Archived: Barrock Court Care Home

Barrock Court Care Home is a residential care home providing personal care for up to 28 people, including older people and people living with dementia. At the time of our inspection, 21 people were living at the home in adapted accommodation at ground level, made up of three separate units.

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

Infection control procedures (IPC), particularly related to the COVID-19 pandemic, had greatly improved since we last inspected. Visiting was safely taking place. We have signposted the provider to support IPC ongoing best practice, particularly regarding testing.

Medicines were generally well managed, but some recording needed to further improve, and we have made a recommendation about this.

Enough staff were on duty but we have made a recommendation regarding this to support ongoing compliance.

Safety checks on the building were carried out and any risks identified to people or staff were assessed and monitored.

People's needs had been assessed prior to moving in. The care provided was good. Some care plans and associated records still needed more detail.

People felt safe and reported that staff were very kind and caring and provided them with a good service. Suitable safeguarding procedures were followed by staff.

Quality assurance checks were in place and we were told these were to be further reviewed. A new manager had very recently come into post and was settling into the role with support from senior management.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 March 2021) with two breaches of regulations and we issued conditions on the providers registration. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations and had met the conditions issued against their registration.

Why we inspected

We carried out an unannounced focused inspection of this service on 5 January 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection. We have found evidence that the provider has made some improvements and addressed the previous breaches of regulations, but further time is required to fully address all areas and sustain good practice.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Barrock Court Care Home on our website at www.cqc.org.uk.

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.

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.

Barrock Court is a residential care home providing accommodation and personal care to a maximum of 28 people. At the time of the inspection 24 people were receiving support across three separate units. One of the units specialised in providing care to people living with dementia.

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

Infection control procedures, including those related to Covid-19 were poor and immediate action needed to be taken.

Quality assurance systems were in place to monitor the service provided. These needed to be reviewed due to the concerns we had found during the inspection.

Staffing issues were addressed by the registered manager; however, we were concerned about the support given to the registered manager regarding investigations and advice they had received from the provider.

Enough staff were on duty and recruitment processes were in place to ensure suitable staff were employed. Some staff reported suitable training and induction were not always in place. We have made a recommendation in connection with this.

Communication within the service was reported to have declined in recent weeks after previously being vastly improved. We have made a recommendation about this.

People, relatives and health care professionals had given feedback on their experiences of the service provided. This had not always been followed up when less positive comments had been made. We have made a recommendation regarding this.

Medicines were generally managed well. There had been a small number of unnecessary delays in receiving some prescribed medicines which was addressed immediately.

People felt safe and safeguarding procedures were followed by staff. Accidents and incidents were reported appropriately and notified to the relevant authorities.

Staff were reported to be kind and caring.

The registered manager had recently resigned their post and was due to leave the service the week of the inspection.

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 required improvement (published 10 April 2020).

Why we inspected

We received concerns about infection control procedures not always being followed. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make further improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Barrock Court on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and discharge our regulatory enforcement functions to keep people safe, and to hold providers to account, where it is necessary for us to do so.

We have identified breaches in relation to preventing and controlling infection and governance/oversight of the service.

Please see the action we have told the provider to take at the end of this report.

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.

Follow up

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Barrock Court Care Home is a residential care home providing accommodation and personal care for up to 28 older people and at the time of the inspection there were 21 people living there.

Accommodation is provided on one level and divided into three named units. One unit is designated for people who have a dementia related illness. There are several communal areas throughout the home including dining areas and lounges.

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

People and visiting professionals told us the service had improved since the last inspection. We were told, “Since the new manager started, communications at the home have improved.”

Medicines were handled safely with appropriate policies, records and systems in place. People received their medications as they had been prescribed. Appropriate arrangements were in place in relation to the storage, care planning and records for the administration of medicines. Safeguarding systems were in place to protect people from the risk of abuse or unsafe care. However, during the inspection, we found a recent incident had not been notified by staff to the manager. The manager acted on the information immediately and referred it to the local safeguarding team. The provider had policies and procedures to support the safe recruitment of staff. Elements of the environment were undergoing redecoration and a plan of improvements was in place.

The manager made sure enough numbers of staff were on duty throughout the day and night by using a number of regular agency staff. However, we saw at times during the inspection staff were not always visible. We have made a recommendation about the deployment of staff to ensure sufficient numbers of staff are available at all times of the day.

People received support to maintain good nutrition and hydration. People were very happy with the quality and choices of food. One person said, “The food is excellent.” Another person said of the food,” It’s very good, my favourite is fish and chips. Chef [name] cooks them nice.”

Staff were regularly supported by the manager through staff meetings, supervision and appraisals. Staff received induction and ongoing training. However, we found some fire evacuation training had not been delivered to all of the staff currently working nights. The training had been requested by the manager and brought forward during the inspection visit.

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 told us they were happy with the staff and care they received. One person said, “Well it’s nice, I’m very comfortable, the girls are very nice to me.” Another person said, “I don’t think you could improve it. I find they [staff] are very nice and helpful.” A relative said, “It’s alright but it’s not as good as it should be. The staff are okay usually, you have to be marvellous to do this work but there are a few, not that they do anything wrong, it’s just the attitude.” During our inspection we observed the conduct of one member of staff was inappropriate. We reported this to the manager and regional manager and action was taken immediately to address the issue.

