About the service: Bessingby Hall is a care home. The service accommodates 65 people in one adapted building. 26 people were receiving personal care across two separate units, each of which had separate adapted facilities. One of the units specialises in providing care to people living with dementia.

People’s experience of using this service:

A new registered manager had recently been employed. This had led to further improvements to those started by an interim management team. The registered manager provided a consistent presence which gave people and staff confidence in the service.

Staff were up to date with training which gave them confidence in their abilities and led to more positive outcomes for people who used the service.

Recruitment of staff now followed the company policy reassuring people that staff were suitable to work in this environment.

Quality monitoring had been improved giving a much better overview of what was happening at the service day to day. Improved systems meant the senior leadership team could access information immediately. As a result any identified issues can be dealt with immediately and should lessen any impact on people who use the service and staff.

Where staff noted a concern they quickly involved healthcare professionals. This included support to manage people’s healthcare conditions and any areas of risk.

Staff were aware of people’s life history and preferences. They used this information to develop positive relationships and deliver person centred care.

People told us they felt well cared for by staff who treated them with respect and dignity. They felt that communication had improved and were pleased with the support they received.

Rating at last inspection: Requires Improvement (Published November 2018)

Why we inspected: The last comprehensive inspection took place in October and November 2017 where we found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. The breaches were in Regulations 12 (Safe care and treatment, 13 (Safeguarding service users from abuse and improper treatment), 14 Meeting nutritional and hydration needs), 17 Good governance and 19 Fit and proper persons employed.

Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring responsive and well led to at least good.

To check that improvements outlined in the action plan were being made and check people were safe we had carried out three focused inspections in February, April, and September 2018. At the focused inspections all the breaches found at the comprehensive inspection of October/ November 2017 had been met and so there were no outstanding breaches when we carried out this inspection.

At this inspection we were able to check whether or not the improvements had been sustained and we found that they had.

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.

We undertook this focused inspection on 19 September 2018 to check that Bessingby Hall had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bessingby Hall on our website at www.cqc.org.uk

This inspection was carried out to check that people were safe following inspections in October and November 2017, January 2018 and April 2018 where there had been serious concerns identified by the Care Quality Commission (CQC), East Riding of Yorkshire Council (ERYC) and East Riding of Yorkshire Clinical Commissioning Group (ERYCCG). The team inspected the service against two of the five questions we ask about services: is the service well led, is the service safe? This is because the service had not been meeting some legal requirements.

CQC had taken urgent action to prevent the provider from admitting people to the service following our comprehensive inspection of October/November 2017. A second condition had also been placed on the providers registration preventing them from providing nursing care at Bessingby Hall. This inspection was to review if the service was sufficiently safe to allow the provider to admit people once again and to ensure people were safe.

Bessingby Hall is a care home that provides accommodation and personal care for up to 65 older people who have physical disabilities and/or are living with a dementia related condition. It is a detached property set out over two floors within its own grounds. There is a separate unit for up to 22 people living with dementia. There were 27 people living at the service when we inspected.

There was a manager employed at this service who was in the process of registering with CQC. 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. They had been registered with CQC since May 2016.

Risks to people had been identified and there was guidance for staff to follow when managing the risks. Accidents were recorded and analysed.

Staff recruitment was robust. There were sufficient numbers of knowledgeable staff on duty to meet people’s needs effectively.

Servicing and maintenance of the environment had been carried out in a timely manner.

There was effective oversight of the service and an improvement in the quality of the service. The quality assurance system was effective in identifying areas which required improvement.

We undertook an unannounced focused inspection of Bessingby Hall on 10 April 2018. This inspection was carried out following serious concerns raised by the local authority safeguarding team (ERYC) and Clinical Commissioning Group (ERYCCG) with CQC about safeguarding, medicine errors, no lessons learned and staff not following policies and procedures.. We had already identified some of these areas of concern at our previous two inspections but since then ERYC and ERYCCG had carried out a joint investigation of the service which had led to them to re-assessing the risk level as high.

The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led. This is because these were the areas of concern and the service was not meeting some legal requirements. We found continuing breaches of Regulations 12, 13, and 17 of the Health and Social Care Act 2008 (Regulated activities) 2014 at this inspection.

No significant changes were identified in the remaining Key Questions through our on-going monitoring or duringour inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating for this inspection.

Bessingby Hall 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.

Bessingby Hall accommodates up to 65 people providing accommodation and personal care to older people and those with a dementia. However, a change to the services registration conditions by CQC meant that currently they are unable to admit people to the service. There were 29 people living at the service on the day of the inspection but only 27 resident as two people were in hospital.

There was a manager employed at this service. The manager had only recently been recruited and was not registered with CQC. 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.

