Care Home: Bywell Grange

What the care home does well People have their needs assessed prior to coming to live at the home so that they and their families know that the home will be able to meet their needs and expectation. Bywell Grange provides a warm caring environment for people to live in. When asked, "do you feel the care home does well?" relatives returning Have Your Say surveys to us told us: "They create a happy atmosphere and are prepared to go the extra yard to help in the event of problems." "The home has high standard of care. We are always greeted with a tray of tea and biscuits to share with our mum. We are impressed with the entertainments laid on for the residents." " The home is always clean and tidy. The staff really care about the residents and there is a lot of fun and laughter at Bywell Grange." Staff are well trained and respond to people as individuals. They get to know the people who live at the home so that they can respond to their dementia care needs. What has improved since the last inspection? This was the first inspection carried out Hazelwood Care Ltd was registered as the provider by the Commission for Social care Inspection (CSCI). What the care home could do better: The manager has agreed to look at options for fitting suitable locks to bathrooms or finding an alternative way of alerting people that the bathroom are in use. CARE HOMES FOR OLDER PEOPLE Bywell Grange 140 Heene Road Worthing West Sussex BN11 4PJ Lead Inspector Mrs Diane Peel Unannounced Inspection 10:00 11 March 2008 th X10015.doc Version 1.40 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 Bywell Grange DS0000070054.V360623.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 Older People. 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. Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bywell Grange Address 140 Heene Road Worthing West Sussex BN11 4PJ 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) 01903 217619 Hazelwood Care Ltd Mrs Wendy Catley Care Home 23 Category(ies) of Dementia (0) registration, with number of places Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Dementia (DE). The maximum number of service users to be accommodated is 23. Date of last inspection N/A Brief Description of the Service: Bywell Grange is a care home registered to accommodate up to twenty-three people in the category dementia (DE). The care home is a large detached property situated in a residential area. It is approximately one mile from Worthing town centre and close to the seafront. Private accommodation is provided in three double and seventeen single rooms, which are located over the ground, first and second floors. A vertical lift services each of the three floors. Communal accommodation is provided in a dining room, a lounge and a conservatory. An attractive secure garden, which is available to residents, is located to the rear of the premises, whilst ample parking facilities are located to the front. The current fees range from £400 to £525. Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced visit to Bywell Grange was carried out by Mrs Diane Peel on the 11th March 2008. During this visit the intended outcomes for 31 standards were assessed; these included the key standards for care homes providing a service to older people. The Annual Quality Assurance Assessment (AQAA) was returned to The Commission for Social Care Inspection (CSCI) prior to this visit to the home and this was used to address areas of improvements with the manager. Have Your Say surveys were returned to us by ten relatives of people living at the home and four staff working at the home. Everybody returning surveys had positive things to say about Bywell Grange praising the management, staff and homely environment. During the course of the visit we met many of the people living at Bywell Grange and spoke with those who were able to converse with us. A case tracking exercise for three people living at the home was undertaken to look at how the assessed needs of this group of residents with diverse needs were being met. Staff were spoken with during the visit and observed during their interaction with people living at the home in the lounge and in the dining room at lunchtime. What the service does well: People have their needs assessed prior to coming to live at the home so that they and their families know that the home will be able to meet their needs and expectation. Bywell Grange provides a warm caring environment for people to live in. Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 6 When asked, “do you feel the care home does well?” relatives returning Have Your Say surveys to us told us: “They create a happy atmosphere and are prepared to go the extra yard to help in the event of problems.” “The home has high standard of care. We are always greeted with a tray of tea and biscuits to share with our mum. We are impressed with the entertainments laid on for the residents.” “ The home is always clean and tidy. The staff really care about the residents and there is a lot of fun and laughter at Bywell Grange.” Staff are well trained and respond to people as individuals. They get to know the people who live at the home so that they can respond to their dementia care needs. What has improved since the last inspection? 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. Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have information about the home, an opportunity to visit the home, and their care needs are assessed so that they can be sure that the home will be able to meet needs and expectations. EVIDENCE: We saw the Statement of Purpose and Service User Guide during our visit to Bywell Grange, which was kept in the office. The manager told us that the new owners of the home are currently updating the Statement of Purpose and Service User Guide. Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 9 The manager had put together an information pack to give to people who make enquiries about moving into the home and told us that people considering moving into a care home and their relatives are encouraged to come and look round but usually it is relatives who visit. The Annual Quality Assurance Assessment (AQAA) returned to us in February 2008 said “ we assess each resident before they come into the home, making sure that we can fully meet their needs. During our visit to Bywell Grange we looked at the needs assessments of two people who had recently moved into the home. They were dated as being carried out prior to the persons moving into the home. For one of the two people who’s assessments were observed, the homes own needs assessment was supported by a care management assessment carried out by a Social Services care manager. The specialist needs of people living at the home were observed to be identified in the care plans viewed during the visit to the home which included, mental health needs, dietary needs and social and religious preferences. Staff training records show that collectively have the skills and experience to deliver a service to people who have dementia. Ten relatives of people living at the home returned Have Your Say surveys to us. When asked the question “Do you feel that the care home meets the needs of your relative or friend?” nine people said always and one person said usually. Bywell Grange does not provide intermediate care. Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning systems are regularly updated and they give clear information to assist with all aspects of health, personal and social care needs so that the changing needs of people living at the home can be monitored. EVIDENCE: There were twenty people living at Bywell Grange at the time of this visit to the home. We looked at four care plans during our visit, which included two people who had recently moved into the home, to see how the needs assessment had been used to develop a plan of care. Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 11 The plans observed showed how people’s needs were to be met by staff and had been regularly updated and reviewed by care staff. The care plans, which we saw, were person centred and included information about people’s family background and interests. The manager told us that for those people who had relatives involved during the process of moving to Bywell Grange they had also been involved in the initial care plan. Daily records were observed to be being used to monitor the wellbeing of the people living at the home and there were documented records of regular monitoring of weight and health. Manual handling risk assessments, fall risk assessments, pressure care risk assessments and nutritional assessments were observed to be being used. Records of visits by other healthcare professionals were being kept and regularly updated these included visits by doctors, district nurses and chiropodists and a dentist. The manager told us that no- one living at Bywell Grange on the day of our visit was able to safely manage their own medication so we looked at the arrangements which the home has in place for making sure that people get their prescribed medication administered by staff and observed a member of staff administering medication over lunch time. Medication in use was being stored in a metal cabinet attached to the wall. Additional medication was also being stored in a locked cupboard and the manager told us that medication opened and not used by the time of the next delivery is returned to the supplying pharmacist for disposal. Medication administration records observed were clear and up to date and reasons for not administering medication had been recorded. During our visit we observed staff to treat people living at the home with respect and respond to their individual needs. They were able to adapt their approach to people in different ways and showed understanding and awareness of peoples rights to remain as independent as possible and retain privacy if they wanted. The two double bedrooms in use had screens in place for use and one person who had requested a lock on their bedroom door told us that they had asked for a lock so that they could lock it when they were not in the room. We noticed the absence of locks on bathroom doors and we discussed with the manager that this is an areas of privacy and dignity, which could be improved Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 12 by the use of an override locks or some other means of identifying that the bathrooms are in use. A relative returning a Have Your say survey to us commented, “ the care staff do their best to treat residents as an individuals.” Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are encouraged to maintain contact with their family and friends so that they can satisfy their social and emotional needs and the social activity programme is flexible to cater for individual residents abilities and to offer variation to daily living. EVIDENCE: The social history of people living at the home was observed to be included in care plans when this information was available. Throughout our visit to Bywell Grange people were observed to be able to exercise choices about what they wanted to do and where they wanted to be and routines were flexible. Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 14 Information about forthcoming entertainment was observed to be on display with a notice inviting friends and relative to an Easter tea and Easter egg hunt on the front door. The AQAA returned to us in February 2008 reported “ Each month we have entertainment come to the home, music for health, art and crafts and singing” and “ we have an activity plan within the home so that each day there is something different to do, flower arranging, card games, dominoes, ball games.” On the day of our visit we observed a member of staff playing dominoes with a small group of people and discussion with people at lunchtime confirmed that they like to play cards as well. There were also activities records in the care records, which we saw recording what each person had taken part in. We also saw framed artwork completed by residents and on display in the lounge and photographs of people taking part in events and activities. Comments received in Have Your Say surveys returned by relatives included,” we are impressed with the entertainments laid on for the residents – particularly the music therapy. The care assistants also offer excellent stimulation, playing ball, spelling games and flower arranging.” Another relative said “ encourages them to take part in activities and nurtures any interest they may show in an activity.” We saw a visitor’s book in use at Bywell Grange, which showed that there are regular visitors to the home. A relative returning a Have Your Say Survey to us commented, “ All visitors are welcome and tea and biscuits supplied.” We discussed choice of food with the cook during our visit and the way that staff find out what food people like and dislike. We were told that a record of what people eat is kept in addition to the entries on daily individual peoples records to monitor what people are eating. The menu for the day was written on a board in the dining room and at lunchtime staff were heard to inform people what the meal was as they were taking to them. We joined people for the main meal of the day, which was liver and bacon with mash potatoes, broccoli and carrots followed by banana custard. People were Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 15 able to eat at their own pace and there was assistance and encouragement from carers for those people who found it difficult eat without assistance. We observed staff offer an alternative of a sandwich to someone who didn’t want to continue eating the liver and bacon. A visitor who we met during our visit told us that they sometimes eat at the home with their relative living there and they thought the food was good. A resident who we spoke with also commented that their relative joined them for a meal at the home “a couple of times a week” they also thought the food was good. Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are policies and procedures in place for responding to complaints and allegations of abuse and neglect so that people can feel safe. EVIDENCE: The complaints procedure was observed to be on display in the entrance to the home and included in the Statement of Purpose and Service User Guide. The AQAA returned to us in February 2008 told us that there had been no complaints received and the manager confirmed this information during our visit to Bywell Grange. We were shown the documentation for recording and responding to complaints during our visit to the home. Out of the ten relatives returning Have Your Say surveys to us eight people told us that they knew how to make a complaint, one person said “no” they didn’t know how to make a complaint but this person also responded “always” Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 17 when asked the question “has the care service responded appropriately if you or the person using the service raised concerns about their care?” The tenth person didn’t respond to the question. All four staff returning Have Your Say surveys to us answered “Yes” when asked the question “ Do you know what to do is a service user/ relative or friend has concerns about the home.” During our visit to the home we observed that the home has a copy of the revised West Sussex Multi Agency Safeguarding Adults procedures besides its own policies and procedures on safeguarding adults and the manager confirmed that she had attended recent updates about the revised policy. The AQAA returned to us in February 2008 reported that that the service had not made any safeguarding adults referrals and we had not been made aware of any safeguarding matters from any other source. Staff training records showed that the majority of staff had already attended safeguarding adults training and we were told that the next training is on the 27th March 2008. Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ongoing redecoration and refurbishment is improving the environment so that people have a more comfortable and homely environment to live in. EVIDENCE: The majority of residents’ private accommodation, the lounge and the dining room, conservatory and bathrooms and toilets were observed during our visit to the home. Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 19 The home was observed to be clean and some redecoration is currently taking place. The manager told us that there is a redecoration plan in place and there are already plans to replace the flooring in the laundry room now that a new washing machine and dryers are in place. The AQAA returned to us in February 2008 also confirmd that the call alarm system is to be replaced and new flooring in the downstairs bathroom is planned. Many residents and their families had personalised bedrooms with pictures, painting and other items, which people had brought to the home. We were told in the AQAA that recent improvements to the home included new furniture in the conservatory, redecoration of the dining room, new beds in some rooms, and the redecoration of two bedrooms. Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The wellbeing, health and security of people living at the home are being protected by the agency’s policies and procedures on recruitment. EVIDENCE: On the day of our visit there were five care staff, the assistant manager and manager at the home supported by two cleaners and a cook. The duty rota on the wall in the office showed consistent staffing levels and showed that staff are allocated responsibility to certain tasks during the week. We looked at recruitment files of three people, two who had started work at the home recently. They had been asked to fill in an application form, provide identification of themselves, which included a photograph, and show that they were medically Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 21 fit to work with people living at the home. References had been obtained from people who they had worked for before. There was acknowledgement that a Criminal record Bureau (CRB) and Protection of Vulnerable Adults (POVA) clearance was in place. Four staff returned Have Your Say surveys to us, which told us that everybody had had an induction and that everybody returning surveys thought that the training being given was relevant to their role. One person said, “they are always updating training in fire training, manual handling, POVA, food hygiene, dementia care and first aid. We also observed training records and certificates of training attended. Information provided in the AQAA returned to us in February 2008 told us that 50 of the staff working at the home has an NVQ level 2 or above and this information was confirmed by the manager during our visit to the home. Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed by a competent and caring manager, who runs the home in the best interests of the people living there. Records are in good order and health and safety issues are addressed so that people can feel safe. EVIDENCE: The manager undertook the fit persons process with us in December 2007 and has managed another care home. Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 23 She has NVQ qualifications at level 4 in social care and is currently undertaking the Registered Mangers Award, A quality assurance process is in operation, which includes inviting people living at the home, their relatives and next of kin are to complete quality assurance surveys which look at areas of the service such as: food choice, entertainment, personal service, management, the level of care and the environment. The manager told us that surveys are also sent to professionals visiting the home to get their views of the service and that monthly audits on the environment are carried out. The manager told us that the home has a policy for not dealing with people’s monies. Services provided which are not included in the fees are invoiced from the company head office. All records observed on the day of our visit to Bywell Grange were clear and up to date and no health and safety matters came to our attention. Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A 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. Refer to Standard Good Practice Recommendations Bywell Grange DS0000070054.V360623.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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