Oaktree Hall & Lodge

Bessingby Hall is a residential care home providing accommodation and personal care to up to 50 people. The service provides support to younger adults, older people, people living with dementia and people who have physical disabilities. At the time of our inspection there were 32 people using the service.

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

People were happy living at the service and they were supported by well trained staff. Staff understood their roles and knew what was expected of them. Risks to people were assessed and reviewed on a regular

basis. Staff were recruited safely and understood the principles of keeping people safe. Medicines were managed safely.

The environment was dementia friendly with accessible gardens. People and their relatives told us there were a wide variety of activities to participate in. Staff had clear knowledge of people's diverse needs and care and support was tailored to meet people's preferences.

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.

The registered manager had embedded a strong ethos of person-centred care which placed people's wellbeing at the heart of their work. Quality assurance systems in place, monitored the service effectively and drove improvements when they were needed. Lessons learnt were used as learning opportunities to continuously develop the service.

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

Rating at last inspection.

The last rating for this service was requires improvement (published 20 April 2021).

Why we inspected

We received concerns in relation to the practice of staff for people who had a DNACPR in place. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective, responsive and well led sections of this full report.

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

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 examples of good practice.

The provider had a robust system in place to ensure that all visitors entering the premises had their vaccination status and lateral flow tests (LFT) checked. The provider required visitors to have a negative LFT before entry, and staff were available and trained to support visitors to complete LFT where needed.

Staff supported people in a person-centred manner to remain active and keep in touch with their families and friends. There was a visiting pod which could be used as required to reduce the risk of infection. Care plans and risk assessments provided information for staff to keep people safe.

The service was very clean, tidy, and well maintained. People were protected by infection control policies and procedures. Staff had received training in infection control and the correct use of personal protective equipment [PPE]. Specific risk assessments had been put in place to support people relating to COVID-19. Staff were engaging in the COVID-19 testing programme.

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

A new management team had recently been appointed and were making improvements since our last inspection. They had identified where improvements were needed and had plans in place to embed them fully into the service.

People living at Bessingby Hall were happy and felt well cared for. Staff were recruited safely and understood the principles of keeping people safe. Risks to people were assessed and reviewed on a regular basis.

Staff were fully supported to understand their roles and responsibilities. People received their medicines as prescribed and the environment was clean and welcoming.

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 positive feedback from staff, relatives and health professionals about the improvements made and the new management team. Quality assurance systems in place, monitored the service effectively and drove improvements. Lessons learnt were used as learning opportunities to continuously develop the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 09 July 2019) and there were two breaches of regulation. 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

We received concerns in relation to the management of medicines and people’s pressure area care needs. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed and the service remains requires improvement. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-led sections of this report.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bessingby Hall is a residential care home providing personal care to 44 people within the categories of older people, people living with dementia and people living with a physical disability. The service can support up to 65 people.

The service accommodates people across two wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia. The residential wing is called Hardmoor, and the dementia wing is Harrington.

People’s experience of using this service

Since our last inspection the provider had failed to maintain high quality standards of practice within the service. The provider demonstrated their willingness to improve by working with us during and after the inspection.

Medicines were not always managed safely within the service and the registered manager had raised safeguarding alerts about these with the local authority.

The standards of hygiene within the service could be improved. Odours and stained furniture were apparent in some areas of the service.

The assessment and monitoring of risk for people was ineffective. Management and senior care staff had not reviewed care plans and risk assessments on a regular basis or when people’s care needs had altered. The quality of the record keeping varied and some care records we looked at did not have the right information in them to manage people’s care safely.

People felt able to raise complaints with the service and the registered manager did look into these. However, there was no evidence that the provider had provided information for people, available in formats they could understand, in line with the Accessible Information Standard.

People were looked after by staff who had not always received sufficient training and support to ensure they could fulfil their role safely. This put people at risk of avoidable harm. We have made a recommendation in the report about staff training and support.

People did not always have an opportunity to take part in stimulating and enjoyable activities. There was a lack of appropriate social interaction for people living with dementia.

People told us they felt safe and well cared for and staff treated people with respect and dignity.

People were able to talk to health care professionals about their care and treatment. People could see a GP when they needed to. They received care and treatment when necessary from external health care professionals such as the district nursing team and speech and language therapists.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service did support this practice.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around safe care and treatment and good governance. Details of action we have asked the provider to take can be found at the end of this report.

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

Rating at last inspection

At the last inspection the service was rated as good (published February 2019).

Why we inspected

This inspection was prompted by information of concern.

