Barrington House

Barrington House is a residential care home providing accommodation for people with learning disabilities who require personal care. The home cares for adults and older people. Barrington House is registered to provide care and support for up to 21 people. At the time of the inspection there were 18 people were using the service. Accommodation was provided on the ground and first floor. People's needs were varied and included support with general age-related conditions. Some people had more specialist needs associated with diabetes, autism and epilepsy.

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

People and their relatives told us they were happy with the service they received. They described the care workers as kind and caring and said the management team were visible and committed.

The registered manager had addressed the areas identified for improvement following the last inspection. For example, systems for managing and monitoring diabetes had been reviewed and were now effective. Incidents were reviewed and safeguarding concerns had been appropriately identified and escalated in line with the provider’s policy.

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.

Systems for monitoring quality and managing risks had been improved and embedded. There were arrangements to support governance and to provide management oversight. Risk assessments and care plans guided staff in how to provide care safely and in the way the person preferred. There were enough suitable staff employed to ensure people were safe.

Appropriate infection control procedures for the COVID19 pandemic were in place to keep people safe. Staff had received additional training and used appropriate Personal Protective Equipment.

People and relatives were happy with how responsive staff were to their needs. Staff and management knew people very well and were proactive in responding to changing health and care needs.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

Staff promoted choice, independence and inclusion. Care plans were person centred and reflected individual’s needs and wishes. People were supported to understand information about their care which promoted their equal rights and maximised their choice and control. The ethos of staff promoted personalised support that was inclusive.

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 requires improvement (published 5 December 2019). The provider completed an action plan after the last inspection to show what they would do, and by when, to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

We carried out an unannounced comprehensive inspection of this service on 9 and 10 July 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, good governance and person-centred care.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the Key Questions of Safe, Responsive and Well-led which contain those requirements. We also looked at the Key Question of Caring.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Barrington House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Barrington House is a residential care home providing accommodation for people with learning disabilities who require personal care. The home cared for adults and older people. Accommodation was provided on the ground and first floor.

People's needs were varied and included support with general age-related conditions. Some people had more specialist needs associated with diabetes, autism and epilepsy.

The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had not always consistently applied them.

Barrington House was a large home, bigger than most domestic style properties. It is registered for the support of up to 21 people. 18 people were using the service at the time of the inspection. This is larger than current best practice guidance. However, the size of the service did not have a negative impact on people. This was because the building design fitted into the local residential area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.

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

Following the last inspection, the provider was served two warning notices for breaches of regulation 12 and regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The regulation 12 warning notice was served due to poor moving and handling, poor management of diabetes and physiotherapy exercises not being completed. The regulation 17 warning notice was served as some people’s weight was not being effectively monitored, ineffective recording systems, lack of activities, recording of people’s food and 1:1 support. These shortfalls were not being picked up through the home’s quality assurance systems.

The provider has been in breach of regulations 12 and 17 for the previous two inspections. At this inspection we found that these breaches had still not been met.

Systems for the care and support of people with diabetes continued to remain unsafe. Oversight of people’s blood sugar levels were not in place and staff knowledge of when they should seek additional health support was poor.

People were not always provided with person centred support and did not always have meaningful engagement or undertake activities that were important to them. Staff did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

Staff did not always have the necessary training and skills to effectively meet people’s individual needs.

Quality assurance systems did not always effectively monitor the quality and safety of the service provided. The provider did not have effective systems in place to ensure that support with people’s epilepsy was delivered safely or effectively.

The issues found above have been highlighted in the previous inspection.

Systems and processes were in place to safeguard people from the risk of abuse. Medicines were managed and administered safely. People told us that there were sufficient staff to keep people safe.

Staff were kind and caring and passionate about the care they provided. People's dignity and privacy was maintained. People and their families consistently told us how well looked after they were, and staff were respectful. One person said, “The staff treat me kindly. They make me feel happy.” Another person said, “It is homely here. The staff make you feel good.”

The registered manager had ensured that people’s communication needs were being met and that they were given information in a way they understood.

People were supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 requires improvement (published 25 July 2018) and there were three breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider remained in breach of three regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three continued breaches in relation to Regulation 9 (person centred care), Regulation 12 (safe care and treatment) and Regulation 17 (lack of effective quality assurance systems) at this inspection.

The service met the characteristics of Requires Improvement in all key questions of safe, effective, caring, responsive and well-led. Warning notices were served following the last inspection. At this inspection we found that these warning notices had not been fully met. 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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The care service has been in operation a long time and the building was therefore not developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. The building could not easily be adapted so it is difficult for the service to meet these standards.

There was a registered manager in post. 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.

This is the second time the home has been rated requires improvement. At the last inspection there were breaches of regulations 9,11,12 and 17 and requirement notices were issued. The breaches were in relation to a lack of assessment of people’s social needs, a failure to give appropriate consideration to Deprivation of Liberty Safeguards (DoLS) requirements, a lack of assessment of the risks to people’s health and safety and doing all that is reasonably practicable to mitigate any such risks and a failure to ensure that accurate record keeping was in place and to ensure actions were taken to mitigate risks. We asked the provider to complete an action plan to show improvements they would make, what they would do, and by when, to improve the key questions in safe, effective, responsive and well led to at least good.

