Bailey House

About the service

Bailey House is a residential care home providing personal care for up to 3 younger adults. At the time of the inspection 3 people living with a learning disability and/or autism were being supported by the service.

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

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. When restrictions were in place, the appropriate authorisations had not been sought once expired. People were not always supported in line with their care plans, preferences and interests.

People did not always get the right support as the provider did not always respond to peoples, needs, preference and choices. The service was not well-led and we were unable to see that improvements had been made since the last inspection.

The provider did not always support people in a safe, well equipped, well-furnished and well-maintained environment that met their needs. People did not have access to a safe outdoor areas and people’s communal space had been reduced as staff were using a dining room as a staff office area. Although some improvements had been made to the environment, further work was required to ensure the service was safe and maintained.

Staff did not follow safe practices in relation to COVID-19. This included wearing and disposing of PPE in line with government guidelines and staff carrying out testing. This meant that people were at risk of harm.

The provider failed to support people to have maximum possible choice, control and independence. People had been restricted of their liberty without the appropriate authorisations in place as these had expired.

Staff did not always support people to achieve their aspirations and goals. Monthly meetings for people to discuss their dreams and goals were not completed or contained the same information each month.

Right Care

People were not being protected by the provider's recruitment process because checks were not robust. People took part in some activities; However the service did not always promote opportunities to try new activities that enhanced and enriched their lives.

People who had individual ways of communicating, using body language, could not always interact comfortably with staff using this method as staff had not had the appropriate training.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so.

People did not always have risk assessments in place, or they were not available, to identify risks people faced and how staff should manage these. Information found was not always up to date or accurate.

Right culture

People were not always supported by management and staff who fully understood the holistic needs of supporting people with a learning disability and autism. A new manager had recently started in post who was keen to develop the service and ensure people holistic needs were met.

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

Rating and Update

The last rating for this service was requires improvement (11 August 2021) and there were breaches of regulation. The service remains rated requires improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

We carried out an unannounced focused inspection of this service on 29 and 30 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained 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 Bailey House 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

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.

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 risk management, infection control, person centred care, deprivation of liberty and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

Bailey House is a residential care home providing accommodation and personal care to people with a learning disability and Autistic people. The service can support up to three people, three people were living at the service at the time of inspection.

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

People living at the service did not always receive safe person-centred care. People were exposed to the risk of harm due to a lack of robust measures in place to manage fire safety. The service did not have adequate measures in place to protect people from the risk of infections spreading.

Staffing levels were not consistently maintained to ensure people’s safety. We have made a recommendation about this.

People received their medicines as prescribed. People at the service received psychotropic medicines and the manager and staff were unaware of supportive guidance relating to these types of medicines. We have made a recommendation about this.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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 that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports Care Quality Commission to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well-led, the service was not able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. People were not given choices or control to maintain their independence with aspects of daily living. Person- centred care was not always promoted by staff and management were not always present at the service to ensure people’s rights were being upheld.

Governance systems were not robust. The oversight of the service was not always effective and had not identified the issues we found at this inspection. People and their relatives gave positive feedback about 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 good (published 22 February 2019).

Why we inspected

We received concerns in relation to the management and leadership of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bailey House 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.

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 risk management, person-centred care and management oversight.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety at the service. We will work alongside the provider and 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 service had 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 a learning disability were supported to live as ordinary a life as any citizen.

People’s experience of using this service: People were happy living at the service. Staff supported people to have a meaningful life and encouraged them to be independent.

Care and support was tailored to each person’s needs and preferences. People and their relatives were fully involved in developing and updating their planned care.

People who lacked capacity were supported to have maximum choice and control of their lives. Policies and systems supported them in the least restrictive way possible.

Detailed risk assessments were in place to support people to take positive risks and remain safe.

Staff understood how to safeguard people from abuse. The staff team empowered people to make choices about what they wanted to do.

Appropriate recruitment checks were carried out to ensure staff were suitable to work in the service.

Medicines were managed safely. Records confirmed people received their medications as prescribed. Training records showed staff received training and competency was checked on a regular basis.

The registered manager demonstrated a commitment to providing person centred care for people. Staff felt the registered manager was supportive and approachable. Staff were happy in their role which had a positive effect on people’s wellbeing.

Rating at last inspection: Good (Report published July 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

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.

