Bay Court Nursing Home

Bay Court Nursing Home is registered to provide nursing and personal care for up to 29 people. Most people using the service have multiple health care needs. There were 29 people living at the home on the first day of our inspection.

Bay Court Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and both were looked at during this inspection. The home is a large detached house in the East Devon seaside town of Budleigh Salterton and is within walking distance of the town centre shops and services. The home is set over four floors with two passenger lifts providing level access to each floor. There is a large main communal lounge with a dining area where people could spend their time as they chose. People have access to a well-maintained garden.

At our last inspection in August 2016 we rated the service Good. At this inspection we found the service remained Good overall but the responsive domain has been rated as outstanding. 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.

Why the service is rated Good.

The registered manager had deregistered with the Care Quality Commission (CQC) in November 2018. 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 and associated Regulations about how the service is run. The deputy manager who had worked at the service for three years had been appointed as the new manager. They had submitted their application to CQC to register as the registered manager and were awaiting an interview. The provider had appointed a senior auditing nurse to support them in their role alongside the senior lead nurse.

The service was well led by the new manager. They were very passionate about people being at the heart of the home. The culture was open and promoted person centred values. People, relatives and staff views were sought and taken into account in how the service was run. There were effective systems in place to monitor the quality of care provided.

There was an excellent understanding of the importance of seeing each person as an individual, with their own social and cultural diversity, values and beliefs. The provider and staff recognised the importance of social activities and understood meaningful activities formed an important part of people’s lives. Staff were very passionate about the activities at the home being meaningful and appropriate. They had established people’s hobbies and interests and supported them to revisit them. There were numerous examples of people doing meaningful activities. One person wanted to fundraise as part of their hopes and dreams in 2018. They had held a bake sale with cakes and a raffle for charity. Another person had previously worked with guide dogs. Staff had contacted the guide dogs for the blind and they had visited and have since regularly visited the home. This had a significant impact on this person who had opened up and was now very active at the home. Staff went above and beyond giving their own time to support people on these activities.

People remained safe at the service. People said they felt safe and cared for in the home. People were protected because staff knew how to recognise signs of potential abuse and how to report suspected abuse. People’s care needs were assessed before admission to the home and these were reviewed on a regular basis. Risk assessments were undertaken for all people to ensure their individual health needs were identified and met.

Medicines were safely managed and procedures were in place to ensure people received their medicines as prescribed.

Staff received a comprehensive induction and were knowledgeable. They had received training and developed skills and knowledge to meet people’s needs. Staff relationships with people were caring and supportive. They delivered care that was kind and compassionate.

There were adequate staffing levels to meet people’s needs. People received person centred care. Staff knew people well, understood their needs and cared for them as individuals. People were relaxed and comfortable with staff that supported them. Staff were discreet when supporting people with personal care, respected people’s choices and acted in accordance with the person’s wishes. People where possible and appropriate family members were involved in developing and reviewing their care plans.

Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to eat and drink enough and maintain a balanced diet. People were positive about the food at the service. The manager and staff were committed to ensuring people experienced end of life care in an individualised and dignified way.

People knew how to make a complaint if necessary. They said if they had a concern or complaint they would feel happy to raise it with the management team. There had been no complaints received at the service since our last inspection. Where there were niggles or concerns action was taken to resolve them.

The premises and equipment were managed to keep people safe. The home was very clean throughout without any odours present and had a pleasant homely atmosphere.

Further information is in the detailed findings below.

Bay Court Nursing Home is registered to provide accommodation with nursing care for up to 29 older people. There were 27 people using the service on the day of our inspection which included one person receiving respite support.

We had previously carried out a comprehensive inspection of this service in May 2015. Two breaches of legal requirements regarding staff levels and recording keeping were found.

There was a registered manager at the service who had been in post since January 2016. They had been successfully registered with the Care Quality Commission (CQC) the week before our visit. A registered manager is a person who has registered with CQC 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 was very visible at the service and undertook an active role. They were committed to providing a good service for people in their care and demonstrated a strong supportive approach to people, their relatives and staff. They were supported by the providers who visited regularly.

