- Care home
Barrington Lodge
Important:
The provider of this service changed. See old profile
All Inspections
15 March 2022
During an inspection looking at part of the service
Barrington Lodge is a nursing home for up to 44 older people, many of whom were living with dementia. At the time of the inspection 42 people were receiving personal and nursing care.
People’s experience of using this service and what we found
Staff recruitment could be improved as the provider did not always obtain references and check gaps in employment history in line with their recruitment policy. The audits in place to check people received a good standard of care required improvement. These audits had not identified the issues we found including staff recruitment, pressure mattress settings being inappropriate to prevent pressure ulcers, medicine temperature checks, lack of a Legionella risk assessment, inaccurate fluid charts, a staff member not wearing PPE, issues in responding appropriately in the case of a heart attack and the way one staff member supported a person to eat.
The registered manager was also a registered nurse and a director. They were experienced and understood their role and responsibilities well overall and took action to improve any gaps in their knowledge, as did staff. The registered manager engaged well with people using the service, relatives and staff and staff felt well supported by the registered manager. The registered manager notified CQC of significant events, such as allegations of abuse, as required by law.
People received the right support in relation to risks such as those relating to living with dementia and other risks in their daily lives. There were enough staff to support people safely and recruitment was ongoing. Staff received training in infection control, including the safe use of personal protective equipment (PPE) to reduce the risk of COVID-19 transmission. People received the right support in relation to their medicines and the registered manager had good oversight of this. The premises were maintained safely with regular checks carried out by staff and external contractors.
Staff received the training and support they needed to meet people’s needs with regular supervision from their line manager. People were supported to maintain their mental and physical health and to maintain contact with professionals involved in their care. People received food and drink of their choice in sufficient quantities with snacks available outside of mealtimes. 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 were positive about staff and had developed good relationships with them. People received consistency of care from a small number of staff who knew them well. People were encouraged to be involved in their care as much as possible, including taking part in their own personal care. Staff treated people with dignity and were trained in how to keep personal information confidential. People’s care plans were based on their individual needs and preferences and were kept up to date. The registered manager investigated and responded to any concerns or complaints in line with their policy.
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 inspected on 9 August 2021 and the report was published on 8 September 2021. The service was rated good.
Why we inspected
This inspection was prompted because we received concerns regarding risks relating to bed rails, staffing levels, infection control practices, the care provided to people isolating in their rooms and the management of the service. We did not find evidence in relation to these specific concerns at this inspection.
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 breaches in relation to recruitment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.
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 continue to monitor information we receive about the service, which will help inform when we next inspect.
9 August 2021
During an inspection looking at part of the service
We found the following examples of good practice.
The provider was following best practice guidance to prevent visitors to the home spreading COVID-19 infections. The provider carried out tests to check whether visitors had COVID-19 infections. All visiting professionals on the national testing programme were asked to show proof of their recent COVID-19 negative test. Visitors did not routinely enter the home to reduce the risk of infections. However, visits were not restricted and visits took place in a well-ventilated, suitable room. The provider also supported people to keep in touch with those who were important to them through visits, phone and video calls.
The provider used extra staff during the pandemic to provide extra support to people, such as increased activities within the home.
The provider had an admissions process in place which followed best practice in relation to COVID-19 which included COVID-19 testing and periods of isolation.
Our observations during the inspection found most staff were adhering to PPE and social distancing guidance. However, two staff members were not always wearing suitable PPE and the registered manager responded to this when we raised our concerns.
The provider had ensured staff who were more vulnerable to COVID-19 had been assessed and plans were in place to minimise the risk to their health and wellbeing.
The provider facilitated telemedicine services with healthcare professionals to reduce the number of external visitors.
Further information is in the detailed findings below.
17 August 2017
During a routine inspection
Barrington Lodge is registered to provide residential and nursing care for up to 44 older people, some of who are living with dementia. There are seven places in the service for people requiring rehabilitation. This intermediate care service provides people with additional support on discharge from hospital, before returning home; or sometimes as an alternative to a hospital admission. Accommodation is arranged over three floors and there is passenger lift access. There were 35 people using the service at the time of our inspection which included seven people staying for rehabilitation.
At the last inspection in 2015, the service was rated Good. At this inspection we found the service remained Good. The provider demonstrated they continued to meet the regulations and fundamental standards.
