Care Home: North Bay House

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What the care home does well The home was clean and attractively furnished, it was reported to us that people were happy with the environment that they lived in. The grounds were attractive and people were observed to be enjoying the garden and the views of the waters of the Broads during the inspection. Interaction between staff and people that lived at the home was observed to be caring, respectful and professional. People were provided with a good activities programme, which they could participate in if they chose to. The menu was balanced and nutritious and people reported that the food was good and that they were provided with enough to eat. Comments made in the service user surveys that we received included `North Bay House is of very high standard and I am very happy here, the staff are excellent and very caring, couldn`t do better`, `I am happy here and my familyare very happy with North Bay House`, `I am very happy here` and `think the staff do the very best, quite honestly I have no complaints`. A comment made in the health professional survey that we received was `I feel they really care for the residents needs, the atmosphere is lovely and the residents have lots of choice. They are well organised too`. A comment made in the relative survey stated `my sense is that Helena runs North Bay with a passion for her staff and a passion to provide the best possible care`. What has improved since the last inspection? The training provision for staff had improved since the last inspection, the manager recognised the importance of providing staff with good quality training to ensure that people`s needs were met appropriately. The care plans had been improved and detailed the support that people required to meet their care and health care needs. There were records of peoples end of life preferences and arrangements to ensure that they would be treated with dignity, respect and that their choices had been listened to. People were safeguarded by the home`s recruitment procedures and appropriate checks were undertaken prior to employing staff in the home. Since the last inspection there had been considerable improvements made and all requirements made at the last inspection had been met. CARE HOMES FOR OLDER PEOPLE North Bay House Borrow Road Oulton Broad Lowestoft Suffolk NR32 3PW Lead Inspector Julie Small Unannounced Inspection 14th July 2008 10:30 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 North Bay House DS0000069810.V368330.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. North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service North Bay House Address Borrow Road Oulton Broad Lowestoft Suffolk NR32 3PW 01502 512489 01502 519779 northbayhouse@btconnect.com 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) Hellendoorn Healthcare Ltd Mrs Helena Hellendoorn Care Home 20 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (14) of places North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th July 2007 Brief Description of the Service: Mr and Mrs Hellendoorn purchased North Bay and became registered as the new proprietors with the Commission for Social Care Inspection (CSCI) in April 2007. The home is registered to provide care to a maximum of 20 older people, including up to 6 people with dementia, over the age of 65. North Bay is an attractively large house standing in its own grounds in a quiet road on the edge of the Oulton Broads. The gardens lead down to the waters edge, with trees, bushes and lawned areas offering a variety of features for people living in the home and their relatives to view. North Bay is approximately one mile from the nearest shops, facilities and Oulton Broad railway station. The home has fourteen single and three shared rooms. Fifteen of the bedrooms have en-suite washing and toilet facilities. Two bedrooms share a separate toilet and a total of ten bedrooms have an en-suite shower or bath facility. Bedrooms are on the ground and first floors; these are accessible by the staircase or a shaft lift. On the ground floor there are two lounge areas, one of which is a library and a reception hall with seating and a separate dining room. Each room is centrally heated. The lounges have views across the gardens to the waters of the Broads. There is a good-sized kitchen and laundry facilities to cater for the people living in the home. The terrace overlooking the gardens and the Broads is accessible for all people including those who use a wheelchair. The home has a statement of purpose and service user guide providing information about the home to prospective customers. Each person moving into the home is provided with a contract, which specifies their agreed fees and how much they are expected to pay on a weekly basis. Fees are calculated depending on the needs of the individual and range from £383 to £500 per week. These do not cover additional services for example, the hairdresser, chiropodist and personal items such as toiletries and daily newspapers. North Bay House DS0000069810.V368330.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 3 star. This means the people who use this service experience excellent quality outcomes. The unannounced inspection took place on Monday 14th July 2008 from 10.30 to 16.15. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The registered manager was present during the inspection, they were receptive to the inspection process and they provided the requested information promptly and in an open manner. During the inspection seven staff recruitment records, training records, the care plans of five people who lived at the home and accident records were viewed. Further records viewed are detailed in the main body of this report. Four staff members and four people who lived at the home were met and spoken with and one regular visitor to the home was spoken with by telephone. