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Inspection carried out on 1 November 2017

During a routine inspection

Barnes Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Barnes Lodge accommodates 101 people across three separate units, each of which has separate adapted facilities. The service specialises in providing care to people living with dementia. The service opened in September 2016 and at the time of the inspection there were 45 people living at Barnes Lodge across two floors of the service with the third floor not yet occupied.

This inspection site visit took place on 1 and 3 November 2017 and was unannounced. The inspection was carried out by two inspectors and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

There was not a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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. The registered manager had left the service the week before the inspection. An interim manager had been appointed and had begun working in the service. We were notified following the inspection that the interim manager had been successful in their application for the role and we received an application for them to be registered for the service with the commission.

At the last inspection on 3 March 2017 we asked the provider to take action to make improvements to safe care and treatment, consent, staffing, personalised care and good governance and this action has been completed.

People were safeguarded from harm and abuse. The registered provider worked proactively with the local safeguarding team to respond to allegations of abuse. They ensured that lessons were learned when things went wrong. Staff knew what action they needed to take to reduce risks and to provide safe care and support. The premises were well maintained and equipment had been checked regularly to ensure it was suitable and safe. The registered provider ensured that the risk of infection in the service was assessed and managed.

People received safe support to manage their medicines. People were supported to stay healthy and staff enabled them to access healthcare professionals as needed. People had a balanced diet and enough to eat and drink.

There were sufficient numbers of skilled and competent staff working in the service to meet people’s needs. The registered provider ensured that staff were safe and suitable to work with people. Staff received appropriate training and support and were enabled to develop their knowledge and skills through qualifications. Staff had positive relationships with the people they cared for.

People were treated with dignity and respect. Their right to privacy was upheld. People were provided with sensitive support at the end of their life that ensured they were comfortable and pain free.

The premises were suitable and comfortable and met people’s needs.

The registered provider ensured that care was planned in line with best practice guidance. They worked effectively with partner agencies to deliver safe and effective care. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice People had choice and control over their lives. Their care was flexible and person centred. Staff understood people’s rights to make their own decisions and followed the principles of the Mental Capacity Act 2005. People were involved in developing their care plans and making decisions about the

Inspection carried out on 3 March 2017

During a routine inspection

Barnes Lodge is a purpose built residential care home offering personal care and accommodation to older people and people who are living with dementia. The service replaced another care home that was previously located on the same site and owned by Abbeyfield. Staff and people from the previous home had moved to Barnes Lodge. The service is registered to accommodate a maximum of 101 people and can provide respite care for short periods of time. It does not provide nursing care. The service opened in September 2016 and had two floors of the three floor building open at the time of our inspection. There were 36 people living at Barnes Lodge.

This inspection was carried out on 3 and 7 March 2017 and was unannounced. The inspection team included two inspectors and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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. A new manager had appointed and had begun working in the service.

At this inspection we found that some regulations were being breached. Risks to individual’s safety and welfare had not always been managed effectively. This was in relation to the risk of choking, food allergies, developing pressure wounds, falls, moving people safely, aggressive incidents and dehydration.

Staff had not received essential training to enable them to carry out their roles effectively. This had impacted on staff’s ability to effectively plan people’s care and meet their needs.

The principles of the Mental Capacity Act 2005 (MCA) had not been followed when obtaining consent from people to care and treatment. This meant that people’s right to make their own decisions had not been promoted and care had been provided without people’s consent.

People’s needs had been assessed before they first moved to the service, but they did not have a care plan that addressed all their assessed needs. People’s care plans lacked the detail necessary to ensure staff could provide personalised care. Care had not always been delivered in line with people’s care plans. People’s care records were not completed with sufficient detail to show that they had received the care they needed and to allow the registered manager to review that care.

The service was not always well led. Systems for monitoring the quality and safety of the service were not always effective in ensuring that necessary improvements were made. Where shortfalls in the service had been identified action had not been taken to resolve the problem.

You can see what action we told the provider to take at the back of the full version of the report.

The risk of infection spreading in the service had been minimised and the premises were kept clean, but we found there was an odour of urine on the ground floor of the premises. We have made a recommendation for improvement.

People had enough to eat to meet their needs. However, it was not clear that people's hydration needs were adequately monitored.

People’s care plans did not demonstrate that they were encouraged to retain or develop their independence. We have made a recommendation for improvement.

It was not always clear that people had been involved in reviewing their care plan. We have made a recommendation for improvement.

People were safeguarded from the risk of abuse. Staff knew how to recognise the signs of abuse and how to report concerns. There was a sufficient number of staff to meet people’s needs in a safe way and the registered provider had ensured robust checks had been made about the suitability of new staff.

People’s