All inspections: Barton House - Care Quality Commission

One adult social care inspector carried out this inspection. The focus of the inspection was to follow up on a compliance action and a warning notice issued following our previous inspection in May 2014.

As part of this inspection we spoke with the Registered Manager and two care staff. We did not speak with people who used the service on this occasion. We reviewed records relating to the management of the home which included four people's care plans, the home's policies and procedures and the safeguarding folder.

Below is a summary of what we found. The summary describes what the Registered Manager and the staff told us, what we observed and the records we looked at.

Following our inspection in May 2014 procedures had been put in place to ensure records were kept up to date and accurate. Systems had been put in place to ensure regular auditing of records took place and staff knew their responsibilities around records. The service had ensured policies and procedures relating to safeguarding had been updated and contained accurate information. Staff had been made aware of correct reporting procedures and where to find appropriate contact numbers.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The service had a policy in place and we spoke with the Registered Manager who told us about an application that had been completed. We spoke with them about recent changes to the legislation.

A single social care inspector carried out this inspection. The focus of the inspection was to answer five key questions (Is the service safe, effective, caring, responsive and well-led?) and to follow up on compliance actions issued following our previous inspection in November 2013.

As part of this inspection we spoke with two people who used the service, the Registered Manager and three care staff. We also reviewed records relating to the management of the home which included four people's care plans, the home's policies and procedures, the safeguarding folder and the home's quality assurance folder. There were 14 people living at the home at the time of the inspection.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

There were systems in place to ensure risks to people's safety and welfare were identified and risk assessments were put in place to minimise such risks. There were systems in place to ensure appropriate procedures were in place in the event of a foreseeable emergency. There were appropriate procedures in place to deal with the administration and storing of medicines. There were systems in place to ensure all staff had received safeguarding training, however, the information they had been given in respect of reporting concerns was incorrect. People we spoke with told us 'I feel very safe' and 'If there was an emergency they would be able to cope with it.'

Records were not always kept up to date. Where changes had occurred in people's weights the corresponding risk assessments had not been updated to reflect these. Other records, such as the waterlow pressure sore risk assessment tool, the Medication Administration Recording (MAR) chart and turning charts, were not up to date and contained gaps.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The service had a policy in place and we spoke with the Registered Manager who told us about an application that was in the process of being made. We saw evidence this application was in the process of being reviewed.

Is the service effective?

People told us they were satisfied with the care they received. We saw from care records that people's care needs had been appropriately assessed and care plans reflected these needs. People we spoke with said 'My needs are met' and 'They look after me.' People were treated with respect and were involved in the planning and delivery of their care.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed understanding, patience and gave encouragement when supporting people. We saw that people were able to do things at their own pace and were not rushed.

People's preferences had been obtained by the home and were included in people's care plans. We observed people being offered choices and staff told us what steps they took to obtain people's views and treat them with dignity and respect. People told us 'You can have what you want. They don't tell me what to do. It's excellent here really.'

Is the service responsive?

Records showed that people's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. We saw records of the home responding to people's changing needs and seeking advice and guidance from relevant healthcare professionals.

Is the service well-led?

Quality assurance processes were in place in the home. We saw evidence of people and their relatives being asked for feedback and this being responded to and acted on. We saw that several audits had been carried out and that any issues identified had been acted upon. Staff told us they were asked for their feedback and felt their opinions had been listened to and used to improve the home.

During our visit we spoke with two people who were using the service and three members of staff. People who used the service told us that they liked living at the home. People told us that staff were nice and the home was a lovely place to live.

We made observations throughout the visit and saw people were offered choices as to what they wanted to drink and eat during the day. We saw people being addressed in a respectful manner.

We saw that Mental Capacity Assessments had been completed for people who used the service. The Mental Capacity Act is designed to protect people who can not make decisions for themselves or lack the mental capacity to do so.

People were not protected against the risks associated with the unsafe use medicines, by means of recording, using, safe administration and disposal of medicines.

