Care Home: Byway House

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What the care home does well Byway House provides a homely environment with dedicated staff and a welcoming atmosphere. The home is set in beautiful gardens that are on level ground and easily accessible. People interested in moving to the home have an assessment of their needs before a decision is made about whether or not staff at Byway House could provide the care they require. Everyone has a care plan that is kept under review and people said that they receive the care they need and that staff are very kind and helpful. There is a programme of activities and people are provided with a healthy and nutritious diet. People know what to do if they have a concern or complaint and people are asked to give their views about the service. The recruitment procedure is thorough to make sure that people are protected. There is an induction and training programme so that staff have the knowledge and skills they need to do the job. The manager has an open door policy and also works alongside staff delivering care each day. Comments that people have made about the home in questionnaires returned to the manager include: "I can only visit occasionally, but I always see patience and kindness", "I have visited the premises for a long time and can honestly state that it is one of the most efficiently run and friendly homes that I have had the pleasure to attend" and "Although X has only been in the home a couple of months, her sons and I are more than happy with the excellent staff". What has improved since the last inspection? This was the first key unannounced inspection since the home was registered under new ownership in August 2008. What the care home could do better: The storage facilities for controlled medication must meet the legislation and guidelines provided by the Royal Pharmaceutical Society of Great Britain. A requirement has been made regarding this matter. The care plans should include more detail about people`s care needs and provide guidance to staff especially regarding behavioural issues. The background, interests and hobbies of people living in the home should be recorded in more detail so that a person centred approach can be taken to activity planning. Key inspection report Care homes for older people Name: Address: Byway House 1 The Byway Middleton On Sea West Sussex PO22 6DR     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: Annette Campbell-Currie     Date: 0 5 0 6 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 28 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 28 Information about the care home Name of care home: Address: Byway House 1 The Byway Middleton On Sea West Sussex PO22 6DR 01243583346 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Byway Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 16. The registered person may provide the following category/ies of service only: Care home only - (PC) 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 (OP). Date of last inspection Brief description of the care home Byway House is a privately owned care home registered to accommodate up to sixteen persons in the category of older persons. It is a detached two storey building situated in the village of Middleton-on-Sea, West Sussex. With a regular bus service available from outside the home, it is within easy reach of Bognor Regis and all its amenities and facilities. There are gardens to the Care Homes for Older People Page 4 of 28 Over 65 16 0 0 5 0 2 2 0 0 9 Brief description of the care home front, side and rear of the property. The accommodation consists of twelve single rooms and two double rooms currently being used for single occupancy. All rooms have en-suite facilities. A large lounge and separate dining area provides the communal space with easy access for wheelchair users. A lift provides access between the ground and first floor. Current fee levels range from £1967 to £3192 per month. Byway Care Ltd is the registered provider who have appointed Mrs Jane Smyth as the responsible individual to supervise the management of the care home. The registered manager is Mrs Christine Tidmarsh who is responsible for the day to day running of the home. Care Homes for Older People Page 5 of 28 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 this service is 2 star. This means that the people who use the service experience good quality outcomes. This was the first key unannounced inspection of Byway House since the current providers registered with the Commission in August 2008. We (the Commission) carried out the site visit over five hours. Mrs Tidmarsh, the registered manager assisted with the inspection. The information and documents required by us to make an assessment of the service were available. There were eleven people living in the home at the time. Mrs Tidmarsh told us that she has handed in her notice and will be leaving at the end of June. The people living in the home had not been told. The manager completed an annual quality assurance assessment form (AQAA) before Care Homes for Older People Page 6 of 28 the inspection. The AQAA provided some information that was used to help plan the site visit, however little evidence was provided to show how the home achieves good outcomes for people in each outcome area. During the site visit we saw people sitting in the lounge or spending time in their bedrooms. Four people were spoken with at length. We saw the communal areas, the kitchen, laundry, bathroom and toilet facilities and a number of bedrooms. The following documents were read: the case records for three people living in the home, other documents relating to peoples care, recruitment records for one member of staff, the complaints policy and procedure, training records, a sample of