Barton Lodge

We found the following examples of good practice

Visitors were screened, temperature taken, a brief questionnaire completed and hand sanitiser used before being allowed to enter. Visits were organised by appointment only and hourly slots allowed time in between visits to clean and make ready for the next visitor. Regular newsletters were sent out which included guidance on compliance with infection control procedures when visiting.

Temperature screening and Covid 19 testing of people and staff took place in line with government guidance. An isolation wing had been created for anyone with confirmed or suspected Covid 19 who were then isolated in their rooms for 14 days. The home was Covid 19 free at the time of inspection.

'At risk' staff, such as those with health conditions or from high risk groups, were supported to shield. The registered manager had moved in to the home early on in the pandemic to support staff. Staff had received external training and wore appropriate PPE including facemasks and visors. They understood the process of safe donning and doffing of PPE in line with government guidance.

The provider had been pro-active and created an audit tool from our IPC inspection tool. This had been completed and actions identified to further improve infection, prevention and control within the home. Many actions had already been completed.

We carried out an unannounced inspection on 16 & 17 November 2017. We now rate this provider as providing good care.

At our inspection in August 2016 we identified the provider was not meeting two regulations; safeguarding people from abuse and staffing. Potential safeguarding concerns had not always been identified and reported to us. Sufficient staff had not always been effectively deployed to keep people safe, for example from falls. We asked the provider to take action to make improvements, and this action has been completed. The provider now met the requirements of the regulations.

A registered manager was in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The registered manager was experienced and understood their responsibilities under the Health and Social Care Act 2008, including when to submit notifications to CQC.

People and relatives told us they felt the home was safe. Staff understood how to identify abuse and explained the action they would take if they identified any concerns.

People were supported by staff, most of whom had received appropriate training, supervision and appraisal to enable them to meet people’s individual needs.

Safe recruitment practices ensured that only suitable staff were employed. There were sufficient staff deployed to meet people’s needs and keep them safe.

Systems to manage and administer medicines, including controlled drugs, were safe. Staff received training to administer medicines and were regularly assessed for competency.

Incidents and accidents had been investigated and learning shared with staff. Individual and environmental risks relating to people’s health and welfare had been reviewed to identify, assess and reduce those risks.

The manager and staff understood and followed the principles of the Mental Capacity Act 2005 designed to protect people’s rights and ensure decisions were made in their best interests.

People were supported to maintain their health and well-being and referrals were made promptly to healthcare services when required.

People enjoyed a variety and choice of freshly cooked foods, prepared in a way that met their specific dietary needs and preferences. People received support from staff, such as prompting or physical assistance to eat their meals, where required.

Staff interacted with people with kindness, compassion and care. Staff treated people with dignity and respect and ensured their privacy and independence was promoted.

Friends and family were able to visit their loved ones at any time and felt welcomed by staff.

Staff were responsive to people’s needs. People and relatives were involved in their care planning and had comprehensive care plans which met their needs and were regularly reviewed.

Opportunities were provided for people to engage in social and physical activities within the home and community if they wished.

Systems were in place to monitor and assess the quality and safety within the home. People and relatives were encouraged to provide feedback on the service.

Residents and relatives meetings took place and enabled people and family members to be consulted and involved with improvements the provider was making.

People and relatives knew how to raise concerns and would do so if they needed to.

The registered manager had good links with other agencies and community organisations to help keep up to date with best practice and local initiatives.

Staff felt supported by the manager who provided clear leadership and direction. Staff were confident to raise any issues or concerns with them and felt listened to and involved.

The provider and nominated individual maintained oversight of all aspects of the running and management of the home. They valued their staff and supported the registered manager in their role.

Barton Lodge is a care home for older people, some of whom may live with dementia. The home is registered to provide accommodation and personal care for up to 48 people. At the time of our inspection there were 38 people living there. The home consists of a main house with a large lounge and separate smaller sitting areas and a large dining room on the ground floor. The bedrooms are accommodated over two floors with lift access to the first floor.

