Archived: Bay Tree Court Care Centre

Bay Tree Court Care Centre 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. Bay Tree Court Care Centre accommodates 59 people in one adapted building. At the time of our inspection there were 41 people living at the home. Bay Tree Court Care Centre no longer provides nursing care.

At the time of our inspection Bay Tree Court Care Centre did not have a registered manager in post. The current manager was planning to apply to be registered with the CQC.

We carried out an unannounced comprehensive inspection of this service on 9 and 12 March 2018 and rated the service ‘Good’. After that inspection we received concerns in relation to the care people received. As a result, we undertook a focused inspection to look into those concerns and our findings are noted in this report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”

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 on-going 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.

Why the service continues to be rated ‘Good’.

The service was implementing the findings of an investigation into recent concerns about people’s care. Their identified areas for action included, monitoring staff’s moving and handling practices and ensuring records relating to people’s care where completed once the care had been given.

People had opportunities to take part in seasonal activities. There were arrangements in place for people and their representatives to raise concerns about the service. Care was provided for people at the end of their life.

Effective quality monitoring systems were in operation. The service was relying on agency staff whilst recruitment was in progress to build a stable staff team. Staff ensured when there were unplanned staff absences that shifts were effectively organised to keep people safe.

Further information is in the detailed findings below.

At the time of our inspection Bay Tree Court Care Centre had a registered manager in post. At our previous inspection in September and October 2016 the service was rated Requires Improvement. At this inspection we found the service was rated Good.

We found improvements to the management of people’s medicines, the accuracy of records relating to people’s care and the delivery of personalised care. Quality monitoring systems had also improved.

We heard positive comments from people using the service at Bay Tree Court Care Centre such as, “All in all I’m very satisfied”, “I’m happy, no complaints whatsoever” and “Very comfortable and very well looked after”.

We found the environment of the care home was clean and had been well maintained.

People received support from caring staff who respected their privacy, dignity and the importance of independence. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People had opportunities to take part in activities both in the care home and in the wider community. People were supported to maintain contact with their relatives. Care was provided for people at the end of their life.

People were protected from harm and abuse through the knowledge of staff and management. Robust staff recruitment procedures were used and staff were supported through training and meetings to maintain their skills and knowledge to support people. There were arrangements in place for people and their representatives to raise concerns about the service. Effective quality monitoring systems were in operation.

Further information is in the detailed findings below.

During the last inspection on 29, 30 and 31 December 2015 we found the provider had not protected people against risks that may have an impact on their health and well-being, had not ensured staff received adequate training and support, had not ensured records relating to people’s care and treatment were accurately maintained and had not ensured people received appropriate care to meet their individual needs. The provider told us when and how they would address this. During this inspection we found these breaches of regulation had been met. In some related areas further improvements were work in progress, such as improvements to the content of people’s care plans, in order to help staff deliver more personalised care.

During this inspection we found the provider had not managed people’s medicines safely. You can see what action we told the provider to take at the back of the full version of the report. We also recommended the provider takes advice, from an appropriate source, to ensure that all quality monitoring processes that are carried out within the care home are being carried out effectively.

A maximum of 59 people could receive care at Bay Tree Court. During the inspection there were 42 people receiving care. The building is set off the main road with care parking to the front. Inside consists of two floors with stair or passenger lift access to the first floor. People’s private accommodation consists of single bedrooms with en suite facilities. Each floor also has lounge and dining room spaces, bathrooms and additional toilets. A safe inner courtyard can be accessed off some bedrooms and communal areas.

The registered manager has managed the care home since July 2015. 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.

In April 2016 the care home stopped employing nurses for the purpose of meeting people’s nursing needs. This change had meant that some people had needed to find alternative accommodation. It also meant if people went on to require nursing care they would need to find an alternative care home and for others it had made no difference. Some health needs subsequently needed to be managed by community nurses. This change took some external health care professionals time to adjust to and at times there was still a need to monitor requests to them to ensure people’s needs were met. People’s medical needs were met by local GPs who visited the care home on a regular basis.

There were arrangements in place to keep people safe and improvements had been made to how risks to people were identified, managed and monitored. This included nutritional risks. Staff were aware of the risks of abuse and knew how to recognise this, report concerns and involve relevant agencies. People were not discriminated against and they were able to raise concerns without reprisal.

