About the service: Bay Tree House is a care home. People in care homes receive accommodation and personal care under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Bay Tree House provides a service for up to 16 older people, some of whom may be living with dementia. At the time of the inspection the service was fully occupied. Accommodation is provided over two floors and people have access to communal areas and well-maintained grounds.

People’s experience of using this service:

People were cared for by sufficient numbers of staff who had been trained. Staff knew people well and provided them with care which met their individual needs.

Peoples health was well managed. When people required support with their health, staff made referrals to health care professionals in a timely manner.

People were asked for their views about the service and had the choice to participate in a wide range of activities.

People were provided with a wide range of meals which they told us they enjoyed. People were provided with the support that they required to eat and drink.

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

People received care and support from staff who were kind and caring. Staff enjoyed working at the service and knew people extremely well.

There was a positive culture within the service and the registered manager and staff team displayed a real passion to deliver care in line with people’s preference.

More information is in the full report

Rating at last inspection: Good (report published 11 May 2016)

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

Follow up: We will continue to monitor all intelligence received about the service to ensure the next inspection is scheduled accordingly.

Bay Tree House provides accommodation and personal care for up to 16 older people including those living with dementia. Accommodation is located over two floors. There were 15 people living in the home at this time of this inspection.

This inspection was unannounced and took place on 6 April 2016.

The home had a registered manager in post. 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 and associated Regulations about how the service is run.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Staff had received training in this subject and those spoken with during this inspection were able to demonstrate that they were aware of the principles of the MCA or DoLS and their obligations under this legislation.

Medicines were not always safely managed. This was because of incorrect recording of staff signatures for topical creams and the way which the separation of people’s medicines was stored.

Care plans contained all of the relevant information that staff required so that they knew how to meet people’s current needs. We were confident that people always received the care and support that they needed.

The provider had a recruitment process in place and staff were only employed within the home after all essential pre-employment checks had been satisfactorily completed.

People’s privacy was respected during our inspection. Staff were seen to knock on the person’s bedroom door and wait for a response before entering. People’s dignity was protected because staff ensured that people were involved in agreeing what care and support they required

People were provided with a varied and balanced diet. Staff referred people appropriately to healthcare professionals when needed.

The provider had a complaints process in place and people were confident that all complaints would be addressed.

The provider had an effective quality assurance system in place to identify areas for improvement. They were able to demonstrate how improvements were identified and acted upon.

This inspection was carried out by a single inspector. As part of our inspection we spoke with three people who were receiving support, three relatives and friends, a health professional, the manager, and four staff working at the service. We also observed people receiving support and looked at the support plans for six people. We used the evidence collected during our inspection to answer five questions.

Below is a summary of what we found.

Is it safe?

People who we spoke with told us that they felt safe and they liked the staff. One person said, "I am happy and safe here.”

Assessments of any potential risks to people had been carried out and measures put in place to reduce the risks. This meant that people were protected from the risk of harm.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had a system in place to demonstrate they had given consideration to whether each person using the service had the capacity to make decisions about their day to day care under the Mental Capacity Act (2005). The Mental Capacity Act is a law which requires an assessment to be made to determine whether a person can make a specific decision at the time it needs to be made. It also requires that any decision made on someone’s behalf is recorded, including the reasons why it has been made, how the person’s wishes have affected the decision and how they were involved in the decision making process.

Is it effective?

People we spoke with told us, and our observations confirmed, that people were happy with the service which they received.

It was clear from our observations, and from our conversations with staff and the manager, that staff knew people’s needs well. We saw that people had a positive relationship with the staff who supported them.

Staff worked closely with other health professionals to ensure that people’s needs were met by staff with the most appropriate, knowledge, skills and experience.

There were effective recruitment and selection processes in place. Appropriate checks were undertaken before staff began work.

Is it caring?

We saw that people got on well with staff, who supported them with respect but also in a friendly manner. The relatives we spoke with all said the staff were very caring to their family members and they treated relatives well when they visited. One person’s relative said, ”We visit here often. The staff are always friendly and welcoming.”

We saw that personal care was offered and delivered discreetly so that people’s privacy and dignity were respected. The staff we spoke with said that they enjoyed their work and they demonstrated a good understanding of the needs of people who lived at Baytree House.

Is it responsive?

