Barkat House Residential Home

Barkat House is a residential care home providing personal care for up to 27 people. At the time of the inspection the service was supporting 23 people.

The care home accommodates people over two floors which are accessed by a lift in one adapted building. Barkat House provides care to older people, some of whom are living with dementia and mental health needs.

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

People felt safe and were supported by a group of staff who knew them well and had received training in how to support people safely. Staff had received training in how to recognise signs of abuse and where safeguarding concerns had been raised, they had been acted on appropriately. People were supported to receive their medicines as prescribed and robust medicines management systems were in place. Staff following the latest Government guidance with respect to infection control and were supplied with the appropriate PPE [Personal Protective Equipment]. Accidents and incidents were regularly reviewed and lessons learnt where appropriate.

People were supported by a group of staff who felt supported and well trained. Staff were provided with the opportunity to discuss their role or raise any concerns through regular supervision discussions, staff meetings and surveys. Systems were in place to ensure people’s needs were fully assessed and staff were provided with the information required to support people safely and effectively. People’s nutritional needs were assessed and their food choices and cultural needs catered for. Staff were aware of people’s health care needs and supported people to access a variety of health care services to help them maintain good health. The environment was currently being refurbished and people had been consulted regarding the redecoration of their home.

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.

People were supported by staff who knew them well and treated them with dignity and respect. People’s choices were respected and they were supported where possible, to be as independent as possible.

People and their loved ones were involved in the development of their care plans. People’s opinions had been sought regarding how they wished to spend their time and this information had been incorporated into their care plans. A variety of activities took place on a daily basis based on what people liked to do. People were encouraged and supported to take part if they wished to do so. Staff respected people’s wishes and offered them alternative activities that were of interest to them. People were complimentary of the service and had no complaints. They were confident that if they did raise a concern, they would be listened to and it would be dealt with appropriately.

The new registered manager and her deputy had a clear vision for the service and were supported by the provider and the staff team as a whole. A variety of audits had been introduced to ensure people’s care needs were being met and identify any areas for action. Staff felt listened to and supported. People had been involved in the development of their care records and spoken positively about the improvements in the service following the arrival of the new registered manager. People told us they felt well cared for and they and their loved ones were complimentary of the service and told us they would recommend it to others.

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 8 December 2020) and there were continued multiple breaches of regulation. 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.

This service has been in Special Measures since 8 December 2020. 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 action we told the provider to take at the last inspection. The inspection was also prompted in part due to concerns regarding diabetes management at the service. A decision was made for us to inspect and examine those risks.

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 found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

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.

Barkat House Residential Home is a residential care home providing personal care for up to 27 people. At the time of the inspection the service was supporting 24 people.

The care home accommodates people over two floors which are accessed by a lift in one adapted building. It provides care to older people, some of whom are living with dementia and mental health needs.

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

Although people told us they were happy and relatives thought people were safe, we found that systems and processes to safeguarding people from abuse were not effective. We observed some poor practice regarding medicine administration and infection control at the home.

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. The needs of people with dementia were not fully considered, however further ‘dementia friendly’ decoration of the service was planned.

We saw some improvements had been made to the environment at the home since our last inspection and some care plans had been updated. However, people’s choices and preferences weren’t always explored or followed. For example, people’s end of life wishes were not always sought. We saw a lack of person-centred activities or meaningful interactions between people and staff.

The registered provider had not ensured there were robust systems in place to keep people safe and meet their needs in a person-centred way. Following our last inspection, the provider had not implemented the improvements in systems and processes required. There continued to be a lack of oversight regarding potential safeguarding matters and feedback from people.

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 June 2020) and there were multiple breaches of regulation. 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. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 14 January 2020. 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 person-centred care, need for consent, safe care and treatment and good governance.

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

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 coronavirus and other infection outbreaks effectively.

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 remained requires improvement. 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.

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

Enforcement

We have identified continued breaches in relation to safe care and treatment, person-centred care, seeking consent for people's care and how the service is managed at this inspection. 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. As there are already positive conditions in place following our last inspection, these will remain and we will continue to monitor the service. Please see the action we have told the provider to take at the end of this report.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the 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.

Special Measures:

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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 to check for significant improvements.

If the provider has not made enough improvement and there is still a rating of inadequate for any key question or overall, 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 the 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.

Barkat House Residential Home is a residential care home providing personal care to 26 people predominantly aged 65 and over at the time of the inspection. The service can support up to 27 people.

The care home accommodates people over two floors which were accessed by a lift in one adapted building. It provides care to older people, some of whom are living with dementia and mental health needs.

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

Although people told us they felt safe, risks to people's safety had not always been assessed and mitigated against. There was a continued failure to ensure all peoples risks were identified and managed well. Environmental risks, included and not limited to, fire safety, food safety, access and security and infection control were identified which did not always ensure people's safety. People told us there were enough staff to support them. People generally received their medicines as prescribed.