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) and surveys were sent to the home to provide people with an opportunity to share their views about the service. The AQAA and seven service user, one health professional, one relative and one staff surveys were returned to us. What the service does well: The home was clean and attractively furnished, it was reported to us that people were happy with the environment that they lived in. The grounds were attractive and people were observed to be enjoying the garden and the views of the waters of the Broads during the inspection. Interaction between staff and people that lived at the home was observed to be caring, respectful and professional. People were provided with a good activities programme, which they could participate in if they chose to. The menu was balanced and nutritious and people reported that the food was good and that they were provided with enough to eat. Comments made in the service user surveys that we received included ‘North Bay House is of very high standard and I am very happy here, the staff are excellent and very caring, couldnt do better’, ‘I am happy here and my family North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 6 are very happy with North Bay House’, ‘I am very happy here’ and ‘think the staff do the very best, quite honestly I have no complaints’. A comment made in the health professional survey that we received was ‘I feel they really care for the residents needs, the atmosphere is lovely and the residents have lots of choice. They are well organised too’. A comment made in the relative survey stated ‘my sense is that Helena runs North Bay with a passion for her staff and a passion to provide the best possible care’. 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. North Bay House DS0000069810.V368330.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 North Bay House DS0000069810.V368330.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, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be provided with the information that they need to make decisions about if the home is where they wish to live and to be provided with a needs assessment which is undertaken prior to moving into the home. The home did not provide an intermediate care service. EVIDENCE: People were provided with detailed information about the home in the Statement of Purpose and Service User’s Guide, which explained the services that they could expect to enable them to make decisions about if the home was appropriate to meet their needs. Both documents were displayed on a table in the entrance hall to the home and a notice stated that they would be provided in larger print or on an audiotape if required, to ensure that the information was accessible to all people. North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 9 The Statement of Purpose was viewed and included details about the management and staffing structure of the home, staff qualifications, details about the facilities in the home, aims and objectives, complaints and compliments, fire safety and the service that people could expect to receive while living at the home, which included the activity programme and how the home met people’s diverse needs with the provision of visitors to the home that provided religious worship. The document explained that prior to admission people were provided with a full assessment of need and that a decision would be made as to if the home could meet their assessed needs. The Service User’s Guide was viewed and included details about the history of the home and it’s building, the private and communal accommodation in the home, admission to the home, terms and conditions, fees, fire safety, care plans, and the services and facilities provided by the home. The Service User’s Guide included information about the grounds of the home, including that the grounds were secure, that they had a vegetable patch which people could attend to if they wished and that the various types of birds that visited the garden may be of interest to people. The document also included several contact details of agencies that may be of assistance to people that lived at the home or their visitors, which included CSCI (Commission for Social Care Inspection), Elder Abuse, East Suffolk Advocacy Network, Citizen’s Advice Bureau, Alzheimer’s Society, Suffolk County Council, Waveney Primary Care Trust, Cruse Bereavement and support organisations for people with sensory loss. Seven service user surveys stated that they received enough information about the home that helped them to decide if it was the right place for them and comments included ‘yes my (family) got all information’ and ‘heard it was the place to be’. The relative survey said that they and their relative always received enough information about the home to help them to make decisions. The AQAA stated ‘an area of strength in the service we currently provide is our attention to detail regarding our admission process. For example we encourage new service users, both relatives and potential residents to visit North Bay House before they make decisions regarding their future care. Furthermore we provide all potential residents with an informational brochure incorporating a statement of purpose and service user guide and potential contract’. The AQAA stated that they have improved by ‘in addition to the our thorough admissions procedure we also have an informational website (www.northbayhouse.co.uk), have produced an improved brochure and employ a post admission questionnaire to ensure that all service users are able with their families to come to an informed decision regarding their future care’ The records of five people who lived at the home were viewed, which held detailed needs assessments that identified the support that each person needed and preferred on a daily basis. The