Care Home: Byars Care Home

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What the care home does well Anyone new coming to the home will have their needs fully assessed before they move in to ensure their needs can be met and staff know what assistance they will need. There are clear and detailed care plans which include information about people`s likes, dislikes and wishes in the event a best interest decision has to be reached on their behalf. One person said, "I tell them what I like and want." There are arrangements made to ensure people receive the healthcare they require and people are given their medication as needed. Staff know how to promote people`s privacy and dignity. There are regular entertainers visiting the home and each person has opportunities to have individual time looking back at the past. People are encouraged to keep in contact with friends and families and are able to send messages over the Internet when not able to see them on a regular basis due to distance. There are systems in place where any complaint can be raised and staff are aware of their responsibility in ensuring residents are safeguarded. Everywhere is kept clean and tidy and staff know how to prevent the spread of infection. Staff have regular opportunities for training and a number of staff have achieved a professional qualification. The correct pre employment checks are carried out before people come to work at the home. There is a suitably qualified and experienced manager in post and people are encouraged to comment on how the home is run. The required health and safety checks and tests to the building and equipment are carried out. What has improved since the last inspection? There were no requirements set at the last inspection. Planning permission has just been agreed to extend the home making all bedrooms into single accommodation and provide additional living space. What the care home could do better: There was some information included within the care plan that could be made more specific about the person. When residents are not readily eating their meals ways of encouraging them to eat should be identified. Key inspection report Care homes for older people Name: Address: Byars Care Home Byars Care Home Caythorpe Near Lowdham Nottinghamshire NG14 7EB     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: Stephen Benson     Date: 0 1 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 27 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 27 Information about the care home Name of care home: Address: Byars Care Home Byars Care Home Caythorpe Near Lowdham Nottinghamshire NG14 7EB 01159663981 01159663529 byars@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Beckedge Limited care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category terminally ill Additional conditions: Date of last inspection Brief description of the care home The Byars is a two-storey building, in a rural setting offering care to 27 service users with nursing needs. There are twenty-one bedrooms; fifteen single and six double, with ample bathroom and toilet facilities. A lift and stair lift facilitates access to the first floor. There is a large open plan lounge; sun lounge and dining area with outlook onto the small but well maintained gardens. There is a small parking area to the front of the building, however car parking is available at the village hall across the road. A fully trained team of nursing and care staff are employed and ensure that all aspects of service users health and social care needs are addressed. There are no restrictions on visiting and the home is well supported by both the local community and service users (past and present) families. The fees range from £419 to £950. A copy of the latest Care Homes for Older People Page 4 of 27 Over 65 0 27 0 10 0 2 Brief description of the care home inspection report is avaiable in the office. Care Homes for Older People Page 5 of 27 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: The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people accommodated and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This was our first visit to the home since 1st April 2009. This inspection involved one inspector; it was unannounced and took place in the daytime, including lunchtime. Prior to the visit an analysis of the home was undertaken from information gathered over the last year including that from the Annual Quality Assurance Assessment they completed. We sent survey forms entitled Have your say about... to a sample of service users and 8 of these were returned, although some had not answered all the questions, so less than 8 views are reflected through the report.. Care Homes for Older People Page 6 of 27 The main method of inspection used is called case tracking which involves looking at the quality of the care received by a number of people living at the home. We also use evidence from our observations; we speak with them about their experience of living at the home; we look at records and talk with staff about their understanding of the peoples needs who they support. The premises were not inspected in detail but various areas of the home were visited as part of the inspection. Care Homes for Older People Page 7 of 27 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. Care Homes for Older People Page 8 of 27 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 27 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 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People coming to live at the home can be confident their needs have been assessed to ensure they can be met. Evidence: Each service user has an individualised pre admission assessment to ascertain whether The Byars can meet their needs. The assessment is carried out by the Registered Manager. The prospective service user is encouraged and supported to be involved in the pre admission process. Additional information is gathered from members of the current healthcare team, Social Workers, doctors and current care plans. With the individuals agreement, relatives and other key supporters are interviewed. The care file for a recently admitted resident was seen and this contained a very detailed pre admission assessment, which showed where the assessment had taken place and how the information had been collected, which included observations. Care Homes for Older People Page 11 of 27 Evidence: There was also a copy of an assessment carried out by the Local Authority on file, which had been received prior to the person moving to the home. Staff said they were made aware of any new residents coming to the home before they started to work with them and they find the information contained in the assessments useful. A recently admitted resident smiled and nodded her head when asked if someone from the home had visited her before she came to the home. Care Homes for Older People Page 12 