Follow up

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

People’s experience of using this service:

A new registered manager had recently been employed. This had led to further improvements to those started by an interim management team. The registered manager provided a consistent presence which gave people and staff confidence in the service.

Staff were up to date with training which gave them confidence in their abilities and led to more positive outcomes for people who used the service.

Recruitment of staff now followed the company policy reassuring people that staff were suitable to work in this environment.

Quality monitoring had been improved giving a much better overview of what was happening at the service day to day. Improved systems meant the senior leadership team could access information immediately. As a result any identified issues can be dealt with immediately and should lessen any impact on people who use the service and staff.

Where staff noted a concern they quickly involved healthcare professionals. This included support to manage people’s healthcare conditions and any areas of risk.

Staff were aware of people’s life history and preferences. They used this information to develop positive relationships and deliver person centred care.

People told us they felt well cared for by staff who treated them with respect and dignity. They felt that communication had improved and were pleased with the support they received.

Rating at last inspection: Requires Improvement (Published November 2018)

Why we inspected: The last comprehensive inspection took place in October and November 2017 where we found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. The breaches were in Regulations 12 (Safe care and treatment, 13 (Safeguarding service users from abuse and improper treatment), 14 Meeting nutritional and hydration needs), 17 Good governance and 19 Fit and proper persons employed.

Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring responsive and well led to at least good.

To check that improvements outlined in the action plan were being made and check people were safe we had carried out three focused inspections in February, April, and September 2018. At the focused inspections all the breaches found at the comprehensive inspection of October/ November 2017 had been met and so there were no outstanding breaches when we carried out this inspection.

At this inspection we were able to check whether or not the improvements had been sustained and we found that they had.

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

This inspection was carried out to check that people were safe following inspections in October and November 2017, January 2018 and April 2018 where there had been serious concerns identified by the Care Quality Commission (CQC), East Riding of Yorkshire Council (ERYC) and East Riding of Yorkshire Clinical Commissioning Group (ERYCCG). The team inspected the service against two of the five questions we ask about services: is the service well led, is the service safe? This is because the service had not been meeting some legal requirements.

CQC had taken urgent action to prevent the provider from admitting people to the service following our comprehensive inspection of October/November 2017. A second condition had also been placed on the providers registration preventing them from providing nursing care at Bessingby Hall. This inspection was to review if the service was sufficiently safe to allow the provider to admit people once again and to ensure people were safe.

Bessingby Hall is a care home that provides accommodation and personal care for up to 65 older people who have physical disabilities and/or are living with a dementia related condition. It is a detached property set out over two floors within its own grounds. There is a separate unit for up to 22 people living with dementia. There were 27 people living at the service when we inspected.

There was a manager employed at this service who was in the process of registering with CQC. 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. They had been registered with CQC since May 2016.

Risks to people had been identified and there was guidance for staff to follow when managing the risks. Accidents were recorded and analysed.

Staff recruitment was robust. There were sufficient numbers of knowledgeable staff on duty to meet people’s needs effectively.

Servicing and maintenance of the environment had been carried out in a timely manner.

There was effective oversight of the service and an improvement in the quality of the service. The quality assurance system was effective in identifying areas which required improvement.

The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led. This is because these were the areas of concern and the service was not meeting some legal requirements. We found continuing breaches of Regulations 12, 13, and 17 of the Health and Social Care Act 2008 (Regulated activities) 2014 at this inspection.

No significant changes were identified in the remaining Key Questions through our on-going monitoring or duringour inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating for this inspection.

Bessingby Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Bessingby Hall accommodates up to 65 people providing accommodation and personal care to older people and those with a dementia. However, a change to the services registration conditions by CQC meant that currently they are unable to admit people to the service. There were 29 people living at the service on the day of the inspection but only 27 resident as two people were in hospital.

There was a manager employed at this service. The manager had only recently been recruited and was not registered with CQC. 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.

Staff understood the principles of safeguarding and were confident reporting issues to the manager. They had not always recognised risks to people or acted upon them but we saw improvement in this area.

There were sufficient numbers of staff to meet people's needs.

Records were not always up to date for each person. Care plans did not contain all the relevant information and there were gaps in recording on documents such as food and fluid charts.

There was a quality monitoring system which was been improved by the management team. Audits had been completed for some areas of care and this level of detail should now be reflected across all areas of the service.

The leadership and management of the service had recently changed and staff were positive about the impact of this. However, sufficient time had not elapsed to make sure leadership and management continued to improve.

