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Care Home: Bystock Court

  • Old Bystock Drive Exmouth Devon EX8 5EQ
  • Tel: 01395266605
  • Fax: 01395222689

Bystock Court is a home, which is owned by a registered charity, Devon Sheltered Housing Trust. The day-to-day operation of the home is carried out by Guinness Care and Support. Bystock Court is registered to provide accommodation and personal care for up to 41 people with learning disabilities. Out of the 41 rooms, one is used to provide short-term care. Although the home does not admit people over retirement age, some of the residents have chosen to continue to live there after their retirement. The main building is an impressive large period house set in extensive grounds on the outskirts of Exmouth, Devon. There are 41 single bedrooms and a range of communal areas including lounge, dining room, ballroom, craft room, games room, laundry and kitchen. There are two semi-independent flats, each with three en-suite bedrooms, a lounge and kitchen. Within the grounds are a range of buildings including a small farm, greenhouses and a paper shredding business. Residents are encouraged to participate in the running of the home and work in units according to their interests and abilities. The home also provides a range of education and leisure activities. Fees paid by people living at the home at the time of this inspection ranged from £356 - £662 per week. These fees do not include the cost of clothing, toiletries, transport, hairdressing, chiropody charges and other personal items.Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 5The CSCI report is displayed on a notice board in the home. The Statement of Purpose, Service User Guide and brochure can be requested from staff at the home.

  • Latitude: 50.643001556396
    Longitude: -3.3819999694824
  • Manager: Mrs Lynda Brenda Lockwood
  • Price p/w: £356
  • UK
  • Total Capacity: 41
  • Type: Care home only
  • Provider: Devon Sheltered Homes Trust
  • Ownership: Voluntary
  • Care Home ID: 3832
Residents Needs:
Learning disability

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Bystock Court.

CARE HOME ADULTS 18-65 Bystock Court Old Bystock Drive Exmouth Devon EX8 5EQ Lead Inspector Vivien Stephens Unannounced Inspection 4th September 2008 10:00 Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bystock Court Address Old Bystock Drive Exmouth Devon EX8 5EQ 01395 266605 01395 222689 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Devon Sheltered Homes Trust Mrs Lynda Brenda Lockwood Care Home 41 Category(ies) of Learning disability (41) registration, with number of places Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 41. 4th September 2007 Date of last inspection Brief Description of the Service: Bystock Court is a home, which is owned by a registered charity, Devon Sheltered Housing Trust. The day-to-day operation of the home is carried out by Guinness Care and Support. Bystock Court is registered to provide accommodation and personal care for up to 41 people with learning disabilities. Out of the 41 rooms, one is used to provide short-term care. Although the home does not admit people over retirement age, some of the residents have chosen to continue to live there after their retirement. The main building is an impressive large period house set in extensive grounds on the outskirts of Exmouth, Devon. There are 41 single bedrooms and a range of communal areas including lounge, dining room, ballroom, craft room, games room, laundry and kitchen. There are two semi-independent flats, each with three en-suite bedrooms, a lounge and kitchen. Within the grounds are a range of buildings including a small farm, greenhouses and a paper shredding business. Residents are encouraged to participate in the running of the home and work in units according to their interests and abilities. The home also provides a range of education and leisure activities. Fees paid by people living at the home at the time of this inspection ranged from £356 - £662 per week. These fees do not include the cost of clothing, toiletries, transport, hairdressing, chiropody charges and other personal items. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 5 The CSCI report is displayed on a notice board in the home. The Statement of Purpose, Service User Guide and brochure can be requested from staff at the home. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. Several weeks before this inspection took place we sent an Annual Quality Assurance Assessment (AQAA) form to the home. The completed form was returned to us before the due date and it contained good information about the way the home is run and the services it provides. We sent survey forms to people living and working in the home, and to health and social care professionals who are connected with the home. We received 17 completed surveys from people who live in the home, 15 surveys from staff and 9 surveys from health and social care professionals. Their responses have helped us to form the judgements we have reached in this report. This inspection began at 9.30am and finished at approximately 7pm. During the day we looked closely at the care given to four people who live in the home. We call this method ‘case tracking’. It involved looking at all of the documents relating to the care of the four people from the initial referral up to the present time. This included talking to the people to find out if their experience of the care matched the information held about them. We also look at how the home helps people plan for their future. We toured the home and looked in five bedrooms, most of the bathrooms and toilets, and in all of the communal lounges, dining rooms and workshops. During the day we talked to many of the people living in the home and staff on duty in the home and in the workshops. We also talked to the General Manager. The records we looked at included assessment and care plan files, staff recruitment, induction, training and supervision records, menus, medicine administration, and records of money held by the home on behalf of those people who have asked for assistance with this. What the service does well: We looked at the way the home has admitted new people in the last year and found they had followed good admission procedures. People have been given plenty of time to visit and get to know the home before any decision to move in is made. They have also been given written information about the home. The home has gathered a range of information about the person to make sure that they can meet the person’s needs, and to be certain that Bystock Court is right for that person. