Bay House Care Ltd

Bay House Nursing Home provides accommodation and personal care for up to 36 older people and people living with dementia in one adapted building. Accommodation is provided over three floors. At the time of our inspection there were 33 people using the service.

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

Systems and processes to assess, monitor and improve the quality and safety of the service provided were in place. Whilst we found there were areas identified as needing to be improved, these were immediately actioned. This was regarding the management of declined medicines and a clear rationale for a person being offered a pureed diet. The registered manager provided an action plan mitigated risk.

People received safe care and support by staff trained to recognise signs of abuse or risk and understood what to do to support people safely. One person said, “I feel safe here, the staff are very kind.” Another said, “I’m safe and well looked after.” Staff had care plans and risk assessments that meant peoples’ safety and well-being were protected.

People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by appropriately trained staff, who had been assessed as competent. The home was well maintained and comfortable. There were enough suitably trained and experienced staff to meet people's needs. Safe recruitment practices had been followed before staff started working at the service.

The premises were clean, comfortable, and well maintained. The provider ensured that when things went wrong, accidents were recorded, and lessons were learned.

The home had an effective management team which provided good leadership for staff and communicated effectively with people, relatives, and professionals. Staff were positive about their roles and felt valued for the work they did.

The views of people who lived at the home, their relatives and staff were encouraged and acted upon by the management team. People and their relatives felt able to raise any concerns they had and were confident these would receive an appropriate response.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic. The manager was aware of the principles of RSRCRC. At the time of the inspection people living with learning disabilities and/or autism required nursing care.

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 22 December 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service and the age of the last rating. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Bay House Nursing Home provides accommodation and personal care for up to 36 older people and older people living with dementia in one adapted building. Accommodation is provided over three floors. At the time of our inspection there were 31 people using the service.

We found the following examples of good practice.

People were supported by staff to have visits from their friends and family in various ways throughout the pandemic. When face to face visits had not been possible, people had, had window/door visits and visits in the summerhouse in garden. The summerhouse has a glass partition which offered appropriate protection. The garden was able to be accessed through a separate entrance. People receiving end of life support were able to have visitors in their room throughout the pandemic. People also used phone and video calls to keep in touch with their loved ones.

The staff have a booking system to ensure people received their visitors safely. All people had a COVID-19 health and visitor risk assessment, which was reviewed and updated regularly. Staff provided people and their relatives with updates to keep them informed of what’s happening at the home and any changes to visiting. The website for Bay House Nursing Home also has up to date information in regard to COVID-19.

Visitors at this time were asked to wear personal protective equipment (PPE), have a lateral flow test on arrival and have their temperature taken. This included health professionals. There was a visiting policy to support visitors regarding this. A new visiting policy in line with the new government guidance was being developed.

There was a clear contingency plan for staff to follow in the event of an outbreak. The layout of the home meant that in the event of an outbreak, people could be supported to safely isolate.

The home was clean and hygienic. Cleaning schedules showed how staff had included contact areas. Personal protective equipment (PPE) stations had been placed throughout the home for staff to access easily.

Staff had received specific COVID-19 training from the provider, and this included guidance for staff about how to put on and take off PPE safely. Updates and refresher training took place to ensure all staff followed the latest good practice guidance. They were seen to be following

correct infection prevention and control practices (IPC). Hand sanitiser was readily available throughout the home.

Regular testing for people and staff was taking place. All staff have a weekly PCR and three lateral flow device test (LFD) weekly. All new arrivals to the home will only be accepted with a negative polymerase chain reaction (PCR) test and then will have LFD and isolate for 10 days. If it is unsafe for the person to isolate, then the person will have daily LFD tests and supported to adhere to social distancing.

The premises has a large lounge/dining room and people who chose to visit the dining area/communal area were supported by staff to maintain social distancing. For example, chairs and tables had been arranged to allow more space between people.

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

The inspection took place on the 26 October 2018. This visit was unannounced. A second day on the 29 October was spent talking with health professionals and visitors who visited Bay House.

Bay House 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. The care home can accommodate up to 31 older people and older people living with dementia in one adapted building. Accommodation is provided over two floors. At the time of our inspection there were 32 people using the service.

At our last inspection we rated the service good. 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 ongoing 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.

