Archived: Barham House Nursing Home

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.

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 16 people using the service at the time of our inspection.

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

There was a lack of leadership at the service and this had impacted on all areas of people’s care. The provider and manager did not have scrutiny and oversight of the service and risks to people’s safety and welfare continued unchallenged.

Areas of the service were not clean and infection control risks were not well managed. Staff did not always wear and dispose of personal protective clothing safely. Robust arrangements were not in place to clean all areas of the building and minimise the risk of infection being spread around the service.

Risks to people had not been fully assessed and action was not consistently taken to keep them as safe as possible. People’s care had not been planned and detailed guidance had not been provided to staff about how to keep people safe and well.

Staff had not been recruited safely. Checks on staffs’ previous conduct and character were not explored before they came to work at the service. Concerns from the Disclosure and Barring service had not been followed up. Staff did not have the skills they needed to keep people safe and respond in an emergency.

People’s relatives had not been able to visit the service because of the Covid-19 pandemic restrictions. Some relatives told us they were informed of what was happening with their relative and this reassured them. Others told us communication was not good, they had not been involved in important decisions or were given contradicting information. People’s relatives were reassured the new manager had plans in place to improve the 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 (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. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about fire safety, risk management, infection prevention and control, and leadership. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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. Following our inspection we took urgent enforcement action to apply conditions to the provider’s registration requiring them to improve infection control measures at the service.

We also identified breaches in relation to risk management, staff recruitment, checks and audits and leadership 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.

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 16 people using the service at the time of our inspection.

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

The provider had been informed by the commissioning authority that the service was not working as well as it should be and had taken action. The provider and manager were working with other local agencies to improve the service and make sure people were safe and receiving the care and support that they needed.

People were not always fully protected from risks. Not all risks had been identified and risks to people had not been properly assessed and minimised. There was not always clear guidance for staff regarding risks relating to choking, when people became distressed and health conditions. Some accidents and incidents were not always reported to enable the manager to investigate, identify the cause and take action to prevent recurrence.

The provider had implemented new quality assurance systems. Some audits and safety checks had been completed. However, some governance and performance management systems were not always effective. The quality of information in people's care plans varied, and some records did not include information about individual risks. The systems used to monitor the quality and safety of the service had failed to pick up and address the areas of concern we found during the inspection. Action had been taken in some areas of the service and improvements had been made. Other areas needed more work and development to ensure improvements were embedded and sustained.

People's care plans were being reviewed and updated to show how person-centred care needed to be delivered in a way that people preferred and suited them best. People needed to be involved in more activities to prevent the risks of social isolation.

People were supported to have day to day choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, the records to assess people's capacity to make decisions was not always clear or completed.

People's needs were assessed before they started using the service. People were supported to express their views and make decisions about their care. People's religious, spiritual and cultural needs were discussed to make sure these needs were met. When people were unwell or needed extra support, they were referred to health care professionals and other external agencies. People enjoyed the food and were encouraged and supported to eat and drink a healthy and nutritious diet. People who needed assistance with their meals were not rushed. People were offered a variety of drinks and snacks.

Staff treated people with dignity and respect. Staff helped to maintain people's independence by encouraging them to do as much as possible. People's medicines were safely managed, and systems were in place to control and prevent the spread of infection. Staff understood how to keep people safe and knew how to report concerns if they had any.

People were treated with compassion and dignity at the end of their lives. Staff were supporting people to make decisions about what they wanted to happen at this time in their lives.

People and their relatives were being asked their opinions on the service by attending meetings. Surveys were going to be sent so suggestions could be acted upon. People gave positive feedback about the service they received. There were procedures in place to quickly investigate and resolve any complaints.

Staff were recruited safely. They received the support and monitoring they needed to undertake their roles effectively and safely. Nurses employed by the service had received clinical supervision to make sure their skills were up to date and in line with best practise. Staff received an induction and ongoing training that enabled them to have the skills and knowledge to provide effective care. Staff said they were listened to and that their opinions and suggestions were acted on. They said the service had improved since the new manager came to post. Lessons were learnt when things went wrong.

The provider had identified areas of the service that needed upgrading and refurbishment. Some environmental improvements were had been made and these were ongoing.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 7 February 2019 and this is the first inspection for this provider.

Why we inspected

This was a planned inspection based on the registration date.

You can read the report by selecting the ‘all reports’ link for Barham House Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified four breaches of the regulations at this inspection. These were in relation to, the management and recording of risk; consent to care and treatment. Also, stimulation and meaningful activities and quality monitoring systems including recording keeping.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect

sooner.