medication records and Regulation 26 reports. Time was spent in the dining room at lunchtime. The outcomes for people living in the home have been assessed in relation to twentyone of the thirty-eight National Minimum Standards for Care Homes for Older People; including those considered to be key standards to ensure the welfare of people living in the home. The quality rating for the home have been assessed in line with the Commissions policy document, Key Lines of Regulatory Assessment (KLORA). Care Homes for Older People Page 7 of 28 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. Care Homes for Older People Page 8 of 28 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 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 have their needs assessed before a decision is made about them moving to the home. Intermediate care is not provided at Byway House. Evidence: The provider said in the annual quality assurance assessment (AQAA) that a full and careful assessment is carried out before a decision is made about someone moving to Byway House and that people are only admitted to the home if it is really felt that the home could meet their needs. The manager said that either she or the deputy manager carry out the pre-admission assessment using a standard format. People are visited in their own home or in hospital and the manager said that relatives are involved if possible. Information is also gathered from professionals who may be involved in the persons life. The Care Homes for Older People Page 11 of 28 Evidence: assessment form includes all aspects of individual need. We (the Commission) looked at samples of assessment forms; these showed that a full assessment had been carried out and signed by the person completing the form. We looked at the case records for three people in detail. It was clear that an assessment had been carried out before the person moved in. The personal and healthcare needs had been noted however there was little detail about peoples backgrounds, interests and spiritual needs. There was a form that included information about the persons wishes after their death, however this had not been completed in all cases. The manager said that when she is carrying out the assessment she takes into account the needs of the person being assessed and also the other people living in the home before making a decision about whether or not Byway House would be a suitable home for them. The manager said that she is particularly mindful when people have a level of confusion that could not be accommodated in the home. People are welcome to visit the home before they make a decision to move in although the manager said it is usually the relatives who visit. Confirmation of a place is given verbally and people do not receive a letter confirming that the home could provide for the persons needs. People living in the home who we spoke with said they are very happy and staff understand their needs. One person said: It is a wonderful place and I love every minute of it. Staff spoken with were very clear about peoples needs and said that everyone is treated as an individual. Intermediate care is not provided at Byway House although respite care can be arranged. Care Homes for Older People Page 12 of 28 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. People have their health, personal and social care needs set out in a care plan that is kept under review so that people receive the health and personal care that they need. The medication policies and procedures protect people in the home, however the storage facilities do not meet requirements. People are treated with respect and their right to privacy is upheld. Evidence: The annual quality assurance assessment (AQAA) did not provide details of the care planning and review process although it states that people are treated as individuals and their needs are regularly re-assessed. The manager said that a new format for care planning, risk assessment and review has been introduced. There has been no training as yet to provide guidance for staff about using the new format or in person centred care planning. Two systems for documenting assessments and care plans are now being used. Some information has been transferred from the Standex system to the new booklet format. This document includes space to detail all aspects of each persons care needs: the Care Homes for Older People Page 13 of 28 Evidence: physical, emotional and personal care that they require. The booklet includes risk assessments for all possible aspects of risk in the home and space for reviews that include the persons views about their care. We looked at the case records for three people. Two people had their photograph on their records so that they can be easily recognised. There was no photograph for one person who had moved to the home recently. The manager said that she would make sure that a photograph is taken and included on the file. Staff are provided with guidance about how to provide personal care as part of their induction and staff spoken with were aware of the information in the care plans. There was a notice in the office reminding staff to include more detail in the information they record: eg carer washed the residents back, legs- bottom half. Resident washed hands and face- not in care plans all care given. In the case records that we saw there was some guidance about peoples care needs and personal goals, for example: to encourage safe mobility and self care so as client is able to return home. There was little guidance to show peoples level of ability with personal care although it was clear from discussion with people living in the home, the manager and staff, that people receive the personal care they prefer although this was not documented. Personal care is provided by female