Archived: OSJCT Bartlett House

Bartlett House is registered to provide accommodation and personal care for up to 36 older people. At the time of our inspection there were 27 people living in the home. People lived in three different units in the home, ‘Up Red’ and ‘Down Red’ were mostly people living with residential care needs. ‘Down Blue’ was a secure unit for twelve people with a diagnosis of dementia.

The inspection took place on 13 and 14 November, and 4 December 2018. The inspection was unannounced on the first day. We provided feedback to the registered manager and area operations manager at the end of the second day. We returned for a third day to gather further evidence and where actions had been taken in response to our feedback, this has been included in the report.

Care plans were not always up to date or reflective of people’s current assessed risks. In addition, some information was missing regarding the assessed risks, to enable staff to provide effective and safe support. This was despite care plan reviews and audits taking place.

Not all staff adhered to the organisations infection prevention and control policy regarding hand hygiene. Some areas of the home also had unpleasant odours, which indicated people’s continence needs were not being supported. However, the rest of the service was mostly maintained to be clean and tidy.

Falls were recorded and monitored, however there were some areas for improvement in the quality of the monitoring. We provided feedback to the registered manager regarding this and saw that when we visited on the third day of the inspection, the improvements had been implemented.

At times, staff were not deployed effectively. This resulted in people seeking assistance and staff not being available to help. There was a dependency calculation tool being used, however this did not account for the layout of the building.

There were safe staff recruitment processes in place.

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.

Access to outside areas was restricted, despite there being adapted flower beds and a raised fishpond for the enjoyment of the people living at the service. The large garden space had not been creatively designed to maximise opportunities for people’s independence to be promoted.

The Down Blue, dementia unit, was not designed to support the needs of the people living there. The lounge space in the unit was a converted bedroom, with only six chairs, despite twelve people living there.

Medicines were stored and managed safely. However, medicines were not always administered with dignity. On two of the three days we inspected, we saw that medicines were administered by a staff member who lacked a person-centred approach.

Staff felt confident they could report any safeguarding concerns to the registered manager and that action would be taken. They also felt supported to raise any queries they had with regards to their work.

We saw safe transfers taking place. People were comfortable and appeared confident in the procedure. We also saw measures to support people’s dignity during transfers were being used, including placing a blanket over people’s laps to prevent their legs being exposed.

There were gaps in the registered manager and senior staff member’s knowledge regarding the Accessible Information Standards 2016 (AIS) and the Mental Capacity Act 2005 (MCA). This meant that procedures to meet the legislative requirements were only partly implemented.

The quality of care interactions varied between different staff members. We saw examples of undignified and abrupt engagement, as well as positive, kind and polite interactions.

People were joined at lunch by staff who sat with them throughout their meal. There was a positive atmosphere in the dining room, with people choosing where they wanted to sit, and staff encouraging conversation.

There was no always a clear managerial vision for how the service could improve and develop. Effective support had not been provided by the organisation to ensure that the service could maintain their previous CQC rating of good; also, to help the service better support the needs of the people who live there, in accordance with up to date practice and national guidance.

We identified breaches of the Health and Social Care Act 2008, (Regulated Activities) Regulations 2014. Details of these and the action we have asked the provider to take have been recorded at the end of the report.

Bartlett House consists of two floors with access to the upper floor by a lift or stairs. There are some shared bathrooms, other shower facilities and toilets. Communal areas include a lounge, other smaller seating areas, a dining room and an outside garden with patio.

The Order of St John Care Trust, Bartlett House is registered to provide personal care for up to 49 people. On the day of the inspection there were 31 people living at the service. The registered manager informed us they recently chose to reduce the number of rooms to 36. We were told this was to make sure there were sufficient staff numbers in relation to the needs of people using the service. The service provides care for people with dementia, learning disabilities, autistic spectrum disorder and older people.

Bartlett House consists of two floors with access to the upper floor by a lift or stairs. There are some shared bathrooms, other shower facilities and toilets. Communal areas include a lounge, other smaller seating areas, a dining room and an outside garden with patio.

A registered manager was employed by the service. 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 inspection took place on 26th and 27th April 2016 and was unannounced.

People told us they felt safe when receiving care. Some relatives said they felt at times there were not enough staff but they did not feel that people’s safety was compromised by this as agency staff were deployed. The registered manager was in the process of recruiting a number of new staff. Safe recruitment practices were followed before new staff members started working at the home. Checks were made to ensure staff were of good character and suitable for the role. During the inspection there were enough competent staff on duty who had the right mix of skills and experience to ensure they could safely meet the needs of people using the service. People who use the service and their relatives were positive about the care they received and said staff had sufficient knowledge to provide support and keep them safe.

