Care Home: Baytree House

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What the care home does well Prospective residents have their needs assessed prior to admission and the information is used as part of the care planning process. Each person at Baytree House has a detailed care plan which describes their health, personal and social care needs. Residents have access to healthcare professionals and they are protected by the home`s medication policies and procedures. Residents have the opportunity to take part in a number of activities, hobbies and pastimes and are supported to maintain contact with family, and friends, according to their wishes. Residents, their families and friends know their complaints will be listened to, taken seriously and acted upon. Robust procedures are in place that help protect residents from abuse. The home continues to provide a clean, safe and well maintained environment for residents, with further and ongoing improvements being made to the decor and furnishings. Baytree House has robust recruitment policies and practices, the staff have a good mix of skills and they are trained and competent. Residents live in a home, which is run in their best interests by a competent manager/owner. Staff receive regular support and supervision. The health and welfare of residents and staff are promoted and protected by the home`s policies and procedures. What has improved since the last inspection? The manager confirmed in the AQAA that the following improvements have been made during the last twelve months: The Home`s NVQ training Provider has recently been changed, with very positive results acknowledged by the staff and management team. The Home`s operations manager has recently reviewed, researched and put in place new policies and procedures covering all aspects of the Home`s activities. Staff meetings have refocused the staff on the clients and achieving good outcomes for them while living at Baytree House. What the care home could do better: The management and staff at Baytree House continue to meet all the key standards and in many cases exceed them. There are therefore no areas of improvement to put in this section at this time. Key inspection report Care homes for older people Name: Address: Baytree House 423 Unthank Road Norwich Norfolk NR4 7QB     The quality rating for this care home is:   three star excellent 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: Debby Ames     Date: 0 7 1 2 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 34 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 34 Information about the care home Name of care home: Address: Baytree House 423 Unthank Road Norwich Norfolk NR4 7QB 01603458503 01603503528 Baytrhs@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Thomas Paul Hanley,Mrs Sandra Elizabeth Hanley care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Baytree House is a care home providing personal care and accommodation for up to 16 older people with one terminally ill bed/service user. Baytree House is a detached Edwardian property situated in its own grounds in the city of Norwich. Bedrooms are on the ground and first floors and consist of sixteen single bedrooms, seven of which have en suite facilities. The home has three communal areas for the use of service users and a passenger lift to assist service users from ground to first floor. There is car parking to the front and well maintained gardens to the rear of the premises. 0 0 Over 65 1 16 Care Homes for Older People Page 4 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. The fieldwork of this inspection was carried out over a period of five hours and included a tour of the premises, inspection of staff and residents records and the homes records relating to health and safety. Discussions also took place with the manager, staff and a number of residents. Thirteen questionnaires were completed or returned to the Commission by residents or their relatives and thirteen by members of staff, prior to the inspection, which Care Homes for Older People Page 5 of 34 contained mostly very positive comments and responses. Some of the additional comments made by residents or their relatives in the questionnaires included: ...the home does pretty much everything well - food, cleanliness, medical care and staffing... ...calm atmosphere, staff go at each residents pace and try not to make too many demands - i.e. work gradually towards a goal... ...research a new residents condition and allow staff members to attend training together, which makes it easier to implement new ideas... ...I sometimes have to wait for a time before I can be helped to bed. I cannot do this until I have had my tablets at 9pm... ...the home is excellent, the staff are all kind and caring and look after [name]s needs very well... ...the staff are generally helpful, though it would be nice if they could spend a little longer with residents... ...Im happy here... ...welcomes relatives and listens to concerns they have for their family member... ...could do with more exercise/short walks and occasional outings for more physically able residents... ...could encourage informal activities between residents... ...a member of staff sitting chatting with 1-2 