The inspection took place on Monday 29 February 2016 and Tuesday 1 March 2016 and was unannounced. The inspection was carried out by a single inspector on both days.Bymead house is a residential and nursing home situated in Charmouth. It is registered to provide care for up to 30 people and had no vacancies at the time of inspection. The home is a detached property with rooms set out over two floors accessed by stairs or a passenger lift. There are lounge and dining areas on each floor of the home and a rear garden which is fully accessible. 27 of the bedrooms have an ensuite bathroom and all have call bells.
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.
Medicines were stored safely at the home. Medicines were given appropriately according to the MAR (Medicine Administration Records). The MAR correlated with the medicines held at the home.
We looked at the creams which people used at the home. Each cream had a chart with written instructions and a body map indicating the area where the cream should be applied. We looked at creams for three people and found that in two cases, people had additional prescription creams in their rooms which they were no longer using. These should have been disposed of and we told the registered manager about this who immediately removed them. We spoke with staff who were able to tell us what creams were required and the charts in peoples rooms correlated with which creams should be used. We recommended that the creams for all people at the home should be reviewed to ensure that old stock was disposed of.
Staff were aware of how to keep people safe and had undertaken safeguarding training, they were able to explain the signs of abuse and knew how to report any safeguarding concerns
Although some of the staff and people we spoke to didn’t feel that there were enough staff, people’s care and support needs were met. We spoke with the registered manager about staffing and they explained that they use ratios to plan staffing and discuss with staff how to best use them to meet the needs of the people.
We saw evidence of group supervisions from January and February 2016 and the written documentation from these. We saw that each member of staff had scheduled individual supervision bi-monthly and we also saw evidence that the Registered Nurses(RN) had discussed and agreed a plan for managing these for other staff. The registered manager told us that they were in the process of rolling out the individual supervision plan.
The service was effective. Staff had detailed knowledge about the people they were supporting. We spoke to people about the support they received from staff and one told us that staff “support in the way I want”. Another said “If there is something you really wanted, they would get it for you”.
Staff told us that they communicate well and used staff meetings and staff handovers to discuss how to support people. A staff member said “we bring things we want to discuss and set an agenda beforehand”. Another told us that if staff are unable to attend, they “have input via a paper note and the issues are discussed”.
Staff were aware of the MCA and had received training. They were able to explain how they supported people with decision making. For example, one staff member told us that if a person “was confused or unable to make a decision, I would give space and reapproach” they also told us that they would tell the registered nurse(RN) in case the confusion evidenced a change to their health.
People, staff and visitors all told us that the food was good. One person said that the “catering is excellent”, another said that the “food is very nice, no problems at all”. Visitors also told us that the “food is good, offered choices”. Another said that their relative “loves the food, (it is) one of the best things about here”. Visitors said that they were invited to have meals, one told us “meals are good, I’ve stayed for two meals”, another told us that they had been in for lunch recently.
People and visitors told us that the service was caring. One person said “they’re ever so kind aren’t they” and another told us “I’m comfortable, well fed and looked after”. A visitor told us they were “always pleased how happy and cheery the staff are and (there is) a nice atmosphere”. Another visitor said that people were “well cared for, staff are nice, approachable and helpful”.
We looked at the resident’s information and found that advocacy services were explained. However people and staff were not aware about advocacy services. We told the registered manager about this and they told us that they would make sure people, visitors and staff were aware about advocacy and how to refer.
We observed that staff treated people with dignity and respect. We saw one staff member knock on a person’s door and ask whether they were “ready for your wash?”, when the person confirmed that they were, the staff member then closed the door. The service had a system in place to indicate if people were receiving personal care and staff we spoke to were clear about how to use this and also told us about the different ways in which they supported people’s privacy and dignity.
Staff knew the individual needs of people they were supporting. They were able to tell us the preferences and dislikes of people and these were reflected in the care records. People’s care records were written in a person centred way and promoted independence. For example. one record said “encourage me to maintain some of my independence such as washing my face and hands”.
People could visit when they wanted. One person told us that there were “open visiting times and (visitors) come in whenever”. Another said that they didn’t “have to ask if people can visit, they just come in”. Visitors said that “we wander in and out as if it’s your own home”. We observed that visitors arrived at various times throughout the inspection and some chose to stay to share a meal with their relative.
There was an activities co-ordinator and a monthly activities plan with different options every morning and afternoon. Activities included hand massage, art and reminiscence as well as regular trips out. One person told us “anything, I will join in, no problem”. Another person said that they enjoyed “going on trips” in the minibus owned by the service. There were a range of different social opportunities available and people were encouraged to be involved.
People told us that the service was well led. One person said that the “registered manager is a nice person, I would talk to them if I had any problems”. Another person told us that the “registered manager comes in (to each bedroom) each morning and checks on us”. One visitor said that the “management is brilliant, lovely to the people and on the ball. They are straight and firm” and another said that the “registered manager is wonderful”.
Staff spoke highly about their management team. One staff member said that they had “always found them to be completely approachable”. Another said that the “registered manager checks in every morning and the focus is all about the care”. Another told us the registered manager “does a good job of keeping everyone happy. Very approachable and has an open door policy”.
The registered manager had monthly audits in place which covered areas including maintenance, health and safety, medication and care plans. Information from these audits was used to inform changes to the service. For example, one audit highlighted the need to update the nursing documentation to reflect the fundamental standards. The service had commissioned an outside company to provide a quality assurance audit and again, had used this information to inform change.