed. This ensures people can receive the care they need. Evidence: Admissions are not made to the home until a full needs assessment has been undertaken. The assessment involves the individual and their family or representative, where appropriate. Risk assessments are in place to ensure peoples needs are well understood and that they receive the care they need. The home is clear about the range of needs it can cater for and explains this to prospective residents. This ensures that people are not admitted to the home whose needs cannot be met. One person said they had been given the opportunity to look around the home before making a decision about admission and had been encouraged to return and look again until they were sure it was the right place for them. This ensures people can make an informed decision about admission. Care Homes for Older People Page 10 of 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health and care needs well met. They are protected by staff who handle medication safely, however, audits of packeted medication would ensure that all medication could be accounted for. Evidence: A care plan for each person is drawn up, based on the assessment. All specialist requirements are included in this plan, including medical and health needs. This ensures that peoples needs are considered holistically and that these needs may be met. All care plans are reviewed monthly with the person involved where this is possible. The review covers each area of the care plan. This ensures that the home is responsive to the changing care needs of those living there. Three care plans were examined and these contained detailed information on care needs and how these would be met. One member of staff said: These people are encouraged to be as independent as possible and to live the lives they choose. Risk assessments are in place for all appropriate areas of care to ensure people live in a safe environment but are not discouraged from taking part in activities which may have a level of acceptable risk. People living at the home and their relatives reported that people are consulted Care Homes for Older People Page 11 of 23 Evidence: about their lives at The Bay Tree. One relative said: My relative can live comfortably in here and has everything she needs. The care staff are always here to help her whenever she wants it and she can choose where to be and what she gets involved in. Another person said: I think we are all very well looked after here. They understand what we need and the staff are kindness itself. Since the last inspection the home improved its administration practices so that there is only one member of staff administering and recording medication. This ensures that people get the medication they require and reduces the risk of mistakes in administration. The home does not keep a running total of packeted medication and should have an auditiing process so that medication not in the monitored dosing system can be accounted for, this would further reduce the risk of medication errors. All staff who administer medication have received safe handling of medication training to make sure those living at the home are protected from unsafe medication practice. Throughout the day of inspection staff were observed taking care and consideration in their duties with people. Privacy and dignity were well respected. Feedback from people living at the home and from visitors confirmed that the staff treat each individual with respect. This means people experience being respected as individuals. Care Homes for Older People Page 12 of 23 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. Popel have their leisure and social needs met, visitors are welcome and people have a varied and nourishing diet they enjoy. Evidence: The home assesses the leisure and social needs of each person on admission, then offers opportunities for people to get involved in activities of their choice. The home employs an activities organiser three days a week who spends time doing art, craft, exercises, chair net ball, knitting, crosswords, jigsaws and dominoes with people. She also spends time with people individually if they do not wish to be involved in group activities. The Bay Tree organises local trips to theatre and events nearby. This ensures people have their social and leisure needs met. All the residents living at The Bay Tree at the moment have a number of visitors and many go out on trips into the local community with them. If visitors have a long way to travel, the home offers an overnight room. Assessments include life histories and the staff clearly knew each person living at the home and the people who were important to them well. Visitors are welcome at any reasonable hour and are made welcome. One person said: They are always friendly when I call, I know I can drop in whenever I like and they make me feel at home. Care Homes for Older People Page 13 of 23 Evidence: Menus are on a rolling programme with seasonal choices. A midday meal was observed, and the food was of a high quality. One person said: The food is always beautiful, you couldnt fault it, we always look forward to meal times. Specialist diets can be catered for if required. This ensures people a varied diet they enjoy. Care Homes for Older People Page 14 of 23 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. People are listened to and any complaints are addressed quickly. They are protected from risk of harm. Evidence: The home has a complaints policy and procedure. People living at the home said they were always encouraged to say if they were unhappy about any aspect of their care. One person said: They are quick to put things right. Visitors and health care professionals all reported that the home was very responsive to comments and always strove to provide the highest level of care. This ensures that the home works well with people to provide a good service and shows that the home has an open culture where individuals feel safe and supported to share any concerns in relation to their protection and safety. Staff have all received abuse awareness training and those spoken to had a clear understanding of vulnerable adults policy and procedure. This means that people living at the home are protected from harm and risk of abuse. Care Homes for Older People Page 15 of 23 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 well maintained environment. Evidence: The home is comfortably furnished, maintained and kept clean and fresh smelling at all times. The people living at The Bay Tree said it was like being at home. The home has its own fire risk assessment and meets the requirements of the local fire authority, also the environmental health department. The laundry is located away from the kitchen in a separate room. One person said: The clothes are kept very well. This means people have a good laundry service. Care Homes for Older People Page 16 of 23 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. People benefit from a home which is run with sufficient staff, who are well trained and recruited. Evidence: The home is well staffed, with two members of staff and the manager on duty each day and one person on duty at night with the manager on call. The manager owns the home and lives on site. This ensures that staff have good back up and can call for assistance whenever needed. Throughout the day of inspection staff were observed spending time with people and caring for them in an unhurried and friendly way. Staff are all recruited suitably, with required checks in place and references sought. This means that the home recruits staff in a way which protects the welfare of people living at the home. The home employs staff with the needs of people who use the service at its core, this shows in the relaxed and happy atmosphere throughout the home. One person said: The staff and owners are wonderful. Theyve really helped with my confidence and they notice that I do a good job. Another member of staff said:I think the people here benefit from the fact there are enough of us on hand to help out without rushing. A visitor said: All the staff are so friendly and nothing is too much for them. They put themselves out and to make visitors feel comfortable too. Staff have all had induction training. They have also received foundation training on a Care Homes for Older People Page 17 of 23 Evidence: rolling programme. Eleven out of thirteen staff have also acheived NVQ level 2 in care. Some staff had also completed dementia awareness training to better understand the needs of some of the people living at the home. This means people benefit from well trained staff. Care Homes for Older People Page 18 of 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are kept safe by the policies and practices of the home. The home is well managed. Peoples opinions are listened to and their suggestions are acted on. Evidence: The home is owned by Mr and Mrs Dobson and managed by Mr Dobson, who has many years experience in this role. Throughout the inspection he demonstrated a clear vision of the home based on its values and priorities. The manager and staff demonstrated that people living at the home were at the centre of care planning in numerous conversations and interactions throughout the day and further evidence was available in care plans and daily records, from staff and from visitors to the home. This means people live in a well managed home. The manager operates a quality assurance system, where people are consulted about the quality of their care on a regular informal basis and more formally when care plans are reviewed. All written feedback received is kept on file and comments are taken into consideration when planning improvements. Many people commented that the manager encouraged feedback and was good at listening to people and putting Care Homes for Older People Page 19 of 23 Evidence: suggestions into practice. People are kept safe by the policies, procedures, safe working practices, risk assessments, staff training and regular maintenance of systems and equipment in the home. At the latest fire authority visit there were identified shortfalls in the fire alarm system, which needs to be upgraded. This work is planned for in the near future. Some work has already taken place. Internal doors are now fitted with fire resist strips and there are key pads on all the main exits. This helps protect people from risk of fire. Care Homes for Older People Page 20 of 23 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 21 of 23 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 9 13 All packeted medication must be accounted for with running totals kept to reduce the possibiliy of administration error. To ensure people get the medication they are prescribed. 30/11/2009 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 22 of 23 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). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 23 of 23 - 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. 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