Barty House Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

People were safe living at Barty House. Risks had been identified and guidance was in place to mitigate these. Accidents and incidents were learnt from and safeguarding concerns reported. People were cared for by a sufficient number of staff and the service was kept clean and well maintained. People received the medicines they required, although the process and systems around checking medicine stocks was not robust. The registered manager took immediate action.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager had a proactive and positive culture of safety, based on openness and honesty. Lessons were learnt to continually identify and embed good practice.

The registered manager analysed accidents and incidents each month to look for themes and trends. Where incidents occurred which could have been prevented, the registered manager learnt from these and took action to help prevent reoccurrence. Staff also mentioned that falls, accidents and incidents would be reviewed during team meetings, along with any necessary changes to improve safety and quality of care. The registered manager told us, “From previous experience I have learnt wherever possible to carry out assessments for people face to face. I now take nothing for granted (in terms of what I’m told)."

Leaders at the service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They ensured continuity of care, particularly during transitions between different services.

Before people moved into Barty House, a thorough needs assessment was carried out. This helped determine whether Barty House was a suitable environment for them and ensured their care needs could be appropriately met.

The information gathered during these assessments was used to create personalised care plans. This helped to ensure staff had access to important and relevant details about each person from the moment they arrived.

Staff made appropriate referrals to healthcare professionals for example, the GP or the speech and language therapy team so people were able to receive appropriate care and intervention when required and without delay. A health professional working with the service gave positive feedback about how the service engaged with their team. They told us staff referred effectively when needed and were quick to seek advice and follow advice.

Leaders at the service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The provider shared concerns quickly and appropriately.

Where staff suspected abuse may have occurred, they recorded this and raised their concerns. Information was shared with the relevant safeguarding authority, as well as CQC, and investigations were commenced to determine what had gone wrong.

Staff received safeguarding training and were able to tell us what would constitute a safeguarding concern and what they would do in response. A staff member said, “It is about neglect and not providing someone with what they need to meet their needs.” Another told us, “I would approach the deputy manager/registered manager and I am confident it would get resolved.” A health professional told us, “They (staff) are really good with safeguarding. They followed through when a person who came in needed safeguarding.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.

Leaders at the service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People's risks had been identified, and measures, along with clear guidance, were put in place to help staff reduce the likelihood or impact of those risks. For example, when people were cared for in bed and at risk of skin breakdown, staff regularly repositioned them in accordance with the guidance outlined in their care plans. People on pressure relieving mattresses had the mattress set at the correct weight. Some people were diabetic and there was clear information for staff on the signs to look out for should people’s blood sugars go too high or too low. Some people were unable to use their call bells to summon staff. In these cases, staff followed the care plans by checking on them at regular, planned intervals.

Nursing staff knew what to do in emergencies and they had good communication with healthcare professionals when needed. Nursing staff said they had access to clinical policies and procedures and that staff would, “Absolutely alert and press a buzzer if they needed help. They are good in noticing if people are unwell.”

Risk assessments were in place for people. These were reviewed regularly and updated when required. Staff were able to read about people’s individual risks and what they needed to do to help mitigate these. This included guidance such as ensuring one person was sitting upright when eating as they were at risk of choking. People were provided with suitable equipment such as low-rise beds, pressure mattresses, tilting chairs and wheelchairs to help keep them safe.

One relative had complimented the service saying they felt their family member was, ‘safe and comfortable as they had had a lot of falls at home’. They commented they had, ‘peace of mind as they knew they were being well looked after’.

Leaders at the service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People's risks had been identified, and measures, along with clear guidance, were put in place to help staff reduce the likelihood or impact of those risks. For example, when people were cared for in bed and at risk of skin breakdown, staff regularly repositioned them in accordance with the guidance outlined in their care plans. People on pressure relieving mattresses had the mattress set at the correct weight. Some people were diabetic and there was clear information for staff on the signs to look out for should people’s blood sugars go too high or too low. Some people were unable to use their call bells to summon staff. In these cases, staff followed the care plans by checking on them at regular, planned intervals.

Nursing staff knew what to do in emergencies and they had good communication with healthcare professionals when needed. Nursing staff said they had access to clinical policies and procedures and that staff would, “Absolutely alert and press a buzzer if they needed help. They are good in noticing if people are unwell.”