Staff received regular training in relation to their role and the people they supported. Staff received regular supervisions and an appraisal where they could discuss personal development plans. This meant staff received the appropriate support to enable them to provide care to people who used the service.

Medicines were managed safely and administered by trained staff.

People and their relatives told us they had access to health services and there was a weekly visit from their GP.

The registered manager and staff we spoke with were passionate about providing care which was tailored to people’s needs and choices. Throughout our visit we saw most people were treated in a kind and caring way and staff were friendly, polite and respectful when providing care and support to people.

Staff understood the needs of the people they were providing care for. Some care plans were individualised and contained information on people’s preferred routines, likes, dislikes and medical histories. However, other care plans were not person centred or specific to people’s needs. Individual risk assessments were in place and staff we spoke with knew what to do if they were concerned about the safety and well-being of any of the people using the service.

The registered manager and staff acted in accordance with the requirements of the Mental Capacity Act 2005. Where people did not have the capacity to make decisions themselves, mental capacity assessments were in place and records showed that decisions been made in line with the person’s best interests. Where required, Deprivation of Liberty Safeguarding applications had been submitted to the appropriate authority by the registered manager.

People had access to a range of foods and drinks, with their preferences being noted and shared with kitchen staff. Where required, specialist diets were available such as soft or fortified food. People and their relatives spoke positively about the food choices explaining alternatives were always available should they not want what was on the menu.

We saw staff assisting people with their meals although this was not always done according to people’s needs.

Arrangements were in place for keeping the home clean and hygienic and to ensure people were protected from the risk of infections. During our visit, we observed that bedrooms, bathrooms and communal areas were clean and tidy and free from odours.

People who live at the home and staff were encouraged to be involved in regular meetings to share their views and concerns about the quality of the service. The registered manager also sought the views of relatives and professionals. The provider and registered manager had systems in place to monitor and improve the standard of care provided. The registered manager worked with external services and organisations to share best practice and support.

We spoke with five people about their medication. One person told us 'oh yes, they always bring them to me' about their tablets. Another person told us about discomfort they experienced from their arthritis. They reported the staff 'always' gave them their painkillers when they asked for them.

We spoke with three members of staff who administered medication to people. They all told us they had been trained and received regular supervision in administering medicines. We watched a member of staff administering medicines. We saw they did this in a safe way. We observed a person asked for their inhaler. The member of staff promptly fetched it for them and appropriately supported the person while they used it

We saw medicines were securely stored. The home had a full audit trail of medicines received into the home, administered to people and sent for disposal. People had clear care plans about how they were to be supported in taking their medication.

We saw people received the support they needed. We observed a care worker assisting a person to move who was using a frame. They did this carefully, supporting the person to move at their own pace. We met with two people who were living with dementia. Both people were calm and relaxed.

We saw people had relevant care plans in place. These were reviewed when a person's condition changed. Care workers we spoke with gave us detailed information on how they met different people's care needs. Information about people's needs was clearly documented and reflected what care workers told us about.

We observed a care worker administered medicines safely. We found appropriate arrangements were not in place for the storage and disposal of all medicines and the monitoring of expiry dates. Most supporting information for 'variable dose' and 'if required' medicines lacked sufficient information.

The home maintained necessary records. This included monitoring of bath water temperatures and records of general maintenance. Records relating to accidents and incidents were clear. The home also maintained records of audits relating to people who experienced falls. Records showed this information was used to reduce people's risk of falling.

We observed two care workers assist a person to move, using an aid. They assisted the person in a safe manner. We observed systems for giving out medication and saw medicines were given to people in a safe manner and were securely stored. A member of staff told us 'we're getting there' about changes in staffing levels.

Observations of care, discussions with people, and a review of records showed staff were not consistently assessing people's needs or up-dating assessments when relevant. Some people's care plans did not inform staff on how to meet their individual needs and were not reviewed following changes in their condition. This included people's personal care and dementia care needs. We observed some staff did not consistently follow people's care plans.

Some records including people's records and records relating to management of the home had not been completed, although staff we spoke with knew the information. Other records were not completed in such a way as to enable audit of health, safety and quality of service provision.

The provider had much improved its systems to ensure all of people's care needs were met. They had ensured risk to people from cross-infection was reduced. There were clear records maintained, including care records and records relating to heath and safety. The provider's quality audit system identified matters which needed to be addressed and action plans were put in place when deficits were identified.

People told us they did not feel the home's staffing levels supported them at all times. One person said 'staffing levels aren't good'. Staff told us staffing levels could be low, particularly at weekends. Records we reviewed indicated staffing levels at weekends could be an issue.

The home had the equipment and furniture available which people needed. Some equipment, including cleaning and linen trolleys needed attention to ensure they could be cleaned effectively.