assessments included details of support and daily care needs, continence, dietary needs, communication and North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 10 medication. The records included care plans, which identified how their assessed needs were met and they were regularly updated with the people’s changing needs and preferences. The AQAA stated ‘the manager visits all potential service users in order to make an accurate and thorough pre-admission assessment, thereby allowing the formation of carefully constructed individual care plans’. A person was spoken with and reported that they were visited by the management prior to moving into the home and that a needs assessment was completed. North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 11 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, 11 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People can expect to have their assessed needs detailed in an individual case plan, that their health needs are met, to be treated with respect, that their preferences are clearly recorded regarding the time of death and that they are protected by the home’s medication procedures. EVIDENCE: The details of the support that people needed and preferred to meet their assessed needs were clearly detailed in an individual care plan. The care plans of five people who lived at the home were viewed and they included details of the person’s religion, personal care, communication, mobility and dietary needs. Risk assessments were included in the records, which identified the possible risks in people’s day to day living, such as manual handling and using electrical appliances in their bedrooms and the methods of minimising the identified risks. North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 12 The care plans included a ‘person centred’ document, which included details of people’s preferences and the method used for recording in the document included I like…, I enjoy…, I am worried about… and I can…, which clearly identified the areas of their care that they could do independently. The document included people’s likes and dislikes and what support they required with regards to eating and drinking, washing a dressing, sleeping, mobility and their interests. Care plans were updated on a monthly basis by the person and their key worker. The manager of the home, the person and their representatives reviewed their care on a six monthly basis, which ensured that people’s changing needs and preferences were included in the care that they received. Daily records were maintained which clearly identified the well being, activities and observations of each person on a daily basis. Each care plan included a psychological assessment which had been undertaken by a staff member who had achieved a psychology degree and was undertaking their Registered Manager Award (RMA). The assessment included details of what people had said about their self image, how they viewed people that were close to them and their memories of their lives. The document provided staff with a clear ‘pen picture’ of people’s well being and history at the time of its completion. The service user survey asked if they were provided with the care and support that they needed. Five answered always, one answered usually and one answered sometimes and comments included ‘everybody helps me whenever I need any help’ and ‘the staff always give me the all the support needed’. People that were spoken with confirmed that their needs were met and that they were happy with the service that they were provided with. A staff survey stated that they were always given up to date information about the needs of the people that they supported and the ways that they passed information on about people always worked well. Staff spoken with had a clear understanding of people’s individual needs and how their needs were met. The relative survey said that North Bay House usually met the needs of their relative and that North Bay House always provided the support to their relative that they expected or agreed and that the home always met the different needs of people. Comments included ‘they have certainly catered for my (the relative) faith’ and ‘very attentive. (The person) is always clean and well presented, well fed and looked after and says how happy (the person) is’. A regular visitor to the home was spoken with by telephone during the inspection and they reported that the home was ‘excellent’, that the speech therapists that worked with their friend had told them that the home was excellent and that their friend’s needs were met. North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 13 People’s records viewed included an ‘end of life plan’ which included the details of people’s end of life decisions and their funeral arrangements. There was document which had completed through consultation with people and included details of if they wished to be resuscitated, kept alive artificially, artificially fed and if they preferred to remain in the home or go to hospital. The AQAA stated ‘in relation to health and personal care we feel one of our main strengths is the freedom of choice we allow residents regarding their care and their everyday living (cognitive abilities permitting). This may include allow them to have a choice regarding what they would like to wear, their personal care, who they would like as their personal carer, whether they want a shower or a bath and whether or not they desire any beauty or therapeutic treatments such as hair cuts, massages, manicures etc.’ and ‘if residents are completely unable to attend the shopping trips then any specific toiletries they desire are obtained by staff therefore ensuring they have the products they want and not whatever product the home gives them, such freedom of choice is important and allows the residents a sense of empowerment that they may not have in other areas