21 and 22 September 2015
During a routine inspection
We inspected Barford Court on the 21 and 22 September 2015. Barford Court provides accommodation and nursing care for up to 40 people, who have nursing needs, including poor mobility, diabetes, as well as those living in various stages of dementia. There were 39 people living at the home on the days of our inspections. The age range of people varied from 60 – 100 years old.
The home was adapted to provide a safe environment for people living there. Bathrooms were specially designed and doors were wide enough so people who were in wheelchairs could move freely around the building. Accommodation was provided over two floors and split into four units. Two units provided residential care; one unit provided nursing care with the fourth unit providing care and support to people living with dementia.
Barford Court belongs to the organisation (provider), The Royal Masonic Benevolent Institution. The Royal Masonic Benevolent Institution has many care homes throughout England, providing dedicated care to the masonic community.
A registered manager was 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.
People commented they felt safe living at Barford Court. One person told us, “I’ve never seen anything that makes me think it’s not safe.” However, risk assessments did not consistently demonstrate the level of knowledge held by staff. Sufficient guidance was not always in place with clear actions on how the associated risk could be minimised. For people at high risk of skin breakdown, specific risk assessments or care plans were not in place detailing the steps to take to mitigate such risk. Where people were assessed at high risk of falling, risk assessments were not consistently in place detailing the steps required to minimise any risk of falling. We have made a recommendation for improvement in this area.
Recruitment practice was not consistently robust. The provider had not consistently obtained references before staff commenced employment. We have therefore identified this as an area of practice that needs improvement.
People and staff felt staffing levels were sufficient but there could be room for improvement. Call bell response times indicated that on occasions, people had waited 15 – 25 minutes before their call bell was responded to. The management team were working on making improvements and ensuring call bells were answered in a timely manner.
Where people had bed rails in place, documentation did not confirm if they consented to the bed rails or if they were implemented in their best interest to keep them safe. We have identified this as an area of practice that requires improvement.
People spoke highly of the food. One person told us, “The food is very good; I’ve got no complaints whatever.” Any dietary requirements were catered for and people were given regular choice on what they wished to eat and drink. Risk of malnourishment was assessed and where people had lost weight or were at risk of losing weight, guidance was in place for staff to follow.
People told us they were happy living at Barford Court. One person told us, “I’ve been here a couple of years and I love it, it’s free and easy.” Staff spoke highly about the people they supported and spoke with pride and compassion when talking about people. People’s privacy and dignity was upheld and staff recognised that dignity was individualised and based on what the person wants.
Personalisation and person centred care (social care approach which focuses on people having choice and control in their life) was at the forefront of the delivery of care. The management team told us, “We are a resident led home.” There was an outstanding focus on providing care and support that focused on the need of the person but empowered their individuality and identity. The home had achieved an accredited award from Dementia Care Matters. With pride, staff told us how they implemented the Butterfly approach and provided high quality care to people living with dementia.
The provider had processes to support staff to carry out their roles safely and effectively. Staff were encouraged to take further qualifications to develop their careers. People who lived at Barford Court were involved in the recruitment process to ensure staff had the right personal qualities and values to support them.
Medicines were stored safely and in line with legal regulations. People told us they received their medicine on time and nursing and care staff were confident in medicine administration. Robust systems were in place to review any medicine errors, ascertain what happened and implement measures to reduce the risk of any further medicine errors.
People and their relatives told us that they felt the home was safe. Policies and procedures were in place to safeguard people. Staff were aware of what actions they needed to take in the event of a safeguarding concern being raised. There was an open culture at the home and this was promoted by the management team who were visible and approachable.