The care home had been and still was dependent on the use of agency staff to ensure there were enough staff on duty. At the time of the inspection there had been a successful period of recruitment. Managers were waiting for new staffs’ recruitment checks to complete before they could start them. These checks protected people from those who may not be suitable. Changes in how staff were deployed, their roles and responsibilities had been made over the year to ensure the care home had the right staff available at the right time. Staff training and support had improved and some staff were also in the process of adding to their current skills. There had been resistance to these changes from staff which had slowed up progress on this but during the inspection some staff told us they felt the changes were beginning to work. These arrangements were helping staff to be in a position to be more responsive to people’s individual needs. People told us staff were busy but very caring when they attended to them.

People were supported to make their own decisions and when they were unable to do this decisions were made on their behalf and in their best interests. People who lacked mental capacity were protected because relevant legislation was followed. People had access to other health and social care professionals when needed and were free to talk to them in private. People told us they were able to make choices about their care and treatment as well as other day to day choices. People were involved in choosing what activities took place and there was a good attendance at many of these.

Relatives and representatives were appropriately involved and able to speak on behalf of their relatives. Improvements had been made to the content of people’s care records. This ensured staff and other professionals had up to date information about people’s needs. Further improvements were being made to personalise people’s care plans so care could be delivered more around people’s individual preferences and wishes. People and relatives were able to raise complaints and concerns. Over the last year several complaints had been received but they had been investigated where necessary and responded to. There was evidence to show that the issues raised had been seriously considered and steps taken to resolve these and improve the service as a whole.

Improvements over the last year to the support the registered manager received and to the senior management team in the care home had enabled the necessary changes to be managed and subsequent improvements to start having a positive impact. Representatives of the provider had been supportive throughout these changes. They had also altered and improved how they monitored the service. On-going monitoring arrangements within the home itself had not successfully identified shortfalls related to the management of medicines. This needed a review to ensure all staff involved in quality monitoring processes understood what action they needed to take for this to be effective. This inspection found that many improvements had taken place but work was still in progress to ensure changes in practice and systems were embedded and sustained.

The service provided nursing care and personal care to a maximum of 59 people. At the time of the inspection there were 51 people using the service. These were predominantly older people who required support with their physical needs. Some people also lived with dementia. Services were provided in a purpose built building which provided people with a private bedroom with en-suite facilities. There were ample communal rooms where people could sit and eat together but there were also areas where people could sit quietly or receive visitors privately.

The registered manager had been in position since July 2015. 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’s individual risks had not been consistently identified, managed and monitored. Some people had been affected by this. People were protected from abuse and those who would be unsuitable to care for them because good arrangements were in place to ensure this. Action was being taken to ensure people were protected under the Mental Capacity Act 2005. There were not always enough staff to attend to people when needed. Action had started to be taken to address this. The environment was kept safe by good maintenance arrangements and robust health and safety checks.

People’s needs had not always been effectively met. People had not been involved in planning their care, although work had started to improve the care planning process. Staff had been provided with limited training and support to help them improve their practices and knowledge. The recruitment of new senior staff was helping to address this. People had access to health care professionals and senior staff were proactive in getting advice from specialist health care professionals when needed. People received support to eat and drink and people spoke positively about the standard of food and cooking.

Staff treated people as individuals and were respectful and kind, although some staff were better at delivering caring and compassionate care than others. People were provided with opportunities to take part in group or one to one activities, if they wished to do so. Care records had not been well maintained and at times this had an impact on people because staff had lacked accurate information. Actions were being taken to address this. The registered manager was providing strong leadership and was aware of the services strengths and weaknesses. They were making changes which when embedded and sustained would ultimately improve outcomes for people.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These included: people’s risks not being appropriately identified, managed and monitored, people’s needs not always met, gaps in record keeping and a lack of appropriate staff training. You can see what action we told the provider to take at the back of the full version of the report.

We also recommended that the service review the number of staff on duty who were available to attend to people’s needs to ensure people had support when they needed it.

We saw evidence of how a new format for care plans had been introduced which focused the outcomes for people and to ensure that they reflected the care and treatment choices of people living at the service. People told us that: "staff had asked how they wished to be supported".

We looked at all of the communal and some of the individual rooms at the home. There was a programme of redecoration and refurbishment which was on-going. Staff had access to suitable health and safety and specialist training, to enable them to care and support people in the residential and nursing areas of the home.

In summary we found that Bay Tree court was providing a good standard of care and support to people living there.