Archived: Barrisle Care Home

Updated 13 January 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. We also looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

This unannounced inspection was carried out over two days on 12 October and 15 October 2015 by four Adult Social Care inspectors from the Care Quality Commission, who were accompanied by a specialist pharmacy advisor, a specialist dementia care advisor and an Expert by Experience. An Expert by Experience is a person who has experience of the type of service being inspected. Their role is to find out what it is like to use the service. This was achieved through discussions with those who lived at Barrisle and their relatives, as well as observation of the day-to-day activity.

At the time of our inspection of this location there were 37 people who lived at Barrisle. Due to experiencing and living with varying degrees of dementia, the majority of people were unable to speak with us or answer our questions. However, we were able to speak with three of them and five family members. We also spoke with five staff members and the manager of the home.

We toured the premises, viewing all private accommodation and communal areas. We observed people dining and we also looked at a wide range of records, including the care files of nine people who used the service and the personnel records of five staff members. We ‘pathway tracked’ the care of six people who lived at the home. This enabled us to determine if people received the care and support they needed and if any risks to people’s health and wellbeing were being appropriately managed. We also conducted a Short Observational Framework Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. Other records we saw included a variety of policies and procedures, medication records and quality monitoring systems.

The provider sent us a Provider Information Return (PIR) before the last inspection, five months previously. Therefore, we did not request another to be submitted on this occasion. A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

Prior to this inspection we looked at all the information we held about this service. At our last inspection on 08 May and 12 May 2015 we had found significant failings at the service. We reviewed notifications of incidents that the provider had sent us since our last inspection, such as serious incidents, injuries and deaths. We were in regular discussion with local commissioners and community professionals about the service provided at Barrisle Nursing Home. As a result of these discussions and notifications a decision was made to re inspect the service as a full comprehensive inspection to follow up on previous findings.  

Updated 13 January 2016

The first day of this comprehensive inspection was unannounced, which meant the provider did not know we were coming. It was conducted over two days on 12 October and 15 October 2015. The manager of the home was given short notice of the second day of our inspection.

Barrisle Care Home provides nursing and personal care for up to 40 adults who have mental health needs or who are living with dementia. The home is situated in a residential area of Leyland, close to local amenities. Accommodation is at ground floor level in single rooms; although one shared room is available. Ensuite facilities are not provided, but each bedroom has a wash hand basin. Toilets and bathrooms are conveniently located throughout the home. There are two lounges available and a large dining room is provided. There is a garden with patio area for people to use during the warmer weather.

We last inspected this location on 08 May and 12 May 2015, when we found the registered provider had breached a total of 13 regulations of the Health and Social care Act 2008 (Regulated Activities) Regulations 2010 and two of the Care Quality Commission (Registration) Regulations 2009. The breaches related to person centred care, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, dignity and respect, need for consent, safety and suitability of premises, staffing, fit and proper persons employed, safe care and treatment and good governance. These significant failings resulted in each domain of the report being rated as, ‘inadequate’ and therefore an overall rating of ‘inadequate’ was awarded.

As the overall rating for this service was inadequate, the Care Quality Commission (CQC) placed the home into special measures and further enforcement action was taken. Our guidance states services rated as inadequate overall will be placed straight into special measures. We want to ensure that services found to be providing inadequate care do not continue to do so. Therefore we have introduced special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

•Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to cancel their registration.

A formal notice of proposal was issued under Section 26(4)(a) of the Health and Social Care Act 2008 to cancel the provider’s registration in respect of the regulated activities, which were being carried on at Barrisle Care Home. We asked the provider to submit an action plan telling us how and when they would make improvements. This was received and the service was closely monitored by a wide range of community professionals and the CQC, during which time regular support was provided.

At the time of this inspection there was no registered manager appointed. However, a manager had recently been employed, but at that time had not submitted an application for registration to the CQC. She was on duty on both days 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.

The cleanliness of the premises was found to be satisfactory. It was pleasing to note that some improvements had been made to the general environment of the home. However, some areas were still in need of modernising and updating. The manager was in the process of introducing a dementia friendly environment, so that those who lived at Barrisle could experience a meaningful lifestyle.

Systems and equipment within the home had been serviced in accordance with the manufacturers’ recommendations, to ensure they were safe for use. However, during our tour of the premises and the external grounds of the home we found several areas, which were unsafe and therefore this did not protect people from harm.

We looked at medication practices adopted by the home and found failings, which meant that people were not protected against the risk of receiving inappropriate or unsafe care and treatment, because medicines were not being well managed.

Areas of risk had not always been managed appropriately and the correct procedures had not always been followed to safeguard those who lived at the home. Consent had not always been obtained before care and treatment was provided and legal requirements had not always been followed in relation to Deprivation of Liberty Safeguards (DoLS). New staff were appropriately recruited and therefore deemed fit to work with this vulnerable client group.

Induction programmes for new employees were not always formally recorded. Some staff members we spoke with told us they did not have an induction when they started to work at the home. This included agency staff. Supervision and appraisal meetings for staff were irregular and not structured. This meant that the staff team were not supported to gain confidence and the ability to deliver the care people needed. There were sufficient numbers of staff on duty on the days of our inspection. Some improvements had been made to the training programme for staff since our last inspection, which was pleasing to note. However, we found that training in relation to the management of challenging behaviour had not been delivered, which we considered to be an important learning module for those who worked at Barrisle Nursing Home.

We found that people’s privacy and dignity was not always respected and their health care needs, including nutritional support, had not always been met. Guidance from community health care professionals had not been consistently followed. This meant that some people did not receive the care and support they needed. The planning of people’s care varied. Some records were person centred and well written, providing staff with clear guidance about people’s needs and how these were to be best met. Others contained basic information only and did not cover all assessed needs or how people wished their care and support to be delivered. The bathing and showering arrangements were very task orientated and did not allow choice and control. We have made a recommendation about this.

We spoke at length with the activities co-ordinator, who was new in post. She was evidently eager to support people to maintain their leisure interests and had imaginative ideas for future planning of activities for this client group. It would be beneficial if the activities co-ordinator was supported by management to introduce these new concepts for those who lived at the home.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for Person-centred care, dignity and respect, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, premises and equipment, fit and proper persons and good governance.

We also found breaches of the Care Quality Commission (Registration) Regulations 2009 in so much as we found that the registered person had not notified the Care Quality Commission of notifiable incidents. The home remains in special measures, due to the fact that one or more domains remained inadequate and also an overall rating of inadequate was given.

You can see what action we told the provider to take at the back of the full version of this report.  We are continuing to take enforcement action against the service and will report on that when it is complete. Therefore, this service remains in special measures.