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Inspection carried out on 19 October 2018

During a routine inspection

Bailiffgate is a care home that provides accommodation and personal care for a maximum of 11 people with a learning impairment. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. Bailiffgate accommodated eight people at the time of the inspection. The service operates from one large house.

Plans were in place for the care service to adapt and to be developed and designed in line with the values that underpin the Registering the Right Support guidance. The model of care proposed from 2015 and 2016 guidance that people with learning disabilities and/or autism spectrum disorder which proposed smaller community based housing. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

At our last inspection in September 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained good.

The atmosphere was welcoming and the building was well-maintained with a good standard of hygiene. A professional commented, "The manager and team are welcoming and professional and enable effective assessment and support planning with people."

Staff were kind and caring and had developed good relationships with people using the service. People were comfortable in the presence of staff. Relatives confirmed the staff were caring and looked after people very well.

People told us they were safe and were well cared for. Several people commented, "I love living here." Staff knew about safeguarding vulnerable adults procedures. There were enough staff available to provide individual care and support to each person. Staff upheld people's human rights and treated everyone with great respect and dignity.

Staff were well supported due to regular supervision, annual appraisals and a robust induction programme, which developed their understanding of people and their routines. Staff also received a wide range of specialised training to ensure they could support people safely and carry out their roles effectively.

Staff were skilled and knowledgeable and they were committed to making a positive difference to each person. There was clear evidence of collaborative working and excellent communication with other professionals in order to help people progress and become more independent.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff knew the needs of the people they supported to provide individual care and records reflected the care provided. Arrangements for managing people’s medicines were safe.

Staff were well supported by the registered manager and senior management team. The registered manager had a clear vision for the service and its development. They were enthusiastic and believed strongly in the ethos.

People had food and drink to meet their needs. They were provided with opportunities to follow their interests and hobbies and they were introduced to new activities. They were all supported to contribute and to be part of the local community.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Information was accessible and made available in a format that helped people to understand.

There was regular consult

Inspection carried out on 12 July 2016

During a routine inspection

Bailiffgate is located close to the centre of the town of Alnwick. It provides care for up to eleven people who have learning disabilities. There were nine people using the service when we carried out our inspection.

The inspection took place on the 12 and 19 July 2016 and was unannounced. The service was last inspected on 14 and 15 December 2014. There was one breach of regulations at that inspection related to the numbers of suitably skilled staff deployed in the service. It was also found that documentation related to decisions taken in the best interests of people needed to be improved. We found that there had been an improvement in relation to both of these issues during this inspection.

A new manager had been appointed and was in the process of being registered with the care Quality Commission (CQC). There were plans to recruit a deputy 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 received feedback about a number of positive changes made by the new manager.

Suitable numbers of staff were deployed and there had been an increase in staffing since the last inspection. This included the appointment of an activities coordinator. Safe recruitment procedures were followed which helped to protect people from abuse.

Safeguarding policies and procedures were in place and staff had received training in the safeguarding of vulnerable adults. A session had been held with people to raise their awareness of safeguarding issues and how to tell someone if they had concerns.

We checked the management of medicines and found there were suitable procedures in place for the ordering, receipt, storage and administration of medicines. Routine stock checks and audits of medicines were carried out and the competency of staff to administer medicines safely was checked on a regular basis.

Checks on the safety of the premises were carried out including gas and electrical safety and window restrictors and water temperatures. Debris which could have posed a hazard was found in the rear garden and was awaiting disposal. This had been removed by the second day of the inspection.

Individual risks to people were assessed such as risks associated with road safety, behavioural disturbance and falls. Where risks had been identified, care plans were in place. These were up to date and regularly reviewed. A record of accidents and incidents was maintained and monitored for any patterns or trends.

Suitable infection control procedures were in place. The home was clean and well maintained and bedrooms were nicely personalised and homely.

Staff received regular training which was relevant to their role. Staff received regular supervision, and annual appraisals were carried out. This meant that the development and support needs of staff were met.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). Capacity assessments had been carried out and ap

Inspection carried out on 12 and 15 December 2014

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

The inspection took place on 12 December and was unannounced. We carried out a second announced visit to the home on 15 December 2014 to complete the inspection.

The home was last inspected on 21 May 2013 when the provider met all the regulations inspected.

Bailiffgate is a care home located in Alnwick. It can accommodate up to 11 people who have learning disabilities. There were 10 people using the service at the time of our inspection.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

Some staff, relatives and health and social care professionals felt that more staff were required to ensure people’s safety. They said that the registered manager was sometimes included in the staffing numbers and often needed to spend time on management duties. One staff member said, “[Name of registered manager] is included in the numbers and if she is busy then that leaves us with two staff and if one member of staff goes out with a resident that leaves us with one.” Staff also explained that extra staff would enable them to undertake more one to one activities with people.

