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Archived: Barton Grange Requires improvement

Reports


Inspection carried out on 23 March 2017

During an inspection to make sure that the improvements required had been made

This inspection took place on 23 March 2017 and was unannounced. It was carried out by one adult social care inspector.

Barton Grange is a residential care home that can support up to 19 older people, some of who are living with dementia, who require accommodation and personal care. Located in spacious grounds, the accommodation is arranged over two floors. During the inspection, there were 14 people living in the home.

There was not 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. There was a manager in post and at the time of the inspection they had been responsible for the service for two weeks. The manager was also responsible for overseeing one of the provider’s other homes in Weston Super Mare.

We carried out an unannounced comprehensive inspection of this service on 8 September 2016. Breaches of legal requirements were found because the service was failing to ensure effective systems were in place to monitor the quality and safety of the service. Care files were not always accurate, complete and up to date record of people's needs.

After the comprehensive inspection, we issued a request to the provider requiring them to provide us with details of the action they would take to improve the service.

We undertook this focused inspection to check the progress they had made. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

The environment was still not fully safe and clean. Cleaning schedules were not being followed and records were not kept of when cleaning had taken place. Some health and safety checks were not being completed by staff.

We found some action had been taken to improve people’s care records.

The systems for assessing, monitoring and improving the quality and safety of the service provided was still not fully effective. Some of the action we identified as at our previous inspection in September 2016 had not been taken to improve the safety and cleanliness of the home.

We found repeated breaches in two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 8 September 2016

During a routine inspection

This inspection took place on 8 September 2016 and was unannounced. Barton Grange is a residential care home that can support up to 19 older people, some of who are living with dementia, who require accommodation and personal care. Located in spacious grounds, the accommodation is arranged over two floors. During the inspection, there were 18 people living in the home.

We last visited Barton Grange on the14 April 2015. A breach of legal requirements was found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Regulation breached was Regulation 11, need for consent.

There was not a registered manager was in post. The previous manager had left in August 2016 and the deputy manager was in charge. A new manager was due to start the week following our inspection. 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.

A safe environment was not always maintained. We found the building was in need of a refurbishment as all the rooms, fixtures and fittings were showing wear and tear. There were broken bannisters on the main staircase. We saw that the kitchen needed a deep clean. Ceilings were in need of cleaning and dusting. We observed chemicals were not stored securely. There were windows that were observed to have no window restrictors on them in order to maintain people's safety.

We looked at people's care files and found that not all identified health needs were assessed and reflected in their care plans. This meant that staff may not have access to sufficient information to support people safely. The care files we looked at showed staff had completed some risk assessments to assess and monitor people's health and safety. However not all risk assessments provided sufficient detail and were up to date.

Although the care plans we viewed were reviewed regularly, they did not always contain consistent information throughout the care file regarding people's needs.

We looked at the systems in place for managing medicines in the home. A medicine policy was available for staff and staff had completed training in relation to safe medicine administration. Medicines were stored safely and records showed they were administered as prescribed. We found that people's allergies, preferences for administration were not always clearly recorded.

No changes had been made to the environment to support people living with dementia. The environment had not been adapted to meet people's individual needs.

Not all actions and recommendations had been acted upon since the last inspection. The provider employed a compliance manager who visited to assess the service and provided reports of their findings. We viewed completed audits, which included areas such as care plans and medicines; however, they did not identify all of the issues we highlighted during the inspection.

People we spoke with told us they felt safe living in Barton Grange and staff and visitors to the home agreed that care was provided to help keep people safe.

Recruitment and selection procedures were in place and we saw appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff had a good understanding about adult safeguarding. We found that appropriate safeguarding referrals had been made and a system was in place to monitor the outcomes of referrals.

Staff were aware of the home's whistle blowing policy and told us they would not hesitate to raise any issue they had.

Staff had received training around the application of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The staff we spoke with understood some of the requirements of this Act but needed to ensure capacity assessments and best interest decisions were accurately recorded and in place where needed.

We looked at accident and incident reporting within the home and found that this was reported recorded appropriately.

We found that there were adequate numbers of staff on duty to meet people's needs.

Staff we spoke with had received regular supervisions to help support them in their role. Staff had received an annual appraisal and felt supported in their role.

People told us they received enough to eat and drink, which helped to ensure their nutritional needs were met. Each individual's preference was catered for.

People at the home were supported by the staff and external health care professionals to maintain their health and wellbeing.

People told us staff were kind and caring and treated them with respect. We observed people's dignity and privacy being respected by staff, such as staff knocking on people's door before entering their rooms. Interactions between staff and people living in the home were warm and genuine.

We observed relatives visiting throughout the inspection. The deputy manager told us there were no restrictions in visiting, encouraging relationships to be maintained. For people who had no family or friends to represent them, contact details for a local advocacy service were available within the home for people to access.

The new manager told us they had plans to further improve the service.

Feedback regarding the management was positive from people living in the home. People told us they knew who the deputy manager was and that they was approachable.

Processes were in place to gather feedback from people and listen to their views. A complaints procedure was available within the home and this was on display for people to access. People we spoke with told us they knew how to raise any concerns they may have and felt able to do so.

Care files were stored securely in order to maintain people's confidentiality.

The previous manager had notified CQC of events and incidents that occurred in the home in accordance with our statutory notifications.

We found the provider was in breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.

Inspection carried out on 14 April 2015

During a routine inspection

The inspection took place on the 14 April 2015 and was unannounced. Barton Grange is a care home providing accommodation for up to 20 older people some of whom have dementia. During our inspection there were 14 people living at the home. The property is a large detached house situated on the outskirts of the village of Winscombe.

There was a registered manager in post at the 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 and associated Regulations about how the service is run.