Staff understood the principles of safeguarding and were confident reporting issues to the manager. They had not always recognised risks to people or acted upon them but we saw improvement in this area.

There were sufficient numbers of staff to meet people's needs.

Records were not always up to date for each person. Care plans did not contain all the relevant information and there were gaps in recording on documents such as food and fluid charts.

There was a quality monitoring system which was been improved by the management team. Audits had been completed for some areas of care and this level of detail should now be reflected across all areas of the service.

The leadership and management of the service had recently changed and staff were positive about the impact of this. However, sufficient time had not elapsed to make sure leadership and management continued to improve.

The rating for Safe has changed from Inadequate to Requires improvement. The overall rating could not be changed because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

We undertook an unannounced focused inspection of Bessingby Hall on 5 February 2018. This inspection was carried out following concerns raised by the local authority safeguarding team and Clinical Commissioning Group (CCG) with CQC about recruitment and training of nursing staff. We had already identified that staff were not recruited safely and training was not always up to date in our inspection on October 25 and November 6 2017 but these further concerns required us to carry out an inspection. The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led. This is because the service was not meeting some legal requirements. We found continuing breaches of Regulations 12, 13, and 17 of the Health and Social Care Act 2008 (Regulated activities) 2014 at this inspection.

No significant changes were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating for this inspection.

Bessingby Hall 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.

Bessingby Hall accommodates up to 65 people providing residential and nursing services and a service for people living with dementia. Seventeen people were receiving nursing care at the service.

There was a registered manager employed at this service. 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.

Staff understood the principles of safeguarding but had not always followed safeguarding processes. They did not always recognise risks to people or did not act upon them.

The provider had not always maintained equipment in a clean or safe state. This increased the risk of infection for people who used that equipment.

Staff recruitment was not robust. Nursing staff did not have the skills and knowledge required to meet everyone’s needs effectively and safely.

Records were not up to date for each person. Care plans did not contain all the relevant information and there were gaps in recording on documents.

There was a quality monitoring system but we found it was ineffective. Audits and checks had not always been completed to a high standard which prevented areas for improvement being identified.

The leadership and management of the service was inadequate.

This inspection took place on 26 October and 6 November 2017. Day one was unannounced and we informed the manager that we would return on day two. At the last inspection in October 2015 the provider had no breaches of regulation.

We moved our planned comprehensive inspection to an earlier date because we had received concerns about a person who had lived at the service from the provider and East Riding of Yorkshire Council (ERYC). Following the inspection we were informed by ERYC of concerns about three further people who had lived at the service. When we carried out our inspection we identified breaches of Regulations 12 Safe Care and Treatment, 13 Safeguarding service users from abuse and improper treatment, 14 Meeting nutritional and hydration needs, 17 Good Governance and 19 Fit and proper persons employed of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Bessingby Hall is a care home with nursing that provides accommodation and personal care for up to 65 older people who have physical disabilities and/or are living with a dementia related condition. It is a detached property set out over two floors within its own grounds. There is a separate unit for up to 22 people living with dementia. There were 56 people resident at the service when we inspected.

There was a registered manager employed at this service. 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. They had been registered with CQC since May 2016.

Risks to people had not always been identified. Accidents were recorded and analysed.

Staff recruitment was not robust. There were sufficient numbers of staff on duty to meet people’s needs effectively.

Servicing and maintenance of the environment had been carried out in a timely manner.

Most training was completed but updates were needed. Staff were not clear about the principles of MCA and DOLS.

People were not supported to have maximum choice and control of their lives because staff had not supported them in the least restrictive way possible; the policies and systems in the service had not supported this practice. Staff had not followed the correct process for making the best interest decision.

People's nutritional needs had not been met and records in this area were poor.

Staff were clear about supporting people's privacy but they did not always maintain people's dignity. We saw some positive interactions with people.

Activities took place but they were not meaningful. This was being addressed.

The environment was dementia friendly particularly outdoors, but more signage would support people.

People knew how to make a complaint and we saw that where complaints had been made and there was a response which was in line with company policy. One complaint did not have a response recorded.

There had been a lack of effective oversight at the service which had led to a deterioration in the quality of the service. The quality assurance system had not been effective in identifying areas which required improvement.

End of life wishes had not been recorded for some people.

Bessingby Hall is a care home that provides a service for up to 65 older people, some of whom may be living with dementia, as well as people with a physical disability. There is a separate unit for people who are living with dementia and require nursing care. Most people have a single room although there are three double rooms, and most rooms have en-suite facilities. The home is situated within its own grounds and accessed via a private road; there are ample car parking facilities.