residents could reminisce with family photos, play dominoes/cards or look at a newspaper together... ...has warm, friendly, caring staff and a homely atmosphere... Some of the additional comments made by staff members who completed the questionnaires included: ...I believe all residents feel safe and secure in the Home and every resident is treated as an individual, with the respect they deserve... ...each client is individually assessed and catered for... ...provides a caring home for clients and meets all clients needs without being institutionalised... ...Baytree House has a very high standard of care. Our aim is always to meet the clients needs, ensuring the best standards of care are given and maintained at all times... Care Homes for Older People Page 6 of 34 ...provide 24 hour care for residents, whatever their needs, in a quiet calm house that is more like a personal home and not a sterile environment... ...care staff treat service users with respect and dignity at all times and always ensure their emotional and physical needs are seen to... ...risk assessments are carried out regularly to ensure the home is safe for service users and staff... ...Baytree House offers a good variety of entertainment and activities... ...family and friends are made to feel very welcome at any time of the day... ...the care home itself is kept clean to a very high standard and everyone, staff and visitors alike, are aware of infection control procedures... ...there is nowhere else I would rather work... ...I think they provide a first class service not only for the clients but also for the staff... Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The management and staff at Baytree House continue to meet all the key standards Care Homes for Older People Page 8 of 34 and in many cases exceed them. There are therefore no areas of improvement to put in this section at this time. 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 9 of 34 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 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them 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. Prospective residents have their needs assessed prior to admission and the information is used as part of the care planning process, which helps to ensure peoples needs are met. Evidence: The three care plans that were seen, and a discussion with the manager, confirmed that visits are made to prospective residents and pre-admission assessments are carried out to establish whether Baytree House is able to meet the persons needs and help them to make an informed choice about moving into the Home. If the person has a social worker, the manager works closely with them and also uses their assessment reports as part of the overall pre-admission assessment process. It was also confirmed that prospective residents and their relatives are very actively involved in the pre-admission assessment process and the information gathered is used to form the basis of the persons care plan. Care Homes for Older People Page 11 of 34 Evidence: Meanwhile, all thirteen questionnaires that were completed by the residents, or with help from their relatives, responded yes to the questions: Did you receive enough information to help you decide if this home was the right place for you before you moved in? And: Have you been given written information about the Homes terms and conditions? In respect of the question: Do you receive the care and support you need? Six people responded always and seven people responded usually. Care Homes for Older People Page 12 of 34 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. Each person at Baytree House has a detailed care plan which describes their health, personal and social care needs. Residents also have access to healthcare professionals and they are protected by the homes medication policies and procedures. All of these factors help ensure that residents health care needs are fully met. Evidence: Three care plans were looked at in detail and the front part of each one was seen to contain guidance for support staff and carers in respect of supporting and understanding people with dementia. Meanwhile, the main sections within the care plans were seen as follows:1. Admission Record - comprising: Residents Details - i.e. name, forename, title, likes to be known as, date of birth, age, nationality and religion. Care Homes for Older People Page 13 of 34 Evidence: Admission Details - i.e. date of arrival, room number, admitted from, admitted by, keyworker, medication received and logged into Drugs Control system and personal property logged into system. Admission History. 2. Social Profile - included next of kin, general practitioner, social services involvement and financial details. 3. Medical Profile - which included: Past surgical history, past medical and psychiatric history and preliminary assessment - i.e. height, weight, build and self medicating. Mobility, arthritic situation, cardiac problems, respiratory problems, continence and mental state/attitude - i.e. depression, aggression, confusion, wandering, memory (long and short term), comprehension and orientation. 