Bay Tree House

Updated 16 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

The inspection site visit was carried out by one inspector and a medicines inspector. An Expert by Experience spoke with relatives remotely. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Bay Tree 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. Bay Tree 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. The registered manager was also the nominated individual for the provider meaning they were 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 a registered manager in post however they were not present during the inspection site visit. This was because they had come into contact with a person confirmed as having COVID-19 and was therefore refraining from entering the service as per infection prevention and control procedures.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 04 August 2022 and ended on 16 August 2022. We visited the home on 04 August 2022.

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 Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. 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. We used all this information to plan our inspection.

During the inspection

The people who used the service were unable to tell us about their experience of living in the home, so observations of care and support were made. We spoke with six relatives, received written feedback from a seventh relative and spoke with eight staff members. These included the registered manager who was also the nominated individual for the provider, the operations manager, the newly appointed deputy manager, two senior care assistants and three care assistants. We received written feedback from a further four staff members.

A selection of records was also viewed, and these included the care plans and associated records for eight people who used the service. The medicines records for 11 people were also assessed. The governance records viewed included policies and procedures, staff recruitment records, training information, quality monitoring audits and maintenance records.

Updated 16 September 2022

About the service

Bay Tree House is a residential care home providing personal care and accommodation to up to 16 people. The service provides support to older people living with dementia. At the time of our inspection there were 15 people using the service. The home is an adapted period building with accommodation over two floors serviced by a lift.

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

We could not be assured that medicines management was consistently safe and followed good practice. This meant the arrangements currently in place risked error. The quality monitoring governance system in place had failed to identify these concerns.

People were practically 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. However, records did not evidence this approach as required by the MCA. We have therefore made a recommendation regarding adherence to the Mental Capacity Act 2005 (MCA).

Whilst people received dedicated and person-centred care that they had control over, the associated care plans did not reflect formal involvement either by those people that used the service or those people who held legal authority to make decisions on their behalf. The relatives we spoke with told us they wanted this.

The service communicated well with people and their relatives however there were no formal systems in place to seek their feedback such as via meetings or surveys for example. However, relatives told us they were happy with the service provided and had no concerns.

Staff were dedicated, committed and caring however there were concerns there were not always enough staff to manage an emergency event, such as a fire, should it occur. Staff and relatives told us staff were pressured but that it did not impact on the level of service provided. Staff were mostly safely recruited however the provider needs to ensure processes are consistent in seeking assurances about suitability of staff.

People’s nutritional and healthcare needs were met, and we found robust infection and prevention measures in place. For example, the home was consistently clean throughout and the risk of COVID-19 had been assessed and well managed.

Management were supportive and people told us they had confidence in them. Staff worked well together, and the culture was positive, open and nurturing. The provider placed emphasis on training, and this had resulted in staff that demonstrated the right values and skills to care and support the people who lived at Bay Tree House. All the relatives we spoke with told us they would recommend the home.

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

Rating at last inspection and update

This service was registered with us on 06 November 2020 and this is the first inspection.

Why we inspected

We inspected this service due to it being a newly registered 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.

Enforcement and Recommendations

We have identified breaches in relation to medicines management and governance at this inspection.

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.

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.