Barons Down Nursing Home

Updated 14 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of three inspectors.

Service and service type

Barons Down 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.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we held about the service and the service provider. We looked at the action plan from the previous inspection, notifications, and any safeguarding alerts we had received for this service. Notifications are information about important events the service is required to send us by law. We also sought feedback from the local authority and professionals who work with the service.

The provider was asked to complete a provider information return prior to this inspection. It was completed 24 July 2022. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.

During the inspection

We looked around the service and met with the people who lived there. We used the Short Observational Framework for Inspection (SOFI) during the morning of the inspection. SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with 12 people to understand their views and experiences of the service and we observed how staff supported people. We spoke with the registered manager, area manager, deputy manager and 7 further staff members. This included care staff, and ancillary staff.

We reviewed the care records of 9 people and a range of other documents. For example, medicine records, 4 staff recruitment files; staff training records and records relating to the management of the service. We also looked at staff rotas, and records relating to health and safety. We continued to seek clarification from the registered manager and provider to validate evidence found. We spoke with 3 relatives and 4 health care professionals and completed these discussions on 15 June 2023.

Updated 14 July 2023

Barons Down Nursing Home is a care home with nursing and accommodates up to 30 people in a purpose-built building. The service supports adults whose primary needs are nursing care although some are living with dementia type illness. At the time of our inspection there were 26 people living at the service.

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

The providers’ governance systems had not identified the shortfalls found at this inspection. Audit systems and processes failed to identify and manage effectively risks to people's safety and other aspects of the service that required improvement. There were areas of people’s documentation that needed to be improved to ensure staff had the necessary up to date information to provide consistent, safe care.

Risk management needed improvement to ensure peoples’ health and well-being was protected and promoted. We identified shortfalls in respect of the management of risk. For example, the management of incident and accidents. Incident forms were completed but there was a lack of overview, analysis and follow up to prevent a re-occurrence or to mitigate risk. Records were not always clear and accurate regarding people's care and support. Not all staff had the necessary supervision and support to perform their role.

The management of medicines was not always safe. Staff were not monitoring the overall effectiveness of pain relief medicine and mood calmers or looking at the times PRN (as and when needed) requests were made for trends or themes. There were not always sufficient, suitably trained and experienced staff deployed.

We have made a recommendation regarding the need to seek advice for the review Deprivation of Liberty Safeguards conditions to ensure they are current and relevant.

People received support from staff who had been appropriately recruited, trained to recognise signs of abuse or risk. One person said, “I do feel safe, the staff are lovely,” and “Taken care of, in a kind and nice way I feel very grateful to them all.”

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.

The home was clean and well maintained. Infection control procedures were being followed.

The staff were kind in their approach and treated people with respect. Improvements had been made to care plans and they were person-centred and relevant to each person. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives. Complaints made by people were taken seriously and investigated.

The registered manager and staff team were passionate about the service and their plans to continuously improve and had plans to develop the service and improve their care delivery to a good standard. Feedback from staff about the leadership was positive, “We will get there, a lot to do though.”

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 24 May 2022). 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 we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns raised and based on the previous rating. This enabled us to review the previous ratings. We also used this opportunity to look at the breaches of Regulation 9 and 17. As a result, we undertook a focused inspection to include the safe, responsive, and well-led key questions. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall 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.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

The provider and management team took immediate action during the inspection process to mitigate risk.

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 work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.