Archived: Barton Park Nursing Home

Updated 8 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We inspected this service because we had received some information of concern form the local authority with regards to people’s health and well-being. The local authority had been visiting the home regularly to help people transition to new homes and assess people who wished to move from Barton Park. Some of these areas of concern included, mental capacity, financial information, and care planning. We also decided to inspect Barton Park following the guilty verdict of one of the directors of Choiceclassic Ltd. Choiceclassic Ltd is the registered provider of the location, Barton Park. CQC has been aware of this ongoing police investigation which involved the directors Barton Park. One of the trials for one of the directors had concluded, however, the trials for the remaining directors were due to take place later in the year. CQC has not been able to include any information with regards to this in their past reports for Barton Park due to their being a reporting restriction in place. CQC have, however, used their powers to issue conditions on the registered providers registration to prevent them entering the home.

Since we began inspecting this service there has been inconsistency with regards to the meeting of regulations. At the last focused inspection in April 2018, the home was in breach of regulation. The meant that the home was rated as ‘requires improvement’.

In light of the concerns mentioned above, we conducted a comprehensive inspection over two days on 5 & 6 July 2018. The inspection was unannounced. Due to further information which was shared with us we visited the home unannounced on the 25 July 2018. These concerns were in relation to the hot water supply and the lack of food supplies at Barton Park. We specifically checked these concerns with the manager on 25 July 2018, however we found action was being taken with regard to the hot water, and there was enough food in the home.

The inspection team consisted of a total of three adult social care inspectors who attended on different days. An inspector and Inspection manager attended on 25 July 2018.

We did not request a PIR for this service. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We carried out a Short Observational Framework for Inspection (SOFI). SOFI is a methodology we use to support us in understanding the experiences of people who are unable to provide feedback due to their cognitive or communication impairments.

We looked at records and related documentation for five people. Two staff recruitment records, spoke to five staff and two people who lived at the home. We also spoke to three visiting relatives, and one visiting healthcare professional. On day one of our inspection we spoke to the chef, the registered manager and deputy manager. On day two of our inspection we spoke to the new manager and the HR manager. We walked around the home and checked the general environment. We observed lunch on day one of our inspection. We communicated over the two days with the local authority and social workers who were at the home to ensure we shared information regarding the health and well-being of the people who still lived at Barton Park.

Updated 8 September 2018

This inspection of Barton Park Nursing home took place on 5 and 6 July 2018. We completed a further visit at the home on 25 July 2018 to check recent concerns which had been brought to our attention, however we found that these concerns were being addressed appropriately, however we have asked for information from the manager around timescales for completion.

The inspection was unannounced, and was undertaken both due to concerns being raised to us by the local authority.

We completed a focused inspection in April 2018, as we wanted to ensure the home was being managed appropriately, and we had been made aware of a change to the registered manager.

During this inspection in April 2018 we looked at the Safe and Well-led domains and found a breach in relation to the fire doors. We escalated our findings to the Merseyside Fire and Rescue service.

We received information from the registered manager after our inspection in April 2018 ended to confirm that the concerns we found in relation to fire doors had been rectified.

However, we saw during this inspection, that the service was still in breach of regulations in relation to this, and we escalated our findings from this inspection in relation to the fire safety of the home to Merseyside Fire and Rescue service. Merseyside Fire and Rescue service conducted their own inspection of the premises and found concerns relating to some of the fire safety of Barton Park. We have been updated with regards to this.

CQC have closely monitored the home since the since a criminal investigation began in relation to directors of the registered provider, Choiceclassic Ltd. We have been unable to report on this aspect of the inspection under the Well-Led domain due to reporting restrictions being in place. Following this verdict, CQC has followed their own regulatory processes to ensure the safe running of the home. This included imposing conditions on the registered provider’s registration to prevent the directors from entering Barton Park or engaging in the regulated activity of the home. Following this inspection we have imposed a further condition that restricts the service from admitting any new service users given the concerns that we found.

Barton Park is located in Birkdale and is registered to provide nursing care and accommodation for up to 60 people. At the time of our inspection there were 14 people living at the home. This was because the local authority commissioning team had served 28 days’ notice to terminate their contract with the registered provider, Choiceclassic Ltd in light of the guilty verdict of one their directors. On the last day of the inspection only six people lived at Barton Park.

Barton Park 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.

During day one of our inspection, there was a registered manager in post. However, by day two of our inspection the registered manager had been changed, and the deputy manager was on leave, which left a new manager who had started in post the same day as the overall decision maker of the home.