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 spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. Care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking, and moving and handling. For example, pressure relieving mattresses and cushions were in place for those who were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and epilepsy. There was a good level of information and guidance for staff to follow for those people who lived with complex needs. There were safe systems for the management of medicines and people received their medicines in a safe way.

Staff and relatives felt there were enough staff working in the home and people said staff were available to support them when they needed assistance. All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns. Staff had a clear understanding of making referrals to the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. There was a consistent use of agency staff and the registered manager ensured that the agency staff used had the necessary skills to work at Bay House. People said they felt comfortable and at ease with staff and relatives felt people were safe.

People were supported to eat healthy and nutritious diets. Food and fluid charts were completed when risk of poor eating and drinking had been identified and showed people were supported to eat and drink. Staff had received essential training and there were opportunities for additional training specific to the needs of the service. This included the care of people with specific health needs such as diabetes and strokes. Staff had formal personal development plans, including two monthly supervisions and annual appraisals. Staff and the registered manager had a good understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were very complimentary about the caring nature of staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles.

Activities were provided and were seen to be enjoyed by people who lived at Bay House. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. The service worked well with allied health professionals.

Staff said the management team was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was good; the manager was approachable and they would be happy to talk to them if they had any concerns.

Further information is in the detailed findings below

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked reflected the positive comments people made.

Since our last inspection care plans had been reviewed and the format changed. Care plans reflected people’s assessed level of care needs and care delivery was person specific and holistic. The delivery of care was based on people’s preferences. The provider had progressed quality assurance systems to review the support and care provided. A number of audits had been developed including those for care plans, medicines and health and safety.

Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided.

The care planning system had been reviewed and records for each person were specific to their needs, with guidance for staff to ensure people received the support and care they needed and wanted. Risks to peoples’ health and safety were well managed by knowledgeable staff. Care plans showed each person had been assessed before they moved into the home and any potential risks were identified. Risk assessments included, falls, skin damage, behaviours that distress, nutritional risks including swallow problems and risk of choking and moving and handling. For example, cushions were in place for those that were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and epilepsy.

Nurses were involved in writing the care plans and all staff were expected to record the care and support provided and any changes in people’s needs. The registered manager said care staff were being supported to do this and additional training had been arranged. Food and fluid charts were completed and showed people were supported to have a nutritious diet.

Staff had a good understanding of people’s needs and treated them with respect and protected their dignity when supporting them. A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles. People previously isolated in their room were seen in communal lounges for activities, meetings and meal times and were seen to enjoy the atmosphere and stimulation.

Activity provision was provided throughout the whole day and was in line with people’s preferences and interests.

Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there was a sufficient number with the right skills when people were able to move into the home. The registered manager told us it had been difficult to recruit nurses with the right knowledge, a deputy registered manager had been appointed and the provider continued to advertise for full time nurses.

Pre-employment checks for staff were completed, which meant only suitable staff were working in the home.

The provider had made training and updates mandatory for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care, falls prevention and dementia care. Staff said the training was very good and helped them to understand people’s needs.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse and said they would talk to the management or external bodies immediately if they had any concerns, and they had a clear understanding of making referrals to the local authority and CQC. People said they were comfortable and relatives felt people were safe.

Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people’s needs were met. There were systems in place for the management of medicines and we observed staff completing records as they administered medicines.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff said the management was fair and approachable, care meetings were held every morning to discuss people’s changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the registered manager was always available, they would be happy to talk to them if they had any concerns and residents meetings provided an opportunity to discuss issues with other relatives and staff.

The care plans detailed with the individual's needs expressed clearly. The home had a comprehensive emergency plan to ensure the safety and welfare of the people who use the service. This included policies relating to fire, electric failure, flooding and the provision of alternative accommodation.

We saw that the service had policies in place for the safe use of medicines, managing drug errors, covert medication, homely remedies and a protocol for the use of 'when required' medications. The home had undergone changes on staffing but at the time of the inspection was finally fully staffed with no agency being used.

We saw that the home had a detailed complaints policy. This divided complaints into low level complaints which were able to be dealt with by staff immediately and high level complaints which required the formal investigation procedure. Ms Avery was registered manager but no longer in post at the service. Mrs G Carter is the registered manager. We did not inspect the regulated activity of personal care during this inspection.