Archived: Bay View Nursing and Residential Home

You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Bay View Nursing and Residential Home, on our website at www.cqc.org.uk

Bay View Nursing and Residential Home is registered to provide accommodation and nursing care for up to 40 people. At the time of our inspection there were 22 people living at the service.

A registered manager was in post at the time of inspection. 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. The registered manager is also the sole provider of the service.

At our previous inspection the provider was not consistently responsive to people’s needs. People did not have up to date care plans that reflected their current care needs. At this inspection insufficient improvements had been made. The quality and content of care plans was variable. Care plans were not person centred and not always descriptive of people’s needs.

At our previous inspection the provider had ineffective quality assurance processes in place that would help drive forward improvements. At this inspection insufficient improvements had been made. The provider did not have effective systems and processes for identifying and assessing risks to the health, safety and welfare of people who used the service.

The provider had inadequate arrangements for reporting and reviewing incidents and accidents.

The risks associated with people’s care were not consistently managed safely. There was not always sufficient guidance for staff on how to keep people safe because the plans contained limited information.

Medicines were not consistently managed safely.

People were not cared for in a safe, clean and hygienic environment.

People's rights were not consistently upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves.

Staff were not consistently supported through a regular supervision programme. Supervision is where staff meet one to one with their line manager.

People’s nutritional needs were assessed and care plans provided guidance for staff on how to meet these needs. Food and fluid monitoring charts had been completed, but it was unclear how these were monitored.

When asking people if they felt well cared for we received mixed feedback. During our observations we observed some positive interactions. The maintenance person demonstrated an excellent rapport with people. However, a number of interactions between staff and people using the service were often task focussed rather than person centred.

At our previous inspection the provider was not deploying sufficient numbers of staff to ensure they could meet people’s care and treatment needs. At this inspection we found sufficient improvements had been made.

Records showed that a range of checks had been carried out on staff to determine their suitability for work. This included obtaining references and undertaking a Disclosure and Barring Service (DBS) check.

Staff had undertaken safeguarding training. They understood their responsibilities with regard to safeguarding people from abuse.

New staff undertook an induction and mandatory training programme before starting to care for people on their own.

People had access to on-going healthcare. Records showed that people had been reviewed by the GP, the community nutrition nurse, the mental health team and specialist nurses such as a tissue viability nurse.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them. There was a full time activities coordinator in post. They consulted people about their needs and compiled weekly activity plans.

On the day of the inspection we were informed by the provider that they intended to close the service. The provider has also formally notified the local authority about their closure. The service is currently working with the local authority and relatives to find suitable alternative placements for people. The provider told us that their aim is to close in August 2017. Owing to their impending closure the service will not be placed into special measures.

At this inspection we found four breaches of the regulations of the Health and Social Care Act 2008.

The home required a registered manager. 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. There was a registered manager in post who had been registered since the home opened.

People who lived in the home told us they felt safe and had no worries or concerns. From our observations, it was clear that staff cared for the people they supported and knew them well.

People's relatives and friends also told us they felt people were safe but also mentioned the low staffing levels. Staff told us they felt busy and did not have enough time to spend with people.

During lunchtime, staff appeared rushed and did not always support people in an inclusive way.

Most people and relatives spoke positively about the food provided. People had access to food and drinks throughout the day and where people required specialised diets these were prepared appropriately.

All medication records were legible and properly signed for. All staff giving out medication had been trained in medication administration. However, we found gaps in the recording of fridge temperatures.

People did not always have care plans that reflected their current care needs. This included risk assessments and found these needed to be more informative and person centred. The care plans had regular reviews to monitor any changes but there was no evidence that they had been reviewed with people and their relatives.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been followed.

People and relatives we spoke with said they would know how to make a complaint. However, people and their relatives’ views were not routinely sought.

People and staff told us that they thought the home was well led and staff told us that they felt well supported in their roles. The registered manager was a visible presence in and about the home and it was obvious that they knew the people who lived in the home well and that the staff were well supported to carry out their duties.

We saw that infection control standards in the home were monitored and managed appropriately.

Systems in place to monitor the quality of the service were not always effective.

Some audits were completed as necessary and maintenance records were up to date and legible.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We saw that the activities programme was varied and included trips out of the building where people using wheelchairs were able to attend, and that people were given an opportunity to contribute ideas and wishes towards the programme.

We looked at care plans for three people and saw that they were regularly updated and contained in depth information for the staff to be able understand and provide effective care for the people living at Bay View Nursing and Residential Home.

We spoke to six people who gave us positive feedback from their experiences of care at Bay View Nursing Home, and we saw a person leaving the home after a short stay who was very grateful for the support they had received and left confectionary as a thank you for the staff.

We talked with people about the kinds of activities that they had been involved in and one person commented that "plenty goes on here". Another person showed us a floral display that had been created during a flower arranging activity. Several people mentioned that the activity coordinator was "very good".

We did receive some comments which suggested that people felt there weren't always enough staff on duty to support them. One person said that in terms of staff, there was "sometimes a lack of them". Another person told us that in their opinion there weren't enough staff. This person gave the example of being "put in a chair for an hour...it's boring". However, this person also told us that staff were "very good and very kind".