The service did not have a registered manager in place. 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 had been a high turnover of registered managers in the previous four years. We discussed this with the Nominated Individual (NI). An NI is a director, manager or secretary of the company who has been delegated responsibility for supervising the way that the regulated activity is managed. The NI explained the reasons for the turnover, including a transfer of one manager to another of their homes. There was now a new manager in place who had started their application process to register with the Commission.

Staff knew how to identify some aspects of potential abuse and understood the home’s safeguarding and whistle blowing procedures and who to contact if they had any concerns. However, incidents between people who lived at the home had not been identified as abuse and had not been reported appropriately to the Commission or the local authority.

Incidents and accidents were recorded, but were not always investigated appropriately. It was not always clear what, if any, action had been taken to learn from these events to minimise the risk of them happening again.

The deployment of staff required review as some people were not always supported in a timely way and in line with their preferences. People at potential risk of harm were not always adequately supervised in communal areas. The manager and provider told us they were in the process of recruiting an additional staff member which they said would address this.

There were robust systems in place to manage and store medicines safely. Staff had a good knowledge of people’s medicines.

Most staff interacted positively with people and were caring and kind and respected their dignity.

The provider was in the process of updating people’s care plans and transferring them on to an electronic system. However, we found some inconsistencies and inaccuracies in some people’s care plans which may have led to them receiving inappropriate care.

Staff had not all received regular supervision and appraisal in order to provide formal opportunities to discuss performance and personal development. However, the new manager had put a schedule in place and was almost up to date with this.

Staff received regular training and there was a staff training programme in place for the next year. Staff felt very well supported by the new manager who they said was approachable and proactive.

The provider followed robust recruitment practices to ensure that only people suitable to work in social care were employed.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005, (MCA) which applies to care homes. The new manager understood their responsibility in relation to DoLS and MCA.

Staff knew what was important to people, their life histories and interests and had time to sit and talk them. People were supported to take part in activities within the home.

People were supported to maintain their health and wellbeing and were referred promptly for specialist treatment and advice, such as GPs, district nurses or end of life care. People living at the home were happy with the care they received and had no complaints.

People were offered a choice of drinks and home cooked meals. The chef was knowledgeable about people’s dietary needs and prepared their meals in a way that met their specific needs. Staff assisted and encouraged people to eat if they needed help.

Quality assurance systems were in place to assess and monitor the quality of care and drive improvements. However, these were not always effective in identifying areas for improvement.

There was a programme of maintenance in place and regular safety checks were carried out on the fire system, fire equipment and other equipment such as hoists.

We last inspected the home in November 2013 when we found no concerns.

At this inspection we found 2 breaches of the Health and Social Care Act 2008. You can see the action we have asked the provider to take in the main report.

The relative we spoke with commented that they "didn't have any concerns" about the service provided for their father and that "all the staff were very friendly". One of the people we spoke with told us the staff were "marvellous" and that the home was "nice and clean". One of the professionals visiting Barton Lodge said "there was a good choice of activities" for the people who lived in the home.

We found that before people received any care or treatment, they were asked for their consent and the provider acted in accordance with their wishes.

We found that people's health, safety and welfare was protected when more than one provider was involved in their care and treatment.

We found that the provider had appropriate procedures in place to ensure people were protected from unsafe or unsuitable equipment.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

In this report, the name of a registered manager appears who was not in post and was not managing the regulatory activities at this location at the time of our visit. Their name appears because they were still a Registered Manager on our register at the time.

Where people had mental capacity to make decisions about their lives they were consulted about their care and choices. Where people did not have mental capacity, staff were aware of the need to make best interest decisions on behalf of people. Care plans provided staff with guidance on how to support people. Relatives were involved in the care of people who did not have capacity to make decisions.

People’s needs had been assessed and care plans developed and put in place to make sure that people received appropriate care and support.

Staff had been trained in the recognition of abuse and the actions they should take should they suspect a person was being mistreated. The home had all the relevant policies and procedures relating to the safeguarding of vulnerable adults.

There were robust recruitment procedures in place to make sure that appropriate people were employed to work at the home.

The home maintained a record of complaints made about the service. The complaints procedure was well publicised and we saw that complaints were responded to within the time scales of the home’s procedure.