Care Home: Baytrees Nursing Home

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What the care home does well Staff treat residents with dignity and respect. Residents have a choice of activities that they can participate in and receive a choice of well balanced, nutritious meals. Residents appeared appropriately dressed for their age, culture and the climate. Bedrooms are personalised to suit individual interests and hobbies. All the residents that we spoke with during our visit expressed satisfaction with staff. Comments include "they are wonderful" and "the girls are lovely". Regular servicing of equipment is undertaken making it safe for use. What has improved since the last inspection? Pre admission processes have been reviewed to include communication, assistance required with education and training and cultural and faith needs. The home has started to introduce a new care planning system. The new system is person centred, uses symbols and the use of colour to aid communication and involvement. Regular residents meetings are now taking place and a fortnightly residents suggestion scheme has been introduced to encourage people to participate in decision making. Preferences with regard to the gender and age of staff supporting individuals is now sought and where possible acted upon. Records are now maintained of appointments with opticians, dentists and chiropodists. Medication practises now offer safeguards to residents. The home has introduced a fortnightly suggestion scheme where the complaints procedure is reiterated and residents are encouraged to raise issues. This venue is also used to give feedback on previous issues raised. The main lounge and hallways in the home have been redecorated and a outside smoking area provided for residents. All areas of the home now have adequate heating, infection control measures in the kitchen have improved and of the twenty eight staff employed at the home twenty four have now received infection control training. The majority of staff have now undertaken training in fire, moving and handling and first aid. Recruitment practises now offer safeguards to residents.Staff now receive regular, formal supervision that supports them to fulfil their roles and responsibilities. A quality assurance system has been introduced that includes seeking the views of residents and relatives. The home sent us its AQAA when requested. The contents of this are more detailed and informative than previous submissions. What the care home could do better: No requirements were made as a result of this inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: Baytrees Nursing Home 1 Highfield Road Worthing West Sussex BN13 1PX     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: Lesley Webb     Date: 0 8 0 6 2 0 1 0 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 Adults (18-65 years) Page 2 of 29 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 Adults (18-65 years) 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Baytrees Nursing Home 1 Highfield Road Worthing West Sussex BN13 1PX 01903693833 01903693822 baytreeshomes@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bay Trees Homes Ltd Name of registered manager (if applicable) Mrs Denise McWilton Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users to be accommodated is 30. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD). Date of last inspection Brief description of the care home Baytrees Nurings Home is a care home proving nursing care and accommodation for 30 younger adults with physical disabilities. Baytrees Homes Limited owns the service and the Responsible Individual on behalf of the company is Mr T Francis. The Registered Manager responsible for the day to day running of the service is Mrs Denise McWilton. The home is located in Worthing and is close to shops, pubs and other amenities. The main house consists of a three-storey building, which has been extended and adapted. In 2004 a new extension for 10 service users was added to the Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 2 5 0 3 2 0 1 0 Brief description of the care home premises this increased the registration to 30 service users. All rooms in the new extension and a small number of rooms in the main house have en-suite facilities. All rooms are accessible by a passenger lift. Service users have level access to two lounges/dining rooms, a conservatory and a large decked area to the rear of the property. The fees charged range from £662.46 to £1500.00 per week. Additional charges are made for dry cleaning, newspapers, hairdressing, personal items, clothing and toiletries. Care Homes for Adults (18-65 years) Page 5 of 29 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited this home on Tuesday 8th June 2010, arriving at 10.00 am and staying until 3.00 pm. The purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. Both the registered manager and director of the service were present during our visit. They assisted us by providing documentation and answering any questions we raised. During our visit to the home we examined the records of six residents and recruitment records of three staff. We also looked at other documentation maintained in the home such as training, medication and quality monitoring records. Since our last key inspection of 5th January 2010 we have also undertaken a random visit to the home on the 25th March 2010 to assess compliance with two Statutory Requirement Notices that were issued for medication and staff training. Information from the random visit is included in this report. Care Homes for Adults (18-65 years) Page 6 of 29 While at the home we also spoke with four residents and two staff. Prior to our visit the home supplied us with copy of its Annual Quality Assurance assessment (AQAA). This document gives the home the opportunity to say what it does well and provide evidence of that. It also gives them the opportunity to say what they feel they could do better and what their future plans are, how it dealt with any complaints and concerns, any changes to how the home is run, the providers view of how well they care for people, the views of the people who use the service, their relatives and staff who work for the service. Before we visited the home we received nine residents surveys. Information from all of the above sources was assessed and used to help us form judgements on the quality of service people living at the home receive. