Barton House

Barton House was a residential care home providing personal care to 14 people aged 65 and over at the time of the inspection. The service can support up to 15 people.

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

Following the last inspection, a new quality assurance system had been introduced by the provider and registered manager with the support of other professionals. During this inspection, we found aspects of this new process still needed to be fully embedded as issues we noted with people’s records and training shortfalls had not been identified. The registered manager took prompt action when informed of our findings.

We found people’s medicines were administered safely however, there were aspects of the management of medicines that we needed to be assured about during our time on site. These were addressed or were in process of being addressed. For example, ensuring the details of how and when all ‘as required’ medicines should be given by staff.

The service had not experienced Covid 19 and the home was clean. We found that the infection control of the service was mostly good. How professionals and new people were admitted to the service needed to improve and was addressed while we were on site. Since the last inspection the laundry had been refitted and there was constant cleaning to ensure touch points were cleaned.

Staff demonstrated they knew people well and, a close working relationship with the GP, district nurse and other health professionals meant any changes were reviewed quickly.

People described being happy, safe and well looked after by the staff. Good communication had been maintained despite the challenges faced by the pandemic. Visiting was taking place in line with current government guidance.

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.

People felt part of the service and able to suggest changes and new ideas on how the service was run or how their care was provided. Staff spoke about being valued by the registered manager and provider.

Rating at last inspection

The last rating for this service was requires improvement (published 18 March 2020).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 6 February 2020. Breaches of legal requirements were found. The provider completed an action plan to show what they would do and by when they would improve the issues identified. These were in respect of people’s ability to consent, safe care and treatment, safeguarding people, staff training and supervision and, how the service was being governed. The registered manager and provider had also not ensured they told us about safeguarding concerns and when people had died as required.

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, effective and well-led which contained those requirements.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as Requires improvement. This is based on the findings at this inspection.

On this inspection, we have identified a repeated breach of regulation in respect of good governance. All other breaches from the last inspection had been addressed and the changes maintained.

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

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

Follow up

We will ask the provider for an action plan and, continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information, we may inspect sooner

Barton House is a residential care home in the coastal town of Dawlish, providing personal and nursing care to 15 people aged 65 and over at the time of the inspection. The service can support up to 15 people and is set over three floors in a listed building.

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

The registered manager and provider had made some efforts to improve the service based on the feedback from our last inspection, we saw more detailed care planning and some environmental improvements had been made. The service was no longer in breach of regulations around premises and equipment. However, some changes had yet to be embedded and the service needed more time to ensure they could evidence a sustained change. People were placed at risk because of a lack of knowledge regarding the requirements of the service to ensure a safe and quality service was provided.

We identified new concerns at this inspection regarding the safe management of medicines and safeguarding. These issues placed people at potential risk of avoidable harm.

People told us they felt safe and relatives said they were pleased their loved ones lived in Barton House. We found some discrepancies in the safe management of medicines and asked the registered manager to address these immediately. We found an infection control concern in the laundry. However, the rest of the service was clean and feedback from people and relatives was they were very happy with the cleanliness of the service.

There were enough staff to meet people’s needs and spend time with people in their rooms. However, staff training was lacking in key areas such as safeguarding to ensure that staff had all the knowledge and skills they needed to meet the needs of people. Supervision was not taking place as it should be according to the policy of the service.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People said they enjoyed the food and were offered drinks regularly. Professionals told us it was a cost effective, friendly local service. Some people were supported to achieve positive outcomes like losing weight or building up their confidence. Activities were provided in the form of entertainers visiting the service, in-house activities and staff sat with people in their rooms.

Staff were kind and friendly and worked hard. Staff told us they felt very supported by the registered manager. Systems to identify areas that needed attention were not robust enough to identify the concerns we picked up on. There was further training and support needed for the management team to be confident in their knowledge of regulatory requirements to ensure a safe and well-led service.

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 (report published on 6 February 2019). The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding, consent, staff training and supervision, making notifications, and good governance.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good and request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

Improvements needed to be made in the building so people could access the communal areas easily and safely. There was no hot water on the upper floors and the lift was out of order.

