Baytree House

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.

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 9 people; at the time of inspection 9 people were living at the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities 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 or autistic people.

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

People were not safe from abuse. The provider had failed to ensure safeguarding systems were robust and had not ensured managers and staff had suitable training, skills and knowledge to report incidents of potential abuse. Lessons had not been learnt from a recent inspection of another of the providers locations.

Risks to people had not been fully considered and did not encourage positive risk taking. Managers and staff lacked suitable training and skills to always support people whose behaviours may challenge themselves or others safely in the least restrictive and most person-centred way. The provider had not fully considered safety risks in the service or the potential impact these could have on people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The model of care and setting did not maximise people’s choice, control and independence. The layout of the premises offered limited space. The dining area was also used by managers to work on their laptops as the office was on the top floor and so cut off managers from being able to observe and interact with people and staff.

People were supported by staff who knew them well, however the provider had failed to ensure staff had received suitable induction or training. This meant people did not always receive person-centred care or support which promoted people’s dignity, privacy and human rights. Care and activities did not focus on developing people’s strengths and aspirations.

People were not supported by managers and staff who understood current best practice in relation to learning disability and/or autism. The provider had failed to ensure managers and staff received support to keep their knowledge and skills up to date. There were shortfalls in governance systems which did not ensure people remained safe, lessons had been learnt or improvements made.

Some people were not always supported to have maximum choice and control of their lives and staff¿did not¿always support¿them in the least restrictive way possible¿and in their best interests; the policies and systems in the service¿were not always understood by managers and staff.¿

People were positive about their experience of the service. Some had lived at Baytree House for many years and one person told us, “It’s nice here.” They went on to describe other people who lived at Baytree House as “Their friends”. Some people were unable to express their views. Relatives were positive and told us, “It’s absolutely fantastic” another said, “I’m very impressed.”

People told us they liked the garden and enjoyed the meals. People were happy to show us their rooms which were personalised and reflected their choices. People told us about activities they were participating in which included regular walks, shopping and art and craft activities in Baytree House.

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 good (published 27 September 2019). The service has now been rated inadequate.

Why we inspected

This inspection was prompted in part due to concerns about people’s safety we identified in another of the providers locations. We inspected in order to provide assurance people were safe and to check the service was applying the principles of Right support, right care, right culture.

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 have found evidence the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Following the inspection the provider has taken some actions to mitigate the risks. This is an ongoing process.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person-centred care, safe care and treatment, safeguarding, staffing, notifying CQC of incidents and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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

Baytree House provides personal care for up to nine people living with a learning disability and/or autism. At the time of the inspection, the home was full. 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 similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The service applied 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.

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

People were involved in all aspects of the service and made suggestions on how it was run. They were encouraged to make decisions relating to their care and support; their independence was supported and promoted. 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.

Before people came to live at the home, careful thought was given in the planning process. People who already lived at the home were involved and asked for their feedback about any potential, new admission. Care plans were person-centred in design and provided staff with detailed information and guidance about people’s care needs and how they wished to be supported. Staff completed a range of training to enable them to deliver personalised care to people.

People were involved in all aspects of the home, from choosing and planning menus to deciding how they wanted to spend their days. Most people attended day services during the week. People were encouraged to participate in the community and were supported by staff in activities such as bowling and swimming. Holidays were planned with people and staff accompanied them. People had access to a range of healthcare professionals and services. Positive, caring and compassionate relationships had been developed between people and staff.

People were protected from harm by staff who understood what actions to take if they suspected any form of abuse. Risks to people were identified and assessed as needed, with guidance for staff which was followed. There were enough staff to support people and help them engage with activities. Medicines were managed safely.

A range of audits measured and monitored all aspects of the home and service delivery. Staff felt supported by the management team and involved in developing the service.

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 28 January 2017).

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.

Baytree House is a care home registered to provide accommodation and care for up to nine people with a learning disability and/or mental health needs. At the time of our inspection, the home was fully occupied. Baytree House is a large, detached Victorian House situated close to the centre of Worthing, with easy access to public transport. Communal areas include a sitting room, a dining room and gardens. Accommodation is provided over two floors and all bedrooms are of single occupancy.

A registered manager was 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.

People told us they felt safe living at Baytree House. Staff had been trained to recognise the signs of potential abuse and knew what action to take. People’s risks were identified, assessed and managed appropriately and clear guidance was provided to staff on how to mitigate people’s risks. Staffing levels were sufficient to meet people’s needs and recruitment processes for new staff were robust. Medicines were managed safely.

