Barty House Nursing Home

Barty House 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.

Barty House Nursing Home is registered to provide accommodation and personal or nursing care for up to 58 older people. Accommodation is provided over two floors and is wheelchair accessible with a passenger lift between floors. There are well maintained gardens and off-road parking. There were 51 people living at the service when we inspected.

At our last comprehensive inspection on 14 April 2016 we rated the service good. The Safe key question had been rated as ‘Requires Improvement’ as a breach of regulation 12 (1) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Medicine records had not been maintained to make sure people had received their medicines as prescribed. A follow up responsive inspection took place on 23 June 2017 to check whether the breach of regulation had been met. This inspection showed that improvements had been made and the safe key question was rated as ‘Good’.

At this inspection on 7 and 12 December 2018 we found the evidence continued to support the rating of good, with the Responsive key question improving to ‘Outstanding’. There was no evidence or information from our inspection and ongoing monitoring that demonstrated any risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good overall with the Responsive domain improving to Outstanding.

There was a registered manager in post at the time of 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.

People received an individualised service that increased their self-worth and well-being. There was an innovative approach to supporting people to live a happy and fulfilled life. People’s dreams and aspirations were encouraged and fulfilled. People were supported to follow their likes and interests with a wide range of social activities within the service and out in the local community. People played an active role in their local community hosting events throughout the year.

People received person centred end of life care that encompassed their wishes and offered support to loved ones. People were treated with dignity and compassion at all times. The care team worked alongside health care professionals to ensure people could remain at Barty House and have a comfortable and pain free death.

Care plans were comprehensive and detailed the person’s wants and needs from their support. People’s care and nursing needs were assessed with them prior to receiving a service and these were kept under continuous review. People’s specific health care needs were met with the support from health care professionals.

People were treated with kindness and compassion. Staff understood the importance of promoting and respecting people’s privacy and dignity. People were encouraged and empowered to remain as independent as possible.

People received a service that promoted their safety whilst promoting their rights and choices. Potential risks had been mitigated. People were protected from the risk of infection with appropriate control measures. The environment and equipment had been maintained to promote people’s safety.

People received safe care from enough care and nursing staff. Nurses and care staff had been trained to meet people’s needs including their specialist needs. Staff received regular support and guidance from the management team.

People were supported to maintain their nutrition and hydration. The kitchen team ensured people had access to a variety of food choices. People that required additional support with their meals were catered for and supported in a safe way.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were given the opportunity to raise and concerns or make suggestions about the service they received. These were listened to and acted on.

Systems were in place to monitor and improve the quality of the service.

Further information is in the detailed findings below.

Barty House Nursing Home is a care home providing accommodation for up to 58 older people who require nursing and personal care. The home is located in a rural area outside Maidstone. At the time of the inspection 53 people lived at the service.

There was a registered manager in post. 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.

At our previous inspection on 14 April 2016, the service was in breach of regulation 12 (Regulated Activities) Regulations 2014. This breach was in relation to medicine management. We found medicines records were not always maintained to protect people's health and wellbeing in line with current legislation and guidance. We found gaps in people's medicine records. At this inspection improvements had been made and the service was no longer in breach of the regulation.

Nurses were signing people’s medicine records accurately. There were no identifiable gaps in people’s medicine records. The provider had introduced an electronic system to record when people were taking their medicines and nursing staff were also completing hand written medicine records.

Staff received appropriate training for moving handling. During our inspection we observed good moving and handling practices.

The provider had ensured that there were appropriate systems in place to identify and minimise risk for people living at the service. Risks to people's safety had been assessed and actions taken to protect people from the risk of harm.

There was sufficient staff to provide care to people. Staff had safety checks to ensure they were safe to work with adults.

People were protected from abuse by trained staff who could identify the forms of abuse and who they could report to. The provider had effective safeguarding systems in place.

The service provided accommodation, personal and nursing care for up to 58 older people. There were 51 people living in the service when we inspected. People predominantly needed nursing care to assist them to manage chronic and longer term health issues associated with aging or after an accident or illness. This included compassionate end of life care.