Risk assessments were in place for people. These were reviewed regularly and updated when required. Staff were able to read about people’s individual risks and what they needed to do to help mitigate these. This included guidance such as ensuring one person was sitting upright when eating as they were at risk of choking. People were provided with suitable equipment such as low-rise beds, pressure mattresses, tilting chairs and wheelchairs to help keep them safe.

One relative had complimented the service saying they felt their family member was, ‘safe and comfortable as they had had a lot of falls at home’. They commented they had, ‘peace of mind as they knew they were being well looked after’.

Leaders at the service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People generally reported staff responded to their needs in a timely manner. One person said, “There is always someone looking after you. Regular carers know what I like.” Another told us, “I like a schedule. I like to get up by 10:30 and that’s done 95% of the time.”

However, we observed one instance where a person's call bell went unanswered for over 15 minutes. The person commented, “I often have to wait. It’s that time of day when staff are on their break.” We attempted to find care staff to assist but were unable to locate anyone, so we informed a nurse. Despite this isolated incident, we received no further feedback suggesting inadequate staffing levels or poor staff deployment. Throughout the day, we observed staff regularly acknowledging people and moving in and out of rooms to provide care. Relatives told us they had no concerns about a lack of staff and felt their family members were well looked after. One told us, “No concerns (about staffing). When I go there, there are always people (staff) about.”

Staff felt there were enough of them with one telling us there were sufficient staff but they could access agency staff if needed. A nurse told us, “Sometimes I can’t find a carer straight away, the wait is not long though.” Senior staff told us a higher number of agency staff had been used recently to cover annual leave, but that, normally there was little need for agency staff. A healthcare professional told us, “There always seems to be a lot of staff around.”

Staff received training and supervision which equipped them to carry out their roles confidently and competently. A member of care staff told us they felt the training was comprehensive and gave them all the knowledge and skills they needed. Staff were supported when needed. Senior staff said, “We will give additional support or shadow shifts to build up staff confidence.”

We reviewed the staff training information and saw staff had completed essential training such as fire safety, safeguarding and infection control, in addition to more specific training like dementia, diabetes or catheter care.

Staff were recruited through a robust recruitment process. This included them providing proof of their right to work in the UK, a full employment history, evidence of performance in previous roles and their fitness to undertake the role.

Leaders at the service did not consistently assess or manage the risk of infection, nor did they always take steps to detect and prevent its spread through effective communication. During our visit, we were made aware that 1 person had a contagious infection. However, this had not been disclosed to us upon arrival. When we raised this with the deputy manager, they stated they had also not been informed of this upon returning from leave that morning. Additionally, a member of care staff unknowingly introduced us to the individual without being aware of their infection status. We raised this concern with staff and the operations manager during our visit and we were shown a personal protective equipment (PPE) station located outside the person’s room. After our visit we were provided with evidence that a sign had been placed by the room to alert others to the infection risk.

In spite of this incident, we found the service to be well-maintained and clean. Housekeeping staff were seen working throughout the day in all parts of the building and staff were using appropriate PPE when carrying out tasks. One visitor told us, “The housekeeping staff are friendly and caring, but above all keep the home in an excellent condition."

Leaders at the service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Clinical rooms where people’s medicines were stored were tidy and organised. The GP carried out a weekly visit to the service and medicines got returned every cycle with a new supply arriving each month. This reduced the risk of the service holding out of date medicines.

However, we found some medicine bottles had not been dated upon opening, and there were gaps in the clinical fridge temperature records. Additionally, there were no recorded stock checks when new medicine cycles began, and no formal system was in place for monitoring stock levels of liquid medicines or tablets stored in bottles. Staff said liquid medicines were only checked visually to see if the quantity appeared ‘roughly’ correct, while bottled tablets were not counted at all. As a result, there was limited assurance regarding how discrepancies would be detected, although we found no evidence of any harm to people. Upon speaking with the registered manager, they told us they would take action to put systems in place.

People did, however, receive the medicines they required. With one person telling us, “I get pain and they give me pills at night. They’re not allowed to give me too many” and a relative said, “They haven’t had any incidents with her medicines. She has never said she hasn’t had them.”

The risk of a medicine error was reduced as people’s medicine administration records were stored on an electronic system. This system alerted staff to any missed administration of medicine. In addition, only trained and competency-assessed staff were able to dispense and administer medicines. This helped ensure medicines were given safely, accurately, and in line with best practice.