Care Home: Byron Lodge Care Home

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What the care home does well People`s needs were assessed before being admitted to the home. Their health care needs were met by the staff, the GP who visited the home and the community health workers. People spoken with said that they enjoyed the meals and that the food was nice. Staff were seen giving assistance to people at mealtimes. People were offered drinks and snacks throughout the day. One staff member said, that they work toward developing a mutual trust between the people their families and themselves and often this took time. Another said that the manager was good and she was fair and gave everybody equal opportunities. A relative who was visiting the service said, "I observe what goes on here when I visit. The staff are very kind and hard-working." A further two relatives we spoke with were very positive about staff and praised the support and care provided by them. What has improved since the last inspection? There was a programme of routine maintenance and renewal. People were consulted about their interests and a programme of activities was provided. What the care home could do better: The management need to fully consider the dependency levels of people when deciding the number of staff to be allocated on each floor for every shift. One person spoken with said, " Some people need 2 people to move. Often staff had to wait to get help. Two care staff on a busy shift is not enough". There were also some concerns expressed around the increasing staff vacancy at the service and the impact that this had on covering shifts when staff were off sick. Staff training and supervision too need to be regular so that staff receive support. We have asked the provider to take action and monitor progress through their monthly provider visits so that people receive appropriate and safe care with continuity. Key inspection report Care homes for older people Name: Address: Byron Lodge Care Home Dryden Road West Melton Rotherham South Yorkshire S63 6EN     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: Marina Warwicker     Date: 2 5 0 8 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: Byron Lodge Care Home Dryden Road West Melton Rotherham South Yorkshire S63 6EN 01709761280 01709878567 byronlodge@care.wanadoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mimosa Healthcare Holdings Ltd care home 61 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 61 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 46 Dementia Code DE, maximum number of places 30 Date of last inspection Brief description of the care home Byron Lodge is situated close to all local amenities in the residential area of West Melton. It is a purpose built home with parking to the front of the building. Accommodation is on two floors and is serviced by a passenger lift. The home is divided into four units. On the first floor Ruskin Unit provides nursing and residential care for people with dementia and Shakespeare Unit provides nursing care. On the ground floor, both Browning and Wordsworth Units provide residential care. Care Homes for Older People Page 4 of 27 Over 65 0 46 30 0 Brief description of the care home Each unit has a lounge, dining room, bathrooms and lavatories and all bedrooms have en-suite lavatories. The fees ranged from 366 GBP to 584 GBP. Hairdressing, newspapers, personal toiletries and private chiropody were not included in the weekly fee and were charged separately. The registered manager supplied this information. The homes statement of purpose, service users guide and most recent inspection report were displayed in the foyer. People living in the home had copies of the service user guide in their bedrooms. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for the service is two star. This means the people who use the service experience good quality outcomes. The inspection visit was unannounced and took place over full a day. People living at the home, the staff, visitors and the manager were spoken with during our visit. Some people had communication difficulties, but we observed them during the visit to see how well their needs were met by staff. We also looked at the information that we have received since the last key inspection on the 31 January 2008. This included: The AQAA (annual quality assurance assessment) completed by the provider. This is a self assessment document that the provider uses to tell us about what they believe that they do well, could do better and any plans for improvement. Care Homes for Older People Page 6 of 27 What the service has told us about the incidents and the accidents that had happened in the service, these are called notifications and the providers are legally bound to inform CQC. The previous key inspection report and the requirements made and the progress by the service. Feedback from the surveys of the people living at the home, the staff, relatives and professionals that visit. During our visit we chose four people at random and used Case tracking to find out whether they were receiving the correct level of care. We interacted with those who were responsive, we observed the others, read some care records, and spoke with the staff on the units. We toured the building which included the communal areas, the service areas such as the kitchen, laundry and with the permission of the people some bedrooms. Due to unforeseen circumstances there has been a delay in releasing this report. However we have been in touch with the management of the home and we are able to confirm that the management have confirmed that they had taken action on our findings during our site visit. 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. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 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 9 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to use the service have access to the information they need to choose the home that will meet their needs. Evidence: We spoke to four visitors and two staff to find out the process for admitting people into the home. We also checked two recently admitted peoples needs assessments, which had been completed by the placing authorities. The following were our findings. The new admissions were referred to the home by social workers. The staff said that the manager or one of the senior staff carried out the assessments of the people to see whether the home was able to meet their needs before admission. These were some of the comments we received. Two relatives said that people had come to live at Byron Lodge through recommendations from relatives. We ascertained that the majority of people using the service had lived locally and were able to have friends and relatives visit them at the home. Care Homes for Older People Page 10 of 27 Evidence: The care staff said that individuals took a different length of time to