Archived: Barnes Lodge

Updated 26 May 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 Health and Social Care Act 2008.

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 was carried out by 2 inspectors, a medicines inspector, a specialist advisor nurse and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Barnes Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Barnes lodge is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

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

Due to technical problems, the Provider Information Return (PIR) was not available prior to the inspection so could not be taken into account. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We also sought feedback from the local Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all this information to plan our inspection.

During the inspection

We spoke with 10 people who used the service and 6 relatives about their experience of the care provided. We observed the care provided within the communal areas. We spoke with 14 members of staff including the registered manager, operations director, the clinical leads, senior care workers, care workers including agency staff, admin staff, maintenance staff, domestic staff and kitchen staff.

We reviewed a range of records. This included 18 people's care records and multiple medication records. We looked at 4 staff files in relation to recruitment and staff supervision, as well as agency proforma’s for agency staff on duty. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 26 May 2023

About the service

Barnes Lodge is a nursing home providing personal and nursing care, for up to 101 people. The service provides support to people with complex health needs such as kidney failure, Type 1 diabetes, Parkinson’s disease and people receiving care at the end of their life. Some people were living with dementia or deteriorating mobility. At the time of our inspection there were 43 people using the service.

Barnes Lodge is a purpose-built nursing home set out across 3 floors with 2 wings on each floor. Two floors only were being used at the time of this inspection.

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

Although improvements had been made to the identification and mitigation of individual risk and to the safe management of people’s medicines, further improvement was ongoing to ensure people’s safety. Fire risks had reduced, however, some further improvement was needed to the checks in place. The provider still needed to make further improvements to their recruitment processes.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Although improvements had been made to the recording of peoples’ assessed needs, care plans were not always reviewed and updated to reflect changes.

Work needed to continue to make sure people’s care plans were individual and provided the guidance and information needed to make sure staff could deliver personalised care.

The provider’s governance systems were still a work in progress. Monitoring systems introduced since the last inspection were not kept up to date to make sure people received safe and good quality care.

People told us they felt safe. One person said, “I always feel safe here”. Improvements had been made to people’s safety. Staff said they felt more able to raise concerns about people’s care and were now confident they would be listened to. Staffing levels had improved and staff said they had more time to spend with people. The levels of agency staff had reduced and the agency staff supporting people now were regular agency staff who were treated as part of the team. Infection prevention and control was better managed, and staff understood their responsibilities.

People received better care with their health needs, however, better care planning could enhance the care people received. We have made a recommendation about this.

People were now treated with more dignity and respect, although some improvement was still needed. Staff knew people well and spent more time with them. People told us they were happy living at Barnes Lodge and thought staff were kind and caring. One person said, “They are lovely whether regular or agency staff, all the same attitude, kind and gentle, they will do anything for you.”

Some areas needed more improvement to the accessibility of information, for example, menus were not in large print or easy read to support people’s understanding. More activities were available to support people to have a more meaningful day and staff had more time to engage with people. The registered manager had improved the investigation and response to complaints. People were supported to make a plan for the end of their life.

Staff said the culture had changed, they felt they were listened to and were more able to speak up if they needed to. Staff had only positive things to say about the registered manager and were happy with the changes being made. The provider had engaged with people, relatives and staff and were in the process of providing responses to recently completed surveys.

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 inadequate (published 14 September 2022) and there were breaches of regulation. We took enforcement action against the provider. At this inspection we found the provider remained in breach of some regulations, however improvements had been made.

This service has been in Special Measures since 13 September 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

We have identified breaches in relation to individual risk, medicines management, person centred care, people’s rights under the MCA, record keeping, and good governance, management and leadership at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Please see the action we have told the provider to take at the end of this report for some of the identified breaches of regulations.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.