4. Care Plan Sheets - which included: a) Routine on waking. b) Breakfast, Lunch, Dinner. c) Daily routine and interests. d) Routine on retiring (bed time) including preferred times. e) Likes, Dislikes and Allergies. f) General Medication. g) Personal Hygiene - bath/shower preferences and hairdressing (including colours, perms and frequency). h) Activities/Occupation/Links with the Community. i) General Health. j) Social Needs and Relationships. k) Special Service Needs - i.e. Occupational Therapist, Physiotherapist, Optician, Chiropodist, Speech and Language Therapist, Dietician, Beautician, Social Worker, District Nurse, Community Psychiatric Nurse and Continence Advice. 5. Residents Funeral Arrangements - which included funeral director, burial/cremation preference and any special requests. 6. Personal Property Register A summary care plan was also seen to have been written up in a very person centred manner. This included the following:a) Nutritional Assessment, which stated the risk level identified, actions initiated, evaluations and a dietary assessment. Care Homes for Older People Page 14 of 34 Evidence: b) Moving and Assisting - guidelines and protocols and personal/ person centred information. c) Risk Assessments. d) Continence Chart e) Daily Report Sheets f) Monthly Reviews - which included care plan reviews, mobility, nutrition, hydration, weight, continence, sleep pattern, social life and family involvement. At the time of this inspection, four residents were partially self medicating and policies, procedures, risk assessments and regular reviews were seen to be in place to support people to continue doing this. The lunchtime medication round was observed being carried out by a senior member of staff whose practice was seen to be professional and caring and residents were treated respectfully, in a cheerful and dignified manner. Baytree House uses a Monitored Dosage System (MDS) and monthly medication audits are carried out as part of the Homes quality monitoring process. Controlled medication was seen to be stored in a metal cabinet inside the locked medication cupboard and the records are signed by two staff members. A new lockable fridge for medication has also recently been purchased and installed. All staff, who administer medication have received appropriate training and no errors or omissions were noted from the records seen during this inspection. Observations and discussions with a number of residents confirmed that the people living at Baytree House are treated with respect and genuinely valued as people. Meanwhile, some of the additional comments made by residents or their relatives in the questionnaires included: ...the home does pretty much everything well - food, cleanliness, medical care and staffing... ...calm atmosphere, staff go at each residents pace and try not to make too many demands - i.e. work gradually towards a goal... Care Homes for Older People Page 15 of 34 Evidence: ...research a new residents condition and allow staff members to attend training together, which makes it easier to implement new ideas... ...I sometimes have to wait for a time before I can be helped to bed. I cannot do this until I have had my tablets at 9pm... ...the home is excellent, the staff are all kind and caring and look after [name]s needs very well... Some of the additional comments made by staff members who completed the questionnaires included: ...I believe all residents feel safe and secure in the Home and every resident is treated as an individual, with the respect they deserve... ...take all residents needs as individuals into account at all times... ...each client is individually assessed and catered for... ...provides a caring home for clients and meets all clients needs without being institutionalised... ...provide a choice of shower for clients (this improvement is already being considered, plus other developments to improve clients way of life at Baytree)... ...Baytree House has a very high standard of care. Our aim is always to meet the clients needs, ensuring the best standards of care are given and maintained at all times... ...provide 24 hour care for residents, whatever their needs, in a quiet calm house that is more like a personal home and not a sterile environment... ...we give clients a choice regarding all aspects of their care... ...care staff communicate well regarding service users care plans... ...care staff treat service users with respect and dignity at all times and always ensure their emotional and physical needs are seen to... ...risk assessments are carried out regularly to ensure the home is safe for service Care Homes for Older People Page 16 of 34 Evidence: users and staff... Care Homes for Older People Page 17 of 34 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the opportunity to take part in a number of activities, hobbies and pastimes and are supported to maintain contact with family, and friends, according to their wishes. Evidence: Baytree House has a good selection of organised activities available on a weekly basis such as extend, reminiscence and craft sessions. In addition to these a seasonal entertainment programme is published in the regular newsletter, which goes out to all residents, their relatives. The winter/spring entertainment programme was seen to include the following: Songs and Chat