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? Pre admission processes have been reviewed to include communication, assistance required with education and training and cultural and faith needs. The home has started to introduce a new care planning system. The new system is person centred, uses symbols and the use of colour to aid communication and involvement. Regular residents meetings are now taking place and a fortnightly residents suggestion scheme has been introduced to encourage people to participate in decision making. Preferences with regard to the gender and age of staff supporting individuals is now sought and where possible acted upon. Records are now maintained of appointments with opticians, dentists and chiropodists. Medication practises now offer safeguards to residents. The home has introduced a fortnightly suggestion scheme where the complaints procedure is reiterated and residents are encouraged to raise issues. This venue is also used to give feedback on previous issues raised. The main lounge and hallways in the home have been redecorated and a outside smoking area provided for residents. All areas of the home now have adequate heating, infection control measures in the kitchen have improved and of the twenty eight staff employed at the home twenty four have now received infection control training. The majority of staff have now undertaken training in fire, moving and handling and first aid. Recruitment practises now offer safeguards to residents. Care Homes for Adults (18-65 years) Page 8 of 29 Staff now receive regular, formal supervision that supports them to fulfil their roles and responsibilities. A quality assurance system has been introduced that includes seeking the views of residents and relatives. The home sent us its AQAA when requested. The contents of this are more detailed and informative than previous submissions. 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 Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main people who may use this service and their representatives have the information needed to decide if the home will meet their needs. However this is still not available in alternative formats. This might disadvantage people who cannot understand the written word. Assessment processes ensure prospective residents health needs are identified before the move into the home. Evidence: Prior to our inspection the home sent us its Annual Quality Assurance Assessment (AQAA). With regard to assessment processes it states All prospective service users are given a pre admission assessment, which takes place at a place of their convenience, but preferably at the home. We involve relatives, social workers and any other representatives to be involved in the assessment, and all are invited to look around the home, speak to our residents and spend time to get to know us. Prospective service users are invited to join us for as much time as possible and have a meal with us. We have a statement of purpose and service users guide available, which includes a copy of our latest inspection report and a summary of our service Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: users surveys and our complaints procedure. Our residents agreements are discussed with all concerned to ensure all concerned are aware of what is included in the price, what can be expected of us and what conduct we expect to ensure compatibility with all other service users. The AQAA also informs us of improvements that have been made to the homes assessment processes. It states Our assessment process has been modified in January this year to ensure that in the assessment process we discuss the appropriate communication processes, personal support required, family and social contact, assistance required with education and training, risk assessment, cultural and faith needs, physical and mental health care, specific condition related needs and specialist input required, the provision of disability equipment including arrangements for payment and supply and compatibility with others living in the home. As a result of a safeguarding investigation the home cannot currently admit any new residents. During our visit to the home we spoke with the Director of the home who confirmed no new people had moved in. The Director also confirmed the improvements to assessment processes as described in the AQAA stating, these are more person centred now. Nine residents completed questionnaires and returned them to us before we visited the home. Five state they were asked if they wanted to move into the home and four that they were not. Six state they received enough information about the home to help them decide if it would be the right place for them and three that they did not. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Care planning and risk management processes give information to staff in order that they can meet individuals needs. Processes within the home now encourage residents in decision making. Evidence: With regard to individual needs and choices the homes AQAA states We have a care planning document and risk management process in place to inform staff how to meet the individuals needs. We encourage input from relatives and friends and have an open visiting policy within the home. Referrals are made and professional assistance is sought where required, such as input from speech and language and physiotherapy. Advocacy groups are advertised within the home. We respect our service users rights to make choices about themselves and a risk assessment is carried out where necessary. Since our last inspection the home has started to introduce a new care planning system. The new system includes social, educational, spiritual and emotional needs of Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: individuals. Care plans and risk assessments are combined, and include aims and objectives. The new system is person centred, uses symbols and the use of colour to aid communication and involvement. We were informed that the new care planning system has been introduced for approximately ten of the current twenty five residents. Nine residents completed questionnaires and returned them to us before we visited the home. Five state they always make decisions about what they do each day and four that they do usually. Throughout our visit we observed residents being treated with dignity and respect. Staff were heard to address residents by their preferred names, seeking their permission before offering assistance, knocking on bedroom doors before entering and and talking to individuals in a polite and respectful manor. A requirement was made at our last key inspection with regard to supporting people in decision making processes. This is now met. Records that we looked at evidence that for five months regular residents meetings have been taking place, residents are involved in the recruitment of new staff, a fortnightly residents suggestion scheme has been introduced and that residents preferences with regard to the gender and age of staff supporting them with personal care is respected. Residents that we spoke with confirmed that their views are now being sought. As one person explained, things have certainly improved, Ive never been asked my opinion so much. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 have a choice of activities that they can participate in and receive a choice of well balanced, nutritious meals. Evidence: With regard to lifestyle choices the homes AQAA states Service users are encouraged to set personal goals, educational and training needs and discuss how we can help them to achieve these. Any spiritual needs of the service user are investigated and opportunities sought for them to have their spiritual needs met. We employ an outing and activities co-ordinator who works hard to ensure that the service users social needs are met. Service users would be encouraged to take part in activities engaged prior to admission and assisted wherever possible. Hobbies are encouraged and frequently suggested. Arts and crafts sessions are held in the home. The service users enjoy games and quiz events. Service users have a good knowledge of the local Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: community and use the local shops, pub, hairdressers, restaurants and takeaways and are supported to use them by staff. As at our previous inspection we found evidence that the home provides a variety of activities to ensure that there is stimulation and interest for the people living there. For example records and discussions with residents confirm regular outings using the homes transport take place to places including shopping and garden centres. As at our last key inspection in January 2010 a notice board in the main lounge area displays information regarding forthcoming activities. These include arts and crafts and forthcoming day trips to a garden centre, museum and the zoo. Nine residents completed questionnaires and returned them to us before we visited the home. When asked the question what does the home do well comments were recorded of good social activities and going on outings. As at our previous inspection specialist diets are catered for and a menu was seen to be on display that offers a choice of meals at every sitting. Residents that we spoke with confirmed their satisfaction with meals provided. For example one person said, the meals are lovely, things have gotten a lot better lately. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Residents are treated with respect and their rights to dignity and privacy upheld. The health needs of residents are now monitored safely and consistently. Medication practises offer safeguards to residents. Evidence: As at our last key inspection in January 2010 residents that we saw during our visit appeared appropriately dressed for their age, culture and the climate. Staff were observed speaking and assisting residents with dignity and respect. For example staff were observed to knock on bedroom doors before entering and using individuals preferred choice of name when having conversations with them. Records show that residents have access to community based health professionals such as district nurses where appropriate and general practitioners. A requirement was made at our last key inspection that records must demonstrate residents receive any necessary treatment from dentists, opticians and chiropody services. This is now met. We looked at the records of six residents, all of which detailed appointments, treatment received and if a service had been declined the Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: reason why for over a six month period. On the 25th March 2010 we visited the home to assess compliance with a Statutory Requirement Notice (SRN) issued for medication. We found that the SRN was met but that further work should be undertaken so that when new medication is prescribed or changes in direction authorised, risk assessment protocols need to be updated as soon as possible to ensure medication systems are robust. A new requirement was also made that accurate records must be maintained confirming residents are given their medication as directed in order that systems are safe. At this visit we found that improvements have been made and the medication requirement met. The home uses a local pharmacy to supply medication and a monitored dose system is in place. Medication is safely stored in a locked cupboard and Medication Recording Sheets were current and in good order with no discrepancies found on those sampled. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Residents are able to express their concerns, have access to a complaints procedure and their views are listened to and acted upon. Safeguarding procedures offer protection to people. The systems for managing residents finances offer safeguards to individuals. Evidence: With regard to complaints and protection the homes AQAA states There is a clear and effective complaints procedure displayed throughout the home and within the service users guide. Our service users are spoken with fortnightly to confirm they know how to use the complaints procedure. Training is given on safeguarding of vulnerable adults during the induction period for all new staff and procedures are in place to show up to date training for all staff. As at our previous inspection we saw that the complaints procedure was displayed in the home. At our last key inspection a requirement was made that residents must be made aware of the complaints procedure and that the home must be able to evidence issues raised were investigated and where possible acted upon. This is now met. The home has introduced a fortnightly suggestion scheme where the complaints procedure is reiterated and residents are encouraged to raise issues. This venue is also used to Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: give feedback on previous issues raised. In addition to this regular residents meetings are now taking place and complaint processes are being monitored in the new quality assurance system that has been introduced. The AQAA informs us that the home has received eight complaints in the last twelve months, six of which were upheld. All were resolved within 28 days. Nine residents completed questionnaires and returned them to us before we visited the home. All state they know who to speak to if not happy. Seven state they know how to make a complaint and two that they do not. We saw that the home has a copy of the West Sussex Multi-disciplinary safeguarding adult policy and procedures in place. During this visit we were supplied with training documentation that states there are currently twenty eight staff employed at the home, twenty four of whom have undertaken safeguarding training. As at previous inspections there are systems in place to manage personal finances of residents who are not able to do this. These include individual records that detail income, expenditure and balances. Care Homes for Adults (18-65 years) Page 20 of 29 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 now live in a safe and comfortable environment. Evidence: With regard to the environment the homes AQAA states The premises are suitable for our stated purpose. Our home is clean and tidy, safe, well ventilated, comfortable, bright, cheerful, airy and free from offencive odours. Our residents have access to all bedrooms, communal areas and gardens. Our premises meet the requirements of the local fire service and environmental health. Our residents bedrooms are well appointed. We welcome and assist residents to personalise their bedrooms. Laundry facilities are of a high standard and situated away from the main building so that they can be accessed from the outside. Sluicing areas are of a good standard and are kept clean at all times. infection control procedures are followed and staff are trained in the prevention of infection. We looked around the home and found no health and safety issues. There is a large decking area accessible to people who use wheelchairs through the lounge/conservatory. Since our last inspection the furniture in this room has been rearranged in order that visitors can use this facility if they wish when visiting their relatives. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: As at previous visits we found that residents bedrooms have been personalised to suit their individual interests and hobbies. The AQAA informs us of improvements that have been made to the environment over the past twelve months. These include the redecoration of the main lounge and hallways and the provision of an outside smoking area for residents. A requirement was made at our last key inspection with regard to the environment. This is now met. All areas of the home now have adequate heating, infection control measures in the kitchen have improved and of the twenty eight staff employed at the home twenty four have now received infection control training. Nine residents completed questionnaires and returned them to us before we visited the home. Six state the home is always fresh and clean and three that it is usually. Care Homes for Adults (18-65 years) Page 22 of 29 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are now supported by caring and suitably qualified staff. Recruitment practises now offer safeguards to residents. Staff now receive regular, formal supervision that supports them to fulfil their roles and responsibilities. Evidence: With regard to staffing the homes AQAA states Baytrees is an equal opportunities employer. Two written references are obtained before making an appointment and any gaps in the employment record are explored. All staff appointments are subject to a three month probationary period. Induction training is completed within six weeks of appointment in post. New staff who are being trained and supervised by colleagues are supported and supervised by senior staff. Staff have access to the homes written grievance and disciplinary procedures. Staff work well as a team to support the aims of the home and are helpful, courteous and respectful. During this visit the Director of the home informed us that there are seven or eight carers on duty of a morning, three carers of an afternoon and two during the night. In addition a qualified nurse is on duty at all times day and night. Kitchen and domestic staff are on duty seven days a week. The managers hours are supernumerary. Nine residents completed questionnaires and returned them to us before we visited Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: the home. Seven state the care staff and managers always treat them well and two that they usually do. When asked the question what does the home do well comments were recorded of I am very happy with all the wonderful girls and they cater to my every need. All the residents that we spoke with during our visit expressed satisfaction with staff. Comments include they are wonderful and the girls are lovely. On the 25th March 2010 we visited the home to assess compliance with a Statutory Requirement Notice (SRN) issued for training. We found that the SRN was met but that further work should be undertaken so that new training is embedded into practise. Records now demonstrate that the majority of staff have undertaken training in fire, moving and handling and first aid. The deputy is responsible for training of staff. During our visit she informed us that she is due to complete a Train the Trainer course on the 10th June 2010 and that as a result of undertaking this It has made me more confident, given me ideas of different ways of presenting things to staff. The registered manager is yet to undertake this qualification. She informed us that she is on a waiting list with a training company but as yet no date has been arranged. The homes AQAA informs us that nine of the staff team hold a National Vocational Qualification (NVQ) at level 2 or above and six other members of staff are in the process of completing this. It also informs us that the common induction standards are used for all new members of staff. There is a robust recruitment process in place, three staff files were seen and all contained the required documentation including current Criminal Bureau Checks and references. This meets a requirement made at the last key inspection. A requirement was made at our last key inspection that staff must receive regular, formal supervision. This is now met. Records evidence that for the last five months monthly staff meetings have taken place and that staff also receive supervision on a one to one basis. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. Management and new monitoring systems in the home are ensuring the needs of residents are being met safely and consistently. Evidence: The registered manager was present when we visited the home as well as the director. Both assisted by providing written documentation and answering questions relating to the inspection process. The registered manager has been in post for several years and is also a qualified nurse. Since our last inspection the home has introduced a quality assurance system that includes seeking the views of residents and relatives. The new system covers all aspects of the service including the environment, residents records, recruitment, training, complaints and health and safety. Both weekly and monthly checks in various areas are undertaken, the findings recorded including actions taken. The Director of the home expressed the view that the new monitoring system is helping to identify areas of improvement, promoting a proactive approach to service improvement. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: The home sent us its AQAA when requested. The contents of this are more detailed and informative than previous submissions. Information within the homes AQAA states that checks on services and equipment have been undertaken within recommended timescales. We sampled a number of health and safety records, finding all to be in good order and up to date. Care Homes for Adults (18-65 years) Page 26 of 29 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 Adults (18-65 years) Page 27 of 29 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 Adults (18-65 years) Page 28 of 29 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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