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Inspection carried out on 17 May 2018

During a routine inspection

Barnham Manor is a 'care home.' People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Barnham Manor is a home owned by Barnham Manor Limited. Barnham Manor is the only home under this provider.

Barnham Manor is a nursing home registered to provide accommodation, nursing and personal care for up to 33 older persons. At the time of the inspection 32 people lived at the service. The inspection took place on 17 May 2018 and was unannounced.

There were 28 single bedrooms and three shared bedrooms. All bedrooms had an ensuite wet- room bathroom. The home had a lounge - dining room which people were observed using. There were also areas where people and visitors could sit such as recess areas on the first floor. There were well-maintained gardens at the rear which people enjoyed using. A passenger lift was provided so people could have level access the first floor.

The home had a registered manager. 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.

The home was last inspected on 14 June 2016 when we identified a breach of Regulation because the provider had not ensured service user's care records were secure. A requirement was made for this and the provider sent an action plan to say how this was being addressed. At the inspection undertaken on the 17 May 2018, we found action had been taken to improve and secure people’s care records appropriately.

At our last inspection we rated the home as good. At this inspection we found that evidence demonstrated that the service required improvement in some areas.

The provider had failed to adequately assess, and mitigate the risks associated with the safe evacuation of people from the service in the event of an emergency. The provider had not developed personal evacuation plans (PEEPS) for people. These are plans that detail the individual support people would need in the event of an emergency. Many people had different levels of mobility and required the support of staff and equipment to transfer and mobilise.

Although risks associated with people’s mobility had been assessed and recorded, we identified that the manager was not always responsive in reviewing and following up incidents when people had suffered falls.

The provider did not always have a framework in place to ensure quality performance, risks and regulatory requirements were managed.

The provider did not have a consistent approach to involve and engage people who use the service to be involved in their care.

People’s needs had been assessed and care plans developed to reflect these. However, people’s care was not always delivered in a personalised way that met their needs and preferences.

People and their relatives spoke highly of the staff and said they felt safe living at the home. Staff understood their responsibilities to keep people safe. Staff were trained in safeguarding processes and demonstrated understanding of what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. Staff worked together effectively and across organisations to deliver effective support.

Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed. Staff were well trained and were able to meet the care and support needs of people. There were enough suitable staff on duty to care for people. One relative told us, “I think there are sufficient staff. They work very efficiently and Mum has never complained of having to wait if she needs anyone.”

Staff understood their responsibilities regardin

Inspection carried out on 14 June 2016

During a routine inspection

The inspection took place on 14 June 2016 and was unannounced.

Barnham Manor is a nursing home registered to provide accommodation, nursing and personal care for up to 33 older persons. At the time of the inspection 32 people lived at the service.

There were 28 single bedrooms and three shared bedrooms. All bedrooms had an en suite wet- room bathroom. The home had a lounge - dining room which people were observed using. There were also areas where people and visitors could sit such as recess areas on the first floor. There was parking at the front of the building and well maintained gardens at the rear, which people used. A passenger lift was provided so people could access the first floor.

The service had a registered manager. 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.

The service was last inspected on 13 April 2015 when we identified a breach of Regulation because the care plans did not always accurately reflect people’s care needs. A requirement was made for this and the provider sent an action plan to say how this was being addressed. At this inspection we found action had been taken to improve the care plans which now covered people’s care needs.

At this inspection we found people’s confidential records were not secure.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People said they received safe care.

Care records showed any risks to people were assessed and there was guidance of how those risks should be managed to prevent any risk of harm.

There were sufficient numbers of staff to meet people’s needs and a registered nurse was on duty at all times. Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed.

People received their medicines safely.

Staff were trained in a number of areas and people reported they were well cared for by staff. The arrangements for supervising staff were not always clear.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the MCA and DoLS. The staff and registered manager were aware of the legislation and carried out assessments of the capacity of those not able to consent to their care and treatment. Applications to deprive people of their liberty for their own safety were made appropriately. People said they were consulted about their care.

There was a choice of food and people said they liked the food. People were supported to receive adequate nutrition and fluids.

People’s health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular health checks from health care professionals.

Staff treated people with kindness and respect. People were able to exercise choice in how they spent their time. Arrangements were in place so people received care at the end of their life which reflected their wishes.

Each person’s needs were assessed and care plans showed how people’s needs were to be met and how staff should support people. Care was individualised to reflect people’s preferences. Relatives and health care professionals said the staff provided a very good standard of care.

Staff supported people with activities and social events were organised based on what people wanted.

The complaints procedure was available to people and their relatives. People said they had opportunities to express their views or concerns, which were listened to and acted on.

There was a culture which reflected a service based on

Inspection carried out on 14 April 2015

During a routine inspection

This inspection was carried out on the 14 April 2015 and was unannounced.

Our last inspection at Barnham Manor was carried out in February 2014 as part of our dementia themed inspections. At the inspection we found concerns with regard the safety of the care provided to people. Legislation and guidance had not been followed to protect the safety and dignity of people when they needed help with moving or lifting. At this visit we found that appropriate action had been taken.

Barnham Manor is a Nursing Home that is registered to provide accommodation for 33 older people. The registered providers are Barnham Manor Limited. Accommodation is provided over two floors. There are 28 individual rooms all of which are en-suite. There are three shared rooms. On the day of our visit there were 33 people living at the home.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People told us they felt safe. Relative’s told us they had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of harm.

Care records contained risk assessments that gave information for staff on identified risks and guidance on reduction measures. There were also risk assessments for the building and contingency plans were in place to help keep people safe in the event of an unforeseen emergency such as fire or flood.