of their lives, which can consequently have beneficial effects on other areas of their lives such a improving self esteem and general happiness’. It was noted during the inspection that people’s privacy was respected. Staff were observed knocking on bedroom and toilet doors and waiting to be invited in, before entering them. During a tour of the building the manager asked for people’s permission for us to enter their bedrooms. Staff were observed to be attentive to people’s needs and they were observed asking them if they would like drinks and if they were comfortable. The interaction between staff and people that lived at the home was observed to be caring, friendly and professional. It was noted that staff answered call bells promptly. People who lived at the home that were spoken with confirmed that their privacy was respected and that the staff treated them with respect. A health professional survey stated that people’s privacy and dignity was always respected. The care plans viewed showed that people who lived at the care home had their health needs met. There were details of when each person had received health care treatment, such as visits to and from the district nurse, speech therapist, dentist, optician and doctor. The care plans viewed contained details of their continence management, Waterlow assessments, details regarding falls and regular weight checks. The AQAA stated that they provided ‘residents with chiropody and dental services from local health care professionals. Visioncall visit the home to for optical and hearing assessments. They produce sensory deprivation care plans for the residents’. North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 14 The manager explained that they had concerns regarding the eating ability of one person and they were observed explaining their concerns to a health professional by telephone and they arranged an assessment to be undertaken. The manager was observed to record the outcomes of the conversation in the person’s records and passed on the information to senior staff. The manager and senior staff were observed in a daily handover of information regarding the well being and health of each person that lived at the home. Two health professionals were observed to visit people during the inspection, staff were observed to ensure that people were provided with privacy during their visits. A visiting hairdresser was present in a person’s room and they left immediately upon arrival of a health professional, and they reassured the person that they would return when the health professional had left. Seven service user surveys stated that they received the medical support that they needed and one commented ‘have not needed any yet’. A health professional survey stated that the home always sought advise and acted upon it to manage and improve individuals health care needs, that people’s health care needs were always met and that they felt that the staff had the right care and experience to support individuals with their social and health care needs. Medication was stored in a safe way, ensuring that people who lived at the home were safeguarded. The medication was stored in a secured room in the home. In the room was an appropriately secured controlled medicines cabinet, secured cupboards containing creams and a secured medication trolley which contained the MDS (Monitored Dosage System) blister packs. The trolley was used for the administration of medicines. The medication record keeping safeguarded people with regards to the administration of medication. MAR (medication administration record) charts were viewed and were completed appropriately to show when people had taken their medication and when they had refused it and the reasons for refusing the medication, for example if they were not in pain. People’s care plans that were viewed included a list of their prescribed medication. The controlled medication book was viewed and completed appropriately, which included the signatures of two staff to show that people had taken their medication and a running total of the administered and stored medication. Training records were viewed and evidenced that staff who were responsible for administering medication were provided with medication training. The home had a detailed medication procedure which clearly explained the safe handling, storage and handling procedures of medication. North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 15 The AQAA stated ‘we have regular visits from the pharmacist who gives training to staff. Residents are able, following a risk assessment, to self medicate’ and ‘the manager audits the medication documentation. She assesses staff annually on their administration of medication’. North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 16 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 can expect to be provided with an activity programme which meets with their preferences and interests, to be supported in maintaining personal contacts, to be supported to exercise choice and control over their lives and to be provided with a appealing balanced diet. EVIDENCE: People were provided with a full activity programme that met with their preferences and interests that they could participate in if they chose to. The programme of activities was included in the Statement of Purpose and the Service User’s Guide and the weekly activities were displayed on a white board in the home. There was a notice board in the home where photographs of recent activities were displayed. Group activities included visits to a local zoo, boat trips, visits to seaside towns, regular shopping visits to a local supermarket, exercise classes with a qualified fitness instructor, giant crosswords, bingo, quizzes and games. There were also individual activities available such as chats with staff, help with North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 