We inspected this service on 29 October 2015 and the inspection was unannounced. We last visited the service on 5 June 2013 and found that the registered provider was compliant with the regulations we assessed, apart from in respect of record keeping. We carried out a follow up visit on 19 August 2013 and found that the service was compliant.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was not registered with the Care Quality Commission (CQC). However, they had submitted an application for registration. 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 this inspection we found that the service was safe. People’s needs were assessed and comprehensive risk assessments put in place to reduce the risk of avoidable harm.

Staff had received training on safeguarding adults from abuse and any safeguarding concerns had been identified and appropriate action had been taken.

People were supported to make decisions and their rights were protected in line with relevant legislation and guidance.

The service had an effective recruitment process and this ensured only people considered suitable to work with vulnerable people had been employed. There were numerous staff vacancies but new staff had been recruited and were due to start work at the home when their safety checks had been received. We saw that there were sufficient numbers of staff on duty on the day of the inspection.

Staff told us they were happy with the training provided for them, and we saw that there were effective induction training and refresher training programmes in place.

People’s nutritional needs were met; their likes, dislikes and special diets were known by staff and were catered for. People were supported to access healthcare services. We saw that advice and guidance from healthcare professionals was incorporated into care plans to ensure that staff provided effective care and support.

People using the service were positive about the caring attitudes of staff. We observed that staff were kind, caring and attentive to people’s needs and that they respected people’s privacy and dignity. Staff encouraged people to make decisions and have choice and control over their daily routines.

We saw that there were systems in place to assess and record people’s needs so that staff could provide personalised care and support. Care plans were updated regularly and information shared so that staff were aware of people’s changing needs.

People told us they felt able to make comments, complaints or raise concerns and we could see that feedback about the service was used to make changes and improvements.

The manager was proactive in monitoring the quality of care and support provided and in driving improvements within the service. There was clear organisation and leadership with good communication between the manager and staff on both units. We observed that records were well maintained.

We did not speak at length with people who used the service during this inspection as it was a visit to look at the progress made with regard to record keeping. At our previous visit in June 2013 we found people were being looked after by friendly, supportive staff within a warm and homely environment. Staff were respectful and patient with individuals. All interactions we saw put the wishes and choices of people who used the service first and they were included in all conversations.

Our brief chats with people at this inspection indicated they were happy in the service and from what we observed people were settled and relaxed with the staff and other service users.

We found that improvements had been made with regards to record keeping. However, the provider told us that they appreciated further work had to be done to develop the care plans and associated care records in order to sustain these improvements.

People told us that they were consulted about their care and were able to make their own decisions about life in the home. People felt staff respected their privacy and dignity.

We found people were being looked after by friendly, supportive staff within a warm and homely environment. Staff were respectful and patient with individuals. All interactions we saw put the wishes and choices of people who used the service first and they were included in all conversations.

The home was designed to meet the needs of people who lived there and the provider ensured equipment used to assist people with their daily lives was regularly maintained, safe and fit for purpose.

We saw that there were sufficient numbers of staff on duty to meet the needs of the people who used the service. People we spoke with said they liked living in the home. One person told us, “Staff are friendly and give us the support and help we need” and another said “There is a lovely atmosphere in the home, very friendly and welcoming.”

The provider had an effective quality assurance system in place and people’s views and opinions of the service were listened to and acted on where necessary.

The majority of the care plans were up to date and risk assessed. However we found a number of supplementary care records such as food and fluid charts, pressure relief charts, bathing records and wound care records were not completed appropriately.

We found people were being looked after by friendly, supportive staff within a warm and homely environment. The food offered to people was well cooked and offered them a choice of meals. Care was risk assessed and records were up to date.

People we spoke with said they like living in the home and that their care and support was "Satisfactory." One person told us, “Staff are friendly and give us the support and help we need” and another said “There is a lovely atmosphere in the home, very friendly and welcoming.”

People told us that they were consulted about their care and were able to make their own decisions about life in the home. People felt staff respected their privacy and dignity. One person said “I decide when I get up in a morning, when I want to go to bed. I can make choices about what I want to eat or how I want to dress. There are some limits to what I can do for myself because of my health, but staff listen to me and try to do things the way I like them done.”

People said that they had good access to outside healthcare professionals and they were satisfied with the level of medical support given to them. People told us they saw the provider and manager most days to talk to and they were confident of using the complaints system if they needed to.

People were not consulted during this follow up review.

Those people spoken with told us they were happy at the home and brought their own possessions with them when they moved in. They were positive about the food provided and told us there were no restrictions on their movements.

They told us the standard of care was good and the staff were very kind, friendly and helpful. They also told us staff treated them with dignity and they were never forced to do anything they did not want to do. However, people told us they had not been involved with the formulation of their care plans.

People knew who to complain to and were confident the manager would take any concerns seriously. They also told us staff were kind and helpful and they trusted them.

People told us they had attended meetings where they could air their views; they felt their views were taken seriously.