Baytrees Nursing Home

Baytrees Nursing Home is a residential care home providing personal and nursing care to up to 30 people with a variety of health care needs, such as Parkinson’s disease, stroke or frailty of old age. At the time of our inspection there were 27 people using the service in one adapted building.

People’s experience of using this service and what we found

Some medicines had not been disposed of as required. Prescription labels for some of these had been removed and the medicines retained in stock. Some medicines had been removed from their packaging so it was not clear who the medicines had been prescribed for. People were at risk of receiving medicines that had not been prescribed for them.

Systems for monitoring and measuring the service overall had not identified issues found at this inspection.

The home was clean and well-maintained. One person said, “They come in and clean my room. If I’m sleeping, they won’t disturb me. They keep the house clean and if they didn’t, they’d get an earful from the boss!”

People felt safe living at the home, and staff were trained to recognise signs of potential abuse and how to protect people from the risk of harm. There were sufficient trained staff to meet people’s care and support needs, and new staff were recruited safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s diverse needs were recognised and catered for by staff who felt supported in their roles. One person said, “I think it’s good here, it’s all right”.

Residents’ meetings were organised and enabled people to comment about the care they received; these were reviewed and actions taken if needed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 21 July 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Baytrees Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to the disposal and storage of some medicines at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Baytrees Nursing Home is a care home providing personal and nursing care for people

living with a variety of mental health and complex physical health needs. The home supported one person living with a learning disability. There were 28 people living at the service at the time of inspection, the ages of people varied from younger adults to older people. The service can support up to 30 people.

People’s experience of using this service and what we found

People had a wide range of needs and diverse backgrounds, they received individualised support from staff. People were relaxed in the company of staff and we observed friendly interactions. One person told us, "I like to have people around who knows about my condition and how to help me."

People’s needs were met by trained and confident staff. Staff described training opportunities provided to ensure appropriate support for people. Due to people’s complex needs, adaptations and equipment were available for individual’s use. The service sought professional input to improve outcomes for people. A visiting professional told us, "Residents are cared for well and I see the same staff which is good.”

People were supported to make their own choices which were respected. For example, staff offered drinks and people requested a large variety of drinks. One person told us, "The food is the best ever, they supply a menu and you just tick the boxes of what you want."

People confirmed they felt comfortable to speak with staff. One person told us, "The staff are very discrete here, if I ever want to ask for something or talk in private, they will come to my room or we will go somewhere private." People and their relatives were confident in the registered manager and knew them by name. A relative told us, “I have had no cause to complain, if I did, I would speak to staff or [registered manager’s name], we know them all we have such a laugh when we are there.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of Safe and Well led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people's choice, control and Independence. People had access to professional advice and equipment to maximise their independence.

Right care:

• Care is person-centred and promotes people's dignity, privacy and human rights. Staff demonstrated how individualised support was offered to people.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. People’s consent and views were valued by staff and management, improvements had been made to the environment with people’s input.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 2 May 2019).

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. This enabled us to look at the concerns raised and review the previous ratings.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Baytrees Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service met the characteristics of Good overall.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

¿Significant improvements had taken place since the last inspections took place in January and July 2018. However, there were still areas in need of further improvement to ensure people received a consistent, good standard of care. Further work was needed to sustain and embed the improvements made. The registered manager acknowledged she had not completed registered nurses’ competences to administer medicines and that this was work in progress.

¿ People were complimentary about the home and were happy living there, but some people felt that staff were too busy to spend time with them. One person told us, “I’d like to go out, but I will need someone to go with me and there aren’t the staff”. Since the activities co-ordinator had left, there was a lack of organised activities for people and staff did not have time to spend with people outside their caring responsibilities. The provider and registered manager were aware of this and a new activities co-ordinator had been recruited and was due to start the following week. Records showed and we observed that, staffing levels were sufficient to keep people safe.

¿New staff were recruited safely. The majority of staff had received supervisions in 2019 and other staff were due to have supervisions. Staff had completed all the training required to enable them to provide care and support to people in line with best practice. Medicines were managed safely. Care plans had been updated and provided detailed information about people with guidance for staff. People’s risks had been identified and assessed and were managed to mitigate risks.

¿People told us they felt safe living at the home. Staff had completed training in safeguarding and knew what action to take if they suspected abuse was taking place. People’s capacity to make decisions had been assessed. No-one was deprived of their liberty unlawfully. People enjoyed the meals on offer and special diets were catered for. People had access to a range of healthcare professionals and services.

¿People were looked after by kind and caring staff who knew them well. People were treated with dignity and respect and encouraged to be involved in decisions relating to their care and support. People and staff felt the service was well led. They were asked for their views about the service through surveys, residents’ meetings and staff meetings. The provider and registered manager understood their responsibilities under the duty of candour. People’s diverse needs were met.

Rating at last inspection: At the last inspection, this service was rated as Requires Improvement The last inspection report was published in July 2018.