17 choosing books, going out for walks and help with reading and writing letters and reading newspapers. The manager explained that they ensured that there was sufficient staff on duty to allow staff time to be provided to people if they wished to undertake individual activities. The home provided a hairdresser and a beauty therapist and people could choose to enjoy treatments for a reasonable cost. It was noted that a television programme ‘Foyle’s War’ was advertised on the white board for the weekly activities and the manager explained that people were working through the television series. People were supported to participate in religious worship if they chose to. The Salvation Army visited the home on Monday’s for the ‘thought of the week’, regular Communion and Roman Catholic Mass were also provided at the home. People were provided with the opportunity to worship in the community with the manager if they wished to. The manager explained that people had recently attended a church tea, which they had enjoyed. Five people’s care plans were viewed, which included a record of what activities that they had participated in and what their interests and hobbies were. During the inspection people were observed to be undertaking various activities, such as watching television, having their hair styled, reading books, chatting to each other and listening to music. Six people were observed to be sitting in the garden in the sunshine. There was seating and sun umbrellas in the garden to ensure that people were not uncomfortable under the direct sunlight. Two people were spoken with and said that the garden and the views were lovely and that they enjoyed sitting in the garden. People spoken with reported that there were plenty of activities that kept them busy. The service user survey asked if there were activities in the home that they could take part in. Four answered always and three answered usually and comments included ‘yes and my (relative) often takes part when (relative) visits me and is also invited on any trips with us’, ‘yes I take part in nearly all activities and go on all outings’ and ‘here if they want them but was never enthusiastic about joining in’. The AQAA stated ‘we have an active resident & relatives association with whom we plan trips throughout the year. The importance that we place on residents’ social life and the quality we provide in this respect is reflected in the enthusiastic manner in which we inform both residents and relatives of the opportunities available for social activities. For example we send out newsletters so that residents and relatives are aware of forthcoming events, we also liaise with residents to find out if they have any wishes for future activities and give residents/relatives to give feedback on previous activities in order to improve future events’. Care plans included information of contacts with family members and friends that people maintained. People spoken with said that their family and friends North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 18 were welcomed into the home when they visited. A person said that a family member often visited the home and took them out regularly. A visitor to the home was spoken with by telephone and they reported that they regularly visited the home and were always made welcome by the manager and the staff. The Statement of Purpose and the Service User’s Guide stated that visitors were welcome to visit the home and that drinks and privacy would be provided. A relative survey said that they were always kept up to date with important issues affecting their relative and commented ‘Helena acts with the interest of the patients foremost and is willing to put herself and her staff to considerable extra trouble to ensure they achieve this’. People spoken with said that the staff at the home listened to them and that they could choose what they wanted to do. Seven service user surveys said that the staff listened to them and acted on what they said. A health professional survey stated that people were always supported to live the life that they chose. The relative survey said that North Bay House usually provided support to people to live the life they chose and commented ‘they seem to provide life enriching events, especially for the more able’. Five care plans were viewed and people were consulted with regarding the support that they required and preferred, which is discussed fully in the previous section of this report. During the inspection it was noted that people were provided with choices such as their meal and drink choices, where they wanted to eat and what they wanted to do during the day. The manager explained that staff were advised that they must listen to all people’s choices, regardless of their abilities, in their daily living, such as what they wanted to wear. People who lived at the home were provided with a diet which was appealing and nutritious. The menu was viewed and it was noted that the planned meals were balanced and nutritious. On the day of the inspection the main meal was chicken chasseur. The manager explained that if people did not want the meal from the menu they could choose an alternative of what was available in the home. They said that people were asked what their meal choices were the day before. There was a bowl of fresh fruit that people could help themselves to. Tables in the attractively furnished dining room were laid with cutlery, napkins, the menu for the day and salt and pepper. People’s care plans that were viewed clearly identified people’s specific dietary requirements, food allergies and the support that people required. A visitor to the home was spoken with and explained that their friend required a softened diet and that staff assisted them to eat. They said that staff were ‘incredibly patient’ and never rushed the person when they were eating. North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 