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Inspection carried out on 27 July 2017

During a routine inspection

This unannounced inspection took place on 27 and 28 July 2017.

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.

Inspection carried out on 12 July 2016

During a routine inspection

Bay House is situated in the Buckinghamshire village of Olney. It is registered to provide accommodation to people who require personal care and can accommodate up to 24 people, some of whom may be living with conditions such as dementia. At the time of our inspection there were 18 people living at the service, in a mixture of single and double-occupancy bedrooms.

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

Inspection carried out on 19 January 2016

During a routine inspection

Bay House is situated in the village of Olney, in Buckinghamshire. It provides personal care for up to 24 older people, who may be living with dementia. At the time of our inspection, there were 18 people living at the service, in a mixture of single and double-occupancy bedrooms.

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 regis

Inspection carried out on 12 May 2015

During an inspection to make sure that the improvements required had been made

Bay House is registered to provide accommodation and support for up to 24 people who require personal care and may have a range of social, physical and dementia care needs. On the day of our visit, there were 16 people living at the service.

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.

During our inspection in December 2014, we found breaches of regulation in four different areas. 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 and people were not protected from the risks of infection as there were ineffective cleaning processes in place. Following the inspection the provider sent us an action plan detailing the improvements they were going to make and stating that improvements would be achieved by 20 April 2015.

This report only covers our findings in relation to the outstanding breaches of regulation. 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.

This inspection was unannounced and took place on 12 May 2015.

Staff had an understanding of abuse and the safeguarding procedures that should be followed to report potential abuse. Suitable recording and reporting systems were now in place.

Staff were not allowed to commence employment until robust checks had taken place to establish that they were safe to work with people.

Systems and processes in place ensured that the administration, storage, disposal and handling of medicines were now safe.

Appropriate standards of cleanliness and hygiene of the environment were now maintained within the home.

While improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating for safe at the next comprehensive inspection.

Inspection carried out on 30 December 2014

During a routine inspection

The inspection was unannounced and took place on 30 December 2014.

B

ay House is registered to provide accommodation and support for up to 24 people who require personal care and may have a range of social, physical and dementia care needs. On the day of our visit, there were 16 people living at the service. 

 

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.

We found that safeguarding systems and processes were in place at the service but were not followed consistently. During our inspection we identified two incidents that had occurred within the service, which had not been reported to either the Care Quality Commission (CQC) or the Local Authority. Although the cause of both incidents had been identified, there was no explanation of how the service would prevent them from happening again; neither was there any remedial action identified.

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. It was evident that there were not effective processes in place for the ordering and recording of medicines at the service.

We found that cleaning within the service was not satisfactory. People were not protected from the risks of infection as there were ineffective cleaning processes in place.

People who used the service and their relatives told us that they were happy with the care they received from staff, and felt that they were involved in decisions about their care and day to day choices.

There was sufficient on duty staff to meet people’s needs and keep them safe. Staff numbers were based upon people’s dependency levels and were flexible if people’s needs changed. 

Staff had been provided with a formal induction, essential training, on-going supervision and appraisal to enable them to care for people effectively.

We saw that there were policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) to ensure that people who could make decisions for themselves were protected. The documentation we looked at did not consistently evidence that formal mental capacity assessments had taken place for important decisions; for example the use of bed rails.

People could make choices about their food and drink and were provided with a choice of food and refreshments, with support to eat and drink where this was needed.

People had access to health and social care professionals as and when they needed. Prompt action was taken in response to illness or changes in people’s physical and mental health.

Staff were knowledgeable about the specific needs of the people in their care, so that the service was effective in meeting people’s individual needs. People’s personal views and preferences were responded to and staff supported people to do the things they wanted to do.

The home had an effective complaints procedure in place. Staff were responsive to people’s concerns and when issues were raised these were acted upon promptly.

The registered manager and senior staff encouraged feedback from people and their representatives, to identify, plan and make improvements to the service.

The provider had internal systems in place to monitor the quality and safety of the service but these were not always used as effectively as they could have been, particularly in relation to the monitoring of staff records, medication and infection control. 

You can see what action we told the provider to   take at the back of   the full version of this report.

Inspection carried out on 5 March 2014

During an inspection to make sure that the improvements required had been made

We spoke with six of the 13 people that lived at Bay House. They all told us that they were very happy. One person said �It is a happy home, good carers and I have a lovely cosy room�. Another person said �Everything is satisfactory and there is a good cook�. During our inspection we also spoke with visiting healthcare professionals who told us that staff at Bay House promptly reported any physical health issues to them.

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.

Inspection carried out on 17 May 2013

During a routine inspection

On the day of our inspection there were 14 people who used the service. We were not able to speak with all of the people as some people�s ability to communicate had been impaired by their condition. We spoke with four people who told us that they were happy at Bay House, they all told us that the food was very good and that the staff were very kind.

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.

Inspection carried out on 10 December 2012

During an inspection to make sure that the improvements required had been made

We conducted an inspection site visit at Bay House on the 12 September 2012. We found that the provider was not meeting three government essential standards of quality and safety in relation to care and welfare of people who use services, staffing and safety and suitability of premises. We conducted a follow up unannounced site visit on the 10 December 2012 to check that the provider had made improvements in these three essential outcome areas. On the day of the visit, there were 14 people living at the home.

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.

Inspection carried out on 11 September 2012

During a routine inspection

At the time of the inspection there were 12 people living at Bay House. We spoke with six people and three relatives who were visiting their family members. The majority of people we spoke with told us that the staff treated them with respect and looked after their needs well. They also told us that the staff came to their assistance quickly when they used the call bell.

Most of the relatives we spoke with also told us that the care their family members received was good. They told us that the staff kept them informed of any issues regarding their family members care. One relative told us that the staff had been �fantastic� when their family member lost weight. They told us that their weight and food intake had been monitored each week until they had regained weight. A visiting professional also told us that the care for people at the end of their lives was good.

Most of the people living at the home and their relatives told us that they thought there were enough staff on duty to care for their needs. However, some of the staff and a visiting professional said that there were not enough staff during the early mornings. We spoke with the manager about this and they told us that they would put another member of staff on duty during the morning shift to make sure people were cared for promptly.

On the day of the inspection visit we found that the front door and the door bell were not working properly. We were concerned about this because we were able to enter the home without the staff having knowledge of our presence. We were also able to enter the living room without being asked to confirm our identity. We saw that the people in the living room were vulnerable because there were no staff in the room. We spoke with the manager about this and they told us that the door had an electrical fault. They told us that this concern had been raised with the provider on several occasions. We also saw that there were several other repairs needed around the home and some of these posed a health and safety risk to staff and people living at Bay House.

One of the relatives also raised a concern about the care of their family member. They told us that their family member had a recent fall and the staff had delayed in calling for an ambulance. We were concerned about this because on admission to the hospital the person was diagnosed with a fracture to their hip. We spoke with the registered manager about this and they told us that they had investigated this incident. They told us that they had put together an action plan to make sure that this did not happen again.

Reports under our old system of regulation (including those from before CQC was created)