staff as currently there are no men living in the home and no men are employed. There was some information about peoples preferred routine, for example: early tea, breakfast about 8 am and takes all meals in her room. We discussed with the manager the need to support people with their oral hygiene as we noticed this may be an issue for some people. Guidance should be provided to staff about the way each person may need support with oral hygiene. It was documented in the care plan for one person: regular mouth care needed as suffers from mouth ulcers. The manager said that it has been difficult to access a National Health dentist to visit the home. One person said they had requested to see a dentist and it was arranged for a private dentist to visit the home the same afternoon. It was clear from case records that we read that people have access to a chiropodist and an optician when they need these services. The manager said that the home has a good relationship with the local primary care team and people said that they receive the healthcare that they need. People said that they are able to see a general practitioner (GP) when they need to and one person said that she has visits from a district nurse. Care Homes for Older People Page 14 of 28 Evidence: The physical health needs of each person were noted in their case records although in some cases there was little information about the persons medical history. One person had been supported by an occupational therapist with mobilising safely and having home visits to assess their safety at home. There was a note on the case file: OT involved in ensuring client mobilises safely, however there was no detail about steps to be taken by staff to support and encourage this person in mobilising safely. The new care planning format includes risk assessments for all aspects of daily living and health. The care plans that we saw included completed risk assessments, however there were some contradictions, for example it was noted that one person had diabetes but the manager said that this is not the case. Another person had a note in one record that she is a little deaf but in the dependency scores it said: hearing-very good. One person admitted to the home following a fall had a low score on the falls risk assessment although this is clearly a high risk for her. There was little guidance for staff when risks had been identified so that risks could be minimised or prevented. We discussed these issues with the manager who said that the staff need some training in using the forms so that information is clear and accurate. It was clear from the assessments and care plans that peoples mental and emotional health and well being is monitored. When people have a level of confusion or behaviour difficulties then the care plans should detail the possible triggers for staff to be aware of and how staff should manage a situation if it were to arise. For example: X is usually happy but her mood can change quickly and become angry and upset towards other people and for another person: can become verbally aggressive around mealtimes. There may be triggers to these behaviours or ways that the situation could be avoided. Staff should be given clear guidance about managing these behaviours. The care plans did not contain much detail about peoples backgrounds and interests so that a person centred and holistic approach can be taken to providing care. There was evidence to show that care plans had been reviewed and changes of need noted. We looked at the medication storage, administration and record keeping. None of the people living at Byway House have control of their own medication. All staff who administer medication have been trained to do so. The storage of controlled medication does not meet the legislation and guidance provided by the Royal Pharmaceutical Society of Great Britain, a requirement has been made regarding this matter. We looked at samples of medication records and found that they were in order. Care Homes for Older People Page 15 of 28 Evidence: Everyone spoken with in the home spoke highly of the manager and staff. Comments that were made include: the staff are excellent, they are lovely girls and put themselves out, I cant find fault with them and lovely home, kind carers and very willing. During the day staff were communicating effectively and sensitively with people and respecting their privacy by knocking on doors and waiting for a reply berfore entering. The manager said that she feels that the staff team are unique in providing an individualised service and giving people the time that they need. We observed staff treating people with sensitivity and it was clear that their needs come first for the manager and staff. Care Homes for Older People Page 16 of 28 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 are provided with activities and social contact. People are supported to maintain their relationships with family and friends. People have an element of choice in their daily lives and are provided with a balanced and nutritious diet. Evidence: The AQAA indicates that outings are arranged on a regular basis and that local personalities come to the home to speak, sing and arrange quizzes. Funded events also enhance relationships between staff and people living in the home. The AQAA states that the home are planning to introduce a visit by a local vicar or other Christian leader following a request from one or two of the people living in the home. There was some information about peoples interests in their care plan, for example: X likes to do the crossword, read newspapers and magazines, watch TV and sit in the garden, for another person: X sometimes joins in the activities but otherwise likes to do their own thing. Some activities are arranged in the home and a