Bystock Court was last inspected by the Care Quality Commission (CQC) on 18 November 2011.We visited Bystock Court on 27 July 2012 and 02 August 2012.
Bystock Court is owned and operated by Devon Sheltered Homes Trust, with Guinness Care and Support (GCS) being corporate trustees. The manager of the home is line managed through GCS and the policies, procedures and documentation used by the home were those that were used across GCS services.
At the time of the inspection the home was subject to a safeguarding investigation by the local authority. This was because of concerns raised about the safety of people living at the home, from people who visited the home for day care. During the course of the investigation further concerns were raised about the management of risks and the accessibility of information about people's needs and how they were to be met. There were also concerns about the skills and experience of staff, and staffing levels. The provider had started to address these matters.
We met many of the people who lived at Bystock Court while we were looking around the home and grounds. Those we spoke with told us that they were supported to make choices about how they spent their day. They told us about the different things that they did including visiting the local shops and working outside in the home's grounds and on the farm. Two people also told us about the home's band that they play in 'The Bystock Crystals'. We saw that people were able to do what they chose to on the day of our visit. Some people who lived at the home went out shopping while others were helping in the kitchen, laundry and garden.
Each person had a care file that contained a range of documents relating to their care and support needs. We saw two different types of care plans being used and the manager told us they were changing the documentation. The 'new' care plans were very detailed and contained much more information than the 'old' ones. Some risk assessments had been completed including those relating to choking and people's behaviour that was challenging to the service. However, there were no risk assessments completed for nutrition or pressure areas.
Three of the people we spoke with told us that they knew about their care plans and had helped their link worker to complete their new plans. A link worker is a member of staff who takes particular responsibility for the needs of that individual. The fourth person we spoke with said they were not interested in their care plans, but knew their link worker had completed a new one.
There were differences across the new care plans in the information given to staff about how they were to meet people's needs. One care plan gave really good clear directions to staff. However, another care plan did not give specific guidance, just that staff should 'refer to support plan'. However, the support plan only said to 'monitor' the person and did not tell staff what to do if the person displayed specific behaviours.
One staff member that we spoke with told us that they had had some Mental Capacity Act training, but that this had been limited. This Act is in place to ensure everyone has the right to make their own decisions unless it is proven it is not in their best interests to do so. It must be assumed that people have the right to make decisions ' even bad ones ' unless there is evidence that they do not have capacity to do so.
We toured the building, grounds and farm and spoke with staff and individuals living at the home as we walked around. Some people living at the home also showed us their bedrooms. People told us that they had been able to choose the way their rooms had been decorated and we saw that there were many personal possessions in their rooms.
People who visited the home for a day care service no longer used the same dining room as people living at the home. Instead they used the 'ballroom' to eat their lunch and did not access the residential part of the service. This had minimised the risk of incidents occurring between the two groups of people.
People felt there were enough staff on duty to meet their needs and to take them on visits outside of the home. People told us about the holidays they had been on with staff and about their shopping trips. They also told us how staff helped them with their personal needs like showering and helping them put their stockings on.
Staff told us about the training they received and felt that on the whole the service was "Good about training". Staff were also able to tell us what they did to support people living at the home and knew what to do for them if they needed any additional support. Staff told us that they felt well supported by the manager, saying "She is a very good boss, always makes time for people" and "Can talk to her about anything". Staff also confirmed they received regular supervision from the manager when they could discuss any concerns they may have.
In the dining room we saw a 'Hot Question Tree'. This was a poster of a tree that enabled people living at the home to indicate anonymously if they were happy or not about the current 'Hot Question'. We saw that the current 'Hot Question' was 'Are you happy with your link worker'. Leaves had been placed on the tree and indicated some people were happy with their link worker while others were not. The manager told us that although the process was anonymous they would look into the link worker system as some people were not happy with it.
The manager showed us a range of questionnaires that are sent out to people living at the home, their representatives, staff and health and social care professionals. These ask for feedback on the quality of the service provided. We saw that the majority of responses were positive. However, there was no evidence to show what action had been taken where responses were negative.