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 7 People can choose from a wide range of work, education and leisure opportunities. There is a small farm, garden centre, paper shredding business, craft workshop, kitchens and laundry all offering people a fulfilling work opportunity. Many people told us they wanted to move to Bystock Court because of the work opportunities. The home also offers a wide range of leisure facilities both within the house and grounds, and also in the local community. Medicines have been stored and administered safety. The staff who have responsibility for this task have received training on the safe administration of medicines. Safe storage and recording procedures have been followed. Some people have been supported to hold and administer their own medicines following a risk assessment. The home has followed good recruitment and induction procedures. There are usually enough staff to meet people’s needs. The home has provided a good range of training and many of the staff have achieved a recognised and relevant qualification. People told us the home is well run and a happy place to live and work. We received many positive comments about the home, including “I think the staff do a brilliant job here, very thoughtful and understanding.” “I am happy at Bystock and want to stay here please.” A member of staff said “It provides a safe, secure and happy environment for our residents. It is a lovely place to work. I have always enjoyed working here. It provides a diverse spectrum of activities for residents, and they enjoy holidays and trips regularly The home has good systems in place to seek the views of everyone living and working in the home, and of families, friends and professionals connected with the home. They have evidence to show they have listened to people and checked their systems regularly to make sure the home is safe and running smoothly. What has improved since the last inspection? A new style of care plans has been introduced in the last year. The staff have helped each person to write their own care plan using their own words. The plans are straightforward and easy to follow and set out clearly how staff should help people with their personal and health care needs. There are good systems in place to make sure that the staff give people the help and support that is set out in the care plans. In the last year a number of areas of the home have been redecorated or upgraded, including some of the bathrooms and toilets. The home now looks bright and attractive throughout. The grounds and gardens continue to be well cared for. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 8 In the last year the subject of abuse has been discussed with staff and further training has been provided. They have worked hard to try and improve the way the staff talk to people and support them. We found this has improved, although there were still some signs that occasionally staff may have a ‘parental’ manner (see what they could do better). There are robust concerns and complaints procedures in place and people told us they felt confident that they could talk to a manager or a member of staff if they were worried about anything and this would be dealt with correctly. The home has policies and procedures in place, and staff have received training on the protection of vulnerable adults. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 Quality in this outcome area is good. People are given good information and opportunities to get to know the home and decide if it is the right place for them, before any decision to move in is made. The home follows good assessment procedures so people can be confident that the home knows what help they need is able to meet those needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home told us about the way they help people who are thinking about moving in get to know the home. In their AQAA (Annual Quality Assurance Assessment) they said – “Individuals looking for a new home are given lots of opportunities to see and stay at the home before a decision is made to live here. A full person centered care plan is written with this individual making sure that the home can meet all of the individuals needs.” The people who completed a survey form before this inspection told us that they were given enough information about the home before they moved in. They also told us they had plenty of opportunities to visit and get to know the home. One person told us they were able to make up their own mind about whether they wanted to move in. They told us “It was my idea.” Another Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 11 person told us, “Got to stay here for a couple of days and if I like it I will come here.” We talked to two people who had recently moved in. They said they were given information about the home and decided they wanted to visit. They stayed for a few nights before they finally made up their minds to move in. They both said they were certain they had made the right decision and were very happy at Bystock Court. The home uses a tick box style assessment form that guides them to find out a wide range of useful and relevant information about people who are thinking about moving in. The care plan files we looked at also contained information from the person’s previous accommodation and also information and assessments from health and social care professionals. This information helped the home gain a good understanding of the person and to make certain that Bystock Court was the right place for them and could meet their needs. At the last inspection we recommended that the home includes information about the chosen religion of any person who may be moving in. This information was included in the assessments we looked at. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is good People have helped the staff to draw up and plan their own care needs. They can be confident that the staff will give them the right help and support them, and allow them to make choices and decisions in all aspects of their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We selected four people at random who we would follow the care they had received from the point of moving in the home to the present time. The home told us in their AQAA about the way they work with people to draw up and agree the support they need from the staff each day. “All individuals living at the home has a complete person cantered care plan, this includes all aspects of their life, from choice and freedom to health care. Each resident is very much involved when this care plan is written. Care plans are updated Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 13 annually but amendments are made monthly. Each resident is given a copy of their own care plan to keep. All staff has access to this care plan and they are used as a working tool. Each individual has a day activities sheet within their personal file, the activities for each person have been chosen by them themselves. As part of a resident’s independent lifestyle they are supported to take risks. All risk assessments are kept in the resident’s individual personal file.” Each person had a care plan that was held in an A4 clip file along with a wide range of other useful information. The files were divided and had a contents page making it very easy to find relevant information quickly. In three of the care plans we looked at the main care plan document had been drawn up in the person’s own words, and the person had their own copy. The plans had been reviewed regularly and we could see some handwritten notes where care plans have been amended when the person’s needs have changed. Reviews had been carried out with the person, and with anyone else they want to be included in the process. The care plans showed that people made decisions about every aspect of their lives. In just one of the care plans we looked at we found the main document had not been changed to the new format and had been written by the staff, although we were assured that the plan had been discussed and agreed with the person. It had been regularly reviewed and updated. The wording in a few parts of this document suggested a more ‘parental’ approach. We talked to some of the staff about this and they said the document was due to be rewritten in the same way as the other care plans, and they were confident it would then reflect an adult-to-adult approach. We were told that each unit in the home had a daily checklist that the staff followed to make sure they provided the care as set out in the care plans. The people living in the home who completed survey forms before this inspection started told us they were happy with the way the staff supported them. Comments included “I think the staff do a brilliant job here, very thoughtful and understanding.” “I am happy at Bystock and want to stay here please.” We received many positive comments from staff about the way the home organises and provides care to people. Comments included – “staff complete monitoring forms and these are regularly transferred to the resident’s files for accurate up-to-date files. The care plans are updated with information regularly.” “When a resident’s needs change this is usually written into the care plan so that we can work to meet these needs.” A care manager told us – “For a large service it appears to support the service users well and meet their individual needs.” Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 14 The care plan files contained risk assessment documents that showed how the home has considered any potential risks to people’s health or safety. They showed how the home has agreed with the person any safeguards that may help to reduce those risks. People have not been prevented from doing anything they want to do, although they have been given guidance and support to help them reduce any likely risks. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is excellent. People have a wide range of opportunities to lead a fulfilling life. The home will give them help and support to learn new skills, to have a job they enjoy, and to lead a full and varied social life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found that Bystock Court offered a very wide choice of things to do every day. Within the house and grounds there were many opportunities for people to learn new skills, or to do a meaningful and fulfilling job. Some people also went out to colleges or local groups. The work units in the home included a craft workshop, kitchen, laundry, paper shed, gardens and farm. They were hoping to expand the facilities in the future to provide even more work opportunities. We visited all of the units (except the laundry) and talked to many of the people who were working in Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 16 the units and some of the staff. The farm provided people an opportunity to work with a wide range of animals including sheep, cattle, goats, chickens, quails, ponies and guinea pigs. They were also planning to have some alpacas