programme is displayed on the notice board. A music session is arranged on Thursday afternoons, someone visits the home to arrange activities such as quizzes on Wednesday afternoons and there is usually an excercise session on Friday afternoons. One person said that she is supported by staff to go downstairs to the lounge to choose books Care Homes for Older People Page 17 of 28 Evidence: from the small library. During the afternoon of the visit someone came to the home to provide craft activities, however the manager said that people had not been very interested on a previous occasion. There was little information about peoples background or previous lifestyle in their case records; we discussed this with the manager who said that she would make sure that this information was recorded so that a more person centred approach can be taken to activity planning. It was not clear how often people have the opportunity to go out, although some people said that their relatives take them out sometimes. People said that their visitors are always made to feel welcome in the home. The manager said that she feels it is important to involve relatives and friends as she has tried to create a family atmosphere in the home. One person spoken with said: We are like a family here. People have some choices in their daily lives, the manager gave some examples of ways that staff have supporteed choice, for example one person had never tasted dressed crab and this was provided as a special treat. People have a choice of hair stylist who come to the home. One person is supported to see the person who has styled her hair for many years. People said that they can choose when to get up in the morning or what time to retire to bed. The chef recently began working in the home and provides a varied and balanced diet. People said that they have a choice at breakfast and can have a cooked breakfast if they wish. The chef asks people each morning what they would like for their lunch and there is always a choice of at least two dishes. On the day of the site visit the lunch was fish and this was provided as fish and chips, fish pie or fish with a sauce that was requested by one person. Most people said that the food is very good. The manager said that she would be preparing the sandwiches for the evening because the chef finishes work in the afternoon. Lunch was a relaxed occasion and the dining room is arranged around small tables. Several people said that the layout of the dining room had been changed without consultation. People used to eat around one large table and several people said they had preferred the previous arrangement as it was more homely. Care Homes for Older People Page 18 of 28 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 feel that their concerns and complaints would be listened to and acted upon. There are procedures in place to help protect people from harm or abuse. Evidence: There is a complaints policy that is displayed in the hall and people are provided with a copy when they move to the home. There is a system for recording and investigating complaints. None have been received since the new registration. People spoken with said that they know how to make a complaint and people said that the manager addresses any concerns they have without delay. The home follows the West Sussex multi agency policy and procedure for safeguarding vulnerable adults. They do not have a copy of the recently updated policy and the manager said she would apply for a copy of this so that the home has current information. Care staff have attended training in recognising signs of adult abuse and those spoken to were aware of their responsibility to report any concern that abuse may have occurred. The manager was clear about her responsibility with regard to reporting procedures. Training records confirmed that staff have attended training in the protection of vulnerable adults. The manager is aware of the Deprivation of Liberty Safeguarding guidance that has been provided by West Sussex Adult services. Care Homes for Older People Page 19 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a home that is decorated and maintained to a high standard. The home is warm, bright, welcoming and clean. Evidence: The AQAA states that all rooms in the home are maintained to a high material standard and that a full time member of staff is employed for the maintenance of the building. The communal areas are well decorated and comfortably furnished. The bedrooms that we saw were also decorated to a high standard and people said they are very happy with the accommodation. People are encouraged to bring their own belongings so that they feel at home when they move. Any faults in the environment are fixed quickly and one person said that the maintenance man is marvellous and very kind. The gardens are also very well maintained and on a level surface which means that people can easily make use of the grounds in good weather. One person had some attractive plant pots outside her window to brighten up her view. The AQAA states that equipment is serviced as required and that the home meets the requirements of the fire and environmental health officers. It was noted that several door closures did not work as they should and the manager said that she would make sure that this problem is addressed as a matter of urgency. Care Homes for Older People Page 20 of 28 Evidence: The laundry, bathrooms and kitchen were clean and well maintained. Full time domestic staff are employed to maintain a high level of cleanliness in the home. