This inspection took place on 8 September 2016 and was unannounced. Barton Grange is a residential care home that can support up to 19 older people, some of who are living with dementia, who require accommodation and personal care. Located in spacious grounds, the accommodation is arranged over two floors. During the inspection, there were 18 people living in the home. We last visited Barton Grange on the14 April 2015. A breach of legal requirements was found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Regulation breached was Regulation 11, need for consent.
There was not a registered manager was in post. The previous manager had left in August 2016 and the deputy manager was in charge. A new manager was due to start the week following our inspection. 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.
A safe environment was not always maintained. We found the building was in need of a refurbishment as all the rooms, fixtures and fittings were showing wear and tear. There were broken bannisters on the main staircase. We saw that the kitchen needed a deep clean. Ceilings were in need of cleaning and dusting. We observed chemicals were not stored securely. There were windows that were observed to have no window restrictors on them in order to maintain people's safety.
We looked at people's care files and found that not all identified health needs were assessed and reflected in their care plans. This meant that staff may not have access to sufficient information to support people safely. The care files we looked at showed staff had completed some risk assessments to assess and monitor people's health and safety. However not all risk assessments provided sufficient detail and were up to date.
Although the care plans we viewed were reviewed regularly, they did not always contain consistent information throughout the care file regarding people's needs.
We looked at the systems in place for managing medicines in the home. A medicine policy was available for staff and staff had completed training in relation to safe medicine administration. Medicines were stored safely and records showed they were administered as prescribed. We found that people's allergies, preferences for administration were not always clearly recorded.
No changes had been made to the environment to support people living with dementia. The environment had not been adapted to meet people's individual needs.
Not all actions and recommendations had been acted upon since the last inspection. The provider employed a compliance manager who visited to assess the service and provided reports of their findings. We viewed completed audits, which included areas such as care plans and medicines; however, they did not identify all of the issues we highlighted during the inspection.
People we spoke with told us they felt safe living in Barton Grange and staff and visitors to the home agreed that care was provided to help keep people safe.
Recruitment and selection procedures were in place and we saw appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Staff had a good understanding about adult safeguarding. We found that appropriate safeguarding referrals had been made and a system was in place to monitor the outcomes of referrals.
Staff were aware of the home's whistle blowing policy and told us they would not hesitate to raise any issue they had.
Staff had received training around the application of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The staff we spoke with understood some of the requirements of this Act but needed to ensure capacity assessments and best interest decisions were accurately recorded and in place where needed.
We looked at accident and incident reporting within the home and found that this was reported recorded appropriately.
We found that there were adequate numbers of staff on duty to meet people's needs.
Staff we spoke with had received regular supervisions to help support them in their role. Staff had received an annual appraisal and felt supported in their role.
People told us they received enough to eat and drink, which helped to ensure their nutritional needs were met. Each individual's preference was catered for.
People at the home were supported by the staff and external health care professionals to maintain their health and wellbeing.
People told us staff were kind and caring and treated them with respect. We observed people's dignity and privacy being respected by staff, such as staff knocking on people's door before entering their rooms. Interactions between staff and people living in the home were warm and genuine.
We observed relatives visiting throughout the inspection. The deputy manager told us there were no restrictions in visiting, encouraging relationships to be maintained. For people who had no family or friends to represent them, contact details for a local advocacy service were available within the home for people to access.
The new manager told us they had plans to further improve the service.
Feedback regarding the management was positive from people living in the home. People told us they knew who the deputy manager was and that they was approachable.
Processes were in place to gather feedback from people and listen to their views. A complaints procedure was available within the home and this was on display for people to access. People we spoke with told us they knew how to raise any concerns they may have and felt able to do so.
Care files were stored securely in order to maintain people's confidentiality.
The previous manager had notified CQC of events and incidents that occurred in the home in accordance with our statutory notifications.
We found the provider was in breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.