Baylis Place

Baylis Place is a modern purpose-built care home on the outskirts of Hull situated in a residential area close to shops, amenities and public transport. It is registered to provide accommodation for up to eleven adults with learning disabilities, autism and associated complex needs.

The service accommodates people across two floors each of which has separate adapted facilities. The upstairs accommodation also provides a separate self-contained flat.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 11 people. Eleven people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; people's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

We have made a recommendation about fire doors.

Three fire doors did not fully close, and the registered manager had raised this with the estates manager. Records showed that the identified doors were regularly reported and maintained when found to be damaged.

The provider had systems in place to safeguard people from abuse. Staff could recognise and report any safeguarding concerns and understood how to keep people safe. Relevant risk assessments had been completed. Medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends to mitigate risks.

Staff had appropriate skills and knowledge to deliver care and support people in a person-centred way. Staff recruitment was safe.

Care plans had been developed and were regularly reviewed. These contained relevant information about how to meet people's needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems supported this practice. People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before staff undertook support tasks.

The environment was warm, welcoming, clean and free from malodours. People had personalised rooms.

There was a wide range of opportunities for people to engage in activities, attend college courses and follow hobbies and interests.

People were positive about the staff and told us that their privacy and dignity was promoted. Preferences and choices were considered and reflected within records.

People had access to a varied balanced diet. Staff monitored people’s weights and worked with healthcare professionals to make sure people received medical attention when needed.

People were able to see their families as they wanted.

People and staff spoke positively about the registered manager and felt able to raise concerns and were confident these would be addressed. Staff told us they were well supported by the registered manager and management team.

People who used the service, their relatives and staff had the opportunity to feedback about the service. There was a system in place to respond to any concerns.

Checks of safety and quality were made to ensure people were protected. Work to continuously improve was noted and the registered manager was keen to make changes that would impact positively on people's lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 26 June 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner

Baylis Place is a ‘care home’. People in care homes receive care and accommodation as a single package under one contractual agreement. CQC regulates both premises and the care provided, and both were looked at during this inspection. This purpose built accommodation is provided in spacious single bedrooms all with en suite facilities. The accommodation is split over two floors and there are several communal areas, two dining areas, two kitchens, a laundry and a self-contained flat. There is a large secure garden to the rear of the building. The service is situated within walking distance of local shops, amenities and public transport.

At the time of our inspection on 29 March and 19 April there were 11 people living at the service. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

The service had a registered manager in post. 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 manager had registered with the CQC in July 2017.

Governance of the service had improved. Audits were in place to ensure records were fully completed and maintained in relation to people’s care. Risk assessments and behaviour support plans were found to be more detailed; identifying triggers and actions staff should take to support people, including details of when approved interventions would be used and in which circumstances.

Behaviour support plans were found to be regularly reviewed and updated and de briefing took place following each incident. All notifiable incidents had been reported to CQC in a timely way since our last inspection on 3 and 8 March 2017. We found that improvements needed to be made to ensure a more robust analysis of specific incidents was carried out and appropriate action taken to minimise the impact of risks on people using the service. We have made a recommendation about this.

Despite improvements being made to behaviour support plans, there continued to be a high number of incidents involving aggressive behaviours by people using the service towards their peers. Staff were recruited safely and in sufficient numbers, but the deployment of staff within the service did not ensure people were kept safe from harm.

This demonstrated a new breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safeguarding service users from abuse. You can see what action we have asked the provider to take at the end of the report.

Staff knew how to safeguard people from the risk of harm and abuse, but failed to prevent incidents within the service and people being targeted by their peers. They had completed safeguarding training and had policies in place to guide them. Staff spoken with were clear about the alerting procedures to the local safeguarding teams and had made appropriate referrals after each incident. Staff had access to a range of training, supervision, appraisal and support.

People told us staff were kind and caring and respected their privacy and dignity. People using the service had their end of life wishes detailed within their care plans. Staff had a kind and caring approach. They knew people's needs very well and supported them to maintain independence, privacy and dignity. Staff supported people to make decisions in order to maintain their

human rights. They ensured that when people lacked capacity, they included relevant people in best interest decision making.