of Yesteryear, Solo Keyboard Entertainer, Games, Competitions and Prizes, Flower Arrangements - sprays and baskets, Talk with Music on Jazz of 1920s, Solo Accordion Entertainer, Speaking on Various Topics, Speaking on Favourite Singers, Musical Duo with Flute and Guitar, Musical Memories, Talk on Music of the Bible and Talk on Swing Era Jazz. From the daily records seen in the care plans, it was noted that residents are also able Care Homes for Older People Page 18 of 34 Evidence: to be actively involved in various household tasks if they wish and one persons notes were seen to include entries such as; helped staff with washing and laundry, helped staff in the kitchen and tidied own room. Other entries noted were; had communion, chatted to daughter on the phone and enjoyed musical entertainment. It was one residents birthday on the day of the inspection and a small get-together with sherry and cake was held with staff, residents and visitors in the front lounge, which appeared to be enjoyed by everyone who attended. It was noted that visitors are always made welcome and a number of people were observed visiting throughout this inspection. Baytree House carries out a regular Quality Assurance Audit, which includes feedback from residents and their relatives. It was noted that any suggestions made or issues raised are acknowledged and an action plan included. A copy of the results are also published in the newsletter to ensure residents and their relatives are able to seen how their comments have been acknowledged. This has been particularly evident with regard to the menu, where portion sizes have been reviewed and additional choices/selections have been added. Residents were observed during the lunch period and were seen to be able to choose where they wanted to eat, which included the lounge, small dining room near the kitchen, conservatory dining area or in their own rooms. The menus were seen to be over a four week rolling basis and included a wholesome and nutritious variety of choices for lunch and high tea. Some examples from Week One were noted as follows: Sunday Lunch 1) Roast Lamb, Mint Sauce and Yorkshire Pudding 2) Prawn Salad Two Seasonal Vegetables, Roast and Boiled Potatoes. 1) Spotted Dick and Custard 2) Seasonal Fresh Fruit Sunday High Tea 1) Salmon, Egg or Ham Sandwich with Crisps 2) Toasted Tea Cake and Jam 3) Cheese Care Homes for Older People Page 19 of 34 Evidence: on Toast with Fresh Tomato. 1) Coffee Walnut Cake 2) Yoghurt Tuesday Lunch 1) Spanish Chicken Casserole 2) Deep Fried Plaice and Chips with Grilled Tomato 3) Corned Beef Salad Two Seasonal Vegetables and Mashed Potato 1) Pancakes with Lemon and Sugar 2) Banana Split 3) Banana Custard Tuesday High Tea 1) Cheese Scones with Butter 2) Fish Fingers and Beans 3) Ham Salad 1) Danish Pastries 2) Jelly and Fruit Meanwhile, in the completed questionnaires, eight residents responded usually and five responded always to the question: Do you like the meals at the home? Some of the additional comments made by residents or their relatives in the questionnaires included: ...the staff are generally helpful, though it would be nice if they could spend a little longer with residents... ...Im happy here... ...welcomes relatives and listens to concerns they have for their family member... ...could do with more exercise/short walks and occasional outings for more physically able residents... ...could encourage informal activities between residents... ...a member of staff sitting chatting with 1-2 residents could reminisce with family photos, play dominoes/cards or look at a newspaper together... Care Homes for Older People Page 20 of 34 Evidence: ...has warm, friendly, caring staff and a homely atmosphere... Some of the additional comments made by staff members who completed the questionnaires included: ...I am very impressed with the wide range of activities and entertainment provided to the service users on a regular basis... ...maybe a bit more external entertainment... ...more outings for the residents, a mini bus to take them to the coast... ...good communication with care staff and with clients and their families... ...we offer a lot of choice for clients and lots of entertainment... ...good food, good atmosphere, a very nice home to live in... ...Baytree House offers a good variety of entertainment and activities... ...family and friends are made to feel very welcome at any time of the day... Care Homes for Older People Page 21 of 34 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. Residents, their families and friends know their complaints will be listened to, taken seriously and acted upon. Robust procedures are in place that help protect residents from abuse. Evidence: Of the thirteen questionnaires that were completed by residents or their relatives, everyone responded yes that there is someone they can speak to if they are unhappy. Seven people said yes they knew how to make a formal complaint, three said no and three didnt respond. It is confirmed in the Service User Guide that a detailed complaints procedure is available in the hallway of Baytree House and a copy is enclosed with the Service User Guide. A discussion with the manager confirmed that one formal complaint has been