Barrington Lodge Care Home

We found the following examples of good practice.

Checks were made on visitors to the service including their Covid-19 test results. Vaccination status was checked for visiting professionals.

The environment was clean and additional cleaning was taking place for surfaces that were touched frequently, such as handrails.

There was enough personal protective equipment (PPE). Staff had received training and guidance for infection prevention and control.

Staff gave positive feedback about the support they were offered during the pandemic.

Staff had supported people to choose an essential care giver, a visitor who could continue to visit during the Covid-19 outbreak. The registered manager told us they felt it was important for people’s well-being and relationships that these visits continued.

Barrington Lodge is a care home providing nursing and personal care for up to 70 people aged 65 and over. At the time of inspection, there were 58 people living at the home some of whom had a dementia.

People’s experience of using this service and what we found

We found that although there were systems and processes in place to support good infection prevention and control, they were occasions when PPE was not being worn correctly. The provider took immediate steps to address our concerns.

We have made a recommendation about the provider ensuring infection prevention control practices are consistent and understood by all staff.

People received safe care. There were systems in place to safeguard people from harm or abuse. Risk assessments were in place to support people to be as independent as possible. Staff were aware of their responsibility to keep people safe and were confident that any concerns raised would be acted upon by the manager.

Medicines were administered safely, and staff were knowledgeable about people’s needs. Staff undertook training in the safe management of medicines and regularly had their competencies assessed to ensure they were following the correct practices.

There were enough staff to meet people’s care needs. The service followed safe recruitment practices.

People and relatives told us they had no concerns about the service and any day to day issues they raised would be quickly resolved. Relatives had been kept informed of how their loved ones were when they had been unable to visit them in person.

Quality assurance systems were in place to monitor the quality of care and support people received. When people had accidents or incidents these were recorded, and actions taken to minimise the risk of reoccurrence.

Most staff we spoke with felt well supported in their roles. They told us they had clear guidance and the manager was available if they had any queries. Some, however, commented that communication with the management could be improved and they did not always know the outcome if they had raised an issue. The manager was taking steps to improve two-way feedback.

The service worked in partnership with other health and social care professionals to meet people's needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 25 February 2020).

Why we inspected

We received concerns in relation to infection control, medicines and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Barrington Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Barrington Lodge is a care home providing accommodation and nursing and personal care for up to 70 people. At the time of inspection, there were 55 people living at the home.

We found the following examples of good practice.

• All visitors had a temperature check and completed a health declaration before entry. There was ample PPE and handwashing facilities available.

• The home was clean, and staff were regularly cleaning frequently touched surfaces.

• Staff had received guidance on correct PPE use and were following this.

• The manager praised staff for the positive atmosphere in the home and the commitment they had shown throughout the pandemic.

• The provider was creating an indoor visiting area for relatives to visit their loved ones. The home had nominated staff to overseeing visiting arrangements.

Barrington Lodge is a residential care home providing accommodation and personal care to 49 older people at the time of the inspection. The service can support up to 70 people.

People’s experience of using this service and what we found

We received positive feedback from people, who told us they were happy living at Barrington Lodge. They told us they felt safe with the level of care and support available. Relatives were happy with the care and support their relatives were receiving.

People received person-centred support and staff knew people well. The care plans in place covered all aspects of people’s care and support preferences to ensure a personalised experience. People were supported to maintain important personal relationships with friends and relatives.

There were systems in place for communicating with staff, people and their relatives to ensure they were informed.

People were supported to have their say and to exercise their rights and access to advocacy was available if required. Information could be made available for people in the correct format. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Healthcare professionals recommended the home and spoke positively of the registered manager and staff team and were included in people’s care and support as and when needed. People who need specialist diets were supported.

The environment was clean ,recently decorated and maintained to a good standard with personalised bedrooms. Audits and monitoring systems were used effectively to manage the service and to make improvements as and when required. There were enough staff to support people and staff were always visible. Staff received support and a variety of appropriate training to meet people’s needs.

Medicines were managed well, safely administered and recorded accurately. Individualised risk assessments were in place. Staff were confident they would raise concerns to safeguard people. Robust recruitment and selection procedures ensured suitable staff were employed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement ( 9 January 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service was last inspected in October 2017 and was rated requires improvement. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at that inspection, in relation to safe care and treatment (safety checks not being completed) and good governance. We took action by requiring the provider to send us plans and timescales for improving the service. At this inspection we saw improvements had been made to the safety checks in the home and the governance in relation to these.

Barrington Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Barrington Lodge accommodates up to 70 people across four separate areas, each area caters for a group of people with similar needs, such as for people living with a dementia or with nursing needs or with both.

