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Inspection carried out on 11 March 2019

During a routine inspection

About the service: Baytrees Nursing Home is a residential care home that provides personal and nursing care for up to 30 people. At the time of the inspection, 22 people were living at the home. The home supports people with a variety of healthcare needs, including multiple sclerosis, Parkinson’s disease and Huntington’s disease. The ages of people range from younger adults to older people.

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.

Inspection carried out on 2 July 2018

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

We carried out an unannounced comprehensive inspection of this service on 9 January 2018. After that inspection we received concerns in relation to people receiving safe care and treatment. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to the Key Questions under Safe, Responsive and Well Led. 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.

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 addi

Inspection carried out on 9 January 2018

During a routine inspection

The inspection took place on 9 and 11 January 2018 and was unannounced.

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 awa

Inspection carried out on 6 January 2016

During a routine inspection

The inspection took place on 6 January 2016 and was unannounced.

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.

Inspection carried out on 29th October 2014

During a routine inspection

The inspection took place on the 29th and 30th October 2014and was unannounced.

Baytrees Nursing Home provides accommodation for up to 29 people. The home is equipped to provide high levels of nursing care for people with physical disabilities and conditions, including young adults and older people, for permanent and respite care.

At the time of our inspection the registered manager was not in place.

‘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.’ The registered manager had not been working at the home for a year and had failed to notify the Commission. There was an acting manager in post who had applied to become the registered manager.

The experiences of people were positive overall. People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good.

The home met people’s nutritional needs and people reported that they had a good choice of food. Links with healthcare professionals were developed and they stated that the home followed their advice and delivered appropriate care.

Systems and processes were in place to keep people safe and any required improvement that was needed. The home did not have suitable numbers of regular staff with the required skills and experience. Vacant posts needed to be filled, to ensure consistent staffing numbers were maintained. The home had suitable arrangements in place, using agency staff where needed. This meant people may experience inconsistent levels of care and support.

People’s needs were assessed and care plans were developed to identify what care and support they required. Staff liaised with other healthcare professionals to obtain specialist advice to ensure people received the care and treatment they needed.

Staff were patient and polite when supporting people. Staff supported people to eat and they were given the time to eat at their own pace staff asked if they had finished or wanted more. Staff supported people to maintain their dignity and were respectful of their right to privacy.

Most staff felt supported by management to undertake their roles. They had not been receiving regular, formal, supervision and appraisal.

People had access to suitable activities which they enjoyed. Activities took place in and out of the home with regular trips out to local attractions. This included trips to local shops, dog racing, bowling and garden centres.

Resident and staff meetings were not regularly taking place which was missed an opportunity for staff and people to feedback on the quality of the service. Staff and residents told us they would like more regular meetings and felt them to be beneficial.

There was a lack of quality assurance and audit processes. For example the acting manager was not aware of all accidents that had not been followed up and not all complaints had been dealt with effectively.

Staff and management of the organisation were consistent in what they thought were the key challenges faced by the organisation. The majority thought that staffing issues had an impact on the home. The home were planning to address this issue with a new recruitment process.

Inspection carried out on 24 October 2013

During a routine inspection

We spoke with four people who lived at the home. They were satisfied with the care and support they received and were happy living at Baytrees Nursing Home. One person told us, "I do like it here. The place I was before was nowhere near as good as this". Another said, "I have everything I need here. The staff really look after me well". A visitor said, "This is a home from home. I'm always made welcome when I visit". We noted that the home employed two activities co-ordinators; the people we spoke with were happy with the number and variety of activities on offer.

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.

Inspection carried out on 27 March 2013

During a routine inspection

We talked with the majority of the people who used the service, both individually and as we were shown around the building by the provider. They told us that they liked living there, that the care staff showed them respect and looked after them well. They also told us that they were comfortable. One person told us that, �This place suits me, I get out when I want to and get all the help I need.� Another person told us, �I have lived in a few places like this, but this is the best of the lot.�

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.

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