The inspection took place on 28 and 29 September and 1 October 2016 and was unannounced.During the last inspection on 29, 30 and 31 December 2015 we found the provider had not protected people against risks that may have an impact on their health and well-being, had not ensured staff received adequate training and support, had not ensured records relating to people’s care and treatment were accurately maintained and had not ensured people received appropriate care to meet their individual needs. The provider told us when and how they would address this. During this inspection we found these breaches of regulation had been met. In some related areas further improvements were work in progress, such as improvements to the content of people’s care plans, in order to help staff deliver more personalised care.
During this inspection we found the provider had not managed people’s medicines safely. You can see what action we told the provider to take at the back of the full version of the report. We also recommended the provider takes advice, from an appropriate source, to ensure that all quality monitoring processes that are carried out within the care home are being carried out effectively.
A maximum of 59 people could receive care at Bay Tree Court. During the inspection there were 42 people receiving care. The building is set off the main road with care parking to the front. Inside consists of two floors with stair or passenger lift access to the first floor. People’s private accommodation consists of single bedrooms with en suite facilities. Each floor also has lounge and dining room spaces, bathrooms and additional toilets. A safe inner courtyard can be accessed off some bedrooms and communal areas.
The registered manager has managed the care home since July 2015. 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.
In April 2016 the care home stopped employing nurses for the purpose of meeting people’s nursing needs. This change had meant that some people had needed to find alternative accommodation. It also meant if people went on to require nursing care they would need to find an alternative care home and for others it had made no difference. Some health needs subsequently needed to be managed by community nurses. This change took some external health care professionals time to adjust to and at times there was still a need to monitor requests to them to ensure people’s needs were met. People’s medical needs were met by local GPs who visited the care home on a regular basis.
There were arrangements in place to keep people safe and improvements had been made to how risks to people were identified, managed and monitored. This included nutritional risks. Staff were aware of the risks of abuse and knew how to recognise this, report concerns and involve relevant agencies. People were not discriminated against and they were able to raise concerns without reprisal.
The care home had been and still was dependent on the use of agency staff to ensure there were enough staff on duty. At the time of the inspection there had been a successful period of recruitment. Managers were waiting for new staffs’ recruitment checks to complete before they could start them. These checks protected people from those who may not be suitable. Changes in how staff were deployed, their roles and responsibilities had been made over the year to ensure the care home had the right staff available at the right time. Staff training and support had improved and some staff were also in the process of adding to their current skills. There had been resistance to these changes from staff which had slowed up progress on this but during the inspection some staff told us they felt the changes were beginning to work. These arrangements were helping staff to be in a position to be more responsive to people’s individual needs. People told us staff were busy but very caring when they attended to them.
People were supported to make their own decisions and when they were unable to do this decisions were made on their behalf and in their best interests. People who lacked mental capacity were protected because relevant legislation was followed. People had access to other health and social care professionals when needed and were free to talk to them in private. People told us they were able to make choices about their care and treatment as well as other day to day choices. People were involved in choosing what activities took place and there was a good attendance at many of these.
Relatives and representatives were appropriately involved and able to speak on behalf of their relatives. Improvements had been made to the content of people’s care records. This ensured staff and other professionals had up to date information about people’s needs. Further improvements were being made to personalise people’s care plans so care could be delivered more around people’s individual preferences and wishes. People and relatives were able to raise complaints and concerns. Over the last year several complaints had been received but they had been investigated where necessary and responded to. There was evidence to show that the issues raised had been seriously considered and steps taken to resolve these and improve the service as a whole.
Improvements over the last year to the support the registered manager received and to the senior management team in the care home had enabled the necessary changes to be managed and subsequent improvements to start having a positive impact. Representatives of the provider had been supportive throughout these changes. They had also altered and improved how they monitored the service. On-going monitoring arrangements within the home itself had not successfully identified shortfalls related to the management of medicines. This needed a review to ensure all staff involved in quality monitoring processes understood what action they needed to take for this to be effective. This inspection found that many improvements had taken place but work was still in progress to ensure changes in practice and systems were embedded and sustained.