Bay House

Bay House is a residential care home providing accommodation and personal care to up to 24 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 18 people using the service.

People’s experience of using this service and what we found

The provider did not give people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment. Some areas of the home were visibly dirty. Improvements were needed to infection control practices in the service.

Staff did not always receive training to enable them to meet the needs of people and keep them safe. Medicines were not stored safely. Risks were not always fully assessed and planned for and there was limited evidence of learning following incidents.

Ineffective quality monitoring systems had failed to identify and address the failings we found during our inspection. There was a lack of effective monitoring, oversight, and leadership within the home. This had resulted in poor outcomes for people using the service.

People and their relatives were generally positive about the service and the care they received.

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The management team were responsive to the inspection findings and feedback and took action during and after the inspection to improve some systems and action some of the concerns raised.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 09 September 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bay House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safety around the environment, risk management, staff training, and quality monitoring at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

The registered manager had taken steps to ensure staffing was sufficient to fully meet people’s needs. Staff had worked flexibly and had gone above and beyond during a difficult situation, working extra shifts and often taking on new responsibilities to ensure people received safe care and support.

Safe arrangements were in place for visitors to the service. This included the completion of hand sanitisation and wearing a mask.

Staff and visitors were engaged with a programme of regular testing according to government guidance and we saw this taking place on the day of our visit. Staff and visiting professionals were asked to provide evidence of their vaccination status against COVID-19 prior to entering the home.

We saw PPE was accessible within the home and staff used it in accordance with the most up to date guidance. Information about the correct use of PPE and handwashing guidance was displayed throughout the home.

A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. This meant swift action could be taken if anyone received a positive test result.

All staff had completed training in relation to infection control, and recently received training about the correct use of PPE including donning and doffing.

Bay House is registered to provide accommodation and personal care for up to 24 older people. On the day of inspection, there were 16 people living at the home.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People received care from staff that were kind, compassionate and respectful. Their needs were assessed prior to coming to the home and individualised care plans were in place and were kept under review. Staff protected people's dignity and demonstrated an understanding of each person's needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals.

People felt safe in the home and relatives said that they had confidence in the ability of staff to keep people safe. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns.

There were sufficient staff to meet the needs of the people and recruitment procedures protected people from receiving unsafe care from staff that were unsuitable to work at the service. Staff were supported through regular supervisions and undertook training which helped them to understand the needs of the people they were supporting.

People were involved as much as possible in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005. Staff provided people with information in the most appropriate way to enable them to make informed decisions and encouraged people to make their own choices.

Care records contained individual risk assessments and risk management plans to protect people from identified risks and help to keep them safe. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed. Staff provided people with appropriate support to meet their nutritional needs and people were able to choose the food and drink they wanted.

Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

There were systems in place to monitor the quality and standard of the service; action was taken to address any shortfalls. The registered manager was visible in the home and encouraged feedback, actively looking at ways to improve the service.

Following our previous comprehensive inspection on 19 January 2016, we gave this location an overall rating of 'inadequate' and placed them into special measures.

We found that there were ineffective systems in place to manage accidents and incidents, including those of potential abuse. External agencies had not been informed of such incidents and investigations and analysis of incidents and their causes had not taken place, which meant that lessons were not learned and preventative action was not taken. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were not effective or robust recruitment processes in place at the service. The service had not carried out sufficient checks to ensure that staff were of good character and suitable to perform their roles. This included Disclosure and Barring Service (DBS) criminal record checks and references from previous employers. This meant that the provider had not sought assurances that staff were suitable to work with people. This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also found that the service did not have appropriate steps in place to ensure the principles of the Mental Capacity Act 2005 (MCA) were complied with. Mental capacity assessments were not carried out and there was a lack of evidence to show that people's capacity had been considered when decisions were made on their behalf. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were ineffective systems in place to provide sufficient managerial oversight and quality assurance at the service. Checks and audits were not carried out on a regular basis to help monitor, assess and improve the quality of care that people received. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can read the report from this comprehensive inspection by selecting the 'all reports' link for Bay House on our website at www.cqc.org.uk.

The provider submitted an action plan to tell us how they would meet these regulations and the timescale they intended to have them met by. We carried out this unannounced comprehensive inspection on 12 July 2016, to see if the provider had made the necessary improvements to meet these breaches of regulations, and to see whether or not they should remain in special measures. We found that the provider had implemented a number of changes and new systems to meet these regulations and, therefore, the service is no longer in special measures.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

Systems had been introduced to ensure that accidents and incidents were reported and managed appropriately. The registered manager was aware of the requirement to notify and involve external organisations and had introduced processes to ensure that this occurred. Action was taken to investigate incidents and take appropriate action to prevent future incidents from occurring.

