Barchester Tower

Barchester Tower is a residential care home providing personal care for up to 20 older people living with dementia or dementia type illness. At the time of the inspection there were 13 people living at the home.

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

Peoples safety was assessed and monitored. Staff completed safeguarding training and were aware how to recognise and report concerns. Staff worked with other agencies and health professionals to ensure people’s health and support needs were met.

Infection prevention and control measures were in place. Staff used PPE appropriately and reported health concerns when required. The home appeared clean and tidy.

Medicines systems and processes were in place to support people to receive their medicines as prescribed. Staff were safely recruited, and appropriate checks completed before staff began work at the home.

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.

Feedback was sought from people and staff and people were supported to spend their time how they chose. People told us they had no concerns and felt well cared for. Feedback from relatives and health professionals was positive.

Staff received supervision and staff meetings had taken place. Staff felt supported and told us they enjoyed their role.

Governance and auditing systems were in place. This enabled the registered manager to have oversight of the day to day running of the service. Systems and servicing checks were also completed.

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 (published 15 December 2020)

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 regulation.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 4 and 13 November 2020. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Barchester Tower is a residential care home providing personal care to up to 20 older people. At the time of the inspection there were 17 people living there. People were living with a range of needs associated with dementia and frailties associated with old age.

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

Although the home was clean and tidy, we found improvements were needed to ensure that infection prevention and control (IPC) measures were fully implemented and government guidance and best practice was being followed.

Quality assurance systems were in place and used to identify areas for development. However, they had not identified all the areas for improvement that we found on relation to IPC. Improvements were also needed in some aspects of record keeping.

There were systems in place to help maintain people’s safety. Staff understood safeguarding and their own responsibilities about reporting concerns. Risks to people were well managed and staff understood how to support people. There were enough staff to support people each shift and medicines were well managed.

There was a positive culture at the service. Feedback from relatives, staff and visiting professionals was positive. People, relatives and staff were involved in developing the home through regular meetings and feedback surveys. The provider and staff knew people well and understood their care and support needs.

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 26 February 2020).

Why we inspected

We received concerns that people’s health had not always been maintained appropriately. 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 coronavirus 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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. However, we found concerns related to infection prevention and control. Please see the safe section of this report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to infection prevention and control at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Barchester Tower provides personal care and accommodation for a maximum of 17 older people who live with dementia, mental health conditions and long- term health needs such as diabetes. There were 14 people living there at the time of our inspection.

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

People continued to receive safe care and support by staff who had been appropriately recruited, trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “I like living here,” and a visitor said, “There is a locked door system, so no one can enter without permission or get out by mistake.” Medicines were given safely to people by trained and knowledgeable staff, who had been assessed as competent. There were enough staff to meet people's needs. Staff were deployed in a planned way, with the correct training, skills and experience to meet people’s needs. Infection control was well managed and the home was well-maintained and free from hazards.

Staff knew people and their needs well and received the training they needed to meet people’s needs safely and effectively. The training matrix tracked staff training and this had ensured all staff received the training and updates needed to provide safe consistent care. The staff rotas confirmed that staff deployment was consistent and that staff skills were considered when planning the rotas. A plan of supervision to support staff was available and this also included competency sessions on training received. One staff member said, “We get supervision and staff meetings. We can go to the manager anytime we need to.”

People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals. Peoples’ weight was monitored and fortified food provided when necessary. People enjoyed the food and comments included, “Always good,” and “Food is good.” Visitors felt the food was “Good” and their relative had put on weight and eating better since they had moved in.

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.

Everyone we spoke to was consistent in their views that staff were very kind, caring and supportive. People were relaxed, comfortable and happy in the company of staff and we saw positive staff interactions during the inspection. Visitors told us, “Amazing staff, always friendly and welcoming,” and “I can’t praise the staff enough for their kindness.” People’s independence was considered important by all staff and their privacy and dignity was also promoted.

Staff delivered care in a person-centred way based on people's preferences and wishes which were clearly documented.

People were involved in their care planning as much as they could be and families told us that they were involved in the well-being of their loved ones. One visitor said, “I sat down a staff member and discussed the care plan.”

People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated. The provider who was also the manager were committed to continuously improve their service. They had developed structures and plans to develop and consistently drive improvement within the service and maintain their care delivery to a good standard.

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 16 June 2017)

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.=-

Barchester Tower provides personal care and accommodation for a maximum of 22 older people living with dementia. There were 12 people living there at the time of our inspection, one person was on respite (holiday) for a short stay. Most people were not able to express themselves verbally due to their health needs.

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.

At a comprehensive inspection in November 2015, the overall rating for this service was requires improvement with two breaches of regulation: regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance by November 2016.

During our inspection on 11 May 2017, we looked to see if improvements had been made.

At this inspection we found that considerable improvements had been made. We could see that action had been taken to improve people’s safety and the audits demonstrated that there was a commitment to continuously improve. However there were still some areas of medicine and cleaning practices that needed further embedding in to practice to ensure peoples continued health and well-being.

The provider had progressed quality assurance systems to review the support and care provided. A number of audits had been developed including those for accidents and incidents, care plans, medicines and health and safety. However there were certain areas that still need to be progressed further to ensure that the audits identified issues such as cleanliness of furniture and wear and tear of carpets.

Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and, they were always made to feel welcome and involved in the care provided.

Care plans reflected people’s assessed level of care needs and were based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking and moving and handling. For example, pressure relieving mattresses were in place for those that were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and leg ulcers. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. There were systems in place for the management of medicines and people received their medicines in a safe way.

People were encouraged and supported to eat and drink well. One person said, “Tasty and there’s always a choice.” There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People were advised on healthy eating and special dietary requirements were met. People’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed. Food and fluid charts were completed when necessary and showed people were supported to have a balanced diet.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were very complimentary about the caring nature of the staff. People and visitors told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles.

A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. Activities were led by the care staff and were in line with people's individual preferences and interests. People enjoyed the activities and there was a fulfilling atmosphere in the communal areas.

Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider had made training and updates mandatory for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care, falls prevention and dementia care. Staff said the training was very good and helped them to understand people's needs.

All staff had attended safeguarding training and demonstrated a clear understanding of abuse. They said they would talk to the management or external bodies immediately if they had any concerns, and they had a clear understanding of making referrals to the local authority and CQC.

Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. People said they felt comfortable and at ease with staff and relatives felt people were safe.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff said the management was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held regularly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was good; the registered manager was always available and, they would be happy to talk to them if they had any concerns.

People we spoke with said or indicated that they liked living at the home. We saw that staff spoke regularly with everyone and always asked before providing care and support. We looked at people's care plans and saw that their needs had been assessed and regularly reviewed with guidance for staff.

We saw that staff worked with other professionals and services. We were told by a social care professional that the home provided good information when requested and responded to advice and guidance.

We found that equipment was suitable and well maintained. There were quality monitoring systems in place and these were recorded.

We observed staff speaking with people in a respectful and appropriate manner at all times. We observed staff providing support that enabled people to make choices about how they spent their time.

We found that appropriate systems were in place for the management of medicines, to protect people who lived in the home.

We spoke with staff and checked their records to ensure appropriate training and support was in place. Staff had attended training and demonstrated a good understanding of protecting vulnerable people.

Staff told us they lifted a manual hoist up and down steps in the home to transfer people who chose to remain in their rooms. The systems in place for using the hoist did not protect staff.

We found that the systems for recording and reviewing people's care needs were not robust. Some of the information available to staff regarding people's care needs had not been updated, which may put people at risk.