Archived: Barons Down Nursing Home

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 may also be living with dementia. At the time of our inspection there were 22 people living at the service.

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

There was a lack of robust management oversight in some areas of the service. Quality assurance systems did not always identify shortfalls in the service and the provider had not ensured there was a systematic approach to manage improvements. Risks to people’s safety were not always monitored, which meant there was a risk they would not receive the care they required. Safe infection control processes were not followed in all areas. In addition, we found that arrangements for activities did not always provide sufficient stimulation for people and opportunities to go out were limited.

People told us they felt safe living at Barons Down and staff understood their responsibilities in keeping people safe from abuse. People received their medicines in line with prescriptions and medicines were securely stored. There were sufficient staff available to meet people’s needs and safe recruitment processes were followed. Staff received training and an induction to support them in their roles.

People had access to healthcare professionals and advice provided was followed. People’s nutritional needs and preferences were known to staff and people told us they enjoyed the food provided. 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 caring staff who provided choices regarding their day to day care. People and their relatives were involved in making decisions regarding their care and people’s dignity and independence was respected.

The registered manager and senior staff were approachable and responded to any concerns or complaints promptly and in an open and transparent way. Staff were clear about the values of the service and told us they felt proud to work at Barons Down.

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 Good (published 7 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the management of risks to people’s safety, person-centred care, the activities provided and the management oversight of the service. Please see the action we have told the provider to take at the end of this 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.

The home provides support and care for up to 30 people with nursing and personal care needs. There were 25 people living at the home during the inspection. Some people required continual nursing care due to complex health care needs; including end of life care. Other people needed support with personal care and assistance to move around the home safely due to frailty or medical conditions and some people were living with dementia.

A registered manager was responsible for the day to day management of the home. 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 Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes and is part of the Mental Capacity Act 2005 (MCA). We last inspected this home on 25 November 2015 and found additional training was needed to ensure staff had a clear understanding of DoLS. Training in record keeping was required to ensure records reflected the care and support provided and evidence the involvement of people and their relatives in developing and review their care plans.

This inspection took place on 15 February 2017. Additional training had been provided for staff with regard to DoLS and they had a clear understanding of current guidance and their responsibilities. We found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in place supported this practice and the provider was up to date with current guidance to ensure people were protected. This was reflected in the care plans, which were up to date and had been reviewed with each person and their relatives where appropriate.

People said the staff were very good and provided the support they wanted and needed. New staff were required to complete the Care Certificate and ongoing training; including protecting vulnerable people and health and safety, ensured staff had appropriate skills and an understanding of how to meet people’s needs. Staff encouraged people to be independent and make choices and individualised risk assessments provided guidance for staff to assist people to ensure their safety.

There was an effective system in place for the management of medicines and staff competency was assessed to ensure they were up to date with current guidelines. People had access to health professionals as and when they required and visits were recorded in their care plans; with relevant guidance for staff if any changes to support had been identified.

People said the food was very good, choices were provided and the menu was based on people’s likes and dislikes. Group and one to one activities were available for people to participate in if they wished and people chose how and where they spent their time.

Feedback was sought from people, relatives, staff and health professionals through satisfaction surveys for the services overall as well as specific ones, such as a nutritional survey. People, relatives and staff said the management was approachable and the registered manager had an open door policy to encourage them to be involved in developing the services.

A complaints procedure was in place. This was displayed on the notice board near the entrance to the building, and given to people, and relatives, when they moved into the home. People, relatives and staff said they did not have anything to complain about.

We also took information from other sources to help us understand the views of people who used the service, which included resident and relative meeting minutes.

The people we spoke with told us they were happy with the care they received and with the staff team. One person who used the service told us, 'I receive very good care here. The staff are nice and they help me as much as they can.' A relative of a person who used the service told us, 'I don't think I've ever had to complain and my relative feels safe here.'

We saw that the service had systems in place to gain and review consent to care and treatment from people who used the service.

The provider had arrangements in place for the safe ordering, storage, administration and disposal of medicines at the service. Staff had a good understanding of their responsibilities in relation to the safe administration of medicines.

We saw evidence that the provider had an effective recruitment and selection procedure in place to ensure that staff were qualified to do their job.

We also found that care plans, staff records and other records relevant to the management of the home were accurate and fit for purpose.

The people we spoke with told us they enjoyed living at Barons Down Nursing Home. One person said 'I like the staff and the food is good,' 'Great food and my bedroom is warm and comfortable,' and 'really looking forward to the new lounge and dining area.'

One visitor said 'I can not praise the staff enough, kind and caring.'

The staff we spoke with were knowledgeable about people's needs and what support they required.

We saw the service ensured that staff were able to deliver care and treatment safely due to the training and audits in place. The service had assurance systems in place to monitor the quality of the service provided and to gain the views of the people who lived there.