settle in and if there were any problems these were discussed at the reviewing meeting when the placing authority and the relatives were present. We observed the residents to be contented and comfortable. Care Homes for Older People Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice by the staff at the home. Evidence: We observed the residents during our visit, checked four care plans, consulted with some of the people and interviewed four staff on duty. The care plans had been prepared from the individual assessments. There were examples where the care plans had been changed to reflect the changing needs of the people. These were some of the comments from the staff, We know the worry the relatives must go through when they leave their loved ones with us. We keep them informed of any changes and maintain a friendly relationship. It helps when we have the same staff working. It takes time to get to know the people and their families and develop relationships. A relative said, I see what goes on here when I visit. The staff are very kind and hard working. Care Homes for Older People Page 12 of 27 Evidence: During the tour of the premise we noticed a few residents remaining in their bedrooms. We were informed by the staff on the units that, either the service users were too ill or people chose to stay in their rooms instead of going into the lounge areas. We spoke to four people who were in their bedrooms and they confirmed that it was their choice. Those residents we chatted with were clean and smartly dressed. Some of the residents were seen sitting in the lounge, listening to music, watching TV or chatting to other residents, staff or the visitors. We noted a sense of calmness within most of the units. The residents were offered drinks and snacks during the day by care staff. Some residents were helped by the care staff to take fluids. The nurses said that the disposal of medication was contracted out and it was collected regularly from the home. We spoke with a resident who was self medicating. S/he told us where the medicine was kept locked up and that the care staff checked with her every day to make sure s/he had taken the tablets. S/he said that s/he was happy with the arrangement. The general practitioner visited the home regularly and saw people who needed medical attention. During these visits reviews of medication also took place. We sought comments from the general practitioner.He was happy with the care the people received and the commitment shown by staff. We observed care staff administering medication to residents on one unit. The staff gave the people time to take the medicines and checked that they had taken it before moving to the next person. Four residents and two relatives said that the staff were prompt in attending when they rang for help. One person said, If the staff are late it is because they cant always leave what they are doing. I know that. We observed staff discreetly toileting service users before meals. The care staff said that they had not had any specific training on end of life care of residents or to support relatives but they used the common sense approach. They gave some examples. The care staff said, I make sure when people are very poorly they are treated just like all the other residents. We keep them clean and comfortable and the family are kept informed. We stay with them if the family are not around. Sometimes it could be difficult when we are busy but we do our best. The management said that training on end of life care was to be reinstated and staff Care Homes for Older People Page 13 of 27 Evidence: were to be given the opportunity to attend training. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities on the whole meet individuals expectations. Evidence: On the day of our visit the residents and visitors said that the activities person worked part time and that they enjoyed having time with her. They requested more opportunities for going out and taking part in the local area activities for example going to the local public house for lunch or evening meal and spend time with the locals. They also mentioned that there were garden centres which they would like to visit. We were informed that the activities person was on leave and there had been staff absenteeism on the day of our site visit which contributed to people not having formal activities. We saw relatives visiting during the day. They were made welcome by the staff . The visitors told us that they could speak to the residents in private in their individual bedrooms. The relatives were very positive about the staff and praised them for their support and care. Care Homes for Older People Page 15 of 27 Evidence: We saw lunch being served to residents in one of the units. The staff made sure that people received help during their mealtimes. The food was hot and well presented. The residents said that they enjoyed their meals and that the food was good. Three visitors confirmed that the meals served at the home were varied and mostly good. We saw food supplements been offered to those who were unable to have a wholesome diet. One carer said that if they find anyone with a weight problem (weight loss or gain) they recorded all the meals and snacks the person has and monitor over a period and get help from the community dietitian if appropriate. 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. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. Evidence: We checked the complaints records kept at the home. We spoke with the visitors and the staff to find out how the management handled formal complaints. The complaints had been investigated and reports had been prepared with action points to make improvements when the issues raised had been upheld. We were informed by the staff when concerns were raised by the relatives, they tried to correct the issues immediately if possible and let the nurse or the manager know of the complaint. Four staff training records were checked and there was evidence that the staff had received training on Protection Of Vulnerable Adults. The staff were able to tell us what actions they would take if they were to witness any type of abuse at the home. There had been allegations made against the staff at the home during the past year. The management of the home had taken appropriate action and reported the incidents to the relevant social service Safe guarding team and the issues had been investigated according to the National Guidance. These were some comments from the people using the service. I understand what abuse is. Here the nurses and the care staff look after us so well. I Care Homes for Older People Page 17 of 27 Evidence: dont worry about such things happening here. If I am upset I can always talk to the senior staff or my daughter who will sort things out. I am quite safe here. 