Why we inspected: We were required to inspect this service within 12 months of the last inspection because of the rating of Requires Improvement. The provider sent us an improvement plan after the last inspection which outlined the actions they proposed to take to address the issues of concern. This inspection took place to check on the improvements made and in line with CQC scheduling guidelines for adult social care services.

Follow up: We will review the service in line with our methodology for ‘Good’ services.

This focused inspection took place on 2 and 13 July and was unannounced. No risks, concerns or significant improvements were identified in the remaining Key Questions under Effective or Caring through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection. As a result of this focused inspection, the rating for Responsive has deteriorated to Requires Improvement. The overall rating for this service remains as Requires Improvement.

Baytrees Nursing Home is registered to provide nursing and personal care and accommodation for up to 30 people with a variety of health care needs in one adapted building. At the time of the inspection 29 people were living at the home. Communal areas include a large sitting room which also serves as a dining room and a further lounge/conservatory area which has access to the rear garden. Baytrees Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

A registered manager was 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.

Gaps in recording in relation to people’s care and support needs were identified. Information within care plans and daily monitoring charts was not recorded in a consistent way. Systems were not effective in auditing the service to identify any areas in need of improvement. Some aspects of medicines were not managed safely. We have made a recommendation in relation to the management of medicines.

Staff completed training in safeguarding adults at risk and knew what action to take if they had any concerns. People were looked after safely and staff were attentive to people’s needs. Staffing levels were adequate and regular agency staff filled any gaps in staffing rotas. The provider was in the process of recruiting new, permanent staff. Recruitment systems were robust and all necessary checks were completed before new staff commenced employment. Staff were trained in infection control; the home was clean and smelled fresh.

Complaints were managed in line with the provider’s policy. People’s wishes were identified and acted upon as they reached the end of their lives.

Staff felt supported by the management team and enjoyed working at the home. Staff meetings took place and staff said they were listened to; there was an 'open-door' policy. People and staff’s diverse needs were respected and catered for. People and their relatives spoke positively about the care and nursing staff. Residents’ meetings took place and people were encouraged to give their feedback about the home.

In an update from the provider in October 2018, systems had been created to ensure that staff knew where to record information and where to access this. Fifteen care plans had been fully completed and updated with a further four care plans to be completed within the week. Plans to recruit an additional activities co-ordinator had not been successful. However, the existing activities co-ordinator was working extra hours to provide more activities for people at the home.

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

Baytrees Nursing Home is registered to provide nursing care and accommodation for up to 30 people with a variety of health care needs in one adapted building. At the time of the inspection 27 people were living at the home. Communal areas include a large sitting room which also serves as a dining room and a further lounge/conservatory area which has access to the rear garden. Baytrees Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

A registered manager was 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.

When we completed our previous inspection on 19 February 2016, we found concerns relating to staff understanding of the Mental Capacity Act and how this was implemented. We made a recommendation that the provider ensured staff had a good understanding on this topic and were able to put this into practice. At this inspection, we were told that there had been a delay in the delivery of capacity training, but staff completed this after the inspection took place. Care plans were inconsistent in the information provided in relation to consent and lacked clarity. However, people told us that staff did consult them in decisions and sought their consent appropriately.

Not all staff had completed training as needed to ensure they had the skills and knowledge needed to undertake their roles and responsibilities. Some staff had not completed safeguarding training and they were unable to demonstrate their understanding of safeguarding and the different types of abuse they might encounter. Some training had been completed by staff, but there was a lack of oversight in this area to ensure all staff had undertaken training as needed. The induction programme for new staff was not effective and the member of staff who delivered training to staff on a range of topics only had a training qualification in moving and handling. Some staff had received supervision with their line managers, but not all.

No account had been taken of the Accessible Information Standard and how information was presented to people in a way that met their communication needs and in a format which they could understand. Some records had not been kept confidentially. The medicines audit had failed to identify the issues which we found at inspection.

Medicines were not always managed safely. A blister pack was left loose in a locked cabinet with no means of identifying who the tablets belonged to. An ophthalmic solution that was no longer required had not been disposed of as needed. People received their prescribed medicines as needed and Medication Administration Records confirmed this. Medicines were stored appropriately.

People said they were happy living at Baytrees Nursing Home and spoke positively about the registered manager. People were asked for their feedback about the service through surveys and at residents’ meetings. Some systems had been established to monitor and measure the quality of care provided. Staff and visiting professionals were asked for their views on the home. The registered manager kept up to date with latest practice in a variety of ways, through local managers’ meetings and updates from social care and health organisations. Staff felt supported by the registered manager and said there was an 'open door' policy so they could talk with the registered manager at any time. Staff thought their views and suggestions would be listened to and were aware of the provider’s whistleblowing policy.

