Bay House is situated in the village of Olney, in Buckinghamshire. It provides personal care for up to 24 older people, who may be living with dementia. At the time of our inspection, there were 18 people living at the service, in a mixture of single and double-occupancy bedrooms. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time-frame.
If not enough improvement is made within this time-frame so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
We carried out an unannounced comprehensive inspection of this service on 30 December 2014 where we identified four breaches of regulation. The systems and processes in respect of safeguarding people were not consistently followed by staff. We found that new members of staff had commenced work without adequate checks having taken place. The procedure for ordering medicines and recording the administration of medicines was not consistently followed by staff. We also found that people were not protected from the risks of infection as there were ineffective cleaning processes in place. We undertook a follow up inspection on 12 May 2015 to review the action that the provider had taken and found that some improvements had been made. The overall rating of the service remained Requires Improvement, which meant that we were required to complete a further comprehensive inspection within 12 months of this date.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bay House on our website at www.cqc.org.uk.
Our second comprehensive inspection took place on 19 January 2016, and was unannounced. Prior to this inspection we had received concerns in relation to people’s safety and security within the service. It was alleged that people had been provided with inadequate care at night in respect of their continence needs. Concerns had been raised about the ability of people to leave the service unsupervised, leaving them vulnerable to external risks. It was further alleged that staff had used a person’s property without their consent. As a result we undertook a full comprehensive inspection to look into those concerns, in conjunction with reviewing the areas that required improvement from the last comprehensive inspection. We were unable to find evidence to corroborate the concerns regarding security and continence care, however there was evidence supporting the concerns regarding the use of people's property.
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.
There were systems in place to record incidents; however potential safeguarding incidents had not been reported to the relevant external agencies. In addition, there were no records to demonstrate what actions had been taken as a result of the incidents which had been reported. Although risk assessments were in place for people, they only provided staff with a basic risk rating. They lacked information regarding the specific risks people faced, and the control measures in place for these. Staff had not been recruited safely; there was a lack of adequate background checks and work histories in staff files. People were given their medication by trained staff; however there was a lack of oversight and checking of medication.
There was a lack of effective management systems at the service. The registered manager had failed to ensure that the service was meeting the fundamental standards, or to ensure that people received safe, effective and high quality care. Quality assurance audits failed to identify issues at the service, for example within the medication systems or care plans, which meant that any areas for development were not identified, or acted upon, by the provider.
Staff members sought consent from people on a regular basis; however there were not systems in place at the service to ensure that the service was meeting the requirements of the Mental Capacity Act 2005. The registered manager had not considered whether the Deprivation of Liberty Safeguards (DoLS) was appropriate for most of the people living at the service. Staff members received supervision sessions from the registered manager; however these were not recorded regularly so as to provide an accurate record of the areas discussed.
Care plans were in place for people; however it was not clear that they or their relatives had been involved in the production of these plans. This meant they were not as person-centred as they could have been.
People received person-centred care from staff members who knew them well; however care plans were not always personalised to reflect people’s specific needs and wishes. The service had systems for obtaining feedback from people and their family members, including complaints; however they were not able to demonstrate how this information was used for the benefit of driving improvement and enhancing service delivery.
There were ineffective processes in place to monitor and mitigate the risks to people when recruiting staff. We also found that the systems in place to identify why accidents and incidents occurred were not robust and failed to implement preventative measures to reduce future occurrence. .
Staffing levels were sufficient to meet people’s needs and were based upon people’s assessed levels of dependency.
Staff received regular training, including induction training for new staff and refresher sessions for all staff.
People received enough food and drink, and were able to choose what they had to eat and drink. Meals were appetising and well presented, and people were supported to eat if required. Staff supported people to access healthcare professionals for a range of needs, if this was required. Where people could not leave the service, staff arranged for healthcare professionals to visit the service.
Staff had worked to develop positive and meaningful relationships with people, and treated them with kindness, dignity and respect. Visitors to the service were welcomed at any time and were encouraged to visit regularly by the registered manager and staff to maintain important relationships.
People benefited from a range of activities which took place at the service each week. They clearly enjoyed these and there were photos and displays around the service to show the outcomes of these activities.
People and their relatives were positive about the registered manager and felt that they were available when needed. Staff were also positive about the leadership at the service and felt well supported.
We identified that the provider was not meeting regulatory requirements and was in breach of a number 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 the report.