19 The service user survey asked if they liked the meals at the home. Five answered always, one answered usually and one answered sometimes and comments included ‘food is always nice and I have my (relative) to stay for meals with me at times’, ‘food is very good’ and ‘no complaints let the staff know if I had any’. People spoken with said that the food was good at the home and that they were provided with enough to eat. During the inspection staff were observed offering people a choice of drinks and biscuits throughout the day. North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 20 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. People can expect to have their complaints listened to and acted upon and to be protected from abuse. EVIDENCE: People were provided with the information that they needed to enable them to make a complaint about the service that they were provided with. The home had a complaints and compliments procedure and a summary of the procedure was included in the Statement of Purpose and Service User’s Guide and was available in the entrance hall to the home for people’s information. The Statement of Purpose and the Service User’s Guide also provided contact details of other organisations that are identified in the ‘Choice of Home’ section of this report, which people could use in making complaints to other organisations, such as CSCI and Suffolk County Council. The complaints book was viewed and there were no complaints made since the last inspection. The manager and the AQAA stated that they had not received any complaints since the last inspection. A staff survey said that they knew what to do if a resident, relative, advocate or friend had concerns about the home. The service user survey asked if they knew who to speak to if they were not happy. Five answered always and two North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 21 answered usually. Seven service user surveys and a relative survey stated that they knew how to make a complaint. A health professional survey stated that the service had always responded appropriately if they had raised concerns about the home. Staff were informed of their responsibilities in safeguarding adults who lived at the home by attending adult safeguarding training and the home’s safeguarding policy and procedure was available in the staff handbook, which included what abuse was and their responsibilities in safeguarding the people that lived at the home. The manager reported that there was a safeguarding update training course planned for staff to attend October 2008. The manager reported that they had attended an adults safeguarding course the week prior to the inspection. Staff spoken with were aware of their responsibilities in the protection of people who lived at the home and were aware of the whistleblowing procedure. There had been no safeguarding referrals made since the last inspection. The AQAA stated ‘we feel that we listen well, are open to constructive criticism and promptly act in order to rectify an issues from which complaints have arisen. We undertake POVA and CRB checks with each new staff member to ensure the safety of our residents. We have a keypad entry system. All doors are locked and remain locked at night. We have stringent policies on abuse and whistle blowing. No level of abuse is tolerated at North Bay House, staff would be immediately dismissed. The significance we place upon complaints and protection is reflected in the freedom in which we allow residents and relatives to voice their concerns regarding an issue. For example we have a complaints book in the main reception area which is freely available for all to use. We also have leaflets and instructions on how to lodge a complaint, which are additionally reviewed on a regular basis by the manager and all relatives/residents are aware of the simple way in which they can complain’. North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 22 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, 24, 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People can expect to be provided with a safe, well maintained, clean and hygienic environment to live in. EVIDENCE: People were provided with a clean, safe, well maintained and attractive environment to live in. At the time of the inspection it was noted that the home was clean and tidy and there was adequate domestic cover to ensure that the home was regularly cleaned. A tour of the building was undertaken and it was noted that the communal areas were clean and attractively furnished. Seven service user surveys stated that the home was always fresh and clean and one commented ‘the cleaner is always here hoovering and cleaning always smells nice’. People spoken with reported that they were happy with the home that they lived in. North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 23 The communal areas to the home were attractively decorated and furnished. The recently decorated dining area was large, bright and well ventilated, there were sufficient seating and tables for people to enjoy their meals. All tables were attractively laid. The large television lounge was furnished with comfortable armchairs for people to relax in. A second lounge contained comfortable chairs and bookshelves with a good selection of books that people could read if they chose to. Both lounges were light and airy and were attractively decorated and furnished. During the inspection fresh flowers were purchased to display in the communal areas. Bedrooms were noted to be clean and attractively furnished and decorated. All bedrooms contained people’s personal memorabilia and reflected their individuality. People spoken with said that they were happy with their bedrooms and the views from their bedroom windows. The bedrooms at the rear of the home overlooked the home’s attractive grounds and the waters