Care records provided detailed information about people’s care and support needs. People and their relatives said they were involved in reviewing care plans, although this had not been recorded within the care records. A range of activities was on offer which were organised by a part-time activities co-ordinator. Outings into the community took place at least weekly. People enjoyed the activities on offer. People knew how to make a complaint and the complaints log evidenced that complaints were managed satisfactorily. Some people had made decisions in relation to their end of life care and some staff had completed end of life care training.

People said they felt safe living at the home. Their risks were identified and assessed safely. Staffing levels had been identified as a concern at night, when there would not have been sufficient staff to evacuate people safely in the event of an emergency. The provider had taken advice on this and proposed to increase the number of staff on duty at night by one additional staff member. After the inspection, further advice had been sought and there were plans to install a sprinkler system on the second floor to keep people safe in the event of a fire breaking out. Recruitment systems confirmed that new staff were vetted and appropriate checks made before they commenced employment. The home was clean and hygienic and there were no offensive odours. The registered manager understood their responsibilities under Duty of Candour and lessons were learned or improvements made when things went wrong.

People enjoyed the food on offer and felt supported by staff at mealtimes. Menus were planned over four weekly cycles and people had the choice of what they wanted to eat. Special diets were catered for. When people required the services of specialists and other healthcare professionals, referrals were made as needed. People had regular access to a range of healthcare professionals and services. With regard to the environment, staff commented on the lack of investment in the building and some people felt the place would benefit from redecoration.

People were looked after by kind and caring staff and felt they were treated with dignity and respect. People said they were involved in decisions relating to their care and were in control of their lives.

We found a number of issues of concern. You can see what action we told the provider to take at the back of the full version of the report.

Baytrees Nursing Home is a large detached building in a built-up residential area in Worthing. The home is registered to provide care for up to 30 people with a range of physical and mental health needs. At the time of our inspection, 27 people were living at the home. Baytrees Nursing Home has communal areas comprising a large lounge/dining area, a quiet room where people can receive visitors, a further lounge and a conservatory leading to an accessible decking area. Rooms are all single occupancy.

A registered manager was 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 supported to be safe and were looked after by staff who knew what action to take if they suspected any kind of abuse was taking place. Risks to people were identified, assessed and managed appropriately and information and guidance was provided to staff on how to look after people. Emergency evacuation plans were in place should people need to be moved out of the home in the event of an emergency. There were sufficient numbers of staff on duty and staffing levels had been assessed based on people’s individual care and support needs. Robust systems were in place to ensure new staff were recruited safely and all appropriate checks undertaken. Medicines were managed safely by trained staff.

New staff followed an induction programme and all staff received training in a wide range of areas appropriate to the needs of people they were looking after. Staff had regular supervision meetings with their supervisors and staff meetings took place. Staff did not have a thorough understanding of their responsibilities under the Mental Capacity Act 2005, although they had received training on this topic. We have made a recommendation to the provider that they put measures in place to resolve this. People were supported to have sufficient to eat and drink and to maintain a healthy lifestyle. They had access to a range of healthcare professionals and services. People’s rooms were personalised to reflect their tastes.

People were looked after by kind and caring staff and positive relationships had been developed. People and their relatives spoke highly of the staff. Staff knew about people’s personal histories and backgrounds and used this information to help build relationships. People were involved in planning their care and in making decisions about how they wished to be supported by staff. They were treated with dignity and respect. At the end of their lives, people were supported to have a dignified, comfortable and pain free death.

Care plans contained comprehensive, detailed information and guidance to staff about people’s needs. Care and treatment was delivered in line with the requirements of care plans and in a person-centred way. A range of activities was on offer to people on a daily basis with trips out into the community for meals out or theatre trips. Complaints were listened to and managed by the provider in line with the complaints policy and to the satisfaction of the complainant.

The service was well led. People were involved in developing the service and residents’ meetings were held so they could feed back their views. The culture of the home was person-centred and people’s choices were taken account of in the way they were cared for. Staff felt the home was managed well and that the registered manager was accessible and would listen to any issues they wished to discuss. Robust quality assurance systems were in place to audit a range of areas at the home and to drive continuous improvement.

We saw that people's consent was obtained where possible before care and treatment undertaken. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

We saw that the home was a safe and suitable place for people to live in. We noted that there were adequate numbers of skilled and experienced staff to deliver safe and appropriate care. We also found that systems were in place for people and relatives to make a complaint about the service if necessary and that complaints were managed in a satisfactory manner.

We observed that the staff were attentive to people's needs. Staff interacted with the people who used the service in a friendly, respectful and professional manner. We saw that staff sought their agreement before providing any support or assistance. The people we saw were relaxed, engaged with their surroundings and interacted with each other.

We saw that staff were supported through supervision and that they received training essential for caring for people living with disabilities or a debilitating disease. When we talked with staff, we found that they were knowledgeable about the people they supported.

The service had appropriate safeguards in place to protect people from abuse and people told us that they felt safe living in the service.