Staffing levels were maintained at a level to meet people’s needs. The staffing rota and observations showed that on the day of our inspection there were sufficient staff on duty. People and staff told us there were enough staff on duty.

Thorough recruitment procedures were carried out to check staff were suitable to work with people. Staffing levels were maintained at a level to meet people’s needs

People were supported to take their medicines as directed by their GP. Records showed that medicines were obtained, stored, administered and disposed of safely

Staff were supported to develop their skills by receiving regular training. The provider supported staff to obtain recognised qualifications such as National Vocational Qualifications (NVQ) or Care Diplomas. Staff told us the training provided was good. People said they were well supported

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the service had suitable arrangements in place to establish, and act in accordance with people’s best interests if they did not have capacity to consent to their care and support.

People were satisfied with the food provided and said there was always enough to eat. People had a choice at meal times and were able to have drinks and snacks throughout the day and night. Meals were balanced and nutritious and people were encouraged healthy choices.

Staff supported people to ensure their healthcare needs were met. People were registered with a GP of their choice and the manager and staff arranged regular health checks with GP’s, specialist healthcare professionals, dentists and opticians. Appropriate records were kept of any appointments with health care professions

People told us the staff were kind and caring. Relatives had no concerns and said they were happy with care and support provided. Staff respected people’s privacy and dignity and staff had a caring attitude towards people.

Before anyone moved into the home a needs assessment was carried out. People and relatives knew a care plan had been prepared and said they were included in their development. They also confirmed they were invited to attend care reviews.

People’s care plans provided information for staff on how people should be supported. However care plans were task orientated and not person centred, meaning the wishes and preferences of people or those acting on their behalf were not central to their care and support plans. People’s care plans did not contain evidence of people’s involvement. Reviews did not evidence people’s changing needs were consistently monitored so that care plans had up to date information.

We observed a local vicar attending to people’s spiritual needs. Staff were seen engaging with people in a positive way and there was a regular programme of activities.

People and relatives told us the manager and staff were approachable. Relatives said they could speak with the manager or staff at any time. The manager operated an open door policy and welcomed feedback on any aspect of the service. The manager also arranged regular meetings with staff, people and relatives.

The provider had a policy and procedure for quality assurance. However this was not embeded in practice. Staff carried out weekly and monthly checks to help to monitor the quality of the service provided but the registered manager did not check that these were being carried out. Quality assurance surveys were sent out to people and relatives but these were not dated and therefore it was not possible to know when these had been sent out.

We made a recommendation regarding the use of and PRN (wen required) medicines.

We found a breach of Regulation 9 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 4 February 2014

During a themed inspection looking at Dementia Services

At the time of our visit there were 33 people living at the home. Barnham Manor is a nursing home caring for people with a wide range of needs. At the time of our visit, seven of the people living there had a formal diagnosis of a dementia.

We gathered information from a variety of sources. These included talking with eight people who lived at the home and five relatives. We also spoke with the manager and six members of staff. As some people were unable to tell us about their care and support we completed a 30 minute observation using our Short Observational Framework Inspection (SOFI) tool. This tool is designed to help us understand the quality of care that people receive. We also left comment cards for people to complete if they wished to inform us of their views on the home; 15 people returned completed comment cards.

In the main, we found that people received good and safe care. We found, however, that the practices used by staff to help some people to mobilise were not safe. During our visit we observed people being helped to stand or move using drag lifts. This is a hazardous technique which can place people and staff at risk of harm.

People told us that they were very happy with the care and support that they received. One said, “It’s very good, the staff are very good. My room is comfy”. Another told us, “We’re well looked after. The food is very good, we’ve got a very good chef and there is plenty of variety”. Relatives were equally complimentary. One said, “We think so highly of the place. Since X has been at Barnham Manor, I’ve been able to sleep at night”. Another said, “I almost feel that X is being looked after by family”. The one area that people and their relatives said needed to improve was the level of social interaction. One relative said, “I do think the stimulation and emotional side of things could be improved upon”.

Staff were positive about the home and told us that they enjoyed working there. One said, “Everything is organised and clear, I think it is a good home”.

People told us that they were happy with the support they received from the home to access healthcare professionals. We found that the home had a system in place that ensured information was shared appropriately with other professionals and for when people received planned or emergency treatment at hospital.

The provider had a system to regularly assess and monitor the quality of care that people received. This included seeking the views of people who used the service and acting upon their wishes.

Inspection carried out on 21 December 2012

During a routine inspection

At this inspection we spoke with five people who use the service and three relatives. The all spoke positively about the home and the care and support provided to them.

People told us they are happy with the care and support they receive.

One person said, "Its a nice place to be. Staff treat me with respect and I have no concerns."

Another person said, "Staff chat and spend time with me, meals are very good and I am treated well."

We also spent time observing the interactions between staff and people who use the service. we found this to be positive, friendly and caring.

We spoke with to staff who told us that they are very happy working in a home which has a good atmosphere. They felt supported in their work and felt the management was open and supportive.

Inspection carried out on 1 November 2011

During a routine inspection

Everybody that we spoke with told us what a lovely place Barnham Manor was. People said that the providers were very hard working and had “created a real home.”

One person told us that coming to Barnham Manor was the best thing they had ever done.

One visitor said it was “the best home they had ever seen and they had worked for a very long time in the health service.”

About the registered manager someone said “She is an incredible person; she’s always here and always sorting something out; nothing is ever too much trouble for her; she makes you feel like a special family member.”

We were told that a local practice nurse had said “She runs a ‘tight ship’ and is very sensitive to each person’s particular needs.

Reports under our old system of regulation (including those from before CQC was created)