We carried out a review of the data available to us about Barons Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Barons Lodge, you can give feedback on this service.
Barons Lodge is a 'care home' and provides personal care with nursing for up to 34 people with mental health needs and/or physical disabilities in one adapted building. At the time of our inspection, there were 34 people living at the home
People’s experience of using this service and what we found
People using the service told us they liked living at the home and staff were friendly and caring. There was a pleasant atmosphere in the home and we received positive feedback from people and staff about the registered manager and how the home was managed.
The provider had improved the physical environment in the home, making it person centred and more homely for the people living there.
A number of audits were completed to monitor the quality of service. There were formal ways of gathering feedback from people and staff and regular engagement with them.
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 (published 25 July 2021) and there were breaches of regulation in relation to good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection enough improvement had been made and the provider was not in breach of regulations.
Why we inspected
This inspection was carried out to look at improvements against the breaches found at the previous inspection. As a result, we undertook a focused inspection to review the key question of well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Barons Lodge on our website at www.cqc.org.uk.
People’s experience of using this service
People using the service and their relatives were happy with the care and support they received. They all said the provider kept them, or their family members safe. They told us the registered manager was approachable and was always available to speak with. Staff also told said they felt well supported by the registered manager.
Despite the positive feedback, we found the governance procedures within the service were not always effective in identifying some issues we found during the inspection. It was also not always clear whether improvements had been made where concerns had been found. We found some health and safety issues in relation to the premises and some gaps in the training provision for staff.
There were enough staff employed within the service and recruitment procedures were robust. People were supported to remain as safe as possible through effective risk management procedures. Staff had received training in positive behaviour support and knew how to support people and keep them safe from harm. People were supported to take their medicines from staff who were trained and competent to do so.
The premises were kept free of obstacles and hazards which enabled people to move freely around the care home. The interior was furnished to a reasonable standard, however we identified some areas that needed addressing and attention which hadn’t been acted upon.
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.
The service was managed well in some aspects. The registered manager was approachable and encouraged feedback from people and staff. The provider worked with local partners to ensure peoples received the appropriate support.
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 good (published 4 April 2018).
Why we inspected
We received some concerns in relation to the management of the service. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.
We also used a targeted approach to look at specific concerns we had about the premises and the Mental Capacity Act under the Key Question of Effective. As we only looked at part of Effective, we have not changed the rating from the previous inspection for this Key Question.
We reviewed all the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for the key questions of Effective, Caring and Responsive were used in calculating the overall rating at this inspection.
Follow up
We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
We found the following examples of good practice
Measures were in place to minimise the risk of infection from visiting professionals and relatives. Visitors were limited to two visitors from the same household, per resident at a time. There was a booking system in place to stagger visitors and visiting times to minimise visitor numbers. All visitors were screened for symptoms of acute respiratory infection before being allowed to enter the home.
People were supported to maintain social contact with family and friends in a safe way through alternative methods. This included increased use of video-conferencing facilities, utilising the large outdoor space and zoning of the home to allow visitors to meet within individual rooms. A dedicated visitor’s room had been allocated for people to meet their family members or friends, which was subject to enhanced cleaning.
Appropriate measures were in place to support people who had tested positive for Covid-19. Symptomatic residents were isolated in single occupancy rooms and zoning was in place, which minimised the risk of cross infection. The service ensured people were tested for Covid-19, on discharge from hospital or in the community, before agreeing to admit them. New residents isolated for 14 days within their own room. People were assessed daily for the development of a high temperature, a cough, as well as for softer signs of Covid-19, such as shortness of breath, loss of appetite, confusion, diarrhoea or vomiting.
Staff used personal protective equipment (PPE) in accordance with current infection prevention and control (IPC) guidance. There were designated areas for donning/doffing PPE. Disposal of used PPE prevented cross-contamination and followed local protocols. Staff received training in IPC and correct use of PPE.
A testing scheme for all staff and people was being conducted – known as ‘whole home testing’. People were tested monthly and staff were tested at weekly. The registered manager knew how to apply for Covid-19 testing kits to test people and staff at the care home via the online care home portal.
Communal areas, such as outdoor spaces and garden areas, were used creatively to help with IPC. Multiple entrances were restricted for use by different people, such as staff or visitors. There was a designated lead for cleaning and decontamination within the service. Cleaning staff had cleaning schedules to follow which included frequency of cleaning of high touch areas, such as light switches and door handles.
All staff in high risk groups such as Black, Asian and Minority Ethnic (BAME) had been risk assessed, and adjustments had been made. All members of staff worked in this care setting only to prevent the spread of infection between services.
Further information is in the detailed findings below.
Barons Lodge accommodates up to 29 people with mental health needs and/or physical disabilities in one adapted building. At the time of our inspection 27 people were residing at the home.
