Archived: Barnes Lodge

Barnes Lodge is a nursing home providing personal and nursing care, for up to 101 people. The service provides support to people with complex health needs such as kidney failure, Type 1 diabetes, Parkinson’s disease and people receiving care at the end of their life. Some people were living with dementia or deteriorating mobility. At the time of our inspection there were 43 people using the service.

Barnes Lodge is a purpose-built nursing home set out across 3 floors with 2 wings on each floor. Two floors only were being used at the time of this inspection.

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

Although improvements had been made to the identification and mitigation of individual risk and to the safe management of people’s medicines, further improvement was ongoing to ensure people’s safety. Fire risks had reduced, however, some further improvement was needed to the checks in place. The provider still needed to make further improvements to their recruitment processes.

People were not supported to have maximum choice and control of their lives and staff did not 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.

Although improvements had been made to the recording of peoples’ assessed needs, care plans were not always reviewed and updated to reflect changes.

Work needed to continue to make sure people’s care plans were individual and provided the guidance and information needed to make sure staff could deliver personalised care.

The provider’s governance systems were still a work in progress. Monitoring systems introduced since the last inspection were not kept up to date to make sure people received safe and good quality care.

People told us they felt safe. One person said, “I always feel safe here”. Improvements had been made to people’s safety. Staff said they felt more able to raise concerns about people’s care and were now confident they would be listened to. Staffing levels had improved and staff said they had more time to spend with people. The levels of agency staff had reduced and the agency staff supporting people now were regular agency staff who were treated as part of the team. Infection prevention and control was better managed, and staff understood their responsibilities.

People received better care with their health needs, however, better care planning could enhance the care people received. We have made a recommendation about this.

People were now treated with more dignity and respect, although some improvement was still needed. Staff knew people well and spent more time with them. People told us they were happy living at Barnes Lodge and thought staff were kind and caring. One person said, “They are lovely whether regular or agency staff, all the same attitude, kind and gentle, they will do anything for you.”

Some areas needed more improvement to the accessibility of information, for example, menus were not in large print or easy read to support people’s understanding. More activities were available to support people to have a more meaningful day and staff had more time to engage with people. The registered manager had improved the investigation and response to complaints. People were supported to make a plan for the end of their life.

Staff said the culture had changed, they felt they were listened to and were more able to speak up if they needed to. Staff had only positive things to say about the registered manager and were happy with the changes being made. The provider had engaged with people, relatives and staff and were in the process of providing responses to recently completed surveys.

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 inadequate (published 14 September 2022) and there were breaches of regulation. We took enforcement action against the provider. At this inspection we found the provider remained in breach of some regulations, however improvements had been made.

This service has been in Special Measures since 13 September 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Enforcement

We have identified breaches in relation to individual risk, medicines management, person centred care, people’s rights under the MCA, record keeping, and good governance, management and leadership at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Please see the action we have told the provider to take at the end of this report for some of the identified breaches of regulations.

Follow up

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

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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Barnes Lodge is a nursing home providing personal and nursing care, for up to 101 people. The service provides support to people with complex health needs such as kidney failure, Type 1 diabetes, Parkinson’s disease and people receiving care at the end of their life. Some people were living with dementia or deteriorating mobility. At the time of our inspection there were 68 people using the service.

Barnes Lodge is a purpose-built nursing home set out across three floors with two wings on each floor.

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

We found people were not safe living at Barnes Lodge. Risks had not been identified and mitigated by staff and as a result people had been placed at risk. There was a lack of comprehensive guidance in place to inform staff how best to support people with their health needs including wound care, insulin dependent diabetes, chronic health conditions and the risk of falls. There was no effective system to learn from accidents and incidents and no system in place to reduce the risk of the incident reoccurring. Incidents of potential abuse had been identified by staff, but not reported or investigated sufficiently.