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.

We were concerned about this, as there was also no Nominated Individual (person responsible) in post to provide oversight and support with decision making in light of the restrictions on the registration of the directors of Choiceclassic Ltd. The new manager had only taken up post that day, and was not well informed as to the situation at Barton Park with regards the local authority issuing notice on their contract with Choiceclassic Ltd. Subsequently, this meant that people who received local authority funded care provision were being assessed for a place in other nursing homes. Additionally, the new manager had no induction or shadowing opportunity. Staff were also unaware of the changes to the management structure and staff members told us they were unsure what was happening or who they should go to.

Audits had not been completed when required. There was a dignity audit which was due to be completed quarterly, which meant it was due at the end of April 2018. This had not been completed. We saw that medication audits had not been completed since March 2018, therefore the service was unable to demonstrate a good oversight in relation to checking service provision. Governance systems in place also did not pick up on the concerns we found throughout our inspection. Additionally, the breach of regulation in relation to fire safety at the last inspection had not been adequately addressed, which demonstrated that lessons had not been learned from previous shortfalls and addressed or followed up appropriately.

The home was not adequately staffed which we saw during the second day of our inspection. The operation decision to change the registered manager at short notice meant that the nursing provision for the home over the weekend was not covered. This was because the previous registered manager had placed themselves on these shifts. We were concerned about this. Staffing rotas could not be located, and the new manager and HR manager were not sure what shifts needed to be covered. Due to the potential impact this could have for people living at the home, we shared our concerns with the local authority, and requested to be updated throughout the duration of our inspection until the shifts were covered. The new manger covered the shifts with a registered nurse who worked at the home and kept us updated of this.

There were other staffing concerns which we saw during our inspection in relation to supervision and appraisal. There was no documented evidence to show that staff had been engaging in regular supervisions. Three staff supervisions had taken place in 2018, however the rest of the supervisions were from 2017, and we could not determine which staff had been supervised and which hadn’t. We also saw that most staff had not had an appraisal.

We found that medication was not always managed safely. This was because medications requiring cold storage were kept in a fridge, and the temperature had not been taken since April 2018. If medication is not stored within the correct temperature range its ability to work effectively can be compromised

Additionally, the process for administering Controlled Drugs (CDs) was unsafe and not in line with best practice. We have shared some guidance with the new manager around this to ensure they took action and put adequate safeguards in place.

People’s records were disorganised and often contained confusing information. Some care plans were not always clear, and risk assessments for some people had not been reviewed regularly. There were also gaps in the recording of information for some people, such as cream charts and pressure relief charts.

We were made aware by the local authority that some people’s next of kin was still named as the director who had just been found guilty and sentenced for acts of fraud against people who had lived at Barton Park. Some of the financial information for people had not been made readily available for assessment by social workers and advocates when requested. The local authority shared this information with Merseyside police. This meant that people had not been safeguarded appropriately from potential acts of abuse.

The service was not always working in accordance with the principles of the Mental Capacity Act 2005. This was because information around people’s decision-making abilities was not always clear. Additionally, some people’s capacity had not been assessed as part of their admission to the home. One person’s Deprivation of Liberty Safeguard (DoLS) authorisation had expired last year, and had not been reapplied for, nor had their capacity been reassessed.

We looked at the process in place to record and respond to complaints. There was no record of any complaints being received at Barton Park. However, one visiting relative told us they had made a complaint some weeks ago in writing and not had a response. We followed this up and saw there was no record of this complaint. Therefore, we could not be sure whether any other complaints had been received and not acted upon.

Care plans were basic in their presentation; however, they did have details with regards to people’s likes, dislikes and routines. Due to the care records being disorganised, it was difficult to determine from the records if people were in receipt of person centred care. Person centred means care which is based around the needs of the person and not the service. Our observations showed that staff knew people well, and they could clearly explain their routines to us. However, some recording of information was lacking in detail for some people and detailed for others, which did not demonstrate a consistent approach to record keeping.

Staff recruitment records showed that most checks had been undertaken as needed. This included references, identification, and a Disclosure and Barring Service checks. We did see some recruitment files did not contain medical questionnaires or interview notes, whereas others did. This meant that recruitment records did not contain consistent information. We raised this at the time of our inspection and have made a recommendation about this.

We saw on day two of our inspection that there was a singing activity organised which people enjoyed. However, when we asked about other activities people could not remember what they had done, and one person said, “Not much happens in the home.” On day o