Recruitment processes at the service had been reviewed and background checks had been completed for all staff members, to ensure that they were suitable to work with people. Recruitment files had been re-organised to help demonstrate that these changes had been made. There were sufficient numbers of staff to meet people's needs and provide them with the care and support they wanted.

Staff members had been provided with training in the MCA and systems had been put in place to ensure that the principles of the MCA were applied. Where necessary, mental capacity assessments were completed and best interests' decisions were made for those people who were unable to make decisions for themselves.

The provider and registered manager had introduced a number of checks and audits to help them assess and monitor the care being provided. They used these to identify areas for improvement, as well as where staff were performing their roles well.

Risks to people and visitors to the service were managed. Assessments were carried out to help identify risks and steps were put in place to reduce the level of risk, whilst still allowing people to be as independent as possible. People's medication was also well-managed so that they received medicines when they should and medicines were stored and recorded correctly.

Staff members received appropriate training and support to enable them to perform their roles. Training was arranged in a number of different formats to meet people's different learning styles and staff also received additional support in the form of observations and supervisions. This enabled them to discuss any concerns they may have, as well as any performance issues or development needs.

People were supported to have a balanced and healthy diet based on their individual choices and preferences. Staff were aware of people's specific dietary needs and, where required, referrals were made to the dietician to help manage this. Staff also interacted with a range of other healthcare professionals to ensure that people were able to attend all the appointments they needed to.

Staff treated people with kindness and compassion and spent time engaging in activities and conversations with them. People and their family members were familiar with staff members and had developed positive relationships with them. They had also been involved in planning people's care and consulted by the service regarding any changes or updates necessary. People's privacy and dignity were important to staff members and they worked to preserve this at all times.

Care was person-centred and sensitive to people's individual needs and wishes. Assessments were completed on admission to the service to ensure staff could meet people's needs and these were used to develop more robust long-term care plans. These care plans provided staff with specific information they needed to help provide people with the care they wanted.

The service provided a range of activities for people both within the service, and local area. There was an activities coordinator who worked to provide people with stimulation and entertainment and they were supported by members of staff to ensure this process kept going.

The service welcomed people's feedback and had systems in place to receive and act on complaints and compliments. No complaints had been received, however there were processes to ensure they were appropriately handled and information was on display about how to make complaints both internally, and to external organisations, such as the Care Quality Commission.

There was a positive and open culture at the service. People and their families were aware of the current situation at the service and had been supportive of the care that they received. They were aware of who the registered manager was and felt they were approachable and easy to get along with. Staff felt well supported by the registered manager, and were keen to perform their roles and help the service to improve.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time-frame.

If not enough improvement is made within this time-frame so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We carried out an unannounced comprehensive inspection of this service on 30 December 2014 where we identified four breaches of regulation. The systems and processes in respect of safeguarding people were not consistently followed by staff. We found that new members of staff had commenced work without adequate checks having taken place. The procedure for ordering medicines and recording the administration of medicines was not consistently followed by staff. We also found that people were not protected from the risks of infection as there were ineffective cleaning processes in place. We undertook a follow up inspection on 12 May 2015 to review the action that the provider had taken and found that some improvements had been made. The overall rating of the service remained Requires Improvement, which meant that we were required to complete a further comprehensive inspection within 12 months of this date.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bay House on our website at www.cqc.org.uk.

Our second comprehensive inspection took place on 19 January 2016, and was unannounced. Prior to this inspection we had received concerns in relation to people’s safety and security within the service. It was alleged that people had been provided with inadequate care at night in respect of their continence needs. Concerns had been raised about the ability of people to leave the service unsupervised, leaving them vulnerable to external risks. It was further alleged that staff had used a person’s property without their consent. As a result we undertook a full comprehensive inspection to look into those concerns, in conjunction with reviewing the areas that required improvement from the last comprehensive inspection. We were unable to find evidence to corroborate the concerns regarding security and continence care, however there was evidence supporting the concerns regarding the use of people's property.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were systems in place to record incidents; however potential safeguarding incidents had not been reported to the relevant external agencies. In addition, there were no records to demonstrate what actions had been taken as a result of the incidents which had been reported. Although risk assessments were in place for people, they only provided staff with a basic risk rating. They lacked information regarding the specific risks people faced, and the control measures in place for these. Staff had not been recruited safely; there was a lack of adequate background checks and work histories in staff files. People were given their medication by trained staff; however there was a lack of oversight and checking of medication.