in the near future. The produce from the farm was used in the home, and any excess was sold to various outlets locally. The people who showed us around the farm clearly enjoyed their work and were pleased to tell us all about the animals and how they help to care for them. The paper shed produced shredded animal bedding. People showed us how they helped to sort and shred the paper, bag it, and then went in the lorry to deliver to customers. In the gardens there were greenhouses and poly tunnels and people told us how they were involved in a range of tasks from potting on, to weeding and watering, and also helping to sell the plants to visitors and to various local markets and outlets. People also helped to maintain the large grounds that surround the house. The craft workshop in the main house provided people with the opportunity to do a wide range of arts and crafts. We saw some wonderful paintings, needlework, pottery, greetings cards and gifts. Many items had been displayed around the home and some were sold at coffee mornings and fairs. The people we talked to clearly enjoyed doing arts and craft and were proud of the many things they have created. Some people we talked to had several jobs each week. For example, some people told us they work a few days in the kitchens, and a few days in the craft workshops. Other people told us they had worked for some time in one unit and had decided they wanted a change, and have decided to move to another unit. All of the people we talked to said they enjoyed their jobs. Some people told us that they chose Bystock Court because of the wide range of work opportunities. A staff member who completed a survey form before this inspection said, “I feel Bystock is unique in which it boasts a way that the residents can live and have something to do in the day time to encourage them to increase their skills.” Another member of staff told us about Bystock Court - “It provides a safe, secure and happy environment for our residents. It is a lovely place to work. I have always enjoyed working here. It provides a diverse spectrum of activities for residents, and they enjoy holidays and trips regularly The home had three vehicles to take people out – a minibus, a ‘people carrier’ and a smaller car. A fourth vehicle had been ordered – a large multi-person vehicle. We heard that this will mean that more people can go out for planned Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 17 group activities, and it will also provide even better opportunities for people to go out for individual and small group outings. Residents’ meetings are held regularly in the home. These meetings gave people the opportunity to have their say about the way the home was run, and about changes and improvements they would like to see. There were two flats within the main house for up to three people. Each had it’s own kitchen, lounge and dining room. The people who lived in these flats were supported and encouraged by staff to lead independent lives. They could do their own shopping, cook their own meals, and do their own laundry and cleaning using the equipment within their flats. However, no-one was forced to do this if they did not want to. One person told us he preferred to eat the meals provided in the main house rather than do his own cooking. Some people showed us their rooms, and we saw televisions, music equipment, tea and coffee making facilities. Many people enjoy spending time in their rooms during their leisure time. The home also offers a wide range of other leisure opportunities, including computers, outdoor sports and games, outings and holidays. Some people told us about the shopping and pub trips they enjoy. The home has recognised and respected each person’s choice of religion, and they provide transport so that people can go to church if they want to. Many people were involved in local clubs or went out regularly to social events. At lunchtime we sat and shared a meal with people in the main dining room. This is a lively room where people enjoy meeting friends and catching up with news. There is also a quieter dining room if people don’t like too much noise. Alternatively some people have chosen to eat in their rooms or in their flats. At midday people are usually offered a range of light snack type meals – on the day of this visit most people had bacon or cheese sandwiches and then fruit or yoghurts. The main cooked meal is provided in the evening. The meals were served from a hatch between the kitchen and dining room, with some foods offered on a self-service basis. People told us how they have been consulted over the menus and they were always given plenty of choices. We were given a copy of the current menus during this inspection. Special diets were catered for. The menus were varied and included plenty of fresh fruit and vegetables. The care plans gave information about individual dietary needs. They also included information about weight. There is a strong emphasis on healthy eating. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 Quality in this outcome area is good. People have been given good support to meet their physical, personal and emotional health needs. Medicines have been stored and administered safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home told us in their AQAA “All residents with health issues have a medical health check annually. Anyone with on going medical issues is referred for a full assessment. Those residents who needs to have aids and equipment to enable them to have maximum independence will do so. All residents are supported to access NHS healthcare facilities, the residents that need the support to attend outpatients and other appointments will be supported at all times. There are some residents who self administer their own prescribed medication. These residents know how to administer, control and store their own Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 19 medication.” The care plans explained each person’s preferred daily routines, what they are able to do themselves, and what they want the staff to help them with. The plans gave the staff instructions on how to help people with personal care tasks so that their privacy and dignity are maintained. The plans also showed that each person was able to make choices about every aspect of their daily lives. The staff have been guided to offer advice and guidance where appropriate, but none of the people living in the home have been restrained or restricted in any way. The care plan files we looked at showed that the home has identified all health problems, including the risk of any potential illnesses. We saw documents that showed people have received regular check ups with their dentist, optician, audiologist, and/or chiropodist according to their personal needs. In one care plan file the person has been prescribed a cream that the staff administer. The staff were able to give a very clear explanation about how, when, why and where the cream should be administered but the care plan did not give this detail. We suggested that this information should be recorded in the care plan and/or the medication administration records so that any staff who have not worked with the person recently have a good written instruction on this task to back up the verbal instructions given during handover sessions. We also suggested that the home should have a system for monitoring the effectiveness of the creams, and give instructions on the actions staff should take if they find the skin problem is getting worse, or if it has healed. One care plan file showed that the person had a hearing aid, but the records did not show if the person was able to manage the hearing aid themselves, or if they needed help with it. We also saw a reference to a person who had been prescribed continence products, but the care plan did not show what help the person needed to manage any continence problems. In another instance we saw a care plan that showed the person needed help to build up their strength following an illness. The care plan did not give detailed instructions about how this might be achieved. We talked to the senior person who was in charge at the time of our visit and she explained the way the staff have helped these people, and we were assured that the staff have a very good understanding of each person and the help they want. She agreed that the care plans could be expanded further in these areas to make certain that all staff are working in a consistent way and have access to the same information. We talked to staff and people living in the home about how they help people with specific health problems. People told us they were happy with the way the home helps them to stay healthy. We heard about regular medical checkups and appointments. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 20 A dentist who completed a survey form before this inspection told us (it is) “Sometimes difficult for care-givers to deliver good oral hygiene due to challenging behaviours. Generally staff seem to try quite hard.” In answer to the question “What do you feel the home does well?” this person answered “Respects individuals dignity.” A care manager told us that the home always monitors and attends to individual’s health care needs, and added a comment “But still need help with health action plans.” We looked at the way the home stores and administers peoples’ medications. The home uses a monitored dosage system supplied by a local pharmacy. Some people have been assessed as being able to hold and administer their own medications and lockable storage has been provided in their rooms so that they can keep their medicines safe. The medicines for all other people are held in one room on the ground floor. The medicines are held in three secure cupboards – one cupboard for each floor. We heard that in the past they have tried to have a separate medicines store on each floor but this proved to be unsuitable. This was because the home and grounds are very large and people are out and about at all times of the day. After consulting with everyone they decided that, even though it may appear to be ‘institutional’ it was safer for every person to go to collect their medicines from one central room. They have found this system works efficiently and people have happy to go and collect their medicines. We saw some medicines being administered to people after lunch. Each person was given individual assistance according to their needs and wishes, and safe procedures were followed in accordance with the homes’ policy. All staff who regularly administer medicines have received training on this topic and their competence has been checked. We checked the records of medicines received into the home, those administered, and any unwanted medicines returned to the pharmacist. The records were well maintained. There was a good system of accounting for most medications, although there were no ‘brought forward’ records of medicines that were not in the blistered packs – for example liquid medicines, or medicines that have been prescribed on an ‘as required’ (PRN) basis. A person who had been living at Bystock Court recently died in hospital. Some of the people living in the home wanted to talk about this person’s death and how much they missed her. We had also talked to the home manager, Lynn Lockwood, after the person’s death. We were satisfied that the home had consulted closely with the family and all relevant health professionals, and done everything they could to make sure the person received good care. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 21 Some of the people in the home are over retirement age. We saw evidence in the care plans, and by talking to some of these people that the home has considered any age related problems and has sought advice and provided any additional aids or equipment necessary to help people continue to live their lives as they wish. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good People can be confident that their concerns or complaints will be listened to and acted upon. The staff know what to do to make sure people are safe from harm or abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home told us in their AQAA “All staff has full training on the protection of vulnerable adults within their induction period. The home manager takes all complaints serious and everyone will be assured that no one would be victimised for making a complaint. All residents are protected from abuse at all times. Any complaints from residents are acted on immediately, all staff follows the polices and procedures at all times. The complaint procedure has now been written so that all residents can understand it, link workers has also explained the procedure to each individual and they have been given a copy of this procedure. A copy of this procedure is pinned on the resident’s notice board. All staff is trained to listen and act on the views and concerns of the residents, and they would take action before the problems develop and become a formal complaint.” Since the last inspection the home has received 4 complaints. These have been dealt with through their own complaints procedures. No complaints have Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 23 been received by the Commission. One issue has been addressed through the Safeguarding Adults procedures. We were satisfied that the home has taken all issues that have been brought to their attention seriously and have taken appropriate action to investigate and address them. We talked to people living in the home to find out what they would do if they were worried or upset about anything. They told us that they felt confident they could talk to one of the senior staff or managers and the problem would be sorted out. They have all been given a copy of the complaints procedure, and this has been produced using pictures as well as words for those people who have difficulty reading. At the last inspection an instance was noted where staff may have spoken to a person living in the home in a disrespectful manner. Since then the staff have received further training and instructions to address this. During this inspection we saw staff and the people living in the home talking together in a friendly and respectful manner. We saw lots of staff working alongside people in a supportive manner, treating them as equals. In just a few instances we saw staff talking to people in a kind and caring, but rather ‘parental’ manner’. We talked to the General Manager about the possibility of giving staff further guidance and support on how to interact with the people living in the home to ensure that everyone is treated in an adult manner. We looked at the way the home helps people to manage their money. We heard that some people hold their own bank accounts and cash, and the home does not have any involvement in this matter. In other cases the home has talked to people to find out how much help they want and have reached an agreement with them about the way they want to be supported. We heard that everyone has lockable storage in their rooms and they all keep some cash for day-to-day use. Some people have also asked the home to help them save money for larger expenses such as holidays or clothing. This money has been held by the home in a safe manner. We found there was a separate wallet with cash, and record of income and outgoings, including any receipts. We checked a sample of these records and found they have been very well recorded and balances are carefully checked to ensure they are correct. In some instances the home also holds people’s bank or building society accounts. We found the home has kept good records of the money received into these accounts, and all withdrawals could be traced easily to see what happened to the money. The records showed that the home has treated people’s money in a safe manner. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 30 Quality in this outcome area is good People live in a comfortable and well maintained home that meets their needs and suits their lifestyles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home told us in their AQAA “We follow a rolling programme for decorating and replacing carpets in all resident’s bedrooms. The room is painted at least every 5 years and new carpet every 8 years. All staff has full training and follows the policies and procedures for infection control. The home and facilities comply with the water supply regulations.” During our visit we looked around the home. The house is very large, with bedrooms arranged on three floors. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 25 Five people invited us to look at their bedrooms. We also saw all of the communal areas including the kitchens, lounges, dining areas, and ballroom. All areas were found to be bright, clean, attractively decorated and furnished, and comfortable. The people we talked to were very proud of their bedrooms. They had personalized their bedrooms with their possessions such as televisions and music equipment, pictures and posters, ornaments and furniture. Their rooms reflected their interests, hobbies and personalities. Many of the bedrooms are large and have been furnished as bed sitting rooms, some with tea and coffee making equipment and fridges. There are two independent flats within the main building that provide kitchen, living and dining facilities for three people. In these flats each person has their own bedroom with en suite facilities. All bedroom doors have locks and people have their own key. Staff and other people only enter people’s rooms with their permission. All rooms have lockable storage that people can use to keep cash and