Barons Down Nursing Home

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

The providers’ governance systems had not identified the shortfalls found at this inspection. Audit systems and processes failed to identify and manage effectively risks to people's safety and other aspects of the service that required improvement. There were areas of people’s documentation that needed to be improved to ensure staff had the necessary up to date information to provide consistent, safe care.

Risk management needed improvement to ensure peoples’ health and well-being was protected and promoted. We identified shortfalls in respect of the management of risk. For example, the management of incident and accidents. Incident forms were completed but there was a lack of overview, analysis and follow up to prevent a re-occurrence or to mitigate risk. Records were not always clear and accurate regarding people's care and support. Not all staff had the necessary supervision and support to perform their role.

The management of medicines was not always safe. Staff were not monitoring the overall effectiveness of pain relief medicine and mood calmers or looking at the times PRN (as and when needed) requests were made for trends or themes. There were not always sufficient, suitably trained and experienced staff deployed.

We have made a recommendation regarding the need to seek advice for the review Deprivation of Liberty Safeguards conditions to ensure they are current and relevant.

People received support from staff who had been appropriately recruited, trained to recognise signs of abuse or risk. One person said, “I do feel safe, the staff are lovely,” and “Taken care of, in a kind and nice way I feel very grateful to them all.”

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.

The home was clean and well maintained. Infection control procedures were being followed.

The staff were kind in their approach and treated people with respect. Improvements had been made to care plans and they were person-centred and relevant to each person. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives. Complaints made by people were taken seriously and investigated.

The registered manager and staff team were passionate about the service and their plans to continuously improve and had plans to develop the service and improve their care delivery to a good standard. Feedback from staff about the leadership was positive, “We will get there, a lot to do though.”

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 requires improvement (published 24 May 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

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 the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns raised and based on the previous rating. This enabled us to review the previous ratings. We also used this opportunity to look at the breaches of Regulation 9 and 17. As a result, we undertook a focused inspection to include the safe, responsive, and well-led key questions. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

The provider and management team took immediate action during the inspection process to mitigate risk.

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

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

People’s experience of using this service:

The providers’ governance systems had not identified all of the shortfalls found at this inspection. Records were not always clear and accurate regarding people's care and support. For example, oral care, communication needs and daily records. The cleanliness of the home whilst identified in the audits as needing to be improved had not been satisfactorily resolved and we found continued issues.

Care delivery was not always person-centred. The care had not been designed to ensure that people's independence was encouraged and maintained. People were not always offered the personal care they wanted or required consistently. Whilst there were some planned activities, they were not designed in line with peoples’ preferences and interests. Activities for those who remained in their rooms were not planned for.

Areas of the home were not found to be clean

People received care and support by enough numbers of staff who had been appropriately recruited and trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “I have not been here long, but staff are kind and gentle.” A relative said, “Everything seems fine so far,” and another said, “I don’t have any concerns.” There were areas identified to improve and these were taken forward immediately by the registered manager. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by appropriately trained staff, who had been assessed as competent.

People confirmed they were involved in their initial care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives. Complaints made by people were taken seriously and investigated.

The registered manager and staff team were committed to continuously improve and had plans to develop the service and improve their care delivery to a good standard. Feedback from staff about the leadership was positive, “I feel we are going forward, we are working together and building a good team.” We were also told, “Communication between the team is better, I feel supported.”

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 requires improvement (published 21 May 2021) and there were 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 the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns raised and based on the previous rating. This enabled us to review the previous ratings. We also used this opportunity to look at the breaches of Regulation 9 and 17. As a result, we undertook a focused inspection to include the safe, responsive and well-led key questions. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 and Recommendations

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 will take further action if needed.

We have identified continued breaches in relation to person centered care and good governance at this inspection.

The provider took immediate action to mitigate some risks which have been effective.

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

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

People’s experience of using this service:

The providers’ governance systems had not identified the shortfalls found at this inspection. Records were not always clear and accurate regarding people's care and support. For example, oral care, communication needs and daily records. There was also a lack of supporting evidence such as whether it was their choice or for a medical reason for those people who were cared for in bed..

