We carried out a review of the data available to us about Bywell House Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Bywell House Care Home, you can give feedback on this service.
We found the following examples of good practice.
At the time of the inspection, the home was closed to visitors because of an outbreak of COVID-19, with the exception of health and social care professionals who were providing support to people and staff. When the home re-opened, visitors would be required to undertake a lateral flow device test and receive a negative result before being allowed in. Temperature checks, handwashing with alcohol gel and the vaccination status of professionals were all reviewed to protect people from the risk of infection. Visitors were required to wear personal protective equipment when entering the home.
All staff working at the home had been fully vaccinated and completed daily lateral flow device tests before coming to work. They had been trained in the donning and doffing of personal protective equipment and the use of this when providing care to people.
Regular testing for COVID-19 for people and staff helped to prevent the risk of the spread of infection. The majority of people did not understand the concept of social distancing, and the layout of the home meant that people were in close contact with each other in communal areas. Risks had been assessed and identified and measures were taken to mitigate the risk of serious infection. A machine had been purchased that could be used to thoroughly clean parts of the home; this sprayed a fine mist that helped to disinfect and sanitise the premises. The home was well-ventilated, clean and hygienic.
The registered manager had a clear understanding of current government guidance with regard to the management of COVID-19, and the provider’s policies reflected this guidance.
We found the following examples of good practice.
The home had been impacted by an outbreak of Covid-19 early in 2021, and had only recently re-opened for new admissions. Visitors were required to undertake a Lateral Flow Device (LFD) test and obtain a negative result, before being permitted to visit. Visits were made by appointment. Visitors were supplied with Personal Protective Equipment (PPE) such as masks, aprons and gloves. There was a notice on the front door of the home giving information and guidance for anyone intending to visit the home. Except for people receiving end of life care, where visitors were permitted into people’s bedrooms, visits took place in an outside chalet which had a separate entrance. The chalet was thoroughly cleaned between visits. When the home had been closed, people stayed in touch with their loved ones through video calls.
The home had introduced and maintained effective systems and processes to prevent the spread of infection. Staff wore PPE and received training in Infection Prevention and Control (IPC). Their competency in IPC practice was monitored. For example, competency checks were completed on staff hand-washing techniques. Staff had easy access to PPE around the home.
Staff undertook twice weekly LFD tests and weekly Polymerase Chain Reaction (PCR) tests. People completed PCR tests every 28 days. Some people and staff were exempt from testing having contracted Covid-19 previously.
Observations around the home evidenced that laundry, including soiled washing, was managed safely. Regular cleaning schedules, including deep cleaning and sanitising of high-touch areas, had been implemented.
Staff were encouraged to take their breaks separately. There were sufficient staff to support people safely.
At the last inspection, the service was rated 'Good'. At this inspection, we found the service remained 'Good'.
People were protected from avoidable abuse and harm by trained staff. Risks were assessed, identified and managed appropriately, with guidance for staff on how to mitigate risks. Premises and equipment were managed safely and work was in progress to install a new wet room. Staffing levels were sufficient to meet people’s needs and new staff were vetted as to their suitability to work in a care setting before commencing employment. Medicines were managed safely.
Staff had been trained in a range of areas to enable them to provide effective care to people in line with their support needs. Staff received regular supervision and appraisals of their work and performance. Staff meetings were organised. 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 support this practice. Menus provided people with a range of food choices and people enjoyed the food on offer at the home. Healthcare professionals were consulted as needed and people had access to a range of healthcare services.
Staff were kind, caring and compassionate with people. Relatives visiting the home were welcomed and included in the activities. People and their relatives were supported to express their views and encouraged to make decisions about their care. They were treated with dignity and respect.
Care plans were detailed and provided comprehensive information about people, their personal histories and preferences. Staff demonstrated that they had a good knowledge of people’s care needs and that they knew people well. Activities were organised by care staff and entertainers visited from outside the home. Complaints were managed in line with the provider’s policy.
People and their relatives were involved in developing the service; their views and feedback were obtained and acted upon. Residents’ meetings took place and questionnaires were completed by relatives. Feedback was overwhelmingly positive. A registered manager was in post and was freely available to people, relatives and staff. Good quality care was delivered and a system of audits was in place to measure and monitor the service overall. Any actions identified were acted upon.
Further information is in the detailed findings below.
The inspection took place on 7 July 2015 and was unannounced.
Bywell House Care Home provides care for up to 20 older people with dementia care needs. At the time of our inspection, there were 20 people living at the home. Bywell House is a large detached house in the ‘poets’ area’ of Worthing, not far from the town centre and seafront. The bedrooms are all single occupancy and communal areas comprise a large living room, dining room and separate ‘quiet’ room. Accessible gardens furnished with benches and seats are situated at the front of the property.
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 2008 and associated Regulations about how the service is run.
People were protected from avoidable harm and risks were identified, assessed and managed safely. Staff were trained to recognise the signs of potential abuse and had been trained appropriately. Accidents and incidents were recorded and risk assessments updated accordingly. Staffing levels were sufficient to keep people safe and meet their needs. The service followed safe recruitment practices. Medicines were managed safely.