There were sufficient numbers of suitable staff to keep people safe and meet their needs. The registered manager had increased the staff levels at the service. They regularly completed a dependency tool to assess people’s needs. They adjusted the staff levels as required. Staff undertook additional shifts when necessary to ensure these were maintained. When gaps were not able to be covered, agency care workers were used.

Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. They understood where people lacked capacity, a mental capacity assessment needed to be completed with best interest decisions made in line with the MCA. They had submitted nine applications to the local authority Deprivation of Liberties Safeguarding team (DoLS) to deprive some people of their liberties. One of these applications had been authorised with the others waiting to be reviewed. Staff had a good understanding about giving people choice on a day to day basis. Staff had received MCA training to help them understand their responsibilities.

People were supported by staff who had the required recruitment checks in place. Staff had received an induction. The registered manager had put in place a programme of training to ensure all staff had completed the provider’s mandatory training.

Staff had completed safeguarding training and were knowledgeable about signs of abuse and how to report concerns. Staff felt confident any concerns they raised would be investigated and actions taken to keep people safe.

People were supported to eat and drink sufficient amounts and receive a balanced diet. Improvements had been made to the recording and monitoring of people’s diet and fluid intake which was being checked daily by the nurses at the service. People were positive about the food at the service.

Staff treated them with dignity and respect at all times and in a caring and compassionate way. People received their medicines in a safe way because they were administered appropriately by the nurses at the home.

People had access to activities at the service. People were encouraged and supported to be independent and to avoid social isolation.

People’s needs and risks were assessed before and on admission to the home. Risk assessments were undertaken for people to ensure their care needs were identified. Care plans reflected people’s routines and wishes and were updated with people’s changing needs. They gave staff guidance about how to support people safely. People were involved in making decisions and planning their own care on a day to day basis. People were referred to health care services when required and received on-going healthcare support.

The home had a homely atmosphere with no unpleasant odours. The premises were well managed to keep people safe. The provider had a continued programme of redecoration for the service.

The provider had a quality assurance and monitoring system in place. This included regular audits with this year’s annual surveys ready to be sent out for the provider to assess the effectiveness of the service provided.

The registered manager actively sought the views of people and staff through regular meetings. There was a complaints procedure in place. There had been no complaints at the home in 2016. The registered manager had a clear understanding of how to respond to concerns and tried to deal with grumbles before they became complaints.

Is the service safe?

People told us they felt safe with the care workers and they felt staff had received training to ensure they knew what they were doing. One visitor said their relative had "settled in very well" and they felt that they "were safe and well-cared for".

Individual assessments were undertaken before care was delivered and care plans were put in place to support people's safety.

Staff were able to describe what to do if they had a safeguarding concern which showed they understood how to safeguard the people.

Staff received training in the Mental Capacity Act and Deprivation of Liberties (DoLS). The registered manager told us where they identified concerns about a person's capacity, they would work with the GP to ensure that an assessment was undertaken. We saw evidence in care records that mental capacity assessments had taken place.

There were systems in place to ensure the provider learned from accidents, incidents, complaints and concerns which reduced the risks to people and helped the service to continually improve. The registered manager reviewed and analysed recorded incidents to help reduce the risks of similar incidents occurring in the future.

The provider had emergency plans in place to deal with incidents affecting the home or staff shortages

.

Is the service effective?

We reviewed care records which showed that people had had their needs assessed and that care plans had been put in place to address these needs. We saw evidence that these plans were reviewed with people and their relatives and that changes were made to the plan when there was a change in need. People said they had been involved in writing their care plan and they reflected their current needs.

People told us they were able to get involved in a range of activities to suit their interests and this had helped to improve the quality of their lives. We saw one person being supported to use a computer by the activity coordinator and were told by the manager that several people were supported to use computer based video communication applications, such as Skype, to stay in touch with friends and relatives at a distance.

We saw evidence of staff involving other health professionals in people's care when issues arose. As an example of this we spoke with a visiting community nurse, who specialised in end of life care, who told us they had "good communications with the home". We also observed staff supporting a person who needed to visit their dentist as they needed an adjustment to their new dentures.

Is the service caring?

Bay Court was a well maintained home with comfortable, well equipped bedrooms and communal areas, both inside and outside. The provider had undertaken redecoration and refurbishment of the bathrooms, lounge and dining area, which people had commented positively about.