valuables safe. Since the last inspection some of the bathrooms and toilets have been refurbished and now appear modern, clean and homely. Several bedrooms and some communal areas have been redecorated and new furniture purchased. In a telephone conversation with the home manager, Lynn Lockwood, since the last inspection, she told us that the home will pay for new carpets and furniture as and when it is needed. She said that the home will replace ‘as and when needed’. The home is surrounded by very large grounds. These have been very well maintained and provide a variety of areas where people can sit, walk, or play various sporting and recreational games. One care manager commented, in answer to the question “How could the service improve?” – “In view of current Valuing People new agenda consideration about the type of accommodation that could be offered at Bystock eg. turning the house into a series of flats as supportive living environment, expensive venture but possible. This however does not lessen the level of care that is currently being delivered.” Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is good. People receive the support they want by sufficient well-trained and experienced staff. People can feel confident that safe procedures have been followed when new staff are recruited. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home told us in their AQAA before this inspection took place – “81 of the staff team have an NVQ 2 or above. All staff receives a supervision every 6-8 weeks and have at least 6 recorded on file each year. Good recruitment procedures are followed to ensure that the residents are always in safe hands. Residents are very much involved in the recruitment process. Their opinions are valued and documented. All staff is given a defined job description when they are accepted for the job. Staff meetings are regular and they are always recorded.” Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 27 During this inspection we looked at the recruitment files of four staff who have been employed since the last inspection. We found that good recruitment procedures had been followed, including at least two satisfactory references and criminal records bureau (CRB) and protection of vulnerable people (POVA) checks before the staff began work. We were shown copies of induction records that showed that the home has followed nationally recognised standards of induction training. The records have been signed by both the new member of staff and their line manager to show that they were both satisfied that all of the relevant areas had been covered. One staff member who completed a survey form told us - “When I was employed in 1997 under old management induction was very brief. Today it is very different. Staff whatever their position they have been employed for are given as much information about Bystock and service users, their rights, their needs, and the way Bystock is totally committed to being for service users!” We looked at the records of ongoing training given to all staff in the home. We were given a copy of the training plans drawn up by the home. These showed the dates and topics of each training session completed by each member of staff. It also showed the dates of future training that has been booked. This record provided a very useful tool to help the home check on the training records of all staff, and to help them plan future training needs. Staff told us about the training they receive. Comments included - “Most of the time we get very good training and lots of knowledge from more experienced senior staff members. Very good supervision.” The records showed that 81 of staff have achieved a nationally recognised qualification known as NVQ. All staff have also received training and updates on all required health and safety related topics. They have also received training on a range of other topics relevant to the health and personal care needs of the people living at Bystock Court. We received many comments from the staff who completed surveys before this inspection began. These showed that there is a happy staff team who generally feel well supported. There were a few comments about staffing levels including – “I think more staff are needed to ensure the people who use the service have enough time spent with them for a better quality of life for them.” “Sometimes when residents have appointments we can get very short staffed” “There are occasions during holidays or sickness there are less staff, but it is always well managed and staff are very good at covering shifts to make sure Bystock is fully staffed at all times.” Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 28 “Sometimes being short staffed means the residents do not have as much freedom as they want.” “Service users weekdays have working units to go to ie. Gardening, farm, laundry, kitchen, craft, paper shed. Weekends at times there is not enough staff on for the amount of people (over 40) to be able to go out on trips, shopping, one-to-one time. More staff of a weekend would solve this problem.” “Some days staff are very stretched. However this is often caused by circumstances i.e. doctors appointments etc.” “Sometimes at the holiday season where people are taking their holidays, and if service users have doctors appointments where care staff have to take them there is a shortage of staff.” We talked to the senior person in charge of the home on the day of this inspection, and also to the General Manager, about staffing levels. We were told that during holidays and at times of sickness there had been a few occasions when there had been some uncovered shifts, but this had not been very often. We heard that the home was trying to encourage more bank/relief staff, and also some permanent staff, to do extra hours during the busy periods and holiday times to help cover shifts. We received a range of comments from staff