Staff had received all essential training and were encouraged to take additional qualifications in health and social care. New staff shadowed more experienced staff as part of their induction programme. Staff received regular supervisions and were observed in their work practices. Requirements under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards were followed by staff. People’s capacity to make decisions had been appropriately assessed. There was a choice of food and drink available to people and special diets were catered for. People had access to a range of healthcare professionals. Communal areas in the home had been decorated or arranged in a way that enabled people living with dementia to navigate their way around the premises.
People were cared for by kind and friendly staff. They enjoyed the company of pets who had the run of the home. People were encouraged to eat and drink and to take their medicines as needed. The services of an interpreter had been utilised for one person where English was not their first language. People were involved in making decisions about their care and treatment where possible and were treated with dignity and respect.
Care plans provided staff with detailed information about people and their personal histories. Their needs had been assessed and the information provided staff with guidance on how people wished to be cared for. There was a range of organised activities available to people within the home. A BBQ was planned in the summer. People could access the gardens if accompanied by a responsible person. People were also able to go out into town, the park or down to the seafront, if accompanied. Complaints were dealt with effectively in line with the provider’s complaints procedure.
People were asked for their views about the service and had daily contact with the registered manager. Relatives felt welcome at the home when they visited and were asked for their feedback about the home. The registered manager said the culture of the home was “family orientated” and this philosophy was shared by the staff. Staff worked well as a team and regular team meetings were held. There were robust quality assurance and governance systems in place to audit the quality of care delivered. Where issues had been identified, these had been managed effectively and resolved.
One person told us 'Care is very good, I can't fault it. My mother loves the staff, they always have a smile.' Where people were not able to understand their care and treatment choices, records showed that there was consultation with relatives.
People and relatives consistently told us that the staff sought prompt medical advice and assistance. One person who used the service said 'I see the doctor when I need to.' A visiting nurse told us that one person's end of life care needs had met very well by the service. They said 'Our treatment plans were followed, and pressure areas improved.'
We found that the provider had responded appropriately to allegations of abuse. We spoke with a member of staff for the local authority who investigated safeguarding alerts. They told us that the service had cooperated in investigations and had appropriately reported concerns. This meant that the service had acted to protect the people living at Bywell House.
People we talked with felt that staff did a good job. A person who used the service told us 'Staff are very helpful and friendly'. A relative said 'Staff have a good understanding of dementia and my mother.' We found that staff received appropriate professional development such as training and support.
A survey of people's views about their experiences at the service had been recently carried out. The analysis of the feedback received showed that responses had been received from ten relatives of people who used the service, five members of staff, and four visiting professionals. One member of staff had written 'The home is running well, and many families comment on this.' Compliments from relatives had included 'Your resilience, patience and tolerance as well as your kindness have been so appreciated.'
We examined the care records of four people who used the service. We also spoke with four staff working at the time of our inspection.
We were able to speak with four people who used the service. One person told us, 'They serve up some good meals.' Another person told us that, 'Some of the staff are wonderful.'
We found that people's dignity and independence was respected in the service. We observed instances during our inspection where people were provided with a choice and were mostly treated with respect.
People experienced care, treatment and support that met their needs and protected their rights. We saw evidence that care provided to people met their individual needs.
We found that there was a sufficient number of staff on duty for each shift to support the needs of people in the service. We viewed the staff roster, spoke with four members of staff and four people who used the service.
We found that people's personal records including medical records were accurate and fit for purpose.
People told us that there are enough staff on duty to meet peoples' needs although one person said that staff are sometimes rushed.
We were told that people can choose what they do. For instance, one person said that he/she can get up when he/she wants.
People said that they like the food, commenting that it is tasty and that there are ample portions.
People said that they feel safe at the home.
Social services reported that the home has improved its performance under the new acting manager and that there have been no more safeguarding incidents or referrals to deal with. The provision of food was said to have improved as well as the care of the people. At the time of this review social services did not have any concerns about the service and confirmed their view that peoples' needs were now being met.
At the time of this visit the service had an acting manager. It was unclear when a permanent manager will be appointed to run the home.
The Commission has received information from social services regarding the home's lack of ability to meet people's care needs to the extent that social services have concluded that several people's needs have been neglected. In addition, social services' investigations have concluded that one person was assaulted by a member of staff and that the home's staff have had an attitude to people that is described as abusive. This has resulted in decisions being made that several people's needs cannot be met by the service and alternative placements have been sought. At the time of this review social services were looking to move two more people. As a result of this, the registered manager has left the service and the provider has appointed an interim acting manager to oversee improvements at the home. Social services report their confidence in the new manager's ability and competence to improve the home's performance. An action plan has been drawn up by social services and agreed with the providers so that improvements can be made to the home's management, staff performance, staffing levels and to the environment. The acting manager stated that she is working with social services to improve the standard of care at the service. At the time of this review social services report that the service is making progress in working to the agreed action plan.