Background to this inspection
Updated
9 September 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
Two Inspector’s and a member of the CQC medicines team carried out the inspection.
Service and service type
Bailey House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Bailey House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was not a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke/communicated with two people who used the service and one relative about their experience of the care provided.
We are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. In this report, we used this communication tool with one person to tell us their experience.
We spoke with six members of staff including the nominated individual, the manager, and four care workers.
The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included three people’s care records and their medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We received written feedback from one professional who regularly visit the service.
Updated
9 September 2022
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
About the service
Bailey House is a residential care home providing personal care for up to 3 younger adults. At the time of the inspection 3 people living with a learning disability and/or autism were being supported by the service.
People’s experience of using this service and what we found
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right Support
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. When restrictions were in place, the appropriate authorisations had not been sought once expired. People were not always supported in line with their care plans, preferences and interests.
People did not always get the right support as the provider did not always respond to peoples, needs, preference and choices. The service was not well-led and we were unable to see that improvements had been made since the last inspection.
The provider did not always support people in a safe, well equipped, well-furnished and well-maintained environment that met their needs. People did not have access to a safe outdoor areas and people’s communal space had been reduced as staff were using a dining room as a staff office area. Although some improvements had been made to the environment, further work was required to ensure the service was safe and maintained.
Staff did not follow safe practices in relation to COVID-19. This included wearing and disposing of PPE in line with government guidelines and staff carrying out testing. This meant that people were at risk of harm.
The provider failed to support people to have maximum possible choice, control and independence. People had been restricted of their liberty without the appropriate authorisations in place as these had expired.
Staff did not always support people to achieve their aspirations and goals. Monthly meetings for people to discuss their dreams and goals were not completed or contained the same information each month.
Right Care
People were not being protected by the provider's recruitment process because checks were not robust. People took part in some activities; However the service did not always promote opportunities to try new activities that enhanced and enriched their lives.
People who had individual ways of communicating, using body language, could not always interact comfortably with staff using this method as staff had not had the appropriate training.
Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so.
People did not always have risk assessments in place, or they were not available, to identify risks people faced and how staff should manage these. Information found was not always up to date or accurate.
Right culture
People were not always supported by management and staff who fully understood the holistic needs of supporting people with a learning disability and autism. A new manager had recently started in post who was keen to develop the service and ensure people holistic needs were met.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating and Update
The last rating for this service was requires improvement (11 August 2021) and there were breaches of regulation. The service remains rated requires improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.
We carried out an unannounced focused inspection of this service on 29 and 30 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained 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 Bailey House on our website at www.cqc.org.uk.
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
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to risk management, infection control, person centred care, deprivation of liberty and governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.