Archived: Barrington Lodge Nursing Home

We found people and their representatives were involved in making decisions about their care. One person who used the service said 'I can decide what I want to do during the day'. The family of another person, receiving end of life care, told us they were actively included in the care and treatment being decided on for their loved one. We found that people's needs were being assessed and planned for. People were also actively included in this process. The service had sought the advice and support of external health care professionals for people and the staff to help improve the quality of care being given to people. One relative said "The care has been exemplary" and another said "The care is fine, smashing, I cannot fault it". One person who used the service said "They take care of me".

There were good arrangements in place to protect people from care associated infections. The home's policy on this was being adhered to. Evidence of this was seen in how these arrangements were being monitored and in staff practices.

People had been made aware of the complaints procedure and where concerns/complaints had been raised, these had been listened to, investigated and action taken to resolve the issue and prevent it from happening again.

Following our visit on the 19 November 2012 the service had a new manager. The interim manager needed to review the improvement plan originally forwarded to us, assess the progress that had already been made and make any adjustments required. During this inspection the service were able to demonstrate that processes were in place to protect people who cannot give consent. They were also able to demonstrate that improved arrangements were in place with regard to medicines. One person we talked to was able to confirm that staff applied the applications that they required and which had been prescribed for them.

Additional improvements, identified by the service itself as required, were discussed with us. These were work in progress and will benefit people using the service. The manager has remained in contact with us regarding these.

We discussed with managers the improvements that had been put in place to ensure people's needs were both assessed and planned correctly. There were improved systems in place for monitoring people's care. The role of team leader (new when we previously inspected in October 2012) had clearly had a positive impact on this. This staff group were now more knowledgeable and confident in their role and care staff were responding well to the newly organised way of working. Shortfalls in record keeping had been addressed and improvements to this were continuing.

Work had begun on ensuring that legal requirements were in place for people who lacked mental capacity and there were some improvements in medicine management, although both these areas, required further work to achieve full compliance.

One person using the service said "I am very happy with the care" and another said "It's better than some care homes I have stayed in". However, despite these comments other evidence did not show that people's needs were being adequately met. There were shortfalls in risks being identified and subsequent action being taken. There were shortfalls in identifying changes in people's health and in how a change in people's needs were communicated and managed. In some cases visiting professionals had expressed concern following monitoring visits and had also requested certain actions to be completed which had not been done.

The service had been dependent on high levels of agency staff and despite a recruitment drive this had remained problematic. The service had enough staff in numbers to meet people's needs but not enough core staff to maintain effective communication, continuity of care and maintain care records. BUPA's monitoring systems had identified shortfalls in record keeping but actions required had not been implemented by the service. However, during this inspection we witnessed more direct action being organised and implemented by senior BUPA managers to address the matter.