At our last inspection of 08 February 2016 we rated the service good. At this inspection of 04 April 2018 we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
A registered manager was in place at the time of inspection. A registered manager is a person who has registered with the Care Quality Commission 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.
People were kept safe at the home and staff knew how to manage and report any safeguarding concerns. Risks to people were appropriately monitored to prevent incidents occurring and to monitor people’s safety. Medicines were managed in line with good practice to ensure people received medicines as intended by the prescriber. There were suitable numbers of staff to meet the needs of the people living at the home and appropriate steps were taken to prevent and control the spread of infection. The provider followed safe recruitment practices to ensure that persons employed were suitable to work with people.
Staff received regular and suitable training, supervision and appraisal to support them to carry out their roles. Staff understood the principles of the Mental Capacity Act 2005 (MCA) and there was appropriate documentation to ensure that any Deprivation of Liberty Safeguards (DoLS) were followed. People were supported to eat and drink in order to maintain a healthy diet, as well as having access to specialist healthcare professionals as required.
Staff cared for people at the home whilst respecting their privacy and dignity. People were supported to be as independent as possible in their choices and were encouraged to express their views . People were encouraged to practice their religious and cultural beliefs.
People and their relatives were involved in the contribution to people’s care plans to ensure they accurately reflected their needs. Care plans included people’s end of life choices where applicable to ensure that these were met in a dignified manner. The provider had a complaints policy in place and had dealt with complaints to reach a satisfactory resolution.
The registered manager was well thought of, and staff felt that they were well supported. There were systems and processes in place to ensure the registered manager had an overarching view of the service to enable improvements to be made.
This inspection took place on 9 January 2016 and was unannounced. When we last visited the home on the 21 July 2015 we found the service was not meeting the regulation relating to safe care and treatment because the risks of people being scalded by hot water were not adequately managed.
Barons Lodge is registered to provide nursing with accommodation and personal care for 29 people with mental health needs and some physical health needs. The service had increased their registration by seven beds since our last inspection. On the day of our visit there were 28 people using the service.
The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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 premises and equipment were safe and well maintained as the provider had the right checks and systems in place. A renovation programme was almost complete to improve the physical condition of the home.
Medicines management was safe and our checks indicated people received their medicines as prescribed.
Processes were in place to safeguard people and the registered manager reported concerns to the local authority safeguarding team and to CQC. Staff understood the signs people may be being abused and how to report any concerns they had.
There were enough staff deployed on shift to meet people’s needs and the provider recruited staff following robust procedures to check they were suitable to work with people.
The provider was meeting their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. The registered manager had assessed which people required DoLS and made the necessary applications as part of keeping them safe.
People had choice of food and drink and received food in suitable quantities. People received the right support from staff to eat and drink when they required this. People were supported to have their ethnical and cultural dietary preferences met. Staff supported people to meet their healthcare needs including accessing various healthcare professionals.
The provider supported staff to carry out their roles through a programme of training, induction, supervision and annual appraisal.
Staff were caring and treated people with dignity and respect. People were encouraged to be involved in planning and reviewing their own care. Staff supported people to meet their religious and spiritual needs. A range of activities people were interested in was provided. People and staff were involved in the running of the home.
A suitable complaints procedure was in place which was made accessible to people. People and their relatives had confidence in how the registered manager would respond should they wish to make a compliant. The registered manager kept a records showing clear information about complaints received and they action they had taken to resolve these in line with the complaints policy.
The provider had suitable systems in place to assess, monitor and improve the quality of service as well as health and safely. The manager and staff understood their roles well and leadership was evidence in the home. The provider was meeting their requirements to submit notifications to CQC such as of any allegations of abuse or police incidents.
We carried out this unannounced focused inspection of this service on 21 July 2015. When we last visited the home on the 10 October 2014 we found the service was breaching regulations in relation to care and welfare, safety and suitability of the premises, safeguarding people from abuse and notifying CQC of incidents. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.
We undertook this focused inspection to check that they had followed their action plan and to confirm that they now met legal requirements and had addressed all areas where improvement was needed. We found the provider had taken all the necessary action to improve the service in respect of the breaches and issues we found.
This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Barons Lodge on our website at www.cqc.org.uk.
Barons Lodge is registered to provide accommodation and personal care for 22 people with mental health needs. On the day of our visit there were 21 people using the service.
The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.
During the inspection we found the provider had taken the necessary action to improve in relation to the breaches we identified at our last inspection. However, we identified systems to reduce the risks of people being scalded from hot water were insufficient. You can see what action we told the provider to take at the back of the full version of the report.
