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Archived: OSJCT Bartlett House Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

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 legislat

Inspection areas

Safe

Requires improvement

Updated 13 February 2019

The service was not always safe.

Care plans were not always up to date or reflective of people�s current risks.

Staff were not consistently deployed effectively.

Some areas of the home had unpleasant odours.

Medicines were managed safely.

Effective

Requires improvement

Updated 13 February 2019

The service was not always effective.

The service did not consistently meet the principles of the Mental Capacity Act 2005.

The environment had not been adapted to suit the needs of the people living at the service.

People�s healthcare needs were not monitored on a reflective basis to identify if the service could improve.

Caring

Requires improvement

Updated 13 February 2019

The service was not always caring.

We saw lots of undignified interactions and the quality of care varied significantly between different members of staff.

The medicines round was task focussed and lacked personal interaction.

We saw abrupt and rushed engagement.

There were plans to develop the quality of the life histories in people's care plans.

Responsive

Good

Updated 13 February 2019

The service was responsive.

People�s accessible information needs were identified, but there no examples of how the service had responded to this.

The activities programme was not always designed around meeting the needs or interests of people.

Complaints were responded to in detail.

Staff spoke with enthusiasm about wanting to provide a good standard of end of life care.

Well-led

Requires improvement

Updated 13 February 2019

The service was not always well-led.

We identified breaches in regulation.

We raised concerns about shortfalls that had not been picked up through the quality monitoring processes.

There were gaps in the registered manager's understanding and confidence regarding the Mental Capacity Act 2005 and the Accessible Information Standard 2016.