The inspection took place on the 26 October 2018. This visit was unannounced. A second day on the 29 October was spent talking with health professionals and visitors who visited Bay House.

Bay House is a 'care home.' People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 31 older people and older people living with dementia in one adapted building. Accommodation is provided over two floors. At the time of our inspection there were 32 people using the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in post. 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.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. Care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking, and moving and handling. For example, pressure relieving mattresses and cushions were in place for those who were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and epilepsy. There was a good level of information and guidance for staff to follow for those people who lived with complex needs. There were safe systems for the management of medicines and people received their medicines in a safe way.

Staff and relatives felt there were enough staff working in the home and people said staff were available to support them when they needed assistance. All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns. Staff had a clear understanding of making referrals to the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. There was a consistent use of agency staff and the registered manager ensured that the agency staff used had the necessary skills to work at Bay House. People said they felt comfortable and at ease with staff and relatives felt people were safe.

People were supported to eat healthy and nutritious diets. Food and fluid charts were completed when risk of poor eating and drinking had been identified and showed people were supported to eat and drink. Staff had received essential training and there were opportunities for additional training specific to the needs of the service. This included the care of people with specific health needs such as diabetes and strokes. Staff had formal personal development plans, including two monthly supervisions and annual appraisals. Staff and the registered manager had a good understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to

At the last inspection on 28 December 2014 & 05 January 2015 we asked the provider to make improvements to the safety and welfare of people, treating people with dignity and respect and the monitoring and assessing the quality of the care and support provided. The provider sent us an action plan stating they would be addressed by September 2015. We found our concerns had been addressed and the breaches in regulation met.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked reflected the positive comments people made.

Since our last inspection care plans had been reviewed and the format changed. Care plans reflected people’s assessed level of care needs and care delivery was person specific and holistic. The delivery of care was based on people’s preferences. The provider had progressed quality assurance systems to review the support and care provided. A number of audits had been developed including those for care plans, medicines and health and safety.

Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided.

The care planning system had been reviewed and records for each person were specific to their needs, with guidance for staff to ensure people received the support and care they needed and wanted. Risks to peoples’ health and safety were well managed by knowledgeable staff. Care plans showed each person had been assessed before they moved into the home and any potential risks were identified. Risk assessments included, falls, skin damage, behaviours that distress, nutritional risks including swallow problems and risk of choking and moving and handling. For example, cushions were in place for those that were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and epilepsy.

Nurses were involved in writing the care plans and all staff were expected to record the care and support provided and any changes in people’s needs. The registered manager said care staff were being supported to do this and additional training had been arranged. Food and fluid charts were completed and showed people were supported to have a nutritious diet.

Staff had a good understanding of people’s needs and treated them with respect and protected their dignity when supporting them. A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles. People previously isolated in their room were seen in communal lounges for activities, meetings and meal times and were seen to enjoy the atmosphere and stimulation.

Activity provision was provided throughout the whole day and was in line with people’s preferences and interests.

Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there was a sufficient number with the right skills when people were able to move into the home. The registered manager told us it had been difficult to recruit nurses with the right knowledge, a deputy registered manager had been appointed and the provider continued to advertise for full time nurses.

Pre-employment checks for staff were completed, which meant only suitable staff were working in the home.

The provider had

The home had a friendly, warm atmosphere and we observed that the people who use the service appeared comfortable with the staff. People told us that they liked living there and felt safe there. We observed staff interacting with people in a respectful and polite manner. We saw staff asking for the person’s consent before engaging in any care. We noted that staff knocked on people’s doors and waited for a response before entering.

The care plans detailed with the individual’s needs expressed clearly. The home had a comprehensive emergency plan to ensure the safety and welfare of the people who use the service. This included policies relating to fire, electric failure, flooding and the provision of alternative accommodation.

We saw that the service had policies in place for the safe use of medicines, managing drug errors, covert medication, homely remedies and a protocol for the use of “when required” medications. The home had undergone changes on staffing but at the time of the inspection was finally fully staffed with no agency being used.

We saw that the home had a detailed complaints policy. This divided complaints into low level complaints which were able to be dealt with by staff immediately and high level complaints which required the formal investigation procedure. Ms Avery was registered manager but no longer in post at the service. Mrs G Carter is the registered manager. We did not inspect the regulated activity of personal care during this inspection.

People who used the service told us that staff treated them with respect and that their privacy and dignity was taken into account.

People using the service spoken with expressed a satisfaction with the care and support provided.

People’s comments included ‘’I could not be better treated’’, ‘’there is always something to do’’, ‘’activities and staff are wonderful’’.

All feedback from people living in the home and visitors was positive about the home’s facilities and the standard of cleanliness.

People spoken with were positive about the staff working in the home. Comments included ‘’Staff are very nice and kind’’, ‘’Staff are nice and look after us very well’’.

Staff spoken with had a good understanding of peoples needs and understood how to meet these.

Visitors spoken with told us that they felt able to talk to staff about the service and care provided.

We inspected Bay House Nursing Home Nursing Home on the 29 December 2014 and 05 January 2015.

Bay House Nursing Home Nursing Home is registered to provide care to people with nursing needs, such as Parkinson’s, diabetes, and heart failure, some of whom were also living with dementia. The service can provide care and support for up to 36 people. There were 32 people living at the service during our inspection.

A manager was in post. They were not the registered manager, but were undergoing registration with our registration team. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. The home has been without a registered manager for five months.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at did not always reflect the positive comments some people had made.

People’s safety was compromised in a number of areas. Care plans and risk assessments did not all reflect people’s assessed level of care needs and therefore for some people was not person specific or holistic. There were people in the home that did not have care plans or risk assessments and therefore staff could not give a consistent level of care delivery.

Peoples care documentation did not reflect people’s individual preferences and wishes. We saw little documented about their preferences for how they wanted their care delivered. People told us that they had not been involved in care decisions or at managing aspects of their care themselves to maintain their independence.

People were happy with the food provided. The dining experience was a social and enjoyable experience for many people. People were always supported to eat and drink enough to meet their needs.

People’s medicines were stored safely and in line with legal regulations. People received their medicines on time and from a registered nurse.

People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate.

Records showed staff were recruited in line with safe practice. For example, employment histories had been checked, suitable references obtained and appropriate checks undertaken to ensure that potential staff were safe to work with vulnerable adults.

Feedback had been sought from people, relatives and staff. ‘Residents’ and staff meetings were held on a regular basis which provided a forum for people to raise concerns and discuss ideas. Incidents and accidents were recorded.

Staff told us the home was mostly well managed and there were good communication systems in place between all levels of staff. These included handover sessions between each shift, regular supervision and appraisals, staff meetings, and plenty of opportunity to request advice, support, or express views or concerns.

We found a number of breaches including continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.