Baytree House

Updated 26 April 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors carried out this inspection.

Service and service type

Baytree house 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager covers other services for the provider and Baytree house also has a home manager who works exclusively at the service, providing day to day management.

Notice of inspection

This inspection was unannounced

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with seven people who used the service and two relatives about their experience of the care provided.

We are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. In this report, we used this communication tool with two people to tell us their experience.

We spoke with seven members of staff including the registered manager, the home manager and five care staff.

We reviewed a range of records. This included three people’s care records and eight medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with one professional who visits the service.

Updated 26 April 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Baytree House is a residential care home for people living with a learning disability and autistic people. It is registered to provide personal care for up to nine people; at the time of inspection eight people were living at the service. The provider told us they will keep the number of people who can live at Baytree house to eight and had turned the ninth room into a more accessible office space.

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

Right Support

People and relatives told us staff supported people to take part in activities. Staff had adopted new approaches; People were supported to be involved in ordinary daily activities such as housework. It was clear that people were proud of their achievements and this change had improved their feelings of independence. Staff told us that the incidents of people becoming emotionally distressed had reduced and they felt this was the result of people having more choice and control in their daily activities, that considered their hobbies and interests. We saw people preparing their own lunches with staff support, this seemed to be popular with people. People told us they were going out to leisure activities that interested them. One person told us about a recent picnic in the park and another person showed us a folder they had made with photographs of themselves showing staff Makaton signs they used. (Makaton is a type of sign language that helps people who find verbal communication difficult). The service gave people care and support in a safe, clean environment. The layout of the building had been changed since the last inspection and this helped the homely feel of the house. It was evident that improvements had been made since the last inspection and people were seeing the changes as positive. Managers and staff acknowledged more was needed. This included ensuring guidelines to support people to identify and work towards their goals and aspirations were recorded. This would also ensure staff were consistent with each person’s needs.

Right Care

We observed people receiving kind and compassionate care. A relative said, “I have no worries (name of loved one) is the happiest I have seen them in years, a lot calmer now, all smiles.” Staff protected and respected people's privacy and dignity. Staff had been recently received training which provided them with guidance about how to support people with learning disabilities and autism and knew they knew people well. The home manager told us that they had moved away from a model of support where staff did most things for people, to one where people were actively involved in their lives. They said, “This has had the greatest positive impact for people.” People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols we observed to be responding positively to staff’s improved understanding and practice in their use. Managers confirmed although there were improvements with staff communication there were further areas where they needed to improve. For example, staff required more learning about communication and the approaches and tools to use with autistic people in order to create and implement effective communication plans. There were now more visual supports for people to help them find things like what’s for dinner and which staff are working today, this had reduced people’s reliance on staff for information and improved independence. Staff understood how to protect people from poor care and abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People and relatives told us they felt safe. Training had supported staff to understand what people needed when they became distressed, one staff said, “I understand that transitions from one activity to another can be hard for some people, so I make sure I prepare them.”

Right culture

The new emphasis on improving people’s quality of life experiences had begun to make a positive impact for people. We observed people were talking with staff on a more equal footing and were gaining in confidence to make choices, do things for themselves but ask for help when they needed too, which we saw staff respecting. For example, one person called to a staff member by name and asked for help cutting their pie, the staff member helped quietly and only did what the person needed, asking them if they would like them to cut anything else, the person said, “no I am alright now.” The provider had invested in training and development for managers and staff, such as positive behavioural support (PBS) which had helped managers and staff understand the reasons people might behave in a certain way when distressed. Managers now understood how to analyse incidents and share the learning from them to reduce situations which cause people distress. People who had sensory perception and processing needs had been referred to health professionals for assessment. Staff had begun to recognise some sensory needs, for example a person who has difficulty with noise was being supported to avoid prolonged situations they found difficult so they could control their surroundings by taking action themselves. Investment in learning for managers and staff was reflected in staff practice. People and relatives told us they could talk to managers and staff freely. One person said, “I like all the staff.”

Staff told us they felt supported by managers and the provider. New staff were inducted into the values of right support, right care, right culture. One staff told us “it’s their (the people who live at Baytree house) home, we are there to support people to live their own 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 Inadequate (published 30 September 2021). 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.

This service has been in Special Measures since 30 September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned focused inspection based on the previous 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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, safe, effective and well led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sutton court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor the service through the providers monthly report on conditions. We will speak 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.