Bailey House premises consisted of a four-bedroomed, terraced property on a residential street in Goole. It provided care and accommodation for up to three people with a learning disability. All bedrooms were single occupancy. There was a lounge, a dining room and a kitchen, with a yard area to the rear of the property. There were two bathroom facilities. Car parking was on the street outside the property. All local services were within walking distance. There was local bus access to Goole town centre and Doncaster or beyond. There was local train access to larger cities such as Kingston-Upon-Hull, Leeds and beyond. At the time of our inspection there were two people using the service and one person accessing day care.

The registered provider is required to have a registered manager in post. On the day of the inspection there was a manager that had been registered and in post for the last three and a half years. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were managed and reduced by implementing risk assessments so that people avoided injury or harm whenever possible.

The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Staffing numbers were sufficient to meet people’s need and we saw that rosters reflected the staff that were on duty. Recruitment policies, procedures and practices were carefully followed to ensure staff were suitable to care for and support vulnerable people. We found that the management of medication was safely carried out.

People were cared for and supported by trained and competent staff. However, we were not completely assured that induction of new staff was effectively carried out in all cases. Staff were regularly supervised and their performance was assessed using an appraisal scheme. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected.

People received adequate nutrition and hydration to maintain their health and wellbeing and it was sometimes difficult for staff to ensure people ate a balanced diet because people’s choices were respected. The premises were suitable for providing care and support to adults who had a learning disability and/or mental health needs. However, there were parts of the premises that were unsuitably maintained.

We found that people received care and support from kind staff and that staff knew about people’s needs and preferences. 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 care and support tasks.

People’s wellbeing, privacy, dignity and independence were monitored and respected and staff worked to maintain these wherever possible. This ensured people were respected and that they were enabled to take control of their lives.

We saw that people were supported according to their person-centred support plans, which reflected their needs well and which were regularly reviewed. People had the opportunity to engage in pastimes and activities if they wished to. People had good family connections and support networks.

There was an effective complaint procedure in place and people were able to have any complaints investigated without bias. People that used the service, relatives and their friends were encouraged to maintain relationships through frequent visits, telephone calls and sharing of each other’s news.

The service was adequately led and people had the benefit of a culture and a management style that were both positive. There was an effective system in place for checking the quality of the service using audits and satisfaction surveys. While audits were regularly completed, the surveys were not used as often as they ought to be.

People had opportunities to make their views known through direct and informal representation to the registered provider, registered manager or the staff. There were formal complaint and quality monitoring formats also available for people to use to make their views known. However, people were not always able to do this. People were assured that recording systems used in the service protected their privacy and confidentiality as records were well maintained and were held securely.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report

Is the service safe?

We saw that there had been an extensive 'transition period' undertaken for people before moving to the service. This meant they could be safely monitored and their needs could be gradually assessed to ensure care and support given to them was accurate and would therefore meet their needs.

We found that the systems for managing medication were safe and well maintained, records were accurate and people received the drugs they required to maintain their wellbeing.

We saw that the premises were safe for use because they had been checked by competent personnel with regard to gas, electrics and fire safety and they were adequately maintained. The premises were suitable for providing care and support to people that were physically able, because people did not require any adaptations.

People had their needs appropriately met by sufficient numbers of experienced and trained staff, so people were safely cared for.

Is the service effective?

People had a 'transitional' plan in place which was carefully being added to as assessments were being carried out. This meant staff could assist people with their personal 'development and growth' and ensured staff supported people in the best way they could.

Is the service caring?

We observed staff interacting professionally with people that used the service while being kind and caring towards them. The nature of the service was such that staff encouraged people to be independent and to develop their skills, which removed the emphasis on 'doing for' people.

Is the service responsive?

We saw that where people needed guidance with social interaction or with patience in between activities, the staff were firm but polite. Staff were guiding but not overbearing and enabled people to express themselves as they wished or wanted to. The service was responsive to peoples' needs.

Is the service well led?

We found that the service was providing people with safe and varied care that reflected their needs based on the continuous assessment of those needs. This was done under a clear management style that expected thorough processes to be implemented.

Sufficient daily checks had been carried out and people that used the service had been asked about their satisfaction to enable the provider to conclude how individuals' care and support needed to be changed or improved on. The service was well led.