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. The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: We measured this outcome area by speaking to the residents, the visitors and the staff. We also took on board what the surveys said and also using our observations on the day. The outdoor area was tidy and kept safe allowing access for the people using the service. A programme of routine maintenance and renewal was in place. During the tour of the premise we found the home clean and tidy. Bedrooms were kept personalised and tidy. The rooms were centrally heated and had natural lighting. The staff said that they had sufficient aids, hoists and equipment to use when they moved and handled the people. The AQAA from the provider stated that to address the dependency of the people at the home they had purchased extra hoists and aids. Laundry facilities were sited away from the food preparation area. The laundry assistant was on duty during our visit. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff working at the home are skilled to support the people who use the service. However there is a need for the numbers of staff employed during each shift especially on the first floor units to be reviewed and adjusted according to the dependency levels of the people. The management need to continue recruiting staff to achieve a full complement so that people who use the service are able to receive continuity and a home that is run more smoothly. Evidence: The staffing levels within the home have been commented on by relatives, residents and staff working at the home. These were some of the comments we received. The staff should be given a medal for working so hard. There isnt enough staff and people dont get the care they should.. I have spoken to a senior manager from the company about my worries about the lack of staff on the top unit and how the other staff are stretched at all times. He listened but there has not been any changes. There is a big staff turnover and good caring staff have left because they dont get the support they need from the company. I would like more staff on the units so that we can get on without waiting for others. Staff spend time waiting for the care staff because a number of the service users need two people to move. Two staff on a busy shift is not enough. We seem to have minimum staff and when one person goes off sick then it becomes Care Homes for Older People Page 20 of 27 Evidence: dangerous. The manager tries to help but there isnt anyone we can call when there is an emergency. This company has been here now over a year and has done little to recruit and retain staff. If the management want just one advice from me they should concentrate on getting the right number of staff and give them the correct support then things will move smoothly. We have had several managers and have had a rough time. The present manager is doing her best. But what is the company doing to support us. Just throw more work for less staff! We contacted the senior management of Mimosa with regards to the above feedback and shared with them the comments received. The operations director informed us that they were well aware of the concerns and that they were in the process of recruiting the right people for the job and not concentrate on short term fix. He assured us that they were taking these concerns seriously. Due to a change of manager and a high turnover of the staff the team appeared unsettled. The present manager informed us that she was organising training and update sessions for all staff. The training was to include mandatory training such as Moving and Handling, Health and safety and fire safety and service specific training such as dementia care training. During our visit we noted that most of the new staff were experienced and knowledgeable and they had worked in the care sector before. They were familiar with the care needs of those whom they were caring for. Care Homes for Older People Page 21 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. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. Evidence: The person in charge of the home is an experienced first level nurse and has worked as a manager. The senior staff were familiar with the diseases and conditions associated with old age. We noticed that the manager was in the process of reshaping the staff team so that staff were supervised and supported. Three care staff and a nurse told us that they had received supervisions. During the record checks there was evidence of staff supervision. The manager had records of all accidents, injuries and incidents and these events have been notified to the Care Quality Commission. The staff training plans showed that there was to be a rolling programme of training on health & safety, moving & handling, fire safety, food hygiene and Infection control. Dates for the training were finalised and staff were allocated to follow the training. ( We have referred to this Care Homes for Older People Page 22 of 27 Evidence: under staffing standard 30.) The manager confirmed that all service certificates (such as lift checks, electrical circuit, portable appliance checks etc.) were up to date and that regular maintenance checks had been carried through. We were able to evidence this through the AQAA provided by the management. Two recently employed staff confirmed that they had induction training and worked alongside experienced staff before they were allowed to work on their own. The staff rotas were completed in advance and the manager said that they took every effort to cover sickness with their regular staff so that continuity could be maintained. Domiciliary staff were employed in sufficient numbers to deal with cleaning cooking and house keeping. The care staff were given the opportunity to take part in (NVQ Level2) National Vocational Qualifications in care and this had been taken up by some care workers. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 12 16m & n Consult people about their interests and provide a programme of activities suited to their needs 28/03/2008 Care Homes for Older People Page 24 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 1 27 18 The management must recruit to the staff vacancy. So that they are able to allocate the required number of staff and promote continuity of care. 12/01/2010 2 27 18 The ratio of care staff to service users must be determined according to the dependency levels of the residents. So that individuals are able to receive the agreed levels of care from the staff. 12/01/2010 3 30 13 All staff employed at the 12/01/2010 home must receive training and deemed competent by the management on health and safety, fire safety, moving and handling, food hygiene and infection control Therefore protecting the people who live and work at the home. Care Homes for Older People Page 25 of 27 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 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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