There was a sleep-in member of staff on duty during the night. They were required to wake up if assistance was required. We were concerned however, that staff might not wake during the night to give the necessary assistance. One person had epilepsy and an epilepsy monitor was not in place. Such a monitor would alert staff through the night that an epileptic seizure was taking place. The compliance manager informed us this equipment was on order and they were reviewing staffing levels at the home as part of an ongoing process.

This was a breach of regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This corresponds with regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action we have asked the provider to take can be found at the back of this report.

We checked medicines management. The home was changing to a new pharmacy supplier due to problems with the previous supplier. We noted there were some gaps in the administration of topical medicines. The registered manager informed us that the new medicines system would help address the issues with recording of topical medicines.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The manager had submitted DoLS applications to the local authority to authorise. This procedure was in line with legislation. We found however that further improvements were required in this area to ensure “decision specific” mental capacity assessments were carried out in line with legislation.

We found that people’s nutritional needs were met and people were happy with the food provided. Staff were knowledgeable about people’s needs. We spent time observing staff interactions. We observed that people appeared comfortable with staff. They were smiling and laughing. We noticed there were positive interactions between people and staff, but some interactions were more positive than others. Certain staff appeared more confident at communicating with people than others. Further training around effective communication had been arranged with the speech and language therapist.

We noticed staff did not always involve people in day-to-day skills such as cooking. This was confirmed by the local NHS care manager and member of staff from the BAIT [Behaviour and Intervention Team]. The registered manager and compliance manager told us the service was adopting the active support model. Active support is a model of support that aids people to plan the best use of their time, with the correct level of support and engage in all activities that make up day-to-day living.

We considered that further improvements were required to ensure people received personalised care that was responsive to their needs.

A complaints process was in place. The compliance manager informed us that if people or relatives were unhappy with the outcome of a complaint a face to face meeting would be arranged, where concerns could be discussed further.

The compliance manager explained there had been a change in the provider’s organisational structure. A new chief executive had been appointed in June 2014. The previous chief executive had been in post for 18 years.

We asked the staff for their opinions on working at Bailiffgate. Most staff told us that more support from the registered manager would be appreciated and commented that morale was sometimes low.

We considered that improvements were required to ensure that there was a positive culture within the home and visible leadership.

Inspection carried out on 21 May 2013

During a routine inspection

We talked with seven people and one relative to find out their opinions of the service. Some people had difficulty communicating verbally with us because of the nature of their disability. However they gestured to us to indicate that they enjoyed living at Bailiffgate. One person's relative informed us, “I would recommend it 101% just going off my personal experience.” In addition, we spoke with one person’s social worker. She said, “It’s a friendly family home.”

We concluded that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We found that people were supported to be able to eat and drink sufficient amounts to meet their needs. They were provided with a choice of suitable and nutritious food and drink.

We concluded that there was enough equipment to promote the independence and comfort of people who used the service

There were effective recruitment and selection processes in place.

People’s personal records and those relating to staff and the management of the home were accurate and fit for purpose.

Inspection carried out on 10 October 2012

During a routine inspection

We spoke with five people and three relatives to find out their opinions of the service. A high proportion of people who used the service were unable to express their views on the care they received because of the nature of their condition. However people indicated or gestured that they enjoyed living there.

Relatives told us and records confirmed, that consent was gained before care and treatment was carried out. One relative said, “X had to go for a dental procedure and I got a written form to sign.”

Relatives were extremely complimentary about the service and the care and support provided. Comments included, “It’s absolutely brilliant” and “I’m really really happy with the care.” We considered that people experienced care, treatment and support that met their needs and protected their rights.

Relatives we spoke with were complimentary about the cleanliness of the service. Our own observations confirmed this. We considered that people were cared for in a clean, hygienic environment.

Relatives told us and our own observations confirmed that there were enough staff at the home to meet people’s needs.

Relatives said they felt able to raise any concerns or comments about the service and that they had no complaints to make. Records confirmed that people were made aware of the complaints system.

Inspection carried out on 10 January 2012

During a routine inspection

A high proportion of people who used the service were unable to express their views on the care they received because of the nature of their condition. Because of this we spoke with staff and observed their practices in order to determine how this care and support was carried out.

Staff told us that they enjoyed working at Bailiffgate. One member of staff said, “it’s like home from home. It’s lovely to work here.”

We saw surveys had been carried out in April 2011 for people, relatives and supporting professionals. One relative had commented, ‘Bailiffgate is a happy home with God inspired loving and caring staff.’