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number of staff on duty and the skill mix of staff ensures that people have their needs met. People are protected by the recruitment procedure and staff are provided with the training they need to do their job. Evidence: The AQAA states that there is a very low turnover of staff in the home and a remarkably high level of loyalty. The manager said that staffing levels have been reduced due to the number of vacancies in the home. There are two care staff and the manager on duty on weekday mornings and one member of staff and the manager on duty in the afternoons. In the evenings there is a senior carer and one other carer and at night one person is on waking night duty and one is on sleeping in duty in case of an emergency. The current staffing levels mean that the manager often has to provide direct care and was making the supper on the day of our visit. One member of staff said she had just been made redundant and she was very sorry to be leaving. The manager said that there is little opportunity to take people out in the afternoons now due to staffing levels. There is no one in the home who needs two people for moving or hoisting; the manager said that staffing levels would have to be reviewed if this situation were to change. Care Homes for Older People Page 22 of 28 Evidence: The AQAA states that there is an effective recruitment procedure in place. One member of staff have been recruited since the new registration in August 2008. The records showed that the person had completed an application form and that the necessary checks had been carried out before the person began work. The manager said that people living in the home have not been involved in the recruitment process up until now. There is an induction and training programme in place. The AQAA states that all staff completed an induction when they began work and that eight of the twelve care staff have achieved the National Vocational Qualification (NVQ) in Care at level two or above. Two people are studying for an NVQ at level three. We looked at samples of training records that showed that staff have attended training in mandatory topics including: first aid, health and safety, moving and handling, infection control, adult abuse, basic life support and fire safety. Other courses that have been provided include dementia care and palliative care. As already mention no staff have attended training in person centred care planning that would support them in keeping accurate and clear care planning records. Staff spoken with said they feel well supported by the manager and that they have the training opportunities they need to do their job well. Care Homes for Older People Page 23 of 28 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. People benefit from a well run home and their views about the service are sought. Peoples financial interests are being safeguarded. The health, well being and safety of people living in the home and of staff is protected and promoted. Evidence: Byway House was registered under the current ownership in August 2008. Mrs Christine Tidmarsh, the registered manager, worked in the home prior to that date. Mrs Tidmarsh has achieved the NVQ award at level four in Management and also has the Registered Managers Award. She is committed to her ongoing training and development and recently took a distance learning course in Healthy Eating. Mrs Tidmarsh has established a stable staff team and an open and calm atmosphere in the home. Discussions we had with the manager and staff showed that they take a person centred approach to the care they provide for people living in the home. This was not always reflected in the paperwork, however the majority of the managers time is spent providing direct care and consideration must be made to the amount of Care Homes for Older People Page 24 of 28 Evidence: time the manager has to carry out management tasks. On the day of our visit a member of staff offered to stay on for part of the afternoon because the manager wanted to have time to complete the inspection. Quality assurance systems are in the process of being developed. The AQAA states that monthly audits are carried out, however it was not clear how the audits are documented. Regulation 26 visits are carried out by Mrs Smyth and written reports provided. The care planning documentation had not been discussed as part of this process. There were copies of completed questionnaires from people living in the home on file. Comments made were positive and where issues had been raised the manager said these were dealt with quickly. The outcome of quality assurance questionnaires has not yet been collated and published to show that peoples views are being taken into account in the planning of the service. People said that they have not been involved or consulted about some changes that have been made recently, in particular the new arrangements for the dining room. The manager said that people either manage their own financial affairs or have relatives or solicitors to help with this. The manager said that the home does not provide support to anyone with their finances. The AQAA states that there are procedures in place to make sure that equipment is serviced as required. Staff have attended training in mandatory topics including fire safety. The manager must make sure that the door closures that have been fitted to bedroom doors so that they close in the event of a fire, are all in working order. Incidents and accidents are recorded and monitored so that risks in the environment can be identified and minimised. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 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 9 13 The registered providers must ensure that the storage facilities for conrolled medication meets current legislation in order to keep people safe. 31/07/2009 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 27 of 28 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). 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