People benefited from accommodation that was set in a picturesque rural location that had been adapted and modernised for the intended purpose. Accommodation was provided over two floors. A lift was available to take people between floors. 28 rooms had on-suite facilities and the remainder had a wash basin. People in rooms without on-suite facilities had access to nearby toilets and bathrooms.

There was a registered manager employed at the service. 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.

There were policies in place for the safe administration of medicines. Nursing staff were aware of these policies and had been trained to administer medicines safely. However, the processes in place to ensure people received their medicines as prescribed were not always effective. Nurses were not always signing the medicines administration sheets when they administered medicines and the registered manager was not chasing this up in a timely manner after the errors had been identified through the service’s quality monitoring system.

People’s rights were protected through their involvement in decision’s about their care and included discussions and decisions about resuscitation if the circumstance’s arose. However, we noted that the lead nurse completing the do not attempt cardio pulmonary resuscitation forms had not always recorded the involvement of appropriate health and social care professionals in the process. For example, the senior clinician involved in the care, like the GP. We have made a recommendation about this.

Nursing staff assessed people’s needs and planned people’s care. They worked closely with other staff to ensure the assessed care was delivered. General and individual risks were assessed, recorded and reviewed. Infection risks were assessed and control protocols were in place and understood by staff to ensure that infections were contained if they occurred. End of life care was delivered by consent and mutually agreed with people and their families. Additional specialist end of life nursing guidance and training was provided by staff from a hospice.

The provider and registered manager ensured that they had planned for foreseeable emergencies, so that should emergencies happen, people’s care needs would continue to be met. Equipment in the service had been tested and well maintained.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

The registered manager had ensured that they employed enough nursing and care staff to meet people’s assessed needs. A robust agency back up system was in place. The provider had a system in place to assess people’s needs and to work out the required staffing levels. Nursing staff had the skills and experience to lead care staff and to meet people’s needs effectively and the registered manager provided nurses with clinical training and development.

People were supported to eat and drink enough to maintain their health and wellbeing. They had access to good quality foods and staff ensured people had access to food, snacks and drinks during the day and at night.

We observed safe care. Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse. Nursing staff understood their professional responsibility to safeguard people. The registered manager responded quickly to safeguarding concerns and learnt from these to prevent them happening again.

Staff received training that related to the needs of the people they were caring for and nurses were supported to develop their professional skills maintaining their registration with the Nursing and Midwifery Council. (NMC.)

Incidents and accidents were recorded and checked by the registered manager to see what steps could be taken to prevent these happening again. The risk was assessed and the steps to be taken to minimise them were understood by staff.

People had access to qualified nursing staff who monitored their general health, for example by testing people's blood pressure. Also, people had regular access to their GP to ensure their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. This included checking nurse’s professional registration.

We observed staff that were welcoming and friendly. People and their relatives described staff that were friendly and compassionate. Staff delivered care and support calmly and confidently. People were encouraged to get involved in how their care was planned and delivered. Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected.

If people complained they were listened to and the registered manager made changes or suggested solutions that people were happy with.

The registered manager of the service, nurses and other senior managers were experienced and provided good leadership. They ensured that they followed their action plans to improve the quality of the service. This was reflected in the changes they had already made within the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

People in the home spoke very positively about their experiences of living there. Some of their comments included: 'Everything is very good. The food is excellent. And the carers are very good. They always come straightaway if I want anything.' 'We are very happy with everything, there is no question about that!' And, 'I especially enjoy the coffee mornings when we all sit together and chat.'

We found that the staff explained the home's assessment and monitoring processes to people at the time of their admission, and obtained their consent for their care and treatment.

We inspected medication management, and found that there were safe systems in place.

We examined some staff recruitment files, and found that there were robust recruitment procedures in place. This ensured that vulnerable people were cared for by staff who had been appropriately checked for their suitability.

We found that the home had on-going staff training programmes in place, which supported staff in providing reliable and effective care.

We saw that the home had a complaints procedure which was easily accessible. Concerns and complaints were followed through and addressed, to prevent future re-occurrence of these issues.