The service continued to be kept clean, safely maintained and furnished to comfortable standards.
People continued to feel safe and well cared for at Barrington Lodge. Relatives shared similar confidence in the service. Staff knew how to recognise and report any concerns they had about people’s care and welfare and how to protect them from abuse.
Assessments and care plans included person centred information about people’s needs and explained the support people required for their physical, emotional and social well-being. Risks to people’s health and safety were managed and staff took action to minimise these. People’s care records were updated to reflect any changes and ensure continuity of their care and support.
At the time of our inspection there were enough staff to meet people’s needs and keep them safe. Appropriate recruitment checks were completed to make sure staff were suitable to work at the home. Staff received a planned induction and ongoing training to fulfil their roles and keep their knowledge and skills up to date.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff showed understanding, patience and treated people with respect and dignity.
People's wishes, choices and beliefs were reflected in their care plans. They were supported to make decisions and staff promoted their independence as far as possible.
Activities were varied and arranged according to people’s needs and interests. There were meaningful activities for people living with dementia and staff understood the importance and benefits of social interaction for everyone using the service.
The service promoted and supported people's contact with their families. Relatives visited regularly and were encouraged to share their views and opinions. People and relatives felt involved in the way the home was run. They knew how to complain and make suggestions, and were confident their views would be acted upon.
People were supported with their dietary and health needs. There was a varied daily choice of meals and people were encouraged and supported to eat and drink well. Staff took prompt action when people became unwell or were at risk from poor nutrition. They consulted other healthcare professionals to ensure that people received the additional support they needed. Medicines were managed safely and people had their medicines at the times they needed them.
The atmosphere in the service continued to be welcoming, open and inclusive. The registered manager showed effective leadership and people, relatives and staff told us the home was well run. Staff were clear about their roles and responsibilities and felt supported by management and each other.
The provider continued to use effective systems to monitor the quality of the service and make improvements when needed.
30 June and 8 July 2015
During an inspection looking at part of the service
We carried out this inspection on the 30 June and 8 July 2015. The aim of the inspection was to carry out a full comprehensive review of the service and to follow-up on the eight requirement actions made at the previous inspection on 28 and 29 October 2014. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements by the 29 May 2015. At this inspection we found the provider had followed their action plan and improvements had been made in the required areas.
Barrington Lodge is registered to provide residential and nursing care for up to 44 older people, some of who are living with dementia. There are 12 places in the service for people requiring rehabilitation. This intermediate care service provides people with additional support on discharge from hospital, before returning home; or sometimes as an alternative to a hospital admission. Accommodation is arranged over three floors and there is passenger lift access. There were 35 people using the service at the time of our inspection which included nine people staying for rehabilitation.
The home had a registered manager who was also one of the registered providers. 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.
People were protected against the risks associated with the unsafe use and management of medicines. Improved arrangements were in place for the recording, safe keeping and administration of medicines. New audit systems had been introduced and regular checks were being carried out.
At this inspection we found improvements in care planning. Care plans were up to date and reflected the needs of people whose care we focused on. Individual plans were more personalised and detailed, meaning that staff knew what was important to people and how they preferred to receive their care and support. People’s health, care and support needs were assessed and reviewed in a timely manner. External professionals were involved in people’s care so that individuals’ health and social care needs were monitored and met.
Staff recruitment practices had been strengthened and appropriate procedures were followed to make sure suitable staff were employed to work at the home.
More activities were provided for people that met their needs and choices. A new activities coordinator had been employed to facilitate this.
People spoke positively about the quality of the food and choices available and were provided with homemade, freshly cooked meals each day. Menus had improved and included visual prompts to assist people living with dementia in choosing meals.
At the last inspection the provider was not meeting the requirements of the Mental Capacity Act 2005 including the Deprivation of Liberty Safeguards (DoLS). This provides a legal framework to help ensure people’s rights are protected. Staff had completed training about this and understood their responsibilities where people lacked capacity to consent or make decisions.
Action had been taken to make the complaints system more effective. The procedure had been updated and was prominently displayed in the reception area. Complaints had been investigated and there was monthly auditing to make sure that lessons could be learnt. People could therefore be assured that complaints would be investigated and acted on as necessary.
