Archived: OSJCT Bartlett House

Updated 13 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 13 and 14 November, as well as 4 December 2018 and was unannounced. The inspection was completed by two inspectors and one assistant inspector. Prior to the inspection we reviewed information we held about the service, such as statutory notifications and information the provider had sent to us in their provider information return (PIR). The PIR tells us what the provider feels the service is doing well, as well as any areas they have identified for improvements.

During the inspection, we gathered information by reviewing documents relating to people’s care, including care plans and daily records for nine people. We also looked at information relating to the management of the service. This included audits completed by the registered manager and the organisations quality team; falls analysis, and meeting minutes. We spoke with seven people who use the service and two visiting relatives. We also spoke with the registered manager, the area operations manager, and eight members of care and ancillary staff, either through formal interview, or informal conversation.

After the inspection, we wrote to four of the service’s community contacts, as well as three health and social care professionals. We received feedback from two professionals and two community contacts.

Updated 13 February 2019

Bartlett House 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.

Bartlett House is registered to provide accommodation and personal care for up to 36 older people. At the time of our inspection there were 27 people living in the home. People lived in three different units in the home, ‘Up Red’ and ‘Down Red’ were mostly people living with residential care needs. ‘Down Blue’ was a secure unit for twelve people with a diagnosis of dementia.

The inspection took place on 13 and 14 November, and 4 December 2018. The inspection was unannounced on the first day. We provided feedback to the registered manager and area operations manager at the end of the second day. We returned for a third day to gather further evidence and where actions had been taken in response to our feedback, this has been included in the report.

Care plans were not always up to date or reflective of people’s current assessed risks. In addition, some information was missing regarding the assessed risks, to enable staff to provide effective and safe support. This was despite care plan reviews and audits taking place.

Not all staff adhered to the organisations infection prevention and control policy regarding hand hygiene. Some areas of the home also had unpleasant odours, which indicated people’s continence needs were not being supported. However, the rest of the service was mostly maintained to be clean and tidy.

Falls were recorded and monitored, however there were some areas for improvement in the quality of the monitoring. We provided feedback to the registered manager regarding this and saw that when we visited on the third day of the inspection, the improvements had been implemented.

At times, staff were not deployed effectively. This resulted in people seeking assistance and staff not being available to help. There was a dependency calculation tool being used, however this did not account for the layout of the building.

There were safe staff recruitment processes in place.

There was 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.

Access to outside areas was restricted, despite there being adapted flower beds and a raised fishpond for the enjoyment of the people living at the service. The large garden space had not been creatively designed to maximise opportunities for people’s independence to be promoted.

The Down Blue, dementia unit, was not designed to support the needs of the people living there. The lounge space in the unit was a converted bedroom, with only six chairs, despite twelve people living there.

Medicines were stored and managed safely. However, medicines were not always administered with dignity. On two of the three days we inspected, we saw that medicines were administered by a staff member who lacked a person-centred approach.

Staff felt confident they could report any safeguarding concerns to the registered manager and that action would be taken. They also felt supported to raise any queries they had with regards to their work.

We saw safe transfers taking place. People were comfortable and appeared confident in the procedure. We also saw measures to support people’s dignity during transfers were being used, including placing a blanket over people’s laps to prevent their legs being exposed.

There were gaps in the registered manager and senior staff member’s knowledge regarding the Accessible Information Standards 2016 (AIS) and the Mental Capacity Act 2005 (MCA). This meant that procedures to meet the legislative requirements were only partly implemented.

The quality of care interactions varied between different staff members. We saw examples of undignified and abrupt engagement, as well as positive, kind and polite interactions.

People were joined at lunch by staff who sat with them throughout their meal. There was a positive atmosphere in the dining room, with people choosing where they wanted to sit, and staff encouraging conversation.

There was no always a clear managerial vision for how the service could improve and develop. Effective support had not been provided by the organisation to ensure that the service could maintain their previous CQC rating of good; also, to help the service better support the needs of the people who live there, in accordance with up to date practice and national guidance.

We identified breaches of the Health and Social Care Act 2008, (Regulated Activities) Regulations 2014. Details of these and the action we have asked the provider to take have been recorded at the end of the report.