People’s medicines were managed in a safe way and they received them as prescribed. Relatives and healthcare professionals confirmed that staff were caring and looked after people's health

and nutritional needs well. People were provided with the care, support and equipment they needed to stay independent.

People enjoyed the meals provided and there were choices and alternatives on the menus. Staff provided support to people at mealtimes in a patient and sensitive way. Staff contacted dieticians and speech and language therapists when they had concerns.

Activities were provided based on people’s preferences both within the service and the wider community.

The provider had a complaints policy and procedure and staff knew how to manage complaints. Relatives told us they felt able to raise concerns if required. All of the people and relatives we spoke with described an open culture and accessible management.

Staff told us they enjoyed working at the service and felt supported by the registered manager.

Quality assurance processes were in place and regularly carried out by both the provider and the registered manager to monitor and improve the quality of the service. Feedback was sought from people who use the service through regular ‘resident meetings.’

We undertook this unannounced inspection on the 3 and 8 March 2017. At the time of the inspection there were 11 people living at the service.

At the last inspection on 14 July 2014, the registered provider was compliant with all areas assessed and was rated as outstanding.

At this inspection we found breaches of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safeguarding service users from abuse and Regulation 17 Good governance. You can see what action we have told the registered provider to take at the end of the report.

There was no registered manager in post. The service is required to have a registered manager, and as such, the registered provider was not meeting the conditions of their registration. 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. When a service does not have a registered manager in place the rating in well led cannot be rated any more than ‘requires improvement’. A manager had been appointed but had not been through the registration process to become the registered manager. We have called them the ‘manager’ throughout the report.

Improvements were needed to be made to ensure complete records were maintained within the service. This included fluid intake charts and incidents records. Further improvements were also required to ensure any incidents in the service were reported to the local safeguarding team by senior staff when the manager was absent. Risk assessments and behaviour support plans needed to contain more detailed information about how approved interventions are used and in which circumstances. The organisation also needs to further consider how they will prevent inappropriate items being brought into the service which may present a risk to other people using the service.

Staff received effective levels of support, supervision and mentorship and people who used the service were supported by staff who had the skills and experience to carry out their roles effectively. People who used the service were supported to make their own decisions about aspects of their daily lives. The manager followed the principles of the Mental Capacity Act 2005 when there were concerns people lacked capacity and important decisions needed to be made.

People who used the service told us they liked the meals provided and were offered support to prepare their own meals when they wished to do this. Staff supported people with their nutritional and health needs and liaised with healthcare professionals, on people's behalf, if they required support in accessing their GP or other professionals involved in their care.

Records showed people had assessments of their needs and support plans were produced. These showed people and their relatives had been consulted and involved in this process. We observed people received care that was person-centred and care plans provided staff with information about how to support people in line with their personal wishes and preferences.

Risk assessments were completed to guide staff in how to minimise risks and potential harm during activities of daily living. Staff took steps to minimise risks to people's health and wellbeing without taking away people's rights to make decisions.

People received their medicines as prescribed.

There was a complaints procedure in place that was available in alternative formats, enabling people who used the service to access this information if needed.

We found the environment was accessible and safe for people. Equipment used in the home was regularly serviced.

There was a system of audits and checks in place but this had failed to identify the shortfalls in records.

The senior manager confirmed that they would complete an assessment if capacity to make decisions was in doubt and a best interest meeting would be held.

Comments included 'I like it here it's good". 'The staff are good and really help me' and 'The staff help us with things we can't do ourselves, like when we are worried about something.' People were happy with the care they received and told us they saw a range of health professionals for advice and treatment.

Comments included, "We are fully involved in our relatives care. The staff work well with us, to ensure any difficulties can be overcome. It is first rate.'

People spoke positively about their care and support, comments included, "We are very happy with everything, we are in touch regularly and aware of what is going on. We also have the opportunity to ring and discuss any issues when they are at home and the staff are always happy to offer advice.'

We found that staff helped to make sure health and social care was coordinated when provided by a range of professionals.

During a check of medication we found that medicines were appropriately stored.

We found that all staff employed in the service received regular supervision, training and support to enable them to fulfil the role expected of them.