People and their families had been involved in planning and reviewing the care and support they received. Staff treated people with kindness and respect and made sure their dignity was maintained. People were fully supported to maintain their independence. The provider planned people's care to meet their needs and take account of their choices. People could see their families and friends as they wished.

People knew how they could raise concerns about the service provided. The provider and new manager monitored the quality of the service and identified areas which could be improved. New electronic governance and quality assurance systems had been introduced since the last inspection. However, we noted that some aspects we found during our inspection had not been fully included in the auditing processes. We made a recommendation that improvements are made to the processes used for the oversight of the quality service.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement published 27 February 2019 and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: People and their relatives were positive about the service, however we found a range of issues which needed to be addressed.

Medicines were not managed well. Including their administration, storage and recording.

Concerns had been raised over the care of people’s skin. We found mattresses which were not fit to be used and pressure relieving equipment which was not always being used. We also observed people sitting for extended periods with no evidence of being moved.

Safeguarding systems and processes were in place, but these were not robust or monitored fully.

Audits and checks had not found what we had during the inspection.

The provider had not met their legal obligation to send the Care Quality Commission (CQC) all incidents which were notifiable. Staff had received training to protect people from various forms of abuse. Not all incidents had been recorded fully by staff or reported accordingly to the registered manager.

There was a registered manager in place, who was kind and caring. However, we had some concerns over their knowledge and ability to lead the service. They did not have a clear oversight of the care provided and there were mixed views on their visibility within the service.

We received mixed views from staff on the support offered by management. Staff said they felt supported, but that the registered manager did not always fully deal with issues arising.

The service was clean and tidy with no odours. However, we found urine soaked mattresses which were replaced after being found in need of renewal.

There was not enough staff in place to support people to meet their needs. Staff told us that safe recruitment procedures were followed when they applied to work at the service, including vetting checks and reference checks. Staff had received training in various topics, however further training had been organised to take place, including in connection with consent and skin management.

Care records were in the process of being fully reviewed, with new paperwork being implemented. In some cases, detail was missing or contradictory. Archived records were not secure or appropriately stored. We were unable to gain access to some records requested.

People’s dietary needs were met, including those with special requirements. People were complimentary about the meals prepared.

There was a welcoming and homely atmosphere at the service and people and their relatives were happy and felt safe with the care provided and said staff were kind and caring.

A variety of activities took place at the service, but on occasions the activity coordinator was diverted to other duties to support the service which impeded on their availability.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in connection with safe care and treatment, safeguarding service users from harm and abuse, staffing and good governance. We also identified a breach in Regulation 18 of the Care Quality Commission (Registration) Regulations 2009, notification of other incidents. We are dealing with this matter outside of the inspection process.

More information is in the full report below.

Rating at last inspection: Good (Report published on 27 September 2017).

Why we inspected: The inspection was brought forward due to information of risk and concern regarding poor care standards, we had received from the local authority and healthcare professionals.

Follow up: Following the inspection we referred our concerns to the local authority responsible for safeguarding. In addition, we requested an action plan and evidence of improvements made in the service. This was requested to help us decide what regulatory action we should take to ensure the safety of the service improves.

At the last inspection in July 2015 the service was rated Good. At this inspection we found the service remained Good.

This inspection visit took place on 24 August 2017 and was unannounced.

The registered manager had procedures in place to minimise the potential risk of abuse or unsafe care. Staff spoken with were able to identify different types of abuse and had received training in safeguarding adults.

Medicines were stored in a clean and secure environment. We observed staff followed correct procedures when they administered medication and fully completed records.

We found staff had been recruited safely, received ongoing training and, were supported by the management team. They had the skills, knowledge and experience required to support people in their care.

The management team had sufficient staffing levels in place to provide support people needed. We found by our observations staff members could undertake tasks supporting people without feeling rushed. People who lived at the home told us staff were responsive to their needs. One person who lived at the home said, “A very good staff team who know what they are doing.”

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes were recorded.

People who lived at Barrock Court told us they had choices of meals and there were always alternatives if they didn’t like what was on the menu. We observed at lunchtime people who required support were attended to in a sensitive manner. Comments were positive about the quality of food and included, “The food is very good. I like the home made cakes they make.”

People who lived at the home had access to healthcare professionals and their healthcare needs were met. We saw the service had responded promptly when people had experienced health problems.

People who lived at the home told us staff were all caring, kind and respectful. Relatives also commented in surveys how caring staff were.

Staff knew people they supported and provided a personalised service in a caring and professional manner. Care plans were organised, updated when required and had identified the care and support people required. We found they were informative about care people had received.

The service had a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with told us they were happy and had no complaints.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff and resident meetings. In addition relative surveys were collected to seek their views about the service provided.

We returned to the home on March 19th 2014 to follow up this area of non-compliance. During this inspection we found that the home had significantly improved this part of their service and there was clear evidence that they were not only following MCA guidelines but were observing a high standard of practice. We judged that they were now compliant.

We observed staff respecting people's right to consent to care and treatment. However, we looked at records which indicated where people did not have capacity to consent the provider had not acted in accordance with legal requirements.

We spoke to staff who said they felt supported to provide care to people and were happy with the training they received. We found the manager had effective procedures in place to monitor the quality of service that people received, and that complaints were dealt with appropriately.