People were supported by staff who had been trained in a range of areas. New staff completed the Care Certificate, a nationally recognised qualification. Staff received regular supervision meetings and annual appraisals. Staff meetings took place. Staff understood the requirements of the Mental Capacity Act 2005 and put this into practice. People living at the home were subject to Deprivation of Liberty Safeguards and the provider had completed applications for authorisation under this legislation. People were supported to have sufficient to eat and drink and encouraged to maintain a healthy lifestyle. They had access to a range of healthcare professionals and services. People showed us their rooms which were personalised.

Staff were kind and caring and positive relationships had been developed between people and staff. People were involved in decisions about their care. They were treated with dignity and respect.

Care plans provided staff with comprehensive and detailed guidance and information on how to support people in a personalised way. Care plans were written in an accessible format and reviewed every three months. People participated in a range of activities on a day to day basis and many people attended day centres. The provider had an accessible complaints policy in place; no complaints had been received recently.

People were actively involved in developing the service and monthly residents’ meetings were held. Relatives were asked for their views about the service through formal surveys and people also completed questionnaires to provide feedback. Staff felt supported by management and spoke highly of the service and of their enjoyment in working at Baytree House. A range of audit systems was in place to measure and monitor the care delivered and the service overall. A social care professional endorsed the service provided at Baytree House and spoke positively of the care people received and of the support from staff.

This inspection was carried out by one inspector. We gathered evidence that helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with four people using the service, three of the staff supporting them and from looking at records. They included care assessments and care records, staff recruitment and training records, staff rotas and records related to the provider's quality assurance system.

Although we were unable to have meaningful discussions with people, we spent time with people in communal areas. This enabled us to observe interactions between people and members of staff so that we could understand what it was like to live at Baytree House.

Is the service safe?

Care staff had received training in identifying and reporting possible abuse. This meant that people had been safeguarded against the risk of being abused.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection we were told there were no applications made under DoLS that were currently in force. The manager confirmed they understood when an application should be made to deprive someone of their liberty.

The provider had a system in place for gathering, recording and evaluating accurate information about the quality and safety of the care and support the service provides.

Care records had been appropriately maintained to ensure people's needs had been met safely.

The manager demonstrated that a robust recruitment procedure was in place. This meant that the needs of people were met by care staff who were fit, suitably qualified and capable of doing the job.

Is the service effective?

Where possible, people's health and care needs were assessed with them, and they were involved in writing their plans of care.

When necessary best interest decisions had been made to maintain the health and wellbeing of individuals who lacked capacity to make decisions for themselves.

Is the service caring?

From our observations we saw people were treated with respect and dignity by the staff.

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Family members who completed satisfaction surveys reported they had no concerns about the care provided. One relative reported, 'This is a very good example of how it should be done ' well done!'

Is the service responsive?

People completed a range of activities in and outside the service regularly. The activities provided have been in response to requests made by people who lived at the care home.

Care staff supported people to talk about their views and experiences and to sort out any problems.

People and their relatives completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service well-led?

Care staff we spoke with were able to describe their roles and responsibilities.

Staff training records we looked demonstrated they had received induction training.

Staff we spoke with confirmed they felt well supported and well led by the manager.

We found people has personalised care plans and risk assessments. We found for every identified risk there was a plan in place to address the risk. We saw people had daily preference lists that were used to meet their preferences.

People told us "the food is great" and "there's lots to do".

We viewed records relating to staff requirements and found that the provider was not operating effective recruitment procedures.

We found the lack of consistent recording systems meant that there was a risk that information may not be kept up to date and people may not be protected against the risks of unsafe or inappropriate care and treatment.

We found the provider had not submitted the appropriate notifications.

We looked around the home and found that people had been encouraged to personalise their rooms with their own furniture and ornaments. Some people had their own televisions. The manager told us that people were given a choice or decor when rooms were due to be re decorated.

During the inspection we reviewed the provider's policies and procedures. We found policies in place to support the assessment, delivery and review of care. We also spoke with three people who lived at the home and to one person's relative. One person told us "I love it here, I get to do lots of nice things".

We spoke with two members of care staff. One member of staff told us "It is nice working here. I love my job". Our review of records showed that staff were up to date with mandatory training.