People were protected from abuse because the manager and staff had received training in safeguarding and understood how to keep people safe. The manager encouraged staff to report any concerns they had about the service. The manager reinforced safeguarding responsibilities at handovers, staff meetings and supervisions. They shared information about any safeguarding referrals which had been made and updated the team on progress with these to increase their awareness of safeguarding. The service assessed whether people were at particular risk of abuse and put care plans in place for staff to follow to support them in relation to this, as part of keeping them safe. Procedures were in place to keep people, who made repeated allegations of abuse, safe.
At the last inspection we found people were at risk of infections. This was because people they were not always appropriately supported by staff to clean their bedrooms. During this inspection we found the service had improved. Domestic cleaners cleaned all areas of the house each day, including people’s bedrooms. People were encouraged to participate in cleaning, where appropriate, as part of maintaining their independent living skills.
Previously we found the premises were not always appropriately maintained. However, at this inspection we found the necessary repairs had been carried out. The home was in a good state overall and a system was in place for the provider to identify and action repairs in the home ongoing. However, systems to reduce the risks of people being scalded by hot water were insufficient and the provider told us they would take immediate action to rectify this.
The provider had revised the system in place to plan people’s care. We found the provider regularly reviewed people’s needs and put care plans in place for staff to follow in relation to their identified needs. Staff reviewed these care plans each month and the information in them was reliable for staff to follow as it was accurate and up to date.
Since the last inspection the manager notified CQC of a number of incidents, as required by law, including allegations of abuse, serious incidents and deaths of people using the service. Because of this CQC are able to monitor the service as part of our regulatory function.
This inspection took place on 10 October 2014 and was unannounced. When we last visited the home on the 30 July 2014 we found the service was meeting the regulation we looked at.
Barons Lodge provides accommodation, nursing and personal care for 22 people with mental health needs. Many people were older adults and some also had physical disabilities. On the day of our visit the home was fully occupied.
The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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 found that people might not have been protected from abuse. This is because procedures to keep people who made repeated allegations safe were not always appropriate. However, staff had a good understanding of how to identify abuse or neglect.
People’s bedrooms were not always clean and tidy. This was because the provider did not ensure that people were supported appropriately to clean their bedrooms. This could put people at risk from the spread of infection. Other parts of the home were clean.
The premises were not always appropriately maintained. For example, a radiator cover had not been replaced which meant people were at risk of getting scalded if they came into prolonged contact with the exposed radiator. However, other parts of the premises were well maintained, such as the electric and fire detecting and fighting systems.
We found gaps in the planning to meet people’s individual needs and to ensure people’s welfare and safety. Planning of care in relation to falls prevention, promoting continence, prevention of pressure ulcers, mental health screening and therapy provision was not always documented or accurate.
The manager had not notified CQC of several incidents including allegations of abuse involving people using the service and incidents involving the police. This meant the CQC could not monitor how these incidents were being dealt with.
There were enough staff employed to meet people’s needs and recruitment procedures were robust, ensuring that only people who were deemed suitable worked in the home. Staff were provided with support and training to help them carry out their roles.
We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberties in a safe and correct way, when it is in their best interests and there is no other way to look after them.
Staff had a good understanding of the Mental Capacity Act 2005 and their responsibilities under this. This helped to ensure that people’s rights in relation to this were properly recognised, respected and promoted.
People were provided with a choice of food, and were supported to eat when required. Staff supported people who were at risk of malnutrition and those with specialist needs related to their diet. People were supported effectively with their health needs. Medicines were managed safely.
Staff treated people with kindness and compassion, dignity and respect. They responded to people’s needs promptly. People were involved in decisions about their care, and had access to advocates to help them make some decisions. Staff had a good knowledge and understanding of people’s individual needs and preferences.
People using the service, relatives and staff were encouraged to give feedback on the service. There was an accessible complaints policy which the manager followed when complaints were made to ensure they were investigated and responded to appropriately.
The manager carried out regular audits to monitor the quality and health and safety of the service and to plan improvements, although these audits had not identified the issues we found in relation to care planning and notifications.
At this inspection there were breaches of regulations in relation to safeguarding people from abuse, care and welfare of people, safety and suitability of the premises and notifying CQC of incidents. You can see what action we told the provider to take at the back of the full version of the report.
Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
We found that the management of medicines was carried out safely. Procedures for the obtaining, recording, handling, safe keeping, safe administration and disposal of medicines were appropriate. This meant that people were protected from the risks associated with the management of medicines.
We found that people's care plans and risk assessment regularly reviewed. Staff demonstrated the knowledge and skills needed to protect people from abuse.
We found that appropriate checks were carried out on staff before they were employed and completed a comprehensive induction. There was a training programme ensuring that staff had the skills and knowledge to work with people who used this service in a safe effective manner.
The provider had a system in place to regularly assess and monitor the quality of service that people received