of the Broads. The gardens of the home were attractive and secure. There was seating, tables and sun umbrellas provided for people to use if they chose to. The manager stated that they had recently cut back some of the trees to enable improved views of the waters of the Broads. People were observed to be sitting in the garden during the inspection and they stated that they enjoyed the home’s grounds and the views and one person commented on the attractiveness of the trees. A vegetable patch had recently been developed and people could work in it if they wished to. A person’s care plan that was viewed stated that the person enjoyed feeding the birds. The laundry area was clean and contained washing and drying machines and hand washing facilities, including liquid soap and disposable paper towels. Staff were observed using good infection control procedures during the inspection, which included washing their hands and wearing protective clothing when working with food and issues of personal care, which protected people from cross infection. Staff spoken with had knowledge of infection control procedures and the home’s procedures were available for staff in the staff handbook. Training records were viewed and showed that staff had been provided with infection control procedures in the staff handbook. The AQAA stated ‘we employ a full-time cleaner thereby ensuring that the residents constantly have a clean area in which to live and relax. Secondly we feel that the spaces in which the residents reside are of the utmost importance and therefore we pride ourselves on aesthetically pleasing decoration throughout the home, which is maintained via an ongoing programme of routine maintenance and the grounds are also constantly maintained by a gardener. Furthermore we also allow residents to bring their own furniture and possessions in order for them to feel more comfortable in their surroundings North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 24 and this emphasis on residents feeling at ease is further reflected in the fact that there are three communal areas available to residents as well as a balcony in the garden. We have installed a new wire free call bell system. This allows residents to take a pendent with them whenever they would like to sit outside’. North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 25 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. People can expect to be supported by staff that are trained and competent to do their jobs and to be protected by the home’s recruitment procedures. EVIDENCE: Seven staff recruitment records were viewed and held all the required documents that ensured that people were safeguarded by the recruitment procedures of the home. The recruitment records included CRB (criminal records bureau) checks, work history and two written references. The AQAA stated ‘we have a very stringent application and induction programme meaning that only the best candidates for the job are selected with these candidates receiving extensive training to ensure that are staff can provide high quality care to residents. All staff are both POVA and CRB checked’. Staff training records viewed evidenced that newly appointed staff were provided with an induction, which included the Skills for Care Common Induction Standards. A staff survey stated that their induction covered everything they needed to know to do the job when they started. Staff spoken North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 26 with confirmed that they were provided with an induction when they started working at the home. The AQAA stated ‘Once selected new members of staff have a thorough induction and receive extensive training in all the necessary areas. This induction is based around the Mulberry House Induction booklets and the training of new staff is contributed to by the manager, deputy manger, psychologist and head cook. Furthermore annually in October staff attend a variety of mandatory training programmes incorporating fire safety, infection control, basic first aid, food hygiene, manual handling and how to deal with challenging forms of behaviour’. Staff were provided information about how to meet people’s needs and safeguard people who lived at the home by training, the home’s policies and procedures and the staff handbook, which provided the terms and conditions of their job and a summary of the home’s policies and procedures. Staff training records, which included training certificates and a training matrix, were viewed. Training provided to staff included manual handling, fire safety, health and safety, food hygiene, safeguarding adults, medication, infection control and dementia. The manager stated that training updates were planned for October 2008. Staff spoken with stated that they received appropriate training to support them in meeting people’s needs and stated that the provision of training had been improved. A staff survey said that they were provided with training which was relevant to their role, helped them to understand and meet the individual needs of people and kept them up to date with new ways of working and that they felt that they had the right support, experience and knowledge to meet the different needs of people. The home had met the target of 50 staff to have achieved a minimum of NVQ (National Vocational Qualification) level 2 by 2005, which was identified in the National Minimum Standards relating to older people, which showed that staff had been assessed as competent in their job in meeting people needs. The AQAA stated that 95 of the staff that worked at the home had achieved a minimum of NVQ level 2 in care. During the inspection there were four care staff, domestic staff, the cook, the deputy manager and the manager on duty. Staff were observed to meet the needs of people, were attentive to people’s needs and staff treated people with respect. It was noted