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. Whilst staff told us they received regular training, the manager and the systems in place could not confirm this. Generally, people told us they enjoyed their meals but were not involved in the planning of the menus. People’s health care records did not contain sufficient information and guidance for staff to follow. The design and décor of the service failed to show regard for all people’s individual needs.

People told us they were treated with kindness and compassion. However, we found concerns that, on occasions, compromised people’s dignity, respect and positive experiences.

People did not receive personalised care that was responsive to their needs. People were not given information in an accessible way, so it was easier for them to understand. People told us they did not contribute to the planning and reviewing of their care. People we spoke with told us they were bored because there was a lack of social activities. People we spoke with knew how to raise a concern or make a complaint.

The registered provider had not established all the systems and processes that were necessary to operate, monitor and evaluate the operation of the service. The provider did not carry out robust checks to ensure care was being delivered safely and effectively. Whilst people's views about the quality of care had been sought there was no system in place to evidence the feedback had been acted upon. People and staff told us the provider and manager were approachable.

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 31 January 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 enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to the failure to ensure all peoples risks were assessed and mitigated against, the failure to ensure people had consented to some aspects of their care, the failure to ensure people received person-centred care and support that met their needs and personal preferences and the failure to operate effective systems and processes to assess, monitor and improve the quality and safety of the service 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.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People were not consistently protected from potential harm. The registered manager and provider had completed some audits and checks. However, people were not always protected from the risk of harm because processes in place were not consistently managed and were not robust. Risks to people's safety were not always acted on in a timely way. These included risks relating to fire safety, the environment and access to the building.

As a result of our findings we found that the provider was in breach of Regulation 17 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what further action we have taken at the end of this report.

People had access to equipment that reduced the risk of harm and medicines were stored and administered safely. There were sufficient numbers of staff on duty to meet people’s needs. Staff knew how to recognise potential abuse and who they should report any concerns to.

People had a good choice of food which they enjoyed and were supported to maintain a healthy diet in line with their needs and preferences. Staff were trained to meet people’s needs and acted promptly to refer people to healthcare professionals when required.

People enjoyed positive and caring relationships with the staff team and were treated with kindness and respect. People’s independence was promoted as staff were careful not to do things for people that they could do for themselves.

People were supported by staff who knew about their needs and routines and ensured these were met and respected. Staff and relatives knew how to complain and were confident that their concerns would be listened to.

People and staff were happy with the way the service was led and managed and the provider worked well with partners to ensured people’s needs were met.

More information is in the detailed findings below.

Rating at last inspection:

Good (report published 29 January 2016)

About the service:

Barkat House is a care home that provides personal care for older people, some of whom are living with dementia. At the time of the inspection, 26 people lived at the service. Most people lived there permanently and some people spent short periods there to provide respite to their main carers. The home was established over two floors with a range of communal areas included dining spaces, a large garden and smaller lounge spaces.

The service had a manager registered with the Care Quality Commission. This means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection we found the service had changed to Requires Improvement.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

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

At this inspection we saw that there were appropriate systems in place to monitor that medicines were used as prescribed and there was appropriate monitoring of blood sugar levels, people's weights and accidents and incidents. This was because the appropriate systems had been put in place. This meant that people were protected from harm.

We spoke with four people living in the home and they all said they were happy.

We saw that people were treated with dignity and respect. People received care and support that met their individua needs and we saw that people were dressed in styles that reflected their preferences and cultural backgrounds.

People's health needs were met. One person told us they were taken to the hospital so that they could attend their appointments.

People's nutritional needs were met. They were offered choices at all mealtimes and specific dietary needs were met. Eastern and western meals were available to meet people's needs. One person told us, "The food is good."

People living in the home were protected from the risks of abuse and unsafe care.

The management of medicines ensured that people received their medicines as prescribed.

People were supported by staff who were present in sufficient numbers and with the required skills to meet their needs.Staff were knowledgeable about people's needs and able to support people in the way they wanted.

There were some systems in place to get the views of people using the service so that improvements could be made.

Records did not always ensure that people were protected from unsafe and inappropriate care.

People were treated with dignity and respect. We saw that staff explained to people what they were going to do when they were assisting them.

People told us they were happy in the home. One person told us, 'It's a good home. Staff help me keep my room tidy and do my laundry'. People received care and support that met their individualised needs so that their health care needs were met.

People living in the home were protected from the risks of abuse and unsafe care. People were relaxed in their environment and systems were in place to keep them safe from harm. Two people we spoke with told us they felt safe in the home. One person said, It's a good home, I feel safe'.

The premises met people's needs. There was an ongoing maintenance system in place so that the accommodation was continually upgraded and maintained.

Staff were supported to carry out their roles safely. Staff told us they liked working in the home. Staff were knowledgeable about people's needs and able to support people in the way they wanted.

There were some systems in place to monitor how the home was run and to ensure people received a quality service but improvements needed to be made.