The rating for Safe has changed from Inadequate to Requires improvement. The overall rating could not be changed because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

We moved our planned comprehensive inspection to an earlier date because we had received concerns about a person who had lived at the service from the provider and East Riding of Yorkshire Council (ERYC). Following the inspection we were informed by ERYC of concerns about three further people who had lived at the service. When we carried out our inspection we identified breaches of Regulations 12 Safe Care and Treatment, 13 Safeguarding service users from abuse and improper treatment, 14 Meeting nutritional and hydration needs, 17 Good Governance and 19 Fit and proper persons employed of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Bessingby Hall is a care home with nursing that provides accommodation and personal care for up to 65 older people who have physical disabilities and/or are living with a dementia related condition. It is a detached property set out over two floors within its own grounds. There is a separate unit for up to 22 people living with dementia. There were 56 people resident at the service when we inspected.

There was a registered manager employed at this service. 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. They had been registered with CQC since May 2016.

Risks to people had not always been identified. Accidents were recorded and analysed.

Staff recruitment was not robust. There were sufficient numbers of staff on duty to meet people’s needs effectively.

Servicing and maintenance of the environment had been carried out in a timely manner.

Most training was completed but updates were needed. Staff were not clear about the principles of MCA and DOLS.

People were not supported to have maximum choice and control of their lives because staff had not supported them in the least restrictive way possible; the policies and systems in the service had not supported this practice. Staff had not followed the correct process for making the best interest decision.

People's nutritional needs had not been met and records in this area were poor.

Staff were clear about supporting people's privacy but they did not always maintain people's dignity. We saw some positive interactions with people.

Activities took place but they were not meaningful. This was being addressed.

The environment was dementia friendly particularly outdoors, but more signage would support people.

People knew how to make a complaint and we saw that where complaints had been made and there was a response which was in line with company policy. One complaint did not have a response recorded.

There had been a lack of effective oversight at the service which had led to a deterioration in the quality of the service. The quality assurance system had not been effective in identifying areas which required improvement.

End of life wishes had not been recorded for some people.

No significant changes were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating for this inspection.

Bessingby Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Bessingby Hall accommodates up to 65 people providing residential and nursing services and a service for people living with dementia. Seventeen people were receiving nursing care at the service.

There was a registered manager employed at this service. 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.

Staff understood the principles of safeguarding but had not always followed safeguarding processes. They did not always recognise risks to people or did not act upon them.

The provider had not always maintained equipment in a clean or safe state. This increased the risk of infection for people who used that equipment.

Staff recruitment was not robust. Nursing staff did not have the skills and knowledge required to meet everyone’s needs effectively and safely.

Records were not up to date for each person. Care plans did not contain all the relevant information and there were gaps in recording on documents.

There was a quality monitoring system but we found it was ineffective. Audits and checks had not always been completed to a high standard which prevented areas for improvement being identified.

The leadership and management of the service was inadequate.

Our brief chats with people at this inspection indicated they were happy in the service and from what we observed people were settled and relaxed with the staff and other service users.

We found that improvements had been made with regards to record keeping. However, the provider told us that they appreciated further work had to be done to develop the care plans and associated care records in order to sustain these improvements.

We found people were being looked after by friendly, supportive staff within a warm and homely environment. Staff were respectful and patient with individuals. All interactions we saw put the wishes and choices of people who used the service first and they were included in all conversations.

The home was designed to meet the needs of people who lived there and the provider ensured equipment used to assist people with their daily lives was regularly maintained, safe and fit for purpose.

We saw that there were sufficient numbers of staff on duty to meet the needs of the people who used the service. People we spoke with said they liked living in the home. One person told us, 'Staff are friendly and give us the support and help we need' and another said 'There is a lovely atmosphere in the home, very friendly and welcoming.'

The provider had an effective quality assurance system in place and people's views and opinions of the service were listened to and acted on where necessary.

The majority of the care plans were up to date and risk assessed. However we found a number of supplementary care records such as food and fluid charts, pressure relief charts, bathing records and wound care records were not completed appropriately.

People we spoke with said they like living in the home and that their care and support was "Satisfactory." One person told us, 'Staff are friendly and give us the support and help we need' and another said 'There is a lovely atmosphere in the home, very friendly and welcoming.'

People told us that they were consulted about their care and were able to make their own decisions about life in the home. People felt staff respected their privacy and dignity. One person said 'I decide when I get up in a morning, when I want to go to bed. I can make choices about what I want to eat or how I want to dress. There are some limits to what I can do for myself because of my health, but staff listen to me and try to do things the way I like them done.'

People said that they had good access to outside healthcare professionals and they were satisfied with the level of medical support given to them. People told us they saw the provider and manager most days to talk to and they were confident of using the complaints system if they needed to.