received since the last inspection and this was dealt with promptly and fully resolved in accordance with the complaints procedure. Any concerns are usually dealt with informally, although a record of the issues raised is maintained, with details of the response and any action taken. It was also confirmed that the manager has established a very good email system with family members, which has helped further improve communications and deal with any Care Homes for Older People Page 22 of 34 Evidence: issues as they arise. Meanwhile, Baytree House has policies and procedures in place in respect of adult protection, prevention of abuse and whistle blowing and staff records confirmed that staff are well trained in these areas. Care Homes for Older People Page 23 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, 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. The home continues to provide a clean, safe and well maintained environment for residents, with further and ongoing improvements being made to the decor and furnishings. Evidence: A tour of the premises showed Baytree House to be a very clean, hygienic and well maintained environment, with a very homely atmosphere. The manager confirmed that two cleaners are employed between Monday and Saturday each week and each month a walk-around audit is carried out with the senior cleaner, proprietor and the care manager, which has resulted in a much more organised approach to maintenance issues and a faster response time. Meanwhile, it was confirmed in the AQAA that six bedrooms, the dining room and kitchen have recently been redecorated. New furniture purchased includes dining room tables, a storage unit for the assisted bathroom, corridor furniture and bedroom chairs. Plans for improvement in the next twelve months have been confirmed as converting the ground floor bathroom into a shower room and, to make the rear lawns more accessible, the manager is investigating options for pathways to be constructed that Care Homes for Older People Page 24 of 34 Evidence: are wheelchair/walking aid friendly. Some of the additional comments made by residents or their relatives in the questionnaires included: ...homely atmosphere... ...I like the aspect of my room... ...the home is always trying to find ways of improving... ...the size of the room with my toilet and wash hand basin is really too small... ...the premises are very good... ...the furnishings and decoration are very good... ...it is always clean and fresh... ...the rooms could be warmer... ...always nice and clean... Some of the additional comments made by staff members who completed the questionnaires included: ...could do with a shelter on the smoking area... ...we could recycle more... ...more bins are needed... ...a bigger staff cloakroom would be good... ...the care home itself is kept clean to a very high standard and everyone, staff and visitors alike, are aware of infection control procedures... Care Homes for Older People Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Baytree House has robust recruitment policies and practices, the staff have a good mix of skills and they are trained and competent. Evidence: Three staff files were looked at in detail during this inspection and each one was seen to contain all the relevant records such as job application form, interview record checklist, contract, job description, photograph, proof of identification, references and clear, enhanced, disclosure from the Criminal Records Bureau (CRB), all of which helped to confirm that Baytree House continues to have robust recruitment procedures. Other information seen in the staff files included an induction and training plan, codes of practice, aims and objectives and PoVA (Protection of Vulnerable Adults) Awareness. A discussion with the manager confirmed that on completion of the three month probation, staff are encouraged and supported to commence NVQ level two or three. The first appraisal is also held after the probation period and includes a focus on the staff members strengths and weaknesses and a plan for the next years development is compiled. Care Homes for Older People Page 26 of 34 Evidence: There is an excellent training programme available for all staff and the proprietors were noted to be totally committed to providing staff with good quality training opportunities. The rotas were looked at during this inspection and the numbers reflected a good level of staff on duty at all times and none of the questionnaires that were completed made any negative comments about the staffing levels. Observations during the inspection also confirmed sufficient numbers of staff on duty to meet peoples needs as required. On the whole, Batree House has a very stable staff team who were seen to be professional, caring and experienced. Staff team meetings were noted to take place on a regular basis and there was evidence of good communication between staff and the management, especially at shift changes/handovers. Meanwhile, some of the additional comments made by residents or their relatives in the questionnaires included: ...the staff are generally very helpful... ...it would be nice if staff could spend a little more time with the residents... ...the staff are all kind and