Barton Lodge

During the inspection we observed staff using the handwashing sink in the kitchen food preparation area, to wash their hands following care tasks including assisting people with their personal care. Visitors were also directed to use this sink when they arrived. We discussed this with the registered manager, and this was immediately addressed.

We saw that Personal Protective Equipment (PPE) was not always being stored appropriately. For example, on the ground floor PPE was stored in the food pantry. This was addressed following the inspection.

All areas of the home were clean and hygienic. Whilst cleaning schedules were in place, these were not sufficiently detailed or audited. Following the inspection the registered manager introduced and developed more detailed cleaning schedules with staff.

The registered manager assured us that an infection control lead was being introduced in the service to ensure enhanced cleaning and infection control measures were adhered to by all staff.

We found the following examples of good practice.

Robust procedures were in place to prevent visitors to the home from catching or spreading infection. At the time of our inspection, routine visiting had been suspended in line with government guidance.

People were supported to maintain contact with their friends and families using video and phone calls.

Staff had completed training in infection prevention and control and the correct use of PPE. We observed the staff used PPE, in line with best practice guidelines.

The registered manager had ensured sufficient quantities of PPE were available.

People and staff took part in regular COVID-19 ‘whole home’ testing. People and staff who tested positive, followed national guidance and self-isolated for the required amount of time.

The provider had developed specific COVID-19 policies and procedures which had been reviewed and updated where necessary in line with the latest guidance.

Regular audits and checks were being further developed and enhanced to ensure optimum infection control practice was adhered to.

Barton Lodge is a care home that provides personal care for up to 11 older people. At the time of the inspection nine people were living at the service. Some of these people were living with dementia.

The service was last inspected on 28 November 2018. At that inspection the service was rated as Requires Improvement overall and for the key questions of Safe, Effective, Responsive and Well Led. Six breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found.

Following the inspection in November 2018, we asked the provider to complete an action plan to show what they would do and by when to improve. This was completed and informed us what actions they would take and when these actions would be completed by.

At this inspection we found some improvements had been made. However, we continued to find issues of concern. Therefore, the service has remains as requires improvement.

The registered manager had been working with the local authority quality improvement team to embed positive changes. The registered manager said they had been supported by the provider. The registered manager was also the registered manager of the provider’s other service situated in the same town.

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

The service was still not always safe. Some improvements had been made including improving risk assessments for people and staffing levels at night. However, we found people did not always received their medicines safely, staff still had not completed safeguarding or infection control training, the hallway carpet presented a trip hazard, and some rooms had an odour.

The service rating certificate was displayed in the main entrance hallway. However, this was from the inspection completed in 2016, rather than for the last inspection in 2018. This stated the overall rating was Good. Where the last inspection, dated 2018, the service received an overall rating of Requires Improvement.

We were concerned about the level of activities available at the service. For example a relative said there was very little in the way of activities carried out. During our two days at the service no activities where completed until the final hour of our visit. An activity coordinator had been employed since the last inspection but was currently off. No other arrangements had been made to cover activities.

People and their relatives told us they were happy living in the home. Staff told us they enjoyed working at the service. Many people chose to spend time in their bedrooms. Staff were caring, however spent little time chatting and enjoying their time with people as they moved around the service.

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.

Improvements to the environment were still ongoing. For example, a new chair lift had been fitted. However, this left a carpet on the main stairway with holes in which could be dangerous for people due to multiple trip hazards. The registered manager confirmed a new carpet was on order.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. A visiting professional said the service contacted them appropriately and completed all actions requested.

Records of people's care were individualised and reflected each person’s needs and preferences. The service was in the process of introducing a new computerised care planning system. Some records were not available on the day of inspection due to the changes taking place.

Some risks were identified, and staff had guidance to help them support people to reduce the risk of avoidable harm. Staff were responsive to people’s requests and gave people choice and control over their care.

People were involved in menu planning and staff encouraged them to eat a well-balanced diet and make healthy eating choices.

People received support from staff who cared about them. People were supported to express their views in the way they wanted to. People and their families were given information about how to complain and details of the complaint’s procedure were displayed at the service. The management and staff knew people well.

People, their relatives and staff told us the management of the service were ‘hands on’, approachable and listened when any concerns or ideas were raised. However, we found there was a lack of oversight and sufficient knowledge regarding the regulatory requirements of the service, this placed people at risk of avoidable harm.

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 6 February 2019) and there were multiple breaches of regulation. The provider was required to send us an action plan detailing the improvements they had identified and what action they had taken as a result. We have reviewed this report.

At this inspection not enough improvement had been made and the provider was still in breach of regulations. The provider therefore remains as Requires Improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, premises and equipment, notifications, displaying ratings, and good governance.

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

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 and 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.

• People were not always protected from harm because risks were not always assessed. It was not clear on care documents what action staff should take if people became unwell due to specific care needs.

• Safe recruitment practises were not always followed and staff did not always receive an induction when they started working at the service.

