Bymead House

Bymead House is a residential care home providing personal and nursing care to up to 30 people. The service provides support to older people and people who have a physical disability. At the time of our inspection there were 28 people using the service.

Bymead House is an extended premises occupying a large plot with accessible grounds. There is a passenger lift and accessible bathrooms to enable access throughout the service.

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

We have made recommendations about medicines, staff supervision, and storage of confidential information. Throughout the inspection we mentioned any areas of concern found and all were immediately improved, if not completely addressed, a detailed action plan was devised.

There was mixed feedback about meal provision, people and their relatives were involved in giving regular feedback about meals.

We made a recommendation about data storage as we were not assured information in an office had been properly secured. We looked into numerous concerns that had been raised about the service and while able to corroborate some, for others we were not able to find evidence to prove or disprove them.

Not all staff had participated in 1-to-1 staff supervision, and supervisions were not seen as effective. We have made a recommendation to review best practice guidance and update procedures accordingly.

Medicines were safely administered, and audits ensured oversight of the process. There were some improvements required around risk assessments and storage, we have made a recommendation about this.

Accidents and incidents were recorded, and actions taken both to minimise future occurrences and to ascertain any patterns that could inform risk management.

Staff completed training in safeguarding and both people and their relatives felt the service was safe. Staff were safely recruited and, before commencing in post, induction and mandatory training was completed. The premises were very clean and use of PPE and visiting was in line with current guidance.

Peoples’ needs were assessed before being admitted to the service and a procedure of clinical review of assessments prior to admission was in place to ensure only those who’s needs could be met were admitted.

People were 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; the policies and systems in the service supported this practice.

We received mostly positive feedback about the service and the management team, and the provider was developing new quality assurance questionnaires to issue to people, staff, and relatives so they could benchmark people’s opinions of the service.

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 under a previous legal entity was good (published 8 June 2018). The service remains rated good.

Why we inspected

The inspection was prompted in part due to concerns received. A decision was made for us to inspect and examine those risks. We were not able to corroborate most of the concerns raised with us.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bymead House on our website at www.cqc.org.uk.

Recommendations

We have made recommendations in 3 areas following our inspection. We have asked the provider to review data storage, staff supervision and medicines administration, and make improvements as needed.

Follow up

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

We found the following areas of good practice.

Measures were in place to prevent the spread of infection by visitors to the service. All visitors were required to have their temperature taken and complete a full health risk assessment on arrival.

Visitors were required to book in advance to make sure their visits were spread out to avoid the potential risk of transmission to other visitors. This allowed the staff team to clean and sanitise each visiting area between appointments. An internal conservatory area was being used for visits that could be accessed directly from the garden, to avoid visitors moving through the building. People were supported to safely visit loved ones in their bedrooms as they approached the end of their lives.

The registered manager kept people and families up-to-date with the current situation through regular meetings, letters and phone calls. All of the people we spoke with understood the need for the extra precautions and said they felt safe at the service.

The provider had increased staffing levels during the pandemic. An additional activities co-ordinator had been recruited to help promote people’s well-being and continued activities. There had also been an increase in clinical staff hours to ensure additional support was available.

The service had appropriate infection control policies and procedures in place. They had kept up to date with current government guidance and communicated changes to staff promptly.

Regular testing was carried out at the service for both staff and people living there. There was a clear and detailed action plan in place in the event of a positive Covid-19 test. Staff completed daily checks on people's current health status to quickly identify if someone was showing signs of being unwell.

There was a clear policy in place for new admissions to the service; this applied whether it was a new person from the community or someone returning from a hospital stay. The registered manager ensured Covid-19 test results had been confirmed for new admissions prior to any admission. New admissions were required to stay quarantined in their room for 14 days and barrier nursed.

The service had made provision for a designated space for staff to change into and out of their uniform. All staff uniforms were laundered at the service. They used the required personal protective equipment (PPE) appropriately. Sanitisation and PPE stations were placed around the building for easy access.

The service had contingency plans in place in the event of any outbreak of Covid-19 or other emergency.

The home had not had a registered manager in position since February 2018. However a new manager had been appointed who was applying to Care Quality Commission to become the 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good.

There was no evidence or information from our inspection and on going 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.

People received care from a service which was very caring. Staff cared for people in a kind, compassionate manner. People had developed open and honest relationships with staff. One relative told us, “We chose Bymead as it struck us with a strong 'family' feel as soon as we walked in on our first visit.

There were enough staff to meet people’s care and support needs. Staff had been recruited safely including full employment history and disclosure and barring checks. Induction and on-going training provided staff with the skills needed to carry out their roles effectively.

People were involved in decisions about the care and support they received. People’s independence was respected and supported. People told us keeping their independence was important to them. The manager told us they were aware of their responsibility in ensuring people’s rights to choice and independence were fully respected and upheld

People were protected from abuse because staff understood how to keep them safe, including more senior staff understanding the processes they should follow if an allegation of abuse was made. All staff informed us concerns would be followed up if they were raised. People received their medicines safely. There were enough suitable staff to meet people’s needs. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others.

Staff received training to ensure they had the skills and knowledge required to effectively support people. People were supported to eat and drink according to their likes and dislikes. People who lacked capacity had decisions made in line with current legislation. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to engage in activity programmes. People knew how to complain and there were a range of opportunities for them to raise concerns with the manager and designated staff

Further information is in the detailed findings below.

Bymead house is a residential and nursing home situated in Charmouth. It is registered to provide care for up to 30 people and had no vacancies at the time of inspection. The home is a detached property with rooms set out over two floors accessed by stairs or a passenger lift. There are lounge and dining areas on each floor of the home and a rear garden which is fully accessible. 27 of the bedrooms have an ensuite bathroom and all have call bells.

