Our inspector visited the service and gathered information to answer our five questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? 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 people using the service 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 found that there had been improvements made to some of the premises so that there were designated areas suitable for use by people that lived at Bay View. These included eleven bedrooms in total, a main assisted bathroom, two lounges and the dining room. We understood that revenue was limited due to low occupancy and the provider would continue with improvements under a phased improvement plan. Areas used by people that lived in Bay View were safe.

Is the service effective?

We found that people we spoke with were satisfied with the care they received and said their needs were met. We found a quality assurance system had been implemented since our last inspection in April 2014, but it had not yet been analysed or used to determine any improvements.

Is the service caring?

People told us they were treated very kindly by the staff and that they felt looked after. They said they were quite satisfied with the care they received and the support they were given by staff. They said, "The girls are very caring and they do whatever we want them to do," "The staff know me well and understand what help I need" and "Yes I am quite happy with everything, there is no cause for complaint."

Is the service responsive?

People told us they had their needs met and that they needed nothing more.

Is the service well led?

There was a registered manager in post with several years' experience. There were two other staff on duty. The manager had begun to complete some audits and had surveyed people that used the service, their relatives and a district nurse by asking them to complete a satisfaction survey form. Information gathered under the quality assurance system had yet to be evaluated and an action plan to make improvements to the service had yet to be produced.

The service will be inspected again early in our next inspection calendar.

Our inspector visited the service and the information they collected 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 people using the service 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 found that people were safe because their care and health care needs were met. People had their needs assessed and planned for within a care plan document which staff used to deliver the care and support to meet those needs. Care plans were reviewed appropriately.

We found people were safe from the risk of harm or abuse because there were appropriate safeguarding systems in place, which were used by the staff to prevent, where possible, report and record suspected or actual safeguarding situations. Staff were aware of their responsibilities to protect people and to refer information to local authority safeguarding teams or the Police. Staff had not received updated safeguarding training, though the provider was planning this.

People that used the service were safe because their environment was free from hazards: the lay out, design and furnishings were suitable. One lounge carpet could become a potential trip hazard if it continued to stretch and the handyperson was asked to ensure tools and equipment were safely stored away at the end of the day.

However, the environment was not entirely suitable, as three bedrooms were not fit for use. Other bedrooms had old and tired décor and had not been redecorated for several years. Communal toilets and the communal bathroom floor coverings were unsuitable for the purposes of maintaining good infection control.

The safety of vulnerable people was potentially at risk because although there was a procedure in place for recruiting staff which was followed, the manager had misunderstood application of the Disclosure and Barring Service policy. Additional measures had not been taken regarding the 'non-portability' of staff security checks.

Is the service effective?

The service of care provided was effective because people gave consent to care and support on an individual basis as support was offered. People said care was provided how they wanted it to be. Although this support was planned and recorded in documents (care plans) to instruct staff on how best to help people, people had not given formal written consent in the form of a signature for it to go ahead. This would have increased the effectiveness of the service.

Peoples' needs were effectively met by attentive and conscientious staff.

Is the service caring?

People received the care they required from staff that were understanding of their needs and preferences. Staff were empathetic, followed sound ethics and were able to provide individual and targeted care to people that used the service. This was because of the low residency numbers. Staff provided the care and support that a caring relative would give to someone in their own home, because staff completed all tasks within the service: cared, cleaned and cooked. Staff roles were not yet defined according to tasks. This meant that staff knew peoples' likes, preferences and wishes with regard to all their needs.

Is the service responsive?

The service provided at St Kitts was responsive to peoples' individual needs and preferences because people experienced targeted interaction with staff if they wanted this. Whenever people called for assistance it was provided quickly.

People that used the service said they were satisfied with the care they received. We received information that a person who had spent a short stay in the service was planning to return again shortly, because they had been well cared for and had enjoyed and benefited from their stay.

Is the service well led?

The service was not being sufficiently well led from the point of view of formally checking the quality of the care provided. There was a complete quality monitoring system available for use, but it had not been implemented and people had not yet been asked their views. This meant people were unable to provide their opinion of the service and the manager did not know where the service needed to be improved, which meant that improvements had not been made.

The manager had not made use of their time effectively while occupancy had been low: the quality monitoring system had not been implemented to highlight the environmental shortfalls for example, or to audit any areas of the service other than management of medication. Audits could have been completed on staffing issues (recruitment or training), infection control systems, housekeeping, furniture or decoration, so that a baseline assessment of the overall service provision could be used to show what needed doing to improve things.

The inspection of Bay View took place on 7 July and 29 September 2015. At the previous inspection on 10 December 2014 and 5 February 2015 we identified twelve breaches of regulation. These breaches applied to regulations 9 (twice), 22, 15, 12, 21, 13, 23, 17, 14, 24 and 10 under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Since 1 April 2015 the regulations have changed to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Those breaches of regulation therefore equated to breaches of regulation 9: Person-centred care (twice), 18: Staffing (twice), 15: Premises and equipment, 12: Safe care and treatment (three times), 19: Fit and proper persons employed, 10: Dignity and respect, 14: Meeting nutritional and hydration needs, and 17: Good governance.

Bay View is registered to provide care and accommodation to a maximum of 23 older people who are vulnerable because of their age and illness only. There are 21 single occupancy bedrooms and one shared occupancy bedroom on three floors. There are two lounges and a dining room for people to use. There is a passenger lift to the upper floors. At the time of this visit there were four people living there permanently, but two of these were in hospital.

There was a registered manager in post who had managed the service since it was registered under Quality Care UK Limited in August 2014. 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.

During our July and September 2015 inspection we found that the service was still in breach of regulations 15, 19 and 12. The premises were still unsafe with regard to electrical systems and so people were not safe from the risk of harm from electric shock or fire. The registered manager continued to deploy staff that had not been recruited using a robust recruitment procedure. This meant people were cared for by staff that weren't thoroughly checked according to the criteria of ‘fitness’ to work with vulnerable people. People were supported by staff who did not follow the correct dress codes and who did not follow the correct practices with reference to infection control. This meant people were not fully protected from the risks associated with poor infection control.

We are considering our enforcement powers and will report on this at a later date.

We found there was some improvement in the staff training with staff booked on courses but which they had yet to attend. People’s choices had also improved. We found that the service was not as caring as it could have been. Some improvement had been made with staff consulting people more about their preferences and choices. However, the staff weren’t always ensuring people’s dignity was upheld with regard to their personal care needs.

We found there had been improvements in the responsiveness of staff to meeting people’s needs and this was partly due to only two people using the service. We found that care plans had been reviewed and contained better information for staff to know how best to meet people’s needs. We saw that a limited range of activities was provided for people and that complaints were appropriately handled.

The service had improved its cooperation with other providers and organisations so that people were referred to health care specialists for support in a timelier manner and there was improvement in the area of quality monitoring and assuring service provision. However, the service did not accurately maintain the records it was required to in order to manage the regulated activity.

This was a new breach of regulation 17: good governance, with regard to record keeping. You can see what action we told the registered provider to take at the end of the full version of the report.

The overall rating for this provider is ‘Requires Improvement’. However, at the last inspection we found key areas of inadequate care, which gave the service an overall rating of ‘Inadequate’. At this inspection in July and September 2015 the service had not demonstrated sufficient improvement and one key area remained ‘Inadequate’. Therefore this means that the service has been placed into ‘Special measures’ by CQC. The purpose of special measures is to ensure the service improves its care to people that use the service.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s 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.