• Staff required additional training to be able to meet people’s changing needs. Many people in the service had advancing dementia and were becoming increasingly unwell. The training provided to staff did not reflect this changing level of need.

• The premises needed some improvements, the shower was not working and was full of linens and only one bath was working in the service. This was not accessible to all people using mobility aids as there was little space to move in the bathroom. Windows on the upper floor were not restricted posing the risk of people falling from a height.

• Quality assurance processes were not established or effective and did not pick up all the issues we identified. When concerns were noted by internal processes they were not always followed up on or learned from, to improve the service.

• People were not always supported to have maximum choice and control of their lives and were not always supported in the least restrictive way possible.

• People told us they sometimes would like more to do and more social contact. However, everyone we spoke with said they were happy living in the home and staff were kind and caring.

• Staff felt supported and listened to and spoke of working as a team and caring about people in the service.

• We found breaches in six legal requirements in areas relating to consent, safe care and treatment, premises, good governance, staffing, and recruitment.

• More information is in the detailed findings below.

Rating at last inspection: This service was rated good at the last inspection on 15 and 20 June 2016.

About the service: Barton Lodge is a residential care home providing personal care and accommodation to eight people over the age of 65 at the time of this inspection.

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: Please see the end of the report for any enforcement action.

Follow up: We have asked the service to provide us with an action plan with a specific deadline addressing the key concerns identified during this inspection. We will meet with the provider once this has been sent to us to check what improvements have been and are planned to be made.

The inspection took place on 15th and 20th June 2016 and was unannounced. This was the service’s first inspection since change of registration to Libatis Limited in July 2015.

The service had a registered manager. 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 registered manager also managed Barton Lodge’s sister home, Barton House, which was situated close by. The registered manager was supported in running the home by the provider who was one of the owners of the service.

People expressed a high level of confidence in home. They told us they felt safe and happy living at Barton Lodge. One person said “I feel very happy. Staff are so kind. I wouldn’t change a thing about it”. Relatives also felt confident that their loved one was well looked after and safe. One relative said “It’s nice and relaxed and homely here. I am 100% confident Mum is safe and looked after”. We observed laughter and warmth between people and staff. The atmosphere of the home was calm and relaxed throughout our inspection.

People were supported by staff that knew them well. Staff were kind and caring and people spoke very highly of the care they received. One person said “Staff are wonderful. They’ll do anything to help. Nothing is too much trouble” and “its home from home. I love it here”. There were enough staff available to meet people’s care needs safely. Staff worked in a calm, unhurried way and had time for talking and supporting people with activities of their choice. People were encouraged to maintain their independence. Staff were genuinely fond of the people they cared for. One said “Lovely people live here. I enjoy coming to work in the mornings, talking with people and hearing their stories”.

There were robust recruitment processes in place to ensure that suitable staff were employed. Staff were supported by the registered manager through supervision and appraisal. High standards of care were encouraged through staff training and development. Staff participated in a wide range of training courses in topics relating to people’s care needs including diabetes, dementia and end of life care. Staff had received training in, and had a good understanding of, the Mental Capacity Act 2005 and the presumption that people could make decisions about their care and treatment.

Staff ensured people's privacy and dignity was respected at all times. They worked closely with people to ensure they understood their needs and preferences. People were involved in planning and reviewing their care and felt listened to by staff.

Care plans showed each person had been assessed before they moved into the home and any potential risks were identified. Where risks were identified there were detailed measures in place to reduce these where possible. Care records included a summary of people’s care needs and more detailed information where specific care needs had been identified. People were supported to maintain good health from a number of visiting healthcare professionals who expressed confidence in the home.

People all told us they liked the food and had a good choice available to them. Comments included, “I can have anything I want. There is lots of choice” and “The food really is excellent”. People confirmed they were able to continue with their interests and hobbies and enjoyed the activities available. The registered manager told us they encouraged people to have a fulfilling life and remain as independent as possible.

We observed medicines being administered and this was done safely and unhurriedly. Medicines were stored safely and all stock entering and leaving the home was accounted for. Staff received regular training in medicines management and medicines audits were completed to ensure consistent safe practice.

Staff confirmed there were clear lines of responsibility within the management structure and they knew who they needed to go to, to get the help and support they required. They described themselves as a “happy and strong team”. They said they had a very good relationship with the registered manager and provider who were always available if needed.

There were systems in place for managing information relating to the running of the home. The registered providers undertook regular health and safety audits to ensure people’s safety and that of the environment was well maintained and suited to the people living in the home. Systems were in place regarding maintenance of the home, but these had not identified an issue we found in relation to frayed carpets. This could have placed people at risk of tripping. We have made a recommendation in relation to the service’s systems for identifying and prioritising maintenance issues within the home.

There was a policy in place for dealing with any concerns or complaints and this was made available to people and their families. People said they would speak with the registered manager or provider if they had any concerns but they had not needed to as they were happy with the care and support they received.