We carried out this unannounced inspection of Barton Brook Care Home on 12 and 14 July 2017. This was the first inspection of Barton Brook Care Home since it had been re-registered with the Care Quality Commission in January 2017. The re-registration had taken place as a business entity to reflect changes to the providers named responsible people. This did not create any changes to the overall registration of the home.Barton Brook Care Home is a large care home with 120 beds operated by Bupa. The home consists of four different units, each with 30 beds. Each of the units are known internally as Moss (Residential Dementia), Irwell (Nursing and Intermediate Care), Brindley (General Nursing) and Monton (General Residential). The home is situated in the Eccles area of Salford, Greater Manchester and at the time of the inspection, there were 119 people living at the home.
At the time of the inspection the home had a registered manager. 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 feedback we received from staff and some visiting relatives was that staffing levels were not sufficient to meet the needs of people living at the home, particularly on the Brindley, Irwell and Moss Units. We were told there were enough staff on Monton unit. We have made a recommendation about staffing levels in the detailed findings of this report.
We found the home to be clean with appropriate infection control processes in place, with the home achieving a score of 93% during their last audit from Salford City Council. All of the toilets and bathrooms contained appropriate hand hygiene equipment and guidance, with personal protective equipment (PPE) readily available and worn by all staff when necessary.
Each person we spoke with told us they felt safe. Relatives were also satisfied with the safety of their family members, commenting positively on the good standard of care provided. The home had detailed safeguarding policies and procedures in place, with clear instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.
The home had systems in place for the safe storage, administration and recording of medicines. The completion of the medication administration records(MAR) was done consistently and the home had effective systems in place for the administering of topical medicines. Staff authorised to administer medicines had completed the necessary training and had their competency assessed. Safe systems of working were also in place with regards to the administration of controlled drugs.
All staff demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We found DoLS applications were not always made in a timely manner when staff had identified that people lacked the capacity to make their own choices and decisions This presented the risk of people being detained or restricted without lawful authority.
Overall, staff were complimentary about the training provided by the home, regarding both induction and on-going refresher sessions. An online system was available which allowed staff to complete additional training in their own time. Staff told us they received reminders when refresher training was required to keep their skills and knowledge up to date.
Staff on the Brindley unit told us due to the care needs of two people living on the unit who presented with mental health needs, that training in this area would be beneficial to them and other staff working on the unit. We noted this was not an area covered on the homes training matrix. This would enable them to gain more of an understanding in this area and provide appropriate care in response. We have made a recommendation about training in the detailed findings of this report.
Staff confirmed they received supervision and appraisal as part of their on-going development. We looked at a sample of these records during the inspection and found they were completed with good detail about the discussions that had taken place.
Meal time observations showed these to be a positive experience, with people being supported to eat where they chose such as in their bedroom or in the main lounge. Both the Brindley and Irwell House units had a dedicated ‘hostess’ who assisted people at mealtimes as necessary, giving extra to help to care staff as needed.
We found people received enough to eat and drink, however accurate records regarding people’s food and drink intake were not always maintained by staff.
People told us they received enough to eat and drink and were offered a good choice of meal options, with alternatives available. We saw nutritional assessments were in place and special dietary needs catered for.
The people we spoke with and their families told us a good standard of care was provided at Barton Brook. People said they felt treated with dignity, respect and that staff promoted their independence as necessary.
We looked at 17 care files which contained accurate and detailed information about the people who used the service and how they wished to be cared for. Each file contained detailed care plans and risk assessments, along with a range of personalised information which helped ensure their needs were being met and the care they received was person centred.
The home employed several activity coordinators, who planned and oversaw the activities completed within the home. Activities were scheduled throughout the week and were displayed on a notice board on each unit, informing people what was coming up. The activity coordinator also took people out into the local community if they were able to.
There were systems in place to seek and act on feedback from people living at the home such as satisfaction surveys, staff/residents meetings and a complaints procedure. The home maintained a record of compliments in addition, where people had expressed their satisfaction with the service provided.
The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed on a daily, weekly and monthly basis and covered a wide range of areas including medication, care files, infection control and the overall provision of care. Random spot checks were also undertaken on each of the units. This involved either a the unit, or registered manager arriving at the unit out of hours and conducting observations.
We saw evidence of action plans being implemented to address any issues found. Additionally the provider completed monthly inspections of the home, providing a detailed report, along with positive feedback and areas for improvement.
We found the homes internal quality assurance systems had not been fully effective. For example, where DoLS applications had not been made in a timely manner and where accurate records had not been maintained with regards to people’s food and fluid intake.