28 April 2014
During a routine inspection
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well-led?
Is the service safe?
Staff personnel files showed that appropriate pre-employment checks were carried out before staff began working with people. We saw evidence that staff had a valid Disclosure and Barring service (DBS) check which was up to date. This showed that people were protected from the risks of receiving support from unsuitable staff. We saw evidence that staff had received induction training which included shadowing experienced staff and that they completed a six month probationary period. Training records showed that staff had received training for moving and handling, first aid and safeguarding of vulnerable adults and this was up to date.
The provider had a medication policy and procedure in place and the responsibility for administering medication to people was assigned to designated members of staff. We saw evidence from training records that staff completed medication training with a pharmacist. Staff we spoke with described the training regime they had completed before becoming a designated medication administrator. We saw evidence that medicines were stored safely and records showed that medicines were administered correctly.
Arrangements were in place to deal with foreseeable emergencies and staff were aware of what to do in an emergency. Training records showed that staff had received training in fire safety, health and safety and moving and handling. People's files contained care plans that were reviewed regularly and there were risk assessments in place. Care plans contained information about medical history, allergies, mobility needs and emergency contacts.
Is the service effective?
People's needs were assessed and care was planned and delivered in line with their care plan. The provider involved relatives in the assessment and care planning process. We saw evidence that people had signed to consent to the care they received. People's files showed that their capacity had been considered under the Mental Capacity Act 2005.
People we spoke with expressed satisfaction with the care and support given and that their needs were met. One person told us "it's good here." A relative told us that her parent was bedbound and could not speak, but "staff are friendly, always talk to her." It was clear from speaking to staff that they had a good understanding of people's care and support needs.
We saw evidence from staff files that there were effective recruitment procedures in place and that staff had received appropriate induction and training which was regularly updated. Staff received regular supervision and annual appraisals. Training records showed that staff had received training in Dementia and care planning. This showed that people could be confident that they receive effective care from staff who have the knowledge and skills necessary to carry out their roles and responsibilities.
Is the service caring?
People's relatives and friends were able to visit without undue restriction. One relative told us that they "like to be able to give Mum one of her meals" and that she visits every day. The manager told us that the door is open to relatives at any time and that relatives are invited to attend the frequent events that they hold.
During our observations, we saw staff responding to people's needs at the time they needed it. Staff responded to call bells in a timely manner and asked people if they could help them. We observed activities being carried out in the garden and staff were seen to encourage people to join in and checking that they were comfortable and shaded from the sun. For example, one person was looking for a cushion in the dining area to sit on in the garden and a member of staff offered her a garden seat cushion and placed it onto the chair for her. This meant that staff showed concern for people's well-being.
Is the service responsive?
People's needs had been assessed before they started to use the service. We saw evidence that plans were put into place before people moved into the home. People's preferences, likes, dislikes and interests had been recorded on support plans. Care and support was provided in accordance with people's wishes. We saw evidence that people had chosen to continue to administer their own medication independently. Care plans were reviewed regularly and were up to date.
We saw evidence that complaints had been responded to and acted upon promptly and in each case the complainant had been satisfied with the action taken. People we spoke with knew how to make a complaint if they needed to. On the day of the inspection the relatives we spoke with told us that they had no complaints or concerns.
People's files contained a removable information section which could be taken to appointments with other professionals. This information included a summary of the care plan, medication and medical needs. This meant that people's needs could be assessed more accurately and that they received the support they needed from other services.
Is the service well-led?
Relatives we spoke with told us that "management will always find time" if they wanted to raise concerns and that concerns "are always acted on". A member of staff we spoke with told us that they enjoyed working at Bayfield Court because "staff get on well and management are supportive". Another member of staff told us that they liked working at the home because there were "higher standards of care than other places I've worked". The provider had a quality monitoring system in place which showed that opportunities to improve the service were identified and followed up promptly. People who used the service and their relatives were asked to complete feedback surveys on a six monthly basis. Records showed that the provider analysed the outcome of these surveys, identified actions needed and shared this with staff at team meetings. This showed that management used information from concerns to make improvements and from compliments to extend best practice across the service.