There were systems in place to protect people from abuse; however we found these were not always effective. Some staff were not able to tell us where they would report safeguarding concerns to if they needed to go outside of the organisation. Information relating to this was not visibly available throughout the home. People who use the service appeared calm and relaxed during our visit, with one person commenting “I feel safe here”. Relatives told us they thought their family members were safe. Staff were able to recognise signs of abuse and felt confident in reporting it to the registered manager.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are an amendment to the Mental Capacity Act 2005 which allow the use of restraint or restrictions but only if they are in the person’s best interest. We observed where decisions were made for people the principles of the Mental Capacity Act were not always followed. There were no Deprivation of Liberty Safeguards (DoLS) applications made for people living at the home where they were subject to continuous supervision and lacked the option to leave the home without staff supervision. The manager told us they were in the process of seeking advice on making DoLS applications to the local authority.

People’s needs were set out in individual care plans. People’s relatives told us they were involved in the care planning process for their family member. We found the care plans were lacking detail around people’s preferences related to their care and they were not consistently reviewed and updated with input from the person. The registered manager and head of care were in the process of updating the care plans to make them more person centred.

Staff received appropriate training to understand their role. Staff had completed training to ensure the care and support provided to people was safe. New staff members received an induction. We found there were some staff who had not received up to date training, the registered manager had plans in place to address the gaps at the time of our inspection.

There were areas of the home requiring maintenance and repair. The registered manager had an action plan in place to remedy this.

The registered manager did not have effective systems in place to monitor the quality of the service. The Department of Health’s Code of Practice on the prevention and control of infections and related guidance was not being followed at the time of our inspection.

People and their relatives were positive about the care people received and praised the quality of the staff and management. Staff knew the people they were supporting well.

People’s medicines were administered safely. The service had appropriate systems in place to ensure medicines were stored correctly and securely.

People and relative’s told us they were confident they could raise concerns or complaints with the registered manager and they would be listened to.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 2 May 2013

During a routine inspection

During our last inspection in February 2013, we found Barton Grange to be non compliant in Regulation 13 'management of medicines'. During this inspection we found the necessary improvements had been made and the home was compliant with this regulation.

At the time of our inspection there were 19 people living in Barton Grange. During our inspection we spoke with people living in the home, visiting relatives, staff and the deputy manager.

We observed some people being supported and examined their care plan documentation at different stages of their assessments. This was to ascertain if an appropriate level of care was being provided, in line with their assessed needs.

People we spoke with were able to tell us their experience of living in the home. Overall people we spoke with were happy with the care they received. One person told us “I have no complaints and we get a choice of food which is very good “Other people’s comments included;” I get my breakfast in bed at six o’clock just the way I like it” ,“it is like a big family here”. “This house was recommended by my doctor”, “I don’t like to take part in activities but I have my own laptop and Sky TV so I have what I need”.

Comments we received from the visiting relatives were positive. One relative we spoke with told us “the home may not be posh but it is like a real home. We are always made to feel welcome when we come just as you would at a friend’s house”.

Inspection carried out on 20 February 2013

During a routine inspection

At the time of our inspection there were 16 people living in Barton Grange. During our inspection we spoke with five people living in the home, two visiting relatives, three staff and the registered manager.

We observed some people being supported and examined their care plan documentation at different stages of their assessments. This was to ascertain if an appropriate level of care was being provided, in line with their assessed needs.

People we spoke with were able to tell us their experience of living in the home. Overall people we spoke with were happy with the care they received. One person told us "It’s a lovely place the staff are really kind“, “we are well looked after here, lots of cups of tea”. Another person told us that they now lived close to their relatives and they go out with them regularly.

Comments we received from the visiting relatives were positive. Their comments included; “its home from home here”, “I am very happy with the service, they have bent over backwards to help”, “the staff are really helpful and try really hard to involve X in everything”.

Inspection carried out on 10 November 2011

During a routine inspection

We talked with people about being involved in their care planning and also how the service was managed. People who lived at Barton Grange and their relatives told us that they were involved in the assessment of needs when they or their family member came to the home. We were told that people were given information about the choices available to them and participated in making decisions.

We asked people if they felt that their privacy and dignity was maintained. People said that staff always knocked on doors and asked permission before entering someone's room. We also observed staff behaving in this way and being helpful and encouraging to people.

People said that they were encouraged to be as independent as they were able. Some people said that they were enabled to go out with family and friends and that the home also arranged trips to local places of interest. People said and we observed that the home was not locked and people were able and encouraged to spend time in the garden and grounds when the weather was nice.

People told us that they were able to have a bath or shower every day supervised by the staff. People we observed were appropriately dressed and had everything they needed at hand to maintain their independence.

A visitor told us “we have been delighted about the care provided to our relative. This is a small homely inclusive home. Our relative can be very challenging at times and the staff provide a lot of support. It feels like family and they always make us feel welcome. I would recommend this home to any one. The care, food and everything else is excellent”.

One visitor told us that their relative had been living at Barton Grange for approximately three years and during that time there had been no formal reviews. This person confirmed that the manager was approachable and that her relative’s care was discussed with the manager either by telephone or face to face. They said ”if there was anything untoward the manager would ring me". This visitor also said that all relatives are given a complaints procedure when their relative moved into the home. They told us “it is very open and transparent service.

One person we spoke with said “all the staff and the manager are very good. Nobody is rude and everybody is respectful”.

We spoke to a visiting health professional who told us that they had not seen anything to concern them during the times they had visited. They said “it is always very welcoming here“ and “there is no sharpness in any staff member’s voice”.

A visitor said “it is a nice atmosphere here. The staff are very kind and caring. We are happy with care and the staff are very helpful”.

We found the home compliant with the eight essential standards that we inspected, but there were also four improvement actions we recommended to maintain compliance