This comprehensive inspection took place on 16 and 17 May 2018 to check the provider had made suitable improvements to ensure they had met regulatory requirements. We found the home was meeting legal requirements in relation to DoLS. However, we identified there were continuing breaches of Regulations 9,12 and 17. This was because we could not be sure people were receiving person centred care, recommended exercises had not been carried out, risks to people’s care were not always addressed and record keeping was not always up to date or accurate. We made a recommendation to ensure people’s dignity.

Since the last inspection the provider had introduced a new computer package and documentation had gradually been transferred since January 2018. Not all documentation was in place at the time of inspection. Staff had varying levels of skill in using the package. The result meant a distortion in record keeping in some areas so it was difficult to assess records as a reliable source of information and this affected the provider’s ability to monitor the service adequately. It was recognised that additional time was needed to ensure full training on the package and to fully embed progress made into everyday practices.

People told us they were happy and although we observed some negative practices we also observed staff interactions that were very positive and that staff treated people in a caring and kind manner. People told us they would talk to their keyworkers if they had any worries or concerns. The home ensured people’s spiritual needs were met. One person told us their keyworker was, “Very important to me. Tomorrow we are going into town so I can shop for summer clothes. She would always organise anything like that.” Another person told us, “It feels like home. I’ve made lots of friends here. Most of the staff have been here a long time and they know me. They sit and have a chat.”

There were enough staff to meet people’s individual needs. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Incidents and accidents were well managed. People’s medicines were managed safely.

People’s needs were effectively met because staff had the training and skills they needed to do so. Specialist training had been identified as a need for staff and training had been booked. Staff attended regular supervision meetings and told us they were well supported. There were regular staff meetings and staff felt they were updated about the home and could share their views. Staff supported people in the least restrictive way possible. People were encouraged to be involved in decisions and choices when it was appropriate. Mental Capacity Act 2005 (MCA) assessments were completed as required and in line with legal requirements. Staff had attended MCA and Deprivation of Liberty Safeguards (DoLS) training.

Staff had a good understanding of the care and support needs of people and had developed positive relationships with them. People were supported to attend health appointments, such as the GP or dentist.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. 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

There was a registered manager in post. 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.

At our last inspection in August 2014 we issued a requirement notice in relation to staff levels between 6-8pm. We received an action plan from the provider that told us how they would make improvements. At this inspection we found that although records did not show that there was always sufficient staff on duty, all staff confirmed that this was the case.

On the first day of our inspection we assessed that people’s dignity had been compromised. People’s hairbrushes were not clean and toothbrushes did not look as if they had been used. There was no effective system in place to monitor that people’s oral hygiene needs had been met. During our inspection new hairbrushes and toothbrushes were bought and by the second day of our inspection there was a new system to monitor daily that people’s hairbrushes were cleaned and that people’s oral hygiene needs had been addressed.

We identified further areas that required improvement. Some of the staff team had not received appropriate training to meet people's needs. This was particularly evident in relation to specialist training for diabetes, dementia and epilepsy. Although staff felt supported on an informal basis the systems for ensuring staff received regular supervision were not always effective.

Some staff did not have a clear understanding of the Deprivation of Liberty Safeguards (DoLS) and whilst they knew some people had a DoLS in place or that one had been applied for, they were not clear about others. (A DoLS is used when it is assessed as necessary to deprive a person of their liberty in their best interests and the methods used should be as least restrictive as possible).

There was a lack of risk management in terms of fire safety and ensuring that people who needed support to leave the building in the event of a fire could do so safely. Risk assessments did not always included detailed information. For example, there was no advice in one person’s care plan about how staff should support the person if they displayed behaviours that challenged.

There was a lack of individual assessment and planning to ensure that some people’s recreational and social needs were met and there was a heavy reliance on the use of TV as an activity. When activities were provided they were not always recorded so it was not possible to accurately assess the numbers and types of activities available.

There was a lack of monitoring in place to identify that record keeping in many areas such as staff training and supervision, staff rotas, care plans and health and safety documentation were accurate and up to date. Some matters such as menus, and monitoring of personal care had been identified as areas to improve but the monitoring systems that had been put in place to address these areas had not been effective.

Despite these shortfalls people told us they were happy with the care they received. Staff were kind and caring and they had developed good relationships with people. There was a very relaxed and calm atmosphere in the home and staff had a good rapport with people. Bedrooms had been personalised to reflect the people’s individual tastes and interests. People were supported by staff who knew them well as individuals and they were able to tell us about people’s needs, choices, personal histories and interests. A relative told us, “The staff are so pleasant, they can’t do enough for you,” and “I know I can go away and he is completely safe and well looked after.” A staff member told us, “I’m very happy here, it’s a lovely place to work.”

Whilst there were safe procedures for the management of medicines there was no formal system in place to assess staff competency before allowing them to give medicines. People had access to healthcare professionals when they needed specific support. This included GP's, dentists and opticians. Where specialist healthcare was required, for example, from a community nurse, arrangements were made for this to happen.

Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the home.

We found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.