Risks were not fully assessed or reviewed regularly. The service could not mitigate the risks people faced because they did not have current information on people’s needs.

The service was not acting within the principles of the Mental Capacity Act 2005. People were offered some choices in their day but not others.

There was not a robust quality monitoring system in place. Gaps in records and maintenance issues were not identified by quality processes.

The registered manager was open and showed a willingness to improve. They had begun to implement some changes but identified they needed further support to embed them.

People said they felt safe. Staff knew how to identify potential abuse and what to do if they suspected someone was at risk of harm.

Medicines were being managed safely, staff were patient when administering medicines. People’s health needs were being met with timely referrals to health services.

Staff felt supported through supervisions and training and the flexibility the registered manager and provider offered them. Staff supported each other and challenged each other to support people to reach their goals.

Some activities were taking place but improvements were needed to ensure people were having their preferences met in how they spent their time.

The menu had been changed recently to include more home cooked meals. People said they enjoyed the food.

People said staff were kind and caring. The service encouraged visitors and wanted to engage more with the wider local community.

We found breaches in four legal requirements relating to premises, safe care and treatment, consent, and good governance. Further information is in the detailed findings sections below.

Rating at last inspection:

The rating for the last inspection on 13 and 20 May 2016 was good. The report was published on 18 July 2016.

Why we inspected:

This inspection was a planned inspection based on the previous rating.

Follow up:

We have asked for a report of actions within a specific timeframe relating to the issues we found during the inspection and linked the service with local authority quality support. We will meet with the provider and registered manager after they have sent us this report to discuss how they plan to improve the service.

At the time of the inspection there were 14 people living at the service. Some of these people were living with Dementia. During our inspection we observe red a calm and relaxed atmosphere in the home and we saw staff interact with people in a friendly and respectful way.

People, staff and health care professionals told us they were happy with the care being provided at the home. People’s needs had been assessed prior to them moving into the home. Each person had a care plan which had been developed by staff with their and their relatives’ input. These care plans contained information about each person’s needs and how staff should meet these. Staff spoke confidently about people’s individual care needs and how they met these. Staff were knowledgeable about the people they were caring for. They described people past histories and their preferences.

People were treated with kindness, compassion and respect. Relatives said they felt the home was safe and secure. Staffs knew people well and were friendly and supportive. People received care and support at a pace and time convenient for them because staffing levels were sufficient. Staff sought people’s consent for their day to day care.

Staff knew how to recognise and report the signs of abuse and had received training in safeguarding people. They were confident about how to raise concerns if they were concerned about anyone.

Staff received relevant training for their role and there were opportunities for on-going training, support and development. There was enough staff on duty when we inspected to care for the people who lived there.

Recruitment systems were in place; new employees underwent the relevant pre-employment checks before starting work. Staff had completed an application form. One of these did not contain a lot of detail relating to the dates that the person had worked. The registered manager had not explored these gaps. However this was actioned immediately when we pointed this out .

There was a good system in place for ordering, storing and returning medicines, although no checks were carried out to ensure medication was being stored at the correct temperature.

Chemicals were not always being stored in a safe way. However this was actioned immediately when we pointed this out as a potential risk

A number of different activities were provided by the service and included activities which met people’s specific interests.

Meals were appetising and people were offered a choice in line with their dietary requirements.

People told us they enjoyed the food.

People and the relatives we spoke with were aware of how to make a complaint and all felt they would have no problem raising any issues. There was a management structure in the home which provided clear lines of responsibility and accountability. The registered manager showed a great enthusiasm in wanting to provide the best level of care possible. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people.

The premises and equipment were maintained to ensure people were kept safe. There were infection control measures in place to protect people and the home was clean and hygiene People living at the home, their relatives and the staff all told us they felt there were sufficient staff on duty to meet people’s care needs. At the time of the inspection we found there were sufficient staffs on duty. In addition to the registered manager, there was three care staff on duty as well as housekeeping and catering staff.