There was a lack of effective management systems at the service. The registered manager had failed to ensure that the service was meeting the fundamental standards, or to ensure that people received safe, effective and high quality care. Quality assurance audits failed to identify issues at the service, for example within the medication systems or care plans, which meant that any areas for development were not identified, or acted upon, by the provider.

Staff members sought consent from people on a regular basis; however there were not systems in place at the service to ensure that the service was meeting the requirements of the Mental Capacity Act 2005. The registered manager had not considered whether the Deprivation of Liberty Safeguards (DoLS) was appropriate for most of the people living at the service. Staff members received supervision sessions from the registered manager; however these were not recorded regularly so as to provide an accurate record of the areas discussed.

Care plans were in place for people; however it was not clear that they or their relatives had been involved in the production of these plans. This meant they were not as person-centred as they could have been.

People received person-centred care from staff members who knew them well; however care plans were not always personalised to reflect people’s specific needs and wishes. The service had systems for obtaining feedback from people and their family members, including complaints; however they were not able to demonstrate how this information was used for the benefit of driving improvement and enhancing service delivery.

There were ineffective processes in place to monitor and mitigate the risks to people when recruiting staff. We also found that the systems in place to identify why accidents and incidents occurred were not robust and failed to implement preventative measures to reduce future occurrence. .

Staffing levels were sufficient to meet people’s needs and were based upon people’s assessed levels of dependency.

Staff received regular training, including induction training for new staff and refresher sessions for all staff.

People received enough food and drink, and were able to choose what they had to eat and drink. Meals were appetising and well presented, and people were supported to eat if required. Staff supported people to access healthcare professionals for a range of needs, if this was required. Where people could not leave the service, staff arranged for healthcare professionals to visit the service.

Staff had worked to develop positive and meaningful relationships with people, and treated them with kindness, dignity and respect. Visitors to the service were welcomed at any time and were encouraged to visit regularly by the registered manager and staff to maintain important relationships.

People benefited from a range of activities which took place at the service each week. They clearly enjoyed these and there were photos and displays around the service to show the outcomes of these activities.

People and their relatives were positive about the registered manager and felt that they were available when needed. Staff were also positive about the leadership at the service and felt well supported.

We identified that the provider was not meeting regulatory requirements and was in breach of a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We met with the relatives of two people that lived at Bay House and they told us that they were very happy with the care and support their relative was receiving, and that the staff were very caring. We observed staff interact with people in a kind, friendly and respectful way. We saw evidence of activities regularly taking place, such as art and crafts that people had been engaged in.

We found that there had been improvements made in the updating of the assessment, care and ongoing support needs of people.

We found that staff received regular supervision and that annual staff appraisals were in place.

We found that records were held securely and had been updated as people's requirements had changed.

We found Bay House to be caring, responsive and well led.

We spoke with nine visitors some of whom were frequent visitors and they told us that the staff were always very friendly and made them feel very welcome. One relative told us that 'this is a nice care home, they are very happy here'. They told us that staff kept in touch with them if their relative was unwell.

We saw that Bay House was comfortable and homely, and was clean and free from odour. We saw staff interact with people in a kind and supportive way. People told us that they were able to make choices in what they did and that staff supported them in this.

We saw that the equipment had been serviced regularly and was in good working order

We had concerns that not all of the records contained up to date and accurate information about peoples needs and we noted that the reviews of records required improvement in their content to ensure changes were accurately recorded.

We found that staff had not received supervision which ensured that they were supported to carry out the work they undertook and that staff appraisal which would include training and development needs had not been completed.

We saw evidence that the staff had reviewed the emergency procedures that they needed to follow up when a person living at the home had a fall. We also saw that people using the service had up to date risk assessments and care plans in place. This was to make sure people were well looked after in line with their assessed needs and requirements.

We found that the level of staffing hours had increased to ensure people's needs were being met and we also observed that the home had a relaxed and happy atmosphere. We found that the provider had made improvements to the maintenance of the building and they had also re-decorated one person's room. We spoke with the person about the improvements and they told us that they were pleased with the appearance of their bedroom.