caring... ...staffing situation is stable and good working conditions... ...staff are happy to do a good job... ...clients get to know their carers well... ...staff are very caring, they listen to me and respond promptly when I call... ...Baytree staff respond well to ad hoc questions and comments by family members and they have their own internal resident review systems. However, I would appreciate a regular slot with a keyworker to go over my relatives care plan... Some of the additional comments made by staff members who completed the questionnaires included: Care Homes for Older People Page 27 of 34 Evidence: ...I have finished my NVQ 3 in care and I have had full support from my care manager and my employers... ...they have made it possible for me to attend any training and courses available... ...there is nowhere else I would rather work... ...I am learning all the time, not just from my employers but from the residents as well... ...it is a happy place to work... ...staff courses, training, appraisals and supervisions are very good... ... Ive worked at Baytree House for four years and in that time I have completed and passed my NVQ 2, NVQ 3, NVQ Palliative Care and have just finished my NVQ in Management, plus many other courses... ...we work well together as a team... ...management staff are very good, ensuring they understand the service users needs and they communicate very effectively with care staff... ...all staff undergo the necessary training in order to know what to do in the case of an emergency... Care Homes for Older People Page 28 of 34 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. Residents live in a home, which is run in their best interests by a competent manager and staff receive regular support and supervision. Residents are safeguarded and the health and welfare of residents and staff are promoted and protected by the homes policies and procedures. Evidence: The very experienced owner/manager continues to run Baytree House at present and another member of staff is currently developing her role as care manager and has recently completed and achieved the NVQ4 Registered Managers Award. A very good internal Quality Assurance system continues to be carried out on an annual basis and residents meetings are held on a regular basis, in order to ensure Baytree House continues to be run in the best interests of the people living there and that peoples views are listened to and taken into account. From the information provided in the AQAA, Baytree House has good quality policies Care Homes for Older People Page 29 of 34 Evidence: and procedures, all of which were noted to have been reviewed in either July or November 2009. In respect of residents finances, it was confirmed that none of the staff or management at Baytree House handle these. The usual policy is for personal finances to be managed by the residents, their relatives or advocates. A bill is given to each resident on a monthly basis for any personal charges for items such as hairdressing or newspapers etc and appropriate records are maintained. Meanwhile, the records seen during the inspection were found to be satisfactory in respect of the regulated checks for environmental health, fire, water and electrics. Cleaning materials and hazardous chemicals were seen to be stored appropriately and no obvious safety hazards were noted at the time of the inspection. With regard to fire safety, a fire register was seen which included each residents name, room number and an indication of whether the person is on the first floor or unable to get out of bed unaided. Individual needs were also listed on the register for items such as a wheelchair or walking frame. Some of the additional comments made by staff members who completed the questionnaires included: ...there are excellent training opportunities given to care staff and staff are always encouraged to develop their personal skills... ...the rate of pay could be increased to more accurately reflect the level of care provided... ...Mrs Hanley is a credit to Baytree House... ...manager listens very well to staff, clients and family... ...I am very happy at Baytree House and the only thing I think could be better is the pay... ...happy place to work... ...training is prioritised... ...its a pity the Government doesnt help the private sector more... Care Homes for Older People Page 30 of 34 Evidence: ...care staff are all well trained and offered extra training... ...the owner gives you all the support you need in all aspects... ...Mr and Mrs Hanley are always making improvements to Baytree House, whether it is the decor or the furniture/equipment... ...I think they provide a first class service not only for the clients but also for the staff... ...as an employee, there is nowhere else I would rather work... Twelve staff members responded regularly to the question: Does your manager give you enough support and meet you to discuss how you are working, one person responded often. Care Homes for Older People Page 31 of 34 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 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 33 of 34 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. 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