Care delivery was not person-centred. The care had not been designed to ensure that people's independence was encouraged and maintained. People were not always offered the personal care they wanted or required consistently. People were not encouraged to be involved in activities and there were no planned activities in house to encourage people to come out of their rooms and meet other people. Activities for those who remained in their rooms were not planned for.

People received safe care and support by enough numbers of staff who had been appropriately recruited and trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “I feel safe here, they look out for me.” Another said, “I feel safe.” Care plans and risk assessments meant peoples’ health, safety and well-being were protected. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by appropriately trained staff, who had been assessed as competent.

Staff had all received essential training to meet peoples support and care needs. Further service specific training was being arranged by the registered nurses as requested by care staff. There was an induction programme to introduce new staff to the service and during this process they got to know people and their needs well. One new staff member said, “It’s really lovely here, the people are all individual and characters and the staff team have been really supportive.” People's dietary needs were assessed, and people were provided with a choice of cooked meals each day. Feedback about the food was positive and most people said they enjoyed the meals. People’s health needs were consistently met with involvement from a variety of health and social care professionals.

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.

Staff were caring in their approach to the people they supported and at this inspection we saw people were treated with respect and dignity. People and visitors to the service were consistent in their views that staff were kind, caring and supportive. One health professional said, “The atmosphere is more positive, there have been improvements, especially in the leadership, communication has improved.” People were relaxed, comfortable and happy in the company of staff and engaged with in a positive way.

People confirmed they were involved in their care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives. Further training in end of life care was being sought from the local hospice.

Complaints made by people were taken seriously and investigated. There was a need for clearer recording which the registered manager was aware of and taking steps to address.

The registered manager and staff team were committed to continuously improve and had plans to develop the service and improve their care delivery to a good standard. Feedback from staff about the leadership was positive, “We have definitely moved forward, we are having meetings and sharing information. We all feel we can contribute, and our views are respected.”

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

Rating at last inspection:

This service was registered on the 26/03/2020. We undertook a focussed inspection in July 2020 due to concerns received, but did not rate the service. This is the first inspection rating all five key questions.

Why we inspected:

This inspection was prompted in part due to information of risk and concern and to follow up on actions we told the provider to take at the last inspection in July 2020.

CQC received concerns in respect of staffing levels, lack of leadership and poor infection control measures. The concerns raised were looked at during this inspection and have been reflected in the report.

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 found two breaches in relation to person centred care and good governance at this inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

We undertook this targeted inspection to follow up on specific concerns, which we had received about the service. The concerns were about peoples’ safety, medicines, infection control and the governance framework of the service. We inspected using our targeted methodology developed during the Covid19 pandemic to examine those specific risks and to ensure people were safe.

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

Risk of harm to people was not always mitigated as serious incidents and accidents were not consistently reported, recorded or investigated to prevent further harm occurring. Action plans to prevent further incidents were not always in place. However since the acquisition of the home on 25th March 2020, action plans had been put into place by senior management to improve oversight. These were shared with CQC on the day of the inspection.

The recording of wound management was inconsistent and did not follow best practice guidance. Staff had not all received an induction and the training they needed to support them in their role. Not all staff had received supervisions and appraisals. Robust systems for the checking of medicine changes were not in place and had resulted in a serious medicine error. However, action in regard to this has been taken to prevent further possible errors.

There was a lack of robust management oversight in some areas of the service. Quality assurance systems did not always identify shortfalls in the service and the provider had not ensured there was a systematic approach to manage improvements. Risks to people’s safety were not always monitored, which meant there was a risk they would not receive the safe care they required.

Areas of the home and some equipment was not clean. Recent changes to the number of domestic staff had impacted on the cleanliness of the premises. The nominated individual has taken immediate action to address this issue.

Medicines were stored and disposed of safely. People’s medication records were completed, signature gaps had been highlighted and followed up by the deputy manager.

People told us they felt safe living at Barons Down. One person said, “I do like living here, it’s safe and the food is good.” Another person said, “Very nice place to live, the staff are very good.”

Rating at last inspection:

This service was registered on the 27/03/2020 and this is the first inspection.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement:

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.