about the level of supervision and support they receive “Supervisions are done regularly” “We have regular staff meetings and are informed of changes by these meetings, good handovers and memos” “I have regular supervision with an OIC, but the managers do not meet with us to discuss my work, but it would be nice to have positive feedback about how well you are doing in the workplace as it can feel like you are not appreciated.” “I am given a supervision meeting every 6 weeks – this gives an opportunity to discuss any work related issues raised. I always feel I can approach my managers with any issues at any time – not just at supervision meetings.” “Staff meetings are very good and a handover at every shift.” “Management, OIC and staff all need to have the same working practices. New staff complain they are told differently depending on who’s on duty. (They should) praise the staff more – a lot feel under-valued. We are told that we must have more day care to survive. But the general feeling is that too many are not in the best interests of the residents. Despite moans it’s a good place to work with a good atmosphere and a low turnover.” Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is excellent The home is well run and a safe place to live and work. People can be confident that their views will be sought and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home told us in their AQAA – “The registered home manager has been working at the home for just over 10 years, 5 of those have been in a managers position. She has a very good working relationship with all residents and staff. She is always available for everyone to be able to discuss anything with her. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 30 The registered home manager completes a Home Managers Assessment Form every month and sends it to the operations manager at head office. There are regular staff meeting for all staff members. All personal and HR files are kept up to date. The home has all the necessary insurance cover in place to enable it to fulfil any loss or legal liabilities. Risk Assessments are regularly carried out or up dated. There are regular fire drills. Keep a close eye on the homes budgets. The registered home manager is the appointee to most of the residents and she ensures effective safeguarding and management of the resident’s money.” The people we talked to during this inspection, and people who completed survey forms before this inspection took place told us they were happy with the way the home is managed. Comments included – “It is run very well. I cannot see where there can be any improvement.” “Just to say Lynn Lockwood and Andrew Scott are two of the nicest people I have worked for and I sing their praises. They both work so very hard and have Bystock Court and the service users and staff showing respect for them.” “The home manager is always there to listen and help at any time. She will always listen to ideas and take them to meetings.” We were given evidence of the wide range of systems the home uses to continually check and improve the quality of the services they provide. These include regular meetings with the people who live in the home and use the services, also staff meetings. Families and friends of the people living in the home are invited to attend ‘carer’s forums’ three times a year. Minutes are kept of these meetings, and anyone who is unable to attend receives a copy of the minutes to keep them informed. Surveys have been sent out regularly to everyone living, working or involved in the home. We saw copies of the most recent surveys and found that these gave some very useful information that guided the home to make changes and improvements where necessary. The outcomes of the surveys have been discussed at the various meetings held in the home. The home has good health and safety procedures in place. These include staff training on all mandatory topics. Policies and procedures are in place and these are regularly updated. We checked the fire log book and found that all recommended checks, maintenance and training have been carried out. We also saw evidence of accident reports on people’s care plan files to show that accidents and incidents have been reported and recorded correctly. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 4 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 4 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 4 12 4 13 3 14 4 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 3 4 x 4 x x 3 x Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations The home should review the wording in the care plans (particularly those that have not been updated using the words of the person the plan relates to) to ensure they guide staff to treat the person as an adult. Where necessary the detail in the care plans should be improved to give staff a clear explanation about the help each person needs with personal care tasks, for example, hearing aids, continence, cleaning teeth, or dentures. The staff should be given a written instruction on how, why, where and when prescribed creams and lotions should be applied. There should be a system of monitoring skin problems so that staff can tell if the problem is becoming worse, and what they should do if this happens. These instructions should be included in the care plans and/or the medication administration records. A record should be kept of any medicines held in the home at the end of each month and brought forward to the next month. This will ensure that the home has a robust DS0000021897.V367954.R01.S.doc Version 5.2 Page 33 2 YA18 3 YA20 4 YA20 Bystock Court method of accounting for all medicines held and administered by the home. Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bystock Court DS0000021897.V367954.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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