Bali Hai Care Home

Bali Hai Care Home provides accommodation and personal care without nursing for up to 12 people who may have mental health needs. At the time of our inspection there were 8 people were using the service.

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

Effective arrangements were in place to ensure recruitment checks on staff were safe. Minor improvements were required to staff recruitment files. We have made a recommendation about the management of staff recruitment files.

There were safe medicine procedures for staff to follow. However, formal medicine audits were not being completed. We have made a recommendation about medicine audits.

We received positive feedback about the service. A relative told us, "We’re happy with the care. We’re blessed. Staff are fabulous. A very good atmosphere within the home."

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. People were cared for and supported by staff who had received appropriate training. There were systems in place to minimise the risk of infections.

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

Staff understood how to raise concerns and knew what to do to safeguard people.

The provider had monitoring and audit systems to ensure they provided good care and these were kept under regular review.

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 was good (published 06 November 2017).

Why we inspected

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question 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 Bali Hai Care Home on our website at www.cqc.org.uk

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.

Recommendations

We have made recommendations in relation to staff recruitment and medicine audits.

Follow up

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

We found the following examples of good practice.

People and staff had regularly been tested for COVID-19 and where positive results had been returned the manager had acted quickly to support people and mitigate risks.

All staff had received training on infection prevention control and how to use PPE effectively.

The registered manager had followed government guidance on infection prevention control measures and had kept these up to date.

Risk assessments were in place to allow for safe visiting at the service and for people to enjoy visits to the local community or out with their relatives safely. Where visits were unable to go ahead video and telephone calls had been used.

Bali Hai Care Home provides accommodation and personal care without nursing for up to 12 persons who may have mental health needs. At the time of our inspection 10 people were living at the service.

At our last inspection the service was rated as Good. At this inspection we found the service remained Good.

The service was safe. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. People’s medicine’s were dispensed by staff who had received training to do so.

The service was effective. People were cared for and supported by staff who had received training to support people to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to eat and drink enough as to ensure they maintained a balanced diet and referrals to other health professionals were made when required.

The service was caring. Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed decisions.

The service was responsive. People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and also when there was a change in care needs. People were supported to follow their interests and participate in social activities. The registered manager responded to complaints received in a timely manner.

The service was well-led. The service had systems in place to monitor and provide good care and these were reviewed on a regular basis.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw care plans that reflected issues identified in the assessment. These were sufficiently detailed to allow care staff to deliver safe and responsive care. A care worker said, "The care plans are written in enough detail to help us work confidently with that person."

CQC monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an

application should be made, and how to submit one.

People were cared for in a clean, hygienic environment. The service had systems in place designed to assess the risk of, and to prevent, detect and control the spread of infection.

Is the service effective?

We saw that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw that people or their representatives had been involved in their care assessments and reviews. People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person who used the service told us, " We are well looked after and I like the staff." Staff had received appropriate training to meet the needs of the people receiving care.

Is the service caring?

People were supported by kind, committed and attentive staff. We saw that care staff were patient and empathetic when supporting people. One comment from a relative's questionnaire was, "The care is excellent."

Is the service responsive?

People's needs were continually assessed. Records confirmed people's preferences, interests and diverse needs had been recorded and care had been provided in accordance with people's wishes. We observed people who used the service undertaking various activities whilst waiting to go to the day centre. One person was walking in the garden, one person was playing a game on the computer and another was reading a magazine.

Is the service well-led?

Staff had a good understanding of providing personalised individual care and the need to promote independence where possible. Quality assurance processes were in place to support this. People told us they were asked for their feedback on the service they received and they confirmed they had felt listened to. Systems were in place to help the service develop and learn.

We found that care, support and treatment was planned and delivered safely and that risks to the health, safety and welfare of people using the service were assessed and managed.

People received sufficient food and drink. They had good choices in respect of meals, drinks and snacks. Risks of inadequate nutrition and dehydration were assessed. The provider may wish to consider using the Malnutrition Universal Screening Tool (MUST) when assessing people's nutritional needs.

There were arrangements for ensuring that medicines were managed safely and people medicines as prescribed for them.

The premises, facilities and equipment were well maintained and there were arrangements for ensuring that they were safe, comfortable and suitable.

Staff were recruited robustly with all of the appropriate checks in place to minimise risks to people using the service and ensure that they were supported by suitably skilled and knowledgeable staff.

There was an effective complaints procedure and people were able to make complaints or comments about the service they received.

We looked at a sample of care files and found them to be detailed and informative. They had been regularly reviewed and updated to reflect any changes. People told us that their care plans met their needs. We found that staff had been trained and had received regular updates in their training. Staff told us that they felt well supported to do their work.

People were very complimentary about the quality of the service. One person said, 'The food is really good.' Another person said, 'I help out in the kitchen, preparing vegetables and making drinks.' Other comments included, 'The food is nice and there is plenty of choice.'

The records showed that regular quality assurance surveys had been undertaken. The owner/manager had a hands-on approach. They told us that they monitored the service daily to ensure that they were providing safe and appropriate care to the people who use the service.