that call bells were answered by staff promptly to ensure that people were supported when they needed to be. The staff rota was viewed and it was noted that the home was staffed throughout the twenty four hour period. The manager stated that they ensured that there were sufficient staff working at the home to meet people’s needs and provide people with the opportunity and time to chat to staff if they wished to. They reported that the North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 27 home did not have the need to use agency staff and people were provided with staff support that was consistent. A staff survey stated that there were always enough staff to meet the individual needs of the people who lived at the home. The service user survey asked if staff were available when they needed them. Five answered always and two answered usually. The AQAA stated ‘We have an excellent ratio of staff to service users which allows us to deliver high quality care to residents at all times’ and ‘on a weekday morning we have a senior carer and four carers present on site, in the evening a senior carer and three carers present, at night we have two carers and at weekends we again have a senior carer as well as at least three carers present on a site at all times therefore ensuring that we are never understaffed’. North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 28 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, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to live in a home that is managed by a person that is fit to be in charge, that the home is run in their best interests, that their financial interests are safeguarded and that their health, safety and welfare is promoted and protected. EVIDENCE: The home was managed by a person that was fit to be in charge and they had been successful in the CSCI registered manager application process in 2007. The manager was a Registered General Nurse and had achieved a BTEC level 5 in business management and administration. The manager had a good understanding of their role and responsibilities, was receptive to the inspection North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 29 process and provided the requested information promptly and in an open manner. The AQAA that was returned to us included the detailed information that we required and clearly explained the service that the home provided. Staff spoken with were complimentary about the management style of the manager and stated that they were able to approach them for support and guidance. The AQAA stated that evidence of the effective management style ‘can be seen in the responses to the quality assurance questionnaires, which the manager ensures are completed by all staff, residents (where possible), relatives and visiting health professional/specialists. These responses to the quality assurance questionnaires are furthermore readily available and published for public consumption’ and ‘in addition to these questionnaires the professional nature of the management is also reflected in the in depth records regarding the service provided by North Bay House incorporating records regarding Health & Safety audits, Accident Prevention audits, Medication audits and risk assessments’. The Statement of Purpose explained how quality assurance activities were undertaken, which included regular satisfaction surveys. The document included quotes from recent resident and relative satisfaction surveys. The manager explained how they regularly monitored the home’s record keeping practices and the general running of the home to ensure that the best possible service was provided to people. People were consulted with regarding the service that they received through their care planning review meetings. The home’s procedures for safeguarding people’s finances were viewed and it was noted that they were detailed and provided sufficient information to staff who supported people with their spending monies. The finance records of three people were viewed and all transactions were clearly recorded and all monies were accounted for. People’s health and safety was promoted and protected in the home. Health and safety records were viewed and it was noted that regular safety checks were routinely made, such as water temperature, fridge and freezer temperatures, food temperatures and electrical appliance safety. Fire safety records were viewed and regular checks were undertaken of fire safety equipment. The home had a detailed fire risk assessment. It was noted that no fire doors were wedged open during the inspection. Environmental and individual risk assessments were viewed which identified areas for minimising potential risks for people that lived in the home, visitors and staff. North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 30 Staff training records viewed and discussions with staff evidenced that they were provided with health and safety related training such as food hygiene, manual handling and infection control. The home’s policies and procedures were viewed and included food hygiene, manual handling, fire safety, health and safety, personal safety awareness, managing risks for new and expectant mothers and the COSHH (control of substances hazardous to health) manual was viewed. North Bay House DS0000069810.V368330.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 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 4 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X 4 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 North Bay House DS0000069810.V368330.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. Refer to Standard Good Practice Recommendations North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 North Bay House DS0000069810.V368330.R01.S.doc Version 5.2 Page 34 - 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. 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