of 27 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. There is an effective care planning system in place and peoples health, personal and social needs are being met in a dignified manner Evidence: We were told in the assessment they completed that, The Byars strongly promotes independence and service user engagement with the development of care planning. Each service user residing at the Byars is supported to make their own decisions and where they have the capacity they direct/control their care needs. When the individual does not have capacity best interest responses are agreed and acted upon. A sample of care files were seen which contained detailed information about the person including assessments, risk assessments, care plans, a life history, monitoring forms and any correspondence. The information contained in the care plans was very detailed and much of this was tailored to the resident, including information that could be used in the event that someone had to make a best interest decision on behalf of a resident, due to the Care Homes for Older People Page 13 of 27 Evidence: outcome of an assessment of their mental capacity. There was some information seen that was not specific to the particular resident which was repeated in other care plans. One file included a note showing that a relative was gathering information to be included the file. Staff said the care plans ensure they know about each residents likes, dislikes and how they should care for them. Staff said the life history was helped them to know what to talk to residents about. In our survey forms 4 residents said they always receive the care and support they require and 2 said they usually do. A relative commented they seem to meet each individuals care needs in a professional manner. A resident told us, I tell them (staff) what I like and want. Care files showed how peoples healthcare is monitored and recorded any involvement with healthcare professionals. A visiting optician was carrying out eye tests during this inspection. Medication is given out by the nurse on duty and part of the lunchtime medication round was observed. The nurse was seen spending time encouraging one person to take her medication, but when she would not it was disposed of. There is information contained in the newsletter about how residents can access healthcare services and everyone who returned our surveys said they receive the healthcare support they require. One relative commented, this care home is the third my mum has lived in, The Byars has the most calming reaction to mum. Staff said they do all they can to promote peoples privacy and dignity and the home has responded to the dignity challenge initiative. Information about this was seen in the staff room. Staff said they thought they were good at doing this already, but it has made them pay more attention to giving people choice. A visitor commented about his relative, She always looks clean and well presented and wearing clothing that matches. She seems to be happy. During periods of observation staff were seen treating residents in a respectful manner. Care Homes for Older People Page 14 of 27 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 are encouraged to keep an active mind and keep in contact with families and friends. Evidence: There is an activities coordinator employed who said she spends her time organising visiting entertainers, about three every month, liaising with families and having individual reminiscing sessions. The activities coordinator said she ensures that each resident has at least one individual session each week. These take place when the opportunity arises. One resident was seen having a manicure and another was looking at some pictures of the Goose Fair through the years. The resident told the activities coordinator how she could remember the fair used to be in the market square before it moved to its current site. Recent activities are displayed on a moving digital picture display in the entrance and there were pictures seen of a new entertainer who had visited the home this week. The activities coordinator keeps in contact with relatives via email and can provide photographs of whats happened in the home if requested. The activity coordinator intends to make use of the Internet to expand the reminiscence sessions she holds Care Homes for Older People Page 15 of 27 Evidence: with residents. In our survey forms everyone said there are activities arranged they can take part in and one resident commented, They encourage me to go for walks in the village to see my friends and family. Visitors are welcome in the home and there were several seen during the inspection. One resident is able to continue his involvement in the local village by attending events that take place and going to the local pub. The newsletter refers to walks through the village in fine weather stopping at the local pub. Residents were seen being offered choices, one person said she wanted to take the top off her own boiled egg and was left to do so until she recognised she needed some assistance, which was then provided. There were some examples seen where residents could have been offered greater choice, for example drinks being poured out at lunchtime. Lunch was observed and most residents were either able to feed themselves or had some assistance from staff. Some people were observed not eating the meal, one person just pushed the food around on her plate. In our survey forms 4 residents said they always like the meals in the home and 2 said they usually do. A relative said there was a special mention for the cook who does an excellent job at Christmas. Comments made about lunch included, Lovely and The stew was good but I didnt like the carrots. Staff described some ideas about encouraging people with dementia to eat they had discussed on a training course, but had not tried these out. The kitchen was awarded 5 stars, the highest star rating, by the local District Council for food hygiene in March 2009. Care Homes for Older People Page 16 of 27 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 are assured that any complaint would be deal with seriously and steps taken to ensure their safety. Evidence: The home has a complaints procedure displayed and said in the assessment they sent us, The Byars welcomes complaints and suggestions about our service. It is our true intent to take on board positive and critical views, and learn from them in order to improve our service. There was one complaint recorded in the complaints book about food marks on someones mouth. As a result wet wipes were located around the building. The provider said people are very reluctant to make complaints and he had insisted that this comment made was treated as a complaint, and he wants residents and relatives to make use of this procedure. There is also a comments box by the front door for anyone to make comments