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Archived: Bartlett Close Good

Reports


Inspection carried out on 21 March 2016

During a routine inspection

The inspection took place on 21 March 2016. Bartlett Close provides accommodation and personal care to four people who have a learning disability, and the home was fully occupied at the time of the inspection. The service is located in the vicinity of shops, pubs and other local facilities, near the town of Witney in Oxfordshire. Staff are on duty twenty-four hours a day to support people living in the home.

At the last inspection on 20 March 2015 the provider was advised to take action to improve staff’s understanding of the key principles of the Mental Capacity Act 2005. Enhancement of the systems for monitoring the quality of the service was also suggested. All these recommended actions had been completed.

The home had 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 and associated Regulations about how the service is run.

A person who was able to communicate with us verbally told us that they felt safe and happy living at Bartlett Close. Staff understood the systems which were in place to protect people from harm, and were able to recognise and respond to abuse in the correct way. People had risk assessments in place to keep them safe whilst enabling them to be as independent as possible.

People’s prescribed medicines were safely managed by staff. Relevant systems and protocols in place ensured people received their medicines as prescribed. Staff’s competence was reviewed regularly to ensure that the medicines were administered safely.

The legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had completed the required training and was aware of their responsibilities. We found the provider to be meeting the requirements of the DoLS.

Staff had been provided with training and showed an understanding about safeguarding adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The provider helped people to use advocacy services where required.

Staff received comprehensive induction and on-going training. Staff members were supported by the registered manager who gave them regular one-to-one supervisions.

People were provided with sufficient amounts of food and drink, with all recommendations from health care professionals being followed. People were supported by staff to access a range of health care services which ensured their health was monitored and maintained.

Relatives told us they were satisfied with the care people received. Staff treated people with kindness and compassion and respected their privacy and dignity.

People, their families and advocates were involved in the process of planning and reviewing their care. Care plans contained information as to the support and care people required to meet their needs. Staff met people and other interested parties to review and update the plans of care to ensure that people’s needs were responsively met and changes to people’s needs identified.

Staff and relatives told us that the service partly relied on agency care workers. Staff also stated it affected their workload as the agency care workers were not trained to administer medication or to use moving and handling equipment.

We saw that some of the people who use the service had raised complaints during the last 12 months. Staff had supported them through the process and the complaints had been investigated and responded to appropriately in a timely manner. Staff felt able to raise any concerns and knew that the management would act on them.

There was an open and transparent culture within the home. Staff understood the vision a

Inspection carried out on 20 and 23 March 2015

During a routine inspection

We inspected 1 Bartlett Close on 20 and 23 January 2015. 1 Bartlett Close is a residential home providing care and support to four people with a physical and or learning disability. It is located close to the town of Witney Oxfordshire.

The previous inspection of this service was carried out in May 2014. In May the service was found in breach of two regulations in relation to respect and involvement of people and staffing. We also asked the provider to note issues with assessing and monitoring the quality of service. We asked the provider to send us an action plan detailing how they planned to make the necessary improvements. This was an unannounced inspection to see whether these improvements had been made, but also to do a full inspection in order to provide the service with an overall rating.

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 2008 and associated regulations about how the service is run.

People were supported by sufficient numbers of staff to meet their needs at all times. There was a new system to ensure that staff could be called in at late notice should the need arise.

Peoples support plans contained detailed risk assessments to ensure their general safety and also their safety whilst out in the community. There were safe arrangements in place for the administration of medicines. However the storage of medicines was not always safe and in line with relevant guidelines.

Whilst care staff had a clear commitment to ensuring people made their own choices, the principles of the Mental Capacity Act were not being consistently applied. There was evidence that people were being supported through best interest meetings, but not all staff we spoke with understood the key principles of the Act.

Care staff felt supported, but did not always receive a regular formal supervision or appraisal. Care staff received relevant training and were supported to access more if required. The service was also working on developing new individualised training to meet the specific mental health needs of the people they supported.

People benefited from a caring culture where there were positive relationships between people and staff who supported them. People’s privacy and dignity were respected.

People’s needs were assessed and this information was used to develop clear plans to help staff understand more about each person and their support needs. However, the mix of needs within the house meant that people were not always enabled to have as much choice and control as possible.

There management structure did not always evidence that the registered manager understood the requirements of their registration. There were systems in place to monitor the quality and safety of the service.