The provider had also strengthened the arrangements to monitor the quality of the service and involved the people using the service, their relatives and staff to make improvements. The provider listened and acted upon their feedback.
There was more openness and transparency in how the home was managed. People and their relatives were comfortable to raise any issues and felt they were listened to. Staff were clear about their roles and responsibilities and felt supported by management.
There were positive and caring relationships between staff and people who lived in the home and this extended to relatives and other visitors. Staff treated individuals and their guests with respect and courtesy and maintained people’s privacy and dignity at all times.
The provider worked in partnership with key organisations to support care provision and service development. There was effective communication between the home and community intermediate care service team and the manager had been working with the local authority to enhance staff training.
28 and 29 October 2014
During a routine inspection
This inspection took place on 28 and 29 October 2014 and was unannounced.
At our last inspection in November 2013 the provider met the regulations we inspected.
Barrington Lodge is registered to provide residential and nursing care for up to 44 older people, some of who are living with dementia. There are 12 places in the service for people requiring rehabilitation. This intermediate care service provides people with additional support on discharge from hospital, before returning home; or sometimes as an alternative to a hospital admission. Accommodation is arranged over three floors and there is passenger lift access. There were 43 people using the service at the time of our inspection.
There was a registered manager in post. 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.
People were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.
Arrangements to obtain people’s consent were not always in place. Where people were assessed as lacking capacity to make certain decisions there was little evidence that decisions were made in people’s best interests in accordance with the Mental Capacity Act 2005 (MCA).
People using the service were not involved in day-to-day decisions about their care as much as they could be. People's needs had been assessed and basic care plans were developed. Care records identified how care should be delivered, but did not take account of people’s individual preferences and social needs or interests. Information was not always available to people in a format which was meaningful to them and promoted choice.
There was little stimulation or activity for people using the service because there were not enough meaningful activities for them to participate in.
The arrangements for staff recruitment did not ensure that people using the service were protected from unsuitable staff.
Improvements were required to ensure the service was well-led. The registered manager and provider did not have effective quality assurance systems in place. They were unable to demonstrate how they identified where improvements were needed in the service. People had limited opportunities to share their views and comments on the quality of the service. The provider did not use information from people’s complaints or feedback to improve the quality of the service.
People told us they felt safe living in the home and those staying for intermediate care felt the environment provided a homely setting for recuperating. Staff had training and knew how to recognise and respond to concerns about abuse and poor practice. The provider took action to assess and minimise risks to people’s health and well-being.
People were supported to eat and drink enough to meet their nutrition and hydration needs. Care plans contained information about the health and social care support people needed and records showed they were supported to access other professionals when required. We saw that there was effective communication with other professionals and agencies to ensure people’s care needs were met. Where people's needs changed, the provider responded and reviewed the care provided.
People were treated with kindness and patience. There were positive interactions and people were complimentary about the staff. Staff respected people’s privacy and dignity and interacted with people in a caring and respectful manner.
We found breaches of the regulations in relation to consent, care planning and activities for people using the service, the support provided to staff, the management of complaints, the environment, the systems for monitoring the quality of service provision, staff recruitment and medicines management. You can see what action we told the provider to take at the back of the full version of this report. We have also made a recommendation about practice around mealtimes.
21 November 2013
During an inspection in response to concerns
We were able to speak to the registered providers, four other members of staff, six people who were using the service and three relatives who were visiting. All of the feedback we received was positive. People told us that they were free to spend their days as they wished to. Relatives confirmed that they were always welcome in the home and kept informed of any changes in people's healthcare needs. People told us that staff were 'lovely', 'very approachable' and 'very kind'. They told us they never had to wait long for help when they needed it. Relatives confirmed that staff were always visible in the home and there seemed to be enough of them.
All of the people we spoke with told us that they enjoyed the meals they were served, there was always a choice and any special dietary preferences were catered for.
8 May 2013
During a routine inspection
The home was acquired by new providers last year and there had been a significant programme of redecoration and refurbishment. People and relatives commented on how nice the home looked now.They told us that the providers, one of whom is the manager, were frequently in the home and very approachable. They had no concerns about going to them if they had any problems or suggestions.
There was a continuing programme of staff development in place to ensure that staff all had the necessary skills to support the people living in the home.