Background to this inspection
Updated
21 May 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
This inspection was completed by four inspectors. Three inspectors visited the service and another inspector reviewed information off site.
Service and service type
Barham House Nursing Home 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 the care provided, and both were looked at during this inspection.
The service does not have a manager registered with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We used this information to plan our inspection.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with three people who used the service about their experience of the care provided. We spoke with six members of staff including the nominated individual, manager, senior nurse and care workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included nine people’s care records, four staff files in relation to recruitment and medication records for everyone. We also reviewed a variety of records relating to infection prevention and control.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at policies and processes the provider had in place.
Updated
21 May 2021
About the service
Barham House Nursing Home 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 the care provided, and both were looked at during this inspection. Barham House Nursing Home is registered to provide accommodation, nursing and personal care for up to 23 older people in one adapted building. There were 17 people using the service at the time of our inspection.
People’s experience of using this service and what we found
People continued to be at risk of serious harm at Barham House Nursing Home.
There continued to be a lack of leadership and oversight at the service. Again, this had impacted on all areas of people’s care and treatment. The provider and manager had not developed an open and honest culture, centred around the people’s needs and wishes. They did not have the required oversight of the service and poor and unsafe practice continued unchallenged.
The provider had not acted to ensure all areas of the service were clean and free from the risk of infection. Covid-19 tests were not completed on visitors and staff. Robust arrangements had not been put in place to ensure all areas of the building were clean to minimise the risk of infection.
Effective action had not been taken to assess and review risks to people. People’s care and support had not been planned to mitigate risks and keep them as safe as possible. Detailed guidance had not been provided to staff about how to keep each people safe and well. There were not always enough staff on duty to meet people’s needs and protect them from harm.
Staff continued not to be recruited safely. The provider had taken very little action to protect people from unsuitable staff since our last inspection. Checks had not been completed on new staff. No further checks had been completed on senior staff’s character and conduct in previous roles. Concerns from the Disclosure and Barring service had not assessed to ensure staff were safe to work with vulnerable people. Staff did not have the skills they needed to keep people safe and respond in an emergency.
People’s medicines were not managed safely. People did not always receive the medicine they needed. Guidance was not in place to administer emergency medicines. Other medicines were not administered as prescribed.
People were not protected from the risk of abuse. Safeguarding concerns had not been shared with the provider or the local authority safeguarding team.
People, their relatives and visiting professionals had not been asked for their experiences of the service to drive improvement. Robust checks and audits had not been completed to understand the quality of the service and shortfalls we found had not been identified. Action had not been taken since our last inspection to address the poor quality care people received.
Records of the care people received were not accurate and complete. Some confidential information about people was not disposed of securely.
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 12 March 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. We completed a targeted inspection of the service on 27 January 2021. We did not review the rating for the service as part of this inspection. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
Our previous inspection found shortfalls at the service in relation to infection control and prevention, the management of risks to people, staff recruitment and staff compliance and leadership and oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to infection prevention and control, risk management, staff recruitment, checks and audits and governance and leadership, safeguarding people from abuse, medicines management and the completeness of records at this inspection.
We took action against the provider and cancelled their registration. Everyone moved out of the service and the service is now closed.