Care staff, people and their relatives told us the service was well led and told us the manager communicated well. A number of staff also spoke highly of the registered manager’s inclusive nature and willingness to support them.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010/2014. You can see the action we took and what action we told the provider to take at the back of the full version of the report.

We recommend that all medicines should be stored in line with the Royal Pharmaceutical guidelines.

Inspection carried out on 23 May 2014

During a routine inspection

During our inspection we communicated with four people. We also spoke with six care workers. We reviewed four peoples care files and documents made available to us regarding the day to day running of the service.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found;

Is the service Safe?

People were not completely safe, people we spoke with felt safe. One person told us, “I feel very safe”. However, we found that staffing levels did not always adequately ensure people’s safety. This was due to not having enough staff to sleep in, which meant several staff were working after a disrupted night’s sleep. One care worker told us, “when things are running well staff numbers are fine because we have all been here so long, but if residents have a difficult night, or if there is an emergency or one of us is off ill, I do not always feel we could safely deal with it”. We found that on two occasions since our last inspection staff had to work alone as adequate cover could not be found. This meant that people were at risk of not having their needs met safely.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Is the service effective?

We found this service was effective. We found that people were being supported to achieve positive outcomes. One person’s relative told us, “The carers are great, really encourage independence, we have seen massive changes in confidence”. We saw a range of activities that were planned to support people with areas they wish to develop. We saw that these activities were included in people daily plans.

Is the service caring?

We found that the service was caring. People we communicated with felt cared for. One person told us, “They [care staff] are very caring”. Another person told us, “I really like them [care staff], they are kind”. We observed the care of two people who could not communicate with us. We saw that care staff were patient, and showed a clear understanding of what made people feel comfortable. For example, one person who became agitated during our observation was reassured, and engaged in a song they enjoyed. We saw this approach clearly documented in the person’s file which showed that staff understood this person’s care needs.

Is the service Responsive?

We found the service was responsive. We found that when people’s care needs changed the service responded. People’s preferences, interests, aspirations and diverse needs were recorded in care plans. Care and support was provided in accordance with people’s wishes. One person said "The care is good and the staff are very thoughtful". People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. We saw that complaints were dealt with appropriately and in a timely fashion.

Is the service well led?

We found that the service was not always well led. We found that external systems were in place for the Area Manager to monitor the quality and ensure people’s safety. However we found that this system did not effectively identify a number of issues that had the potential to impact on people and their well-being. These checks had not identified some recording errors in people’s risk assessments and also that staff had not received supervision for some time. We found that care staff felt able to approach managers, but did not always have their views sought. People and their relatives were able to share their views, but it was not always clear how these views were used to improve the service.

Inspection carried out on 21 November 2013

During a routine inspection

We met the four people who used the service and spoke to three members of staff, including the manager. We saw care plans, including risk assessments and four individual daily logs of care.

A person who used verbal communication was happy to talk to us. Another person communicated with us non-verbally and was clearly relaxed and content as, we observed, were the other two residents. We observed that people appeared happy and interacted well with staff. One person told us “I do like it” and added that “I’m going to see x” (a friend ).

We found that the provider followed had a thorough safeguarding policy and clear procedures to ensure people’s safety.

We saw duty rotas and records of staff training that showed people were supported by enough suitably prepared and qualified staff. A staff member said “I love coming in.”

We reviewed the provider’s service agreement, complaints policy and quality assurance information. We found that the provider supported people to make comments and to raise concerns or complaints should these arise, and responded promptly.

Inspection carried out on 8 November 2012

During a routine inspection

People who used the service did not all use verbal communication to express their needs. People’s individual preferred form of communication was well known to their key worker. We had informal communication through people’s key workers and observed their interaction with staff and each other. People appeared happy and interacted well with staff and each other. We spoke to relatives of three people who used the service. They told us there was a ‘homely atmosphere’ and ‘staff made you feel welcome’. People who were not able to visit regularly were kept informed by the key worker of any changes. One person had recently arrived at the home and was settling in. The service had provided extra one to one staffing to assist the settling in period. We spoke to the relative of this person who said ‘its early days yet, but it looks very good-very promising’. People were asked if there was enough staff to meet the needs of their relatives. People told us extra staff were on duty at the moment, so there was more than enough at present. People told us that they ‘liked the key worker system’ and that ‘It meant that they had a good point of contact’. One person told us that they ‘liked the home because it was not institutionalised’ and ‘there was a nice balance of service users’

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