At the time of our inspection 49 people were living at the service.

The service does not have 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. The last registered manager ended their registration, as the registered manager of this home, on 29 October 2018. There was a newly appointed manager in the home but they had yet to be registered with CQC.

We identified breaches of regulation in relation staffing, meeting nutrition and hydration needs and good governance which meant continuing and sustained improvements were needed.

People told us there were generally enough staff on duty and that their needs were attended to promptly. On occasion, however, people told us they had to wait for care. We observed there to be sufficient staff on duty during our visit to ensure people had their care delivered in a timely way.

People received their medicine safely and were supported to access the support of health care professionals when needed. We identified an issue with the safe storage of medicines that was rectified immediately.

Where risks were identified to people who used the service, or to the environment, these were assessed and plans put in place to reduce them. The environment was monitored to ensure its safety and cleanliness. Accidents and incidents were analysed to identify trends and reduce risks.

People’s needs had been assessed to identify their care needs. Assessments were detailed and covered all aspects of their care needs, however, we found one occasion where assessments did not contain accurate or current information about the person’s needs.

Staff did not always feel well supported and did not have regular formal support, such as supervision, so that they could discuss their performance and development. Staff received training but this was not always specific to the needs of the service.

People were complimentary about the meals provided. Adapted diets were catered for and choices offered, however, we found that processes did not always ensure people were having adequate food and fluid.

The environment did not always meet the needs of people using the service. Improvements to this were planned.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they thought the service was very caring and we observed compassionate and caring interactions between people and staff. People told us, and we observed, that care was delivered with dignity and respect and people were supported to be as independent as possible.

Care plans reflected people’s preferences but some needed updating to reflect current needs. Work was ongoing to address this issue. Staff were knowledgeable about people’s current needs. People were actively engaged in a range of activities and had opportunities to access the wider community.

There was no registered manager at the time of our visit. We found that there had been inconsistent management since the previous inspection. This had an impact of how people and staff viewed the stability of the management of the home and how systems and processes had been followed. There was a new manager in post but they had not yet had time to familiarise themselves with the service. The new manager was having a comprehensive induction and being supported by senior management.

We found that a system of audits was in place but these failed to address all the issues identified at this inspection. Where issues had been identified and remedial actions plans produced these were still in progress, so had not always rectified the concerns.

Feedback on the service was encouraged and negative comments were responded to. People they knew how to raise a complaint if needed. People told us although there had been a change of management there was always someone in management they could speak with and these people were approachable.

This is the second time the service has been rated requires improvement.

We identified breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014, in relation to staffing, meeting nutrition and hydration needs and good governance. You can see what action we took at the back of the full version of this report.

This unannounced inspection took place on 9, 10, 16 and 20 October 2017.

At the last inspection carried out in August 2015, we rated the service as overall “Good” and found the provider was meeting relevant regulatory requirements.

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. At the time of the inspection there was no registered manager in post. A new manager had subsequently been appointed but had since left the service. The regional manager told us they were in the process of recruiting a manager. During our inspection, the home was being managed by one of the provider’s resident experience support managers. This type of manager provides support to care homes where there is no manager present.

We found fire checks and other maintenance checks had not been carried out as prescribed by the provider in order to keep people safe and ensure the home environment was safe. There had not been a maintenance person employed in the home for some months. The manager agreed to address this issue and begin the recruitment process for a new maintenance person.

Systems were in place to monitor the quality of the service. People were routinely asked for their views. Actions plans were put in place to improve the service when required. However, we found the daily monitoring of the service failed to identify the deficits with cleanliness, storage and the positioning of alarm bells that we found during the first day of our inspection. Following the first day of our inspection the manager addressed the shortfalls in cleanliness and they also ensured emergency pull cords in toilets and bathrooms reached floor level for people to use if they had experienced a fall, and bathrooms were no longer used as storage for equipment.

The food in the home was appetising. Staff knew what people liked to eat. At mealtimes staff were very busy serving meals to people both in the dining room and in people’s bedrooms. We found improvements could be made to the meal time arrangements so staff could support and encourage people to eat.

People were protected from the risk of abuse because the staff in the home understood their responsibility to keep people safe and the actions they needed to take if they were concerned a person may be at risk of harm.

People’s care plans were up-to-date and accurate. We found these were person centred and contained detailed information to enable staff to deliver personalised care to people living in the home. Staff regularly reviewed the plans.

The manager spoke with us about the numbers of staff they expected to have on duty. We reviewed the rotas and found there were enough staff on duty to meet people’s care needs.