People's care records evidenced that their capacity to consent to aspects of their care and support had been considered.

People’s needs and care plans were regularly reviewed by the staff and management at the home. Referrals were made to health professionals to ensure that people received appropriate support by people with the most appropriate knowledge and skills.

Support plans included information on people’s likes and dislikes and their preferences, to ensure care and support was delivered taking into account their personal preferences. The staff we spoke with told us they were trained to do their job and knew how to meet the needs of people using the service.

People participated in a range of activities of their choice and were encouraged to participate in activities within the local community.

Is it well-led?

The staff told us that they felt well supported by the management team. They told us they received guidance from them. One member of staff said, "Management are very supportive. You feel appreciated working here."

People we spoke with who lived at the service, and relatives, told us they felt the service had strong leadership and was well-managed. Relatives we spoke with said they were confident to raise any concerns or complaints they had with the manager. One relative said, “The manager is excellent. Very caring and involved.”

The provider had effective quality assurance and audit systems in place to monitor aspects of the service.

All the people we met and spoke with told us that their privacy and dignity were respected by staff. One person told us that, “This home is very good and l am well looked after.” This demonstrated to us that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We spoke to the cook and they told us that they worked closely with care staff to ensure that individual nutritional needs were being met effectively. This meant that people were protected from the risks of inadequate nutrition and dehydration.

We saw that staff had received regular supervisions and appraisals. Actions had been taken to address any individual learning needs that were identified as a result. This showed us that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We saw that the service kept a record of the concerns and complaints received. This gave us a clear description of the concerns identified and the actions taken to address these as required. This demonstrated to us that there was an effective complaints system available and that the comments and complaints people made were responded to appropriately.

The rrecords kept by the service were seen to be stored securely, accurate and 'fit for purpose'. This meant that people were protected from the risks of unsafe care because accurate and appropriate records were maintained.

The people using the service said they were well looked after and happy living there. One person said, “The carers are really nice and kind”. Another person said, “It’s lovely here. The girls are lovely; they really look after us”.

People we spoke with explained how they had been involved in making their own decision to choose to live at Bay Tree House as well as in the planning of the care and support they required.

Care records were detailed, up to date and person-centred. The care plans were written alongside the person using the service to ensure their individual needs were met. Individual risk assessments were complete and regularly reviewed. The care and support delivered by the care staff reflected what was stated in people’s care plans. Care records were audited and reviewed on a monthly basis.

People living at Bay Tree House told us that they felt safe and that there were plenty of activities to take part in if they chose to do so. All of the people we spoke with highly praised the provider, stating that the home was exceptionally well run and people’s dignity and choice were always promoted.

We saw that there were enough suitably trained and experienced staff to meet the needs of people using the service.

The home had various methods that were used to ensure the quality of the care was assessed. Meetings, reviews and management audits were in place and records were available.

People we spoke with told us that they were very happy living in Bay Tree House.

One person told us that the staff were, "Exceptional" and that they felt, "Very lucky to be living in such a marvellous place". They also told us that their relative had found the home and that it was a, "Perfect choice". This person said that there was no hesitation with deciding to move in, when a room became available.

We spoke with one person who told us: "I can do just as I please, I'm a bit of telly addict and it's lovely and comfortable being able to watch what I want in my own room."

People we spoke with told us that they could have visitors at any time and that they were always made welcome and the relatives we spoke with also said they were able to visit whenever they wanted and could stay as long as they wanted.

One person told us how their family had prepared their room for them, so that when they moved in it would be just like their own home with all their personal pictures, furniture and belongings around them. They also told us that they were delighted with it and, "Couldn't have done it better myself".

The relatives we spoke with praised the provider on the excellent running of the home and said that the care provided was also excellent.

One person commented that the laundry got mixed up occasionally and another person told us that they were sometimes given something different to what they had ordered from the menu.

Two of the people we spoke with told us that they received the care and support they needed and that the staff helped them to stay as independent as possible. One person said, "I never have to wait very long if I need anything" another person told us, "The staff are always quick to respond if I need to call them".

People we spoke with told us they felt well looked after and very safe living in Bay Tree House. They also told us that they could speak to the staff or the owner if they had any concerns. One person stated: "I completely trust all the staff here."

The relatives we spoke with said they felt confident that their family members were safe and well looked after.