Archived: Barham House

Updated 15 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We used information the registered persons sent us in the Provider Information Return. This is information we require registered persons to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also examined other information we held about the service. This included notifications of incidents that the registered persons had sent us since our last inspection. These are events that happened in the service that the registered persons are required to tell us about. We also invited feedback from the commissioning bodies who contributed to purchasing some of the care provided in the service. We did this so that they could tell us their views about how well the service was meeting people’s needs and wishes.

We visited the service on 6 and 9 July 2018 and the inspection was unannounced. The inspection team consisted of one inspector.

We met and spoke with 13 people who lived at the service, we observed some people’s care, the lunchtime meal, some medicine administration and some activities. We spoke with three people’s relatives. We inspected the environment, including the laundry, bathrooms and some people’s bedrooms. We spoke with two care staff, one of the registered nurses, housekeeping and kitchen staff as well as the deputy manager, registered manager, the GP and a visiting reverend.

In addition, we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not speak with us.

During the inspection we reviewed other records. These included staff training and supervision records, five staff recruitment records, nursing staff registrations, medicine records, risk assessments, accidents and incident records, quality audits and policies and procedures.

We displayed a poster in the communal area of the service inviting feedback from people, relatives and staff. Following this inspection visit, we did not receive any additional feedback.

Updated 15 November 2018

This inspection took place on 6 and 9 July 2018 and was unannounced.

Barham House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and care provided, and both were looked at during the inspection. Barham House accommodates up to 23 people in one adapted building. The building is an historic older building providing large communal areas and extensive well kept gardens. At this inspection, 21 people were living at the service.

The registered manager worked at the service each day and was supported by a deputy manager. A registered manager is a person who has registered with CQC 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.

We last inspected Barham House in September 2017 when three continued breaches and two new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We issued requirement notices relating to a lack of robust safeguarding procedures, poorly managed dietary needs, a failure to adhere to the principles of the Mental Capacity Act (2005) and a lack of activities to meet people’s needs. We also issued a warning notice in relation to insufficient staff on duty to meet people’s needs.

At our last inspection, the service was rated ‘Requires Improvement’ overall and in each of the five key areas. This was because there continued to be shortfalls in the service that were identified in the previous inspection. At this inspection, although improvements had been made, there were two further breaches of Regulation and other areas identified that needed improvement. The breaches of Regulations related to failing to meet people’s dietary support needs, some incomplete records and auditing procedures that were not wholly effective. Therefore, this is the third consecutive time the service has been rated Requires Improvement.

People were generally satisfied with the food provided, however, kitchen staff were not always notified of people’s dietary needs. Food was not always prepared and plated in an appetising way and, where people needed adapted plates or cutlery to help them eat more independently and with dignity, this did not always happen.

Record keeping in care plans needed to improve to more clearly document people’s current condition. In addition, control of records about the maintenance of equipment within the service and some checks required for some staff working at the service required more effective oversight. Auditing processes within the service were not sufficiently detailed or effective to identify and drive forward continuous and autonomous improvement.

Medicines were managed safely, there had been no errors in administration and people received their medicines when they needed them. Staff competency had been checked. However, staff needed to ensure disposal of all medicines were fully accounted for. This is an area for improvement.

People were protected from harm by staff who were trained to recognise signs of abuse. However, staff were not continuously aware of risks presenting the potential for unauthorised access to the service and for people using the service to leave unnoticed. This is an area for improvement.

Most people and visitors told us they knew how to complain if they needed to. However, providers are required to meet people’s information and communication needs. Therefore, in settings supporting older people, including some with dementia, providers should develop complaints information to at least be available in larger bold print. Similarly, complaint and client survey tools may be more accessible to some people if, for example, they included facial expressions for, where possible, people to gauge their own level of satisfaction, rather than just a narrative and tick box. These are areas identified for improvement.

Pre-assessments for people moving to the service were comprehensive. Potential risks to people’s health and welfare were identified and there was guidance for staff to follow.

Accidents and incidents were analysed and measures were in place to reduce the occurrence of repeated incidents. Staff were recruited safely, received appropriate training and worked with healthcare professionals to keep people as healthy as possible and deliver effective care.

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

People told us that staff were kind and encouraged them to be as involved as possible in their care and, where people wanted to, they took part in a range of activities.

People were supported to express their end of life wishes. Staff were aware of people’s religious beliefs and received training to support people at the end of their life and keep them comfortable.

The culture within the service was open and transparent. Staff meetings enabled discussion of care practice and how staff could work towards improvement.

The registered manager attended training and local forums and worked with the local commissioning group and safeguarding authority to ensure people received joined up care.

The building was adapted to meet people’s needs. Staff completed checks on the environment and equipment, these helped to ensure people were safe.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. This meant we could check that appropriate action had been taken. The manager was aware that they needed to inform CQC of important events in a timely manner and had done so.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the services can be informed of our judgements. The provider had conspicuously displayed the rating in the reception area of the service. The provider did not have a website to display the rating.

At this inspection two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. You can see what action we have asked the provider to take at the end of the report.