Appropriate steps were taken to ensure that, at all times, there were sufficient numbers of suitably qualified, skilled and experienced persons employed for the purposes of carrying on the regulated activity.

The provider had an effective complaints system available. We saw that complaints people made were responded to appropriately.

Inaccurate and inappropriate records were maintained. This meant that people were not protected from the risks of unsafe or inappropriate care and treatment

The three people we spoke with told us they were very happy with the care and support they received at Barton House. People that we spoke with confirmed that staff always treated them with respect. One person told us that they had been asked about plans to change a bathroom into a wet room. All areas of the home were clean, tidy, warm and comfortable during our visit. People told us that staff looked after them well and respected their privacy.We saw no evidence in care plans that people had received a professional assessment of their capacity to make decisions when major decisions were needed.

The provider told us that they had worked in co-operation with others health care professionals since our last inspection. Medications were generally well managed but not all staff had complied with the home's policies and procedures. One person told us that staff looked after them 'very well'. Staff told us they had been well supported by the providers. Some staff needed their training updated bu this had been planned.

There were no bathing facilities at the service for people who were not mobile.

During our visit to Barton House on Thursday 10 and Monday 14 November 2011, we visited people who live in the home in their private rooms and in the two lounges on the ground floor. We spent time in the dining room at mealtimes, and used a specific way of observing care to help to understand the experience of people who could not talk with us.

People told us there were more staff now (than at the time of our previous visit in August 2011), and more suitable people had been appointed. They said the staff were better organised. The previous manager had left, and the providers had come in to the home to manage the service. New staff had been appointed, including a deputy manager.

People told us that the food had improved. One person told us they give the manager a report on the food every day, to help them monitor the quality and popularity of each meal. During one lunch time we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record whether they have positive responses. We spent 30 minutes watching at lunchtime and found that overall people had positive experiences. The staff supporting them knew what support they needed and respected their wishes if they wanted to manage on their own.

We saw that call bells were placed where people could reach them. Peoples' rooms, though not large, were neat and clean, and people had the equipment they needed. One person told us that they were pleased to be given clean clothes every day. 'They respect us and keep us clean.' They also said that when carrying out personal care, staff have been 'good at wearing gloves and changing between people'. We found that none of the bathing facilities are suitable for people who are unable to support their own weight. These people were washed by staff each day in their bedroom.

People told us that they have sometimes been disturbed by other people who live in the home walking into their room uninvited. Despite there being suitable door locks, these people had chosen to keep their doors open. People told us that their rooms were kept cleaner now, including the tables.

A relative told us that their family member was in better health and spirits now than at any time in the past year.

People were delighted to tell us that they have been supported to go out. Previously, some people had not been out of the house for more than a year. People said they had enjoyed going to the shops, to the beach, and to feed the ducks. We were told that the manager had agreed to hire a suitable vehicle, and plans were being made for a trip to a local garden centre.

People who live in the home told us that they were happy with the staff at the home. Comments included 'they are kind and absolutely wonderful', and 'staff are nice'.

We asked people about the ability of the staff to provide the care and support they needed and their responses included 'the staff are all good, they are usually very busy but they are all caring and friendly'.

We were given examples of choices that people are given such as what time they get up, where they eat, and how they spend their time. We were also told people were very happy with the food at the home. One person said 'the food here is very good'.

People we spoke to confirmed that their bedrooms were cleaned on a regular basis and that the home was 'always' fresh and clean.

One person living at the home told us they wanted to be helped to walk more often. They said they had asked staff but were told that they did not have enough time to spend with her. The person said they felt they were 'losing what little independence [they] had'

We were also told that when being assisted with personal care in the mornings they are often left sitting on a commode for up to half an hour and are 'handled roughly'. They told us when they were later given tea and toast the tea was cold. They complained to staff about this at the time and were surprised by 'the take it or leave attitude' of the staff.

One person told us that when getting ready to go bed at night they were not assisted to undertake any personal care. They said they 'had no preparations for going to bed, didn't get my hair brushed and that's important to me'.

We were also told by a person that they had been 'roughly handled' when being assisted out of bed.