Bayith Rest Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Accident and incident reports were completed. Staff told us about measures to improve safety for people and confirmed learning was shared with them in various ways, such as in meetings or during handover. However, learning from safety events was not always recorded. The manager had recognised this and told us they would be recording this going forwards. This meant a clear audit trail of actions and improvement could be kept and regularly reviewed to keep improving safety. People and relatives told us people received safe care. One relative said, “Mum is very safe, she is a falls risk. They [staff] put things in place to help reduce this risk.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Assessments were carried out before people were admitted into the home, to ensure their needs could be met. Where appropriate, relatives told us they were involved in this process. For example, 1 relative said, “They [staff] involved us in the care plan when she [Person] moved in.” Pre- assessment records did not always contain enough detail. When we told the manager that pre-assessment forms could benefit from more detail, they told us of their plans to improve this. Despite this staff knew people well. Staff had a very good understanding of people's health needs and knew how to access additional support if needed. Hospital passports were available for people attending appointments. These contained information other services may need to know to support them effectively. People were supported to manage their health conditions and staff ensured regular reviews with specialists.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider had safeguarding and whistleblowing policies and procedures, which staff knew how to use. Staff were confident the manager would listen and act if they raised a concern. People told us staff supported them in a kind and respectful way, and they felt able to speak up if needed. For example, 1 person said, “If we [people] are worried about anything we can ask them [staff], they are so sweet, they are prepared to listen to all our what nots”. People appeared to relaxed and comfortable with/around staff.

Risk assessments were not always in place. For example, there were no risk assessments for dehydration, constipation or contractures. This meant staff may not have effective guidance about what actions were needed to reduce these risks for people. Some other risk assessments lacked enough detail to provide effective guidance for staff who may not know people well, such as agency staff. The manager was aware of this and had plans to improve. However, staff knew people well, understood the risks associated with their needs and how to reduce them. We observed people being safely supported and risks were reduced. Relatives provided us with examples of how staff in the service reduced risks for people. For example, 1 relative said, “[Person] is at risk of falls, but staff have put things in place to help reduce the risk, like a pressure mat by her bed so they know when she is up.”

The provider did not always detect and control potential risks in the care environment.

We could not be assured the service had always taken action to reduce environmental risks, such as fire and Legionnaire’s disease. The manager had plans to improve. This included getting a new fire risk assessment completed, and improving water temperature checks to minimise the risk of Legionella. Safety checks of equipment were regularly carried out, and people had personal emergency evacuations plans.At the time of the inspection some works were planned to ensure safety and care provision. For example, installing a wet room and a sluice, fixing a bath and an external door. The manager also told us work would be done in the garden to make it more usable for people. Although the service needed some redecoration in places, it was mostly homely, warm and welcoming.

The provider did not always make sure there were enough qualified, skilled and experienced staff. Three care staff were on duty during the day in line with the providers assessment. Staff told us that due to agency staff arrangements there were times when only 2 care staff were on duty. People, staff and relatives told us this was enough for people to be safely supported. However, some staff and people felt this was not always enough to undertake other tasks such as cleaning and supporting people with social engagement.

People and relatives told us agency staff did not know them as well as permanent staff. For example, 1 person said, “Sometimes we are short of staff, so we get agency, they are good, but they don’t know us. I think we could do with more staff. Sometimes they are short, but it doesn’t affect me. There’s always someone here to be with us.” A relative told us they did not think agency staff were as committed to meeting people’s needs as permanent staff. The manager told us they had plans to recruit more permanent care staff, an additional housekeeper, a cook and an activities coordinator with the aim of improving consistency.

Staff completed a range of training to meet people's needs, which was refreshed and updated regularly. When people’s needs changed, training was arranged so staff could safely support them. Staff told us they felt supported in their roles. They received regular one-to-one sessions of supervision. These provided an opportunity for a supervisor to meet with staff, discuss their training needs, identify concerns, and offer support.

Staff were safely recruited.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading.

The home recently had an audit of their infection prevention and control processes undertaken by a partner agency. This identified actions to ensure safety. For example, processes to clean commodes, limescale build up and exposed rusty pipes. The provider had begun planning for work to be undertaken to fix these issues.

The home was clean overall, and plans were in place to ensure the new cleaner could deep clean areas that needed it. The kitchen was clean and well organised. Staff wore personal protective equipment appropriately.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. However, medicine records needed improvement.

Records to support the safe management of medicines were not always in place or completed appropriately. For example, records did not show which topical creams had been applied, and some ‘as required’ medicines lacked protocols. This meant there was no evidence people had received these medicines as prescribed. The manager was aware of this and implemented new systems to support the improvements needed during the inspection. Time was needed to embed these practices.

People told us they were supported to take their medicines in a way that met their needs. Processes and systems for ordering medicines were effective and well managed between the service, GP practice and pharmacy. Staff received relevant training and regularly had their competency assessed to ensure they were safe to administer people’s medicines.