People told us "Staff at the home are really good". A relative told us "they go out of their way to be helpful. They explained "we are coming to lunch on Sunday for a birthday celebration. We are having lunch put on in a private room so we can be just family".

During our inspection we talked with nine people living at Bay Court and also spoke with four relatives and friends who were visiting. People we talked with said they thought staff were kind and attentive. One person told us "I get on with some better than others but they are all good - just different personalities."

We talked with staff, who told us they got to know the people they cared for really well and enjoyed caring for them. During the day, we observed staff talking to people in a friendly way, taking an interest in their lives and showing that they had a good knowledge of the person's preferences. We also saw a member of staff who was on leave, visit people to introduce them to their young child.

We saw evidence the provider had responded positively to complaints and suggestions for improvements.

One person said they missed their pet dog, but that a friend was able to bring the dog into the home on occasions, which helped ensure they maintained contact.

Is the service responsive?

People knew how to make a complaint if they were unhappy. Most people told us they had not had to make a formal complaint but they felt happy to raise any concerns or issues with staff who would help to resolve them. They told us if that did not solve the issue they would also contact the registered manager who was always happy to help with a problem. However one person did say they did not like to make a complaint as they didn't want any trouble, but that they did find that sometimes their call bell was not answered in a timely manner. They said they had raised the issue with the manager but that it still happened "more frequently than I like".

We reviewed minutes of meetings which people living at Bay Court, their relatives as well as staff were invited to. The provider told us that meetings were held three or four times a year to allow people to air views and make suggestions for improvements. The most recent meeting had been held in January 2014, at which there had been discussions about the redecoration and refurbishment plans as well as about what activities people would like to be arranged.

A survey had also been undertaken in the last twelve months to find out what relatives and staff thought about the home. The provider had not gathered the views of people using the service. The registered manager told us that they talked to the people each week to find out their views on the service but that they were also planning to do a separate survey of people using the service later in the year.

Is the service well-led?

The registered manager together with the care manager and nurses worked together to ensure care workers were supported to deliver care to people according to their needs. They provided support and guidance when staff had concerns.

Staff told us they were clear about their roles and responsibilities. We talked with five staff during our inspection. They had a good understanding of the ethos of the provider and worked to promote good relationships with all the people they worked with as well as other staff. This helped to ensure that people received a good quality service at all times.

We saw evidence that staff received regular supervision from their line manager every three months and staff told us they felt confident they would get additional support if they needed help. Staff were also encouraged to undertake care related qualifications and specialist training in addition to the mandatory training to help them support people with different needs.

We reviewed minutes of staff meetings, which were held every three months. These demonstrated that staff were kept informed about things that were going well and where improvements were needed as well as about changes. Staff were also able to access a private Facebook group where they could receive messages and notices about working arrangements.

People had clear assessments of their needs and plans and strategies were in place to meet them. We saw that care workers interacted with people in a relaxed and respectful manner. People had access to age appropriate social activities. During our visit we saw that people were offered choices throughout the day which supported their independence and provided a meaningful quality of life.

People were cared for in a clean, hygienic environment.

There were enough qualified, skilled and experienced staff to meet people's needs.

Systems were in place to support the ongoing development of the quality of services provided and to support the manager and staff. However the provider may wish to note that audits were not always being completed appropiately.

The records that were in place were generally up to date and fit for purpose. However, the provider may wish to note that not all care plans were reviewed on a regular basis or when people's needs had changed.

Risks to people's health and welfare were identified and their needs were met in a way that was personalised to each person. Health promotion was encouraged through referrals to specialists and through the use of regular dentistry and chiropody services. People told us they felt safe and well cared for. People received their medicines as they were prescribed, and were supported to manage their own medicines if they wished to.

Staff were familiar with how to safeguard vulnerable adults. They were supported to make known any concerns they might have had, through internal mechanisms and by 'whistle blowing' if needed. Staff were maintaining and developing the skills they needed to care for the people through training and supervision.

Systems were in place to support the ongoing development of the quality of services provided and to identify and manage risk.

Some records were not robust enough meaning that some risks were not being sufficiently well managed. For example, evaluations of the efficacy of care delivered sometimes lacked evidence and detail. Some audit records were incomplete.