The provider had a complaints policy in place. Complaints made to the service had been thoroughly investigated and a response had been provided to the complainant.

Work to implement the provider’s framework on dementia had yet to be started. The regional manager explained the plan was to implement the framework when a new manager was appointed.

We found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff approached people with kindness and engaged them in conversation using humour and banter. We found people’s dignity and privacy were respected by staff.

Records showed staff had been supported to carry out their duties through the use of induction training, supervision and appraisal. Staff confirmed to us they received this support.

People and their relatives had been involved in discussing end of life care arrangements so people’s wishes could be met at this important time.

Communications systems were in place to enable staff to be up to date with people’s care needs. Healthcare appointments were documented in a dairy so staff were able to make arrangements for people to attend their appointments.

An activities coordinator was employed by the service. Activities were offered to people either individually or in a group setting. Entertainers had been booked to perform in the home.

When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support. Arrangements were in place to ensure new staff received an induction for working at Barrington Lodge Care Home. All staff were supported through supervision, appraisal and training to carry out their duties.

People were supported as appropriate to receive their medicines safely from staff who were trained and assessed as competent to do so. Staff were able to demonstrate to us how they supported people to take their medicines safely and they informed us about what actions they took to monitor people’s stocks of medicines.

We found the service worked in partnership with key agencies to ensure people’s health care needs were met.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to Safe care and treatment and Good governance. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, seeking experience and views from people who used the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and 'in good hands'. The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application for Deprivation of Liberty should be made, and how to submit one. There were effective systems in place where people did not have capacity and best interest decisions were made through a multi-agency approach.

The service was not clean and hygienic. Appropriate guidance, equipment and facilities were not in place for staff so people were not safe and protected from the risks associated with cross infection. We have told the provider improvements are necessary.

Is the service effective?

People's health and welfare was not always protected and promoted although we do recognise the service had sought expertise and support from other health and social care services that people required, in order to meet their needs effectively.

People did not always receive appropriate care and support because there were not effective systems in place to assess, plan, implement, monitor and evaluate people's needs.

Is the service caring?

We saw that staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. We saw people were receiving care and support in a sensitive way during our visit however staff were not always able to manage behaviours that were complex or challenging.

The manager, deputy manager and staff were knowledgeable about people's lives before they moved into the home. There was interaction between staff and people in the home; everyone was relaxed, happy and comfortable in each other's company.

People were positive about their experiences. Comments included "They are all lovely and very kind", "It's not like being at home but it will do" and "The home is wonderful, I am very well looked after".

Is the service responsive?

Systems were in place to make sure that the manager, deputy manager and staff learnt from significant events including accidents and incidents. Audits helped determine why a particular incident may have happened and what further action was required to help prevent reoccurrence.

Is the service well-led?

The manager, deputy manager and staff continued to look at the needs of people who used the service and ways to improve these for people. It was evident the manger was committed to ensuring people received care which was safe and effective but we did find shortfalls in auditing and care planning which meant people's needs were not always met in a safe and effective way. We told the manager and provider improvements were necessary.

People told us they were happy with the care provided. Comments included 'Staff are very good to (relative's name)', 'The home is as good as the staff and the staff are good', 'I am happy and I would not change a thing' and 'The staff are smashing, I am happy here.'

People were satisfied with staffing levels. One person said 'If I pull the bell they come straight away.' Another person said 'The staff are in and out of (relative's) bedroom all the time.'

We found the provider requested feedback from people who used its services, relatives and staff, and took action to address any concerns.

We found records were up to date and securely held.

Two of the shower rooms had damaged tiles and flooring. The manager told us they were both due to be refurbished in the following weeks.

There were nominated infection control leads within the home. We spoke with staff and they were aware of the measures to be taken to reduce the risk of cross infection.

We had received some information of concern which suggested staff were getting people up and dressed in the early hours of the morning. We therefore began our inspection at 6.30am. We saw the majority of people throughout the home were still in bed at this time.

We had also received some information of concern relating to an ongoing problem with cases of Clostridium Dificile Infection (CDI). CDI is a type of bacterial infection that can be passed out of the human body and can survive for many weeks on objects and surfaces. During our inspection we looked around the home. This was to see if it was kept clean and cross infection minimised. We saw numerous areas of the home were unclean.

We spoke to seven staff, they told us without exception they felt supported. They said they felt able to approach management if they had any concerns or training needs and were listened to. One person said 'I feel able to ask if I want more training'.

People were made aware of the complaints policy. There was a copy on display in the reception area and it was also stated within the Service User guide.