The service had 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.

Medicines were stored safely at the home. Medicines were given appropriately according to the MAR (Medicine Administration Records). The MAR correlated with the medicines held at the home.

We looked at the creams which people used at the home. Each cream had a chart with written instructions and a body map indicating the area where the cream should be applied. We looked at creams for three people and found that in two cases, people had additional prescription creams in their rooms which they were no longer using. These should have been disposed of and we told the registered manager about this who immediately removed them. We spoke with staff who were able to tell us what creams were required and the charts in peoples rooms correlated with which creams should be used. We recommended that the creams for all people at the home should be reviewed to ensure that old stock was disposed of.

Staff were aware of how to keep people safe and had undertaken safeguarding training, they were able to explain the signs of abuse and knew how to report any safeguarding concerns

Although some of the staff and people we spoke to didn’t feel that there were enough staff, people’s care and support needs were met. We spoke with the registered manager about staffing and they explained that they use ratios to plan staffing and discuss with staff how to best use them to meet the needs of the people.

We saw evidence of group supervisions from January and February 2016 and the written documentation from these. We saw that each member of staff had scheduled individual supervision bi-monthly and we also saw evidence that the Registered Nurses(RN) had discussed and agreed a plan for managing these for other staff. The registered manager told us that they were in the process of rolling out the individual supervision plan.

The service was effective. Staff had detailed knowledge about the people they were supporting. We spoke to people about the support they received from staff and one told us that staff “support in the way I want”. Another said “If there is something you really wanted, they would get it for you”.

Staff told us that they communicate well and used staff meetings and staff handovers to discuss how to support people. A staff member said “we bring things we want to discuss and set an agenda beforehand”. Another told us that if staff are unable to attend, they “have input via a paper note and the issues are discussed”.

Staff were aware of the MCA and had received training. They were able to explain how they supported people with decision making. For example, one staff member told us that if a person “was confused or unable to make a decision, I would give space and reapproach” they also told us that they would tell the registered nurse(RN) in case the confusion evidenced a change to their health.

People, staff and visitors all told us that the food was good. One person said that the “catering is excellent”, another said that the “food is very nice, no problems at all”. Visitors also told us that the “food is good, offered choices”. Another said that their relative “loves the food, (it is) one of the best things about here”. Visitors said that they were invited to have meals, one told us “meals are good, I’ve stayed for two meals”, another told us that they had been in for lunch recently.

People and visitors told us that the service was caring. One person said “they’re ever so kind aren’t they” and another told us “I’m comfortable, well fed and looked after”. A visitor told us they were “always pleased how happy and cheery the staff are and (there is) a nice atmosphere”. Another visitor said that people were “well cared for, staff are nice, approachable and helpful”.

We looked at the resident’s information and found that advocacy services were explained. However people and staff were not aware about advocacy services. We told the registered manager about this and they told us that they would make sure people, visitors and staff were aware about advocacy and how to refer.

We observed that staff treated people with dignity and respect. We saw one staff member knock on a person’s door and ask whether they were “ready for your wash?”, when the person confirmed that they were, the staff member then closed the door. The service had a system in place to indicate if people were receiving personal care and staff we spoke to were clear about how to use this and also told us about the different ways in which they supported people’s privacy and dignity.

Staff knew the individual needs of people they were supporting. They were able to tell us the preferences and dislikes of people and these were reflected in the care records. People’s care records were written in a person centred way and promoted independence. For example. one record said “encourage me to maintain some of my independence such as washing my face and hands”.

People could visit when they wanted. One person told us that there were “open visiting times and (visitors) come in whenever”. Another said that they didn’t “have to ask if people can visit, they just come in”. Visitors said that “we wander in and out as if it’s your own home”. We observed that visitors arrived at various times throughout the inspection and some chose to stay to share a meal with their relative.

There was an activities co-ordinator and a monthly activities plan with different options every morning and afternoon. Activities included hand massage, art and reminiscence as well as regular trips out. One person told us “anything, I will join in, no problem”. Another person said that they enjoyed “going on trips” in the minibus owned by the service. There were a range of different social opportunities available and people were encouraged to be involved.

People told us that the service was well led. One person said that the “registered manager is a nice person, I would talk to them if I had any problems”. Another person told us that the “registered manager comes in (to each bedroom) each morning and checks on us”. One visitor said that the “management is brilliant, lovely to the people and on the ball. They are straight and firm” and another said that the “registered manager is wonderful”.

Staff spoke highly about their management team. One staff member said that they had “always found them to be completely approachable”. Another said that the “registered manager checks in every morning and the focus is all about the care”. Another told us the registered manager “does a good job of keeping everyone happy. Very approachable and has an open door policy”.

The registered manager had monthly audits in place which covered areas including maintenance, health and safety, medication and care plans. Information from these audits was used to inform changes to the service. For example, one audit highlighted the need to update the nursing documentation to reflect the fundamental standards. The service had commissioned an outside company to provide a quality assurance audit and again, had used this information to inform change.

People told us they felt they could express their views and that they were listened to by staff. People spoke positively about the care they received. One person told us, 'It couldn't be any better, anything I want they do it.'

People were cared for in a clean, hygienic environment. and there were systems in operation designed to prevent, detect and control the spread of health care associated infections.

People told us there were sufficient numbers of staff on duty to meet their needs.

The home had suitable systems to monitor the quality of service provided.

We found that people's care needs were regularly assessed and reviewed and that their consent to treatment was obtained when required. Staff had appropriate recruitment and were supported through opportunities for their professional development.

The home had implemented effective systems to monitor the quality of the service provided and to assess and manage risks to the health, safety and welfare of people using the service and others.