in, but no recent ones have been received. Some relatives visiting the home commented they were very happy with everything at the home and knew how to complain, but had absolutely nothing they wanted to complain about. Care Homes for Older People Page 17 of 27 Evidence: Staff said they would pass any complaint on to the senior on duty but had not received any. In our survey forms everyone said they knew how to make a complaint. In the assessment they completed it was stated, Procedures are in place to respond to evidence or suspicion of neglect and/or abuse. The procedure indicates when an incident needs to be referred to the Adult Protection unit. In any safeguarding circumstances where referral to other agencies is made, The Byars will remain transparent and will endeavor to fully cooperate with the investigation. The manager showed details of training staff have undertaken, and the policies on safeguarding and protection. Staff who were asked were clear that residents must be protected from abuse, but were not clear on the procedures that would be followed. The manager was surprised at this and said she would organise a supervision session with each member of staff to ensure they fully understood the procedures that should be followed, and will send confirmation when this has been completed. A relative said, I wouldnt move her, she is safe here, at the last place she was always getting out. Care Homes for Older People Page 18 of 27 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 comfortable and well maintained environment that provides a homely atmosphere. Evidence: We were told in the assessment they completed that , We ensure The Byars care environment and outer grounds are well maintained and offer service users a homely place in which to live. The Byars is well lit, clean, tidy, safe, comfortable and provide living surroundings which meet with the individual and diverse requirements of our current service user group and their potentialities. There was a notice on the office door informing everyone that the home had just been given planning permission to extend the home. The plans do not increase the number of people living in the home but make all bedrooms into single rooms and increase the living areas. All areas of the home seen were clean, tidy and fresh. There is a maintenance man employed who carries out routine repairs and decoration. In our survey forms 5 residents said the home is always fresh and clean and 1 said it usually is. One commented, There always seems to be a member of staff going around the home with a duster or cleaning cloth in their hand. Care Homes for Older People Page 19 of 27 Evidence: Staff were seen using protective clothing when handling food and providing personal care. There are hand washes and wipes located around the home. Care Homes for Older People Page 20 of 27 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 are cared and supported by sufficient staff who have been suitably trained to meet their needs. Evidence: We were told in the assessment they completed that, The staff team are trained and skilled at supporting our group of service users and we pro actively manage our internal training and development programmes to ensure that we are able to operate within best practice frameworks and meet with new government initiatives that impact upon the current and potential needs of the people that use our services. Staff said they thought there were sufficient staff on duty, but it was always better to have more. Staff said it was a benefit that there is little turnover amongst the staff and some have been here for many years. It was also commented that the diverseness of culture within the staff group is positive. In our survey forms 4 residents said staff were available when they needed them and 2 said they usually are. One person commented, Everyone who works here seems able to cope with residents and their different requirements. Staff were seen spending time with residents and did not appear to be rushed. One person told us, There is always someone to ask. Care Homes for Older People Page 21 of 27 Evidence: It was stated on the assessment they sent us that over half the staff team have a professional qualification and staff spoken with confirmed they have. A recently appointed member of staff described the recruitment process she had been through and this included completing pre employment checks and providing two references prior to starting work. The member of staff said she is working through an induction she has been given. The application form has been in use for some time and the manager said this is ready to be redone so that it ensures all the required information is collected during the recruitment process. The manager provided a copy of the training staff have had and this showed all staff receive regular training. Staff said they have done a lot of training and spoke of things they had learnt on a course caring for people with dementia, which they said had given them a better understanding. Care Homes for Older People Page 22 of 27 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. There are suitable management arrangements in the home to ensure the home is run in the best interests of people living there. Evidence: We were told in the assessment they completed that, The Byars has a clear and accountable management structure that is appropriate for its size. The providers, one of whom is the registered manager, are involved in the day to day running of the home and make themselves available to residents and their relatives. The manager showed surveys that have been completed by residents and their families. These include many positive comments and show a high level of satisfaction. There is a monthly service user forum where people are encouraged to express their views. The assessment we ask the provider to complete and send back to us was returned on Care Homes for Older People Page 23 of 27 Evidence: time. The information contained in this was detailed and included the views of people living there. and reflected what we saw when we visited. The home does not handle residents money. If any expenditure is made this is paid for by the home and claimed back afterwards. We were told in the assessment they completed that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. Dates were provided showing this to be the case. Staff said they did not have any concerns about health and safety within the home. Care Homes for Older People Page 24 of 27 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 25 of 27 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 1 2 7 15 Make all care plans specific to the person they are prepared for. Identify and try different methods of presenting food that encourage residents to enjoy their meals . Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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