Medicines management was poor. Audits had not been completed regularly and therefore issues with medicines administration had not been identified. These included medicines not being counted on a regular basis to ensure people had received their medicines and ensuring the correct and relevant guidance was in place for staff to follow.

There were insufficient numbers of consistent staff to meet people’s needs and keep them safe. Some people said they had to wait for support and staff did not always know how to support them. There were a high number of unwitnessed falls and bruises that had not been fully investigated to prevent further occurrences. Staff had not been recruited using safe recruitment processes, and staff had not received the training, or competency checks to complete their roles.

People’s needs had not been regularly assessed when they were living at Barnes Lodge. When people’s needs changed, risk assessments and care plans were not reviewed. An effective system was not in place to share important information about changes, with staff. For example, when advice had been given by a healthcare professional about a person’s diet, this had not being followed. People were not always referred to the relevant healthcare professionals for support, when required.

People were not supported to have maximum choice and control of their lives and staff did not 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, and their relatives where appropriate, had not been involved in decisions about their care. An effective system for monitoring DoLS authorisations was not in place to ensure people’s rights were maintained.

People were not supported to maintain their dignity and respect. Staff told us they had seen staff carry out personal care in a way that was undignified and unsafe, People were not always supported to maintain their physical appearance.

Care was not person centred and records did not support an individual approach. Some people had complex health needs and these were not detailed sufficiently to make sure they received the care they required to maintain their emotional and physical health. Limited activity was available for people to prevent boredom and social isolation. A robust system for responding to, investigating and monitoring complaints was not in place.

The provider had very limited oversight of the service. Quality assurance systems were ineffective. The culture within the staff team was poor which had a detrimental effect on the care provided. Staff felt it was not in their interests to raise concerns, as based on previous experiences, they did not believe action would be taken. We found many serious concerns about the service, yet the provider had been unaware of the issues identified.

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 (report published 19 December 2017)

Why we inspected

The inspection was prompted in part due to concerns relating to the safeguarding of vulnerable adults, and staffing. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only. During the inspection we found further serious concerns, so we widened the scope of the inspection into a full comprehensive inspection.

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 overall rating for the service has changed from good to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make significant improvements.

Enforcement and Recommendations

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 will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to people’s safety, abuse, staff recruitment, deployment and training, mental capacity, dignity and respect, person centred care, complaints, record keeping and effective checks and audits at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Following the inspection, we took immediate action to impose urgent conditions on the provider’s registration in relation to risk management and management oversight.

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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

The service was clean and extra cleaning duties were being carried out such as regular deep cleaning and cleaning of areas that were often touched. Such as door handles, wall rails and light switches.

We saw staff using PPE appropriately. Fully equipped PPE ‘stations’ had been distributed in key places around the service to ensure PPE was available to staff when needed.

The provider had built a heated log type cabin in the garden, designed to provide an area for safe, protected visiting with people’s loved ones during the winter months.

The provider and registered manager were following advice and guidance from other agencies about infection control and prevention and had updated staff training and practice accordingly.

Further information is in the detailed findings below.

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 their care.

People were asked their views of the service and their feedback led to improvements. They knew how to make a complaint if they needed to and were confident they would be listened to.

There was not a registered manager in post, but a new manager had been appointed who had begun to provide directive leadership. There were improvements to the culture of the service since the last inspection. Staff worked more effectively as a team and the service was more person centred.

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 medicines were managed safely and they received them at the correct time.

The accommodation was suitable for people’s needs and was comfortable and homely. Consideration had been given to the needs of people living with dementia to help them find their way around their home.

People, and their relatives, told us they felt the staff were caring and treated them kindly. People felt that their privacy was respected and they were treated with respect. Staff knew people well and understood their personalities. Staff provided reassurance and comfort to people when needed.

People told us that they enjoyed the group activities programme.

People and their relatives were aware of how to make a complaint and they felt their views were listened to.

The registered manager understood the requirements of their role and they were open and transparent. Staff felt that the registered manager provided a good level of support and had made positive changes to the culture of the service.