26 September 2023
During an inspection looking at part of the service
Barton Brook is a care home in Salford which is registered with CQC to provide care for a maximum of 120 people, across 4 separate ‘Houses’. These include Monton (EMI Nursing), Moss (Residential Dementia), Brindley (Nursing) and Irwell (Nursing). There were 110 people using the service at the time of the inspection.
People's experience of using this service and what we found
Not all risks were well managed at the home including those relating to falls, skin integrity and the environment. Staff did not always respond appropriately when physical and verbal altercations occurred between people living at the home. We have made a recommendation about staff receiving further safeguarding training. Actions following incidents weren’t always followed through. We received poor feedback about staffing levels within the home and observed staff weren’t always available to respond to people’s needs. There were a number of environmental concerns observed on some of the units which could place people at risk of harm.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. There were a number of restrictions in place for people including 121 care, the use of covert medication and sensor mat/chair alarms. We also observed people’s movements around one of the units being prevented. MCA assessments were not? completed to ensure this was in people’s best interests.
People’s bedrooms were not always personalised and some felt unhomely. The external grounds of the home were not well maintained, with lots of stray litter scattered around and overgrown grass. There were a number of instances where people’s dignity was compromised where staff did not always respond accordingly.
People’s care plans contained contradictory details and this posed the risk of staff not having the correct information regarding the care people needed. Activities and stimulation for people was limited. Nobody was receiving end of life care at the time of the inspection, although we received feedback from the local authority that attendance at their training sessions could improve. People’s communication needs were not always met.
There had been a lack of leadership at the home in the past 12 months, with 5 different home managers in post. Leadership on each of the individual units was also a concern. Meetings for resident/relatives and staff had not been taking place consistently, although had now been scheduled to take place. Staff supervisions and appraisals did not always take place consistently. There had been a failure to ensure compliance with regulations and the ratings for each of the key questions had declined.
Rating at last inspection
The last rating for the service was requires improvement (Published July 2022).
Why we inspected
We carried out an unannounced focused inspection of this service on in May 2022 and a breach of regulation 17 regarding good governance was identified. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance systems within the home.
We undertook this inspection to follow up on specific concerns which we had received about the service including staffing, safeguarding, falls management and leadership. A decision was made for us to inspect and examine those risks.
We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements. We inspected and found additional concerns which could impact people’s safety, so we widened the scope of the inspection to become a comprehensive inspection which included the key questions of effective, caring and responsive (in addition to safe and well-led).
The overall rating has changed from requires improvement to inadequate. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Barton Brook Care Home on our website at www.cqc.org.uk.
Enforcement and recommendations
We identified breaches regarding dignity and respect, consent, safe care and treatment, safeguarding, good governance and staffing. We have also made recommendations regarding safeguarding training, activities and complaints.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.