The inspection took place on 27 October 2014 and was an unannounced inspection.
Barlavington Manor is a care home providing accommodation and personal care for up to 64 people. The home consists of three parts: residential care for 35 people, specialist dementia care for 21 people and eight places in bungalows located on the site. Personal care is not provided to people living in the bungalows. The focus of this inspection was on the residential and dementia care parts of the service. At the time of our visit, there were 63 people living at the service.
The service has 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.
People living in the dementia care part of the service may have been unlawfully deprived of their liberty. A deprivation of liberty occurs when the person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to these arrangements. The door to this part of the service was secured using a key coded lock. The registered manager was aware of a revised test for deprivation of liberty following a ruling by the Supreme Court in March 2014 but told us they had not yet taken action in respect of this. As the registered manager had not carried out assessments in line with the Mental Capacity Act (MCA) there was a risk that people could be deprived of their liberty without appropriate safeguards in place.
Where people lacked the capacity to consent to decisions relating to their care or treatment, the registered manager was unable to demonstrate that best interest decision making procedures had been followed. This is a breach of the regulations because suitable arrangements to establish and act in accordance with people’s wishes were not in place. You can see what action we told the provider to take at the back of the full version of the report.
There was a regular team of staff, some of whom had worked at the service for many years. Staff knew people well and understood how they liked to be supported. New and temporary staff told us that they received clear information on how to support people and were kept up to date at regular handover meetings. At our inspection in December 2013, the provider had recently introduced electronic care records. These were not yet fully completed. We informed the provider that the lack of clear guidance could put people at risk of not having their needs met in the most appropriate way. People’s care records still did not always include details of people’s preferences or detail on how staff should meet their needs. This is a breach of the regulations. The lack of accurate records meant that people were at risk of receiving care that was inappropriate or unsafe. You can see what action we told the provider to take at the back of the full version of the report.
People, their representatives, staff and visiting professionals spoke positively about the service. One person said, “There’s nothing compares with this one”. Two professionals told us that they wouldn’t hesitate to choose Barlavington Manor should they or a loved one require residential care. The atmosphere was warm and friendly. People and staff knew each other well and had developed friendships.
People felt safe. A range of staff, including domestic and activities staff, were employed. There were enough staff on duty to promote people’s safety. Staff were also able to spend time with people on a one to one basis, to share a drink or have a chat. Risks to people’s safety were assessed and reviewed. Any accidents or incidents were recorded and reviewed in order to minimise the risk in future. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse. People received their medicines safely and at the right time.
People had access to healthcare professionals, such as the GP, physiotherapist and dietician. Staff made timely referrals to these and other services to ensure their healthcare needs were met.
People were treated with kindness and respect. We observed staff as they supported people to move around the service, participate in activities or eat their meals. Support was given in a caring way that helped people to maintain their independence as far as possible. One person said, “For kindness you can’t beat them”.
The service was well organised. Staff, including agency staff, were clear on what was expected of them. There were clear schedules of work to ensure that people received the care and support they needed. Staff were satisfied with the training that they received and felt confident to approach the registered manager or provider if they had any concerns or ideas to share.
People told us that they enjoyed the gardens and that they were also able to access the local town and join trips out to other places of interest. The premises and facilities were well maintained. In the dementia care part of the service, action had been taken to promote people’s independence by providing visual references such as memory boxes and brightly coloured handrails to aid visual perception.
There was a varied activity programme. On the day of our visit people were engaged in organised activities such as Pilates or pumpkin carving, as well as routine daily tasks such as folding napkins or wiping place mats. While there was plenty going on, we found that some people with particular interests could have been better supported to pursue these.
People, their representatives and staff were asked for their views on how the service was run and were invited to make any suggestions for improvement. When the registered manager received feedback, they took appropriate and timely action to rectify any problems and to evaluate suggestions. The registered manager kept a record of compliments received. In one card sent following the summer barbeque, we read, ‘The event was really splendid and a great credit to the teamwork of the staff’.
The registered manager had a system to monitor and review the quality of care delivered. This included audits on areas such as premises and medicines, along with spot checks on staff as they supported people. When we provided feedback after our inspection, the registered manager took immediate action to make improvements in the areas we had identified.