Barton Brook Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People had risk assessments in place. We identified staff would benefit from guidance and more detail in care plans relating to distraction and de-escalation techniques, for people who may become agitated. Safeguarding referrals had been made to the host authority and to CQC; staff were aware of when to raise concerns. Staff felt confident in how and when to report abuse, and told us action would be taken by management. Staff were aware of deprivation of liberties safeguards (DoLS) in place, however we found an issue with one condition around medicines not being recorded or met. This was rectified by the manager. We received mixed feedback regarding staffing levels and saw some units were more stretched than others, based on numbers and people’s needs. We provided some negative feedback about staff onto management during the assessment and this was addressed. There was reduced use of agency staff as internal staff covered care shifts; there was a more consistent staff team in place at this assessment. Safe recruitment processes were in place. Relevant pre-employment checks had taken place and gaps in employment explored and recorded. Induction, training and competency checks had been carried out; there was improved oversight of this from management. Supervision of staff had started and was a priority for the manager. The service had systems for appropriate and safe handling of medicines, which staff mostly followed. We identified a number of gaps in medicine administration records and the absence of clear written instructions on how to use one person’s medicine. Staff did not always maintain the required time gap between doses of medicines. We also found that when the temperature of medicine fridges was out of recommended range, action was not taken to make sure medicines inside remained safe and effective. This was abreach of Regulation 12, Safe care and treatment. Records evidenced regular maintenance and service of equipment was up to date.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The learning culture had improved due to a change in management. People, their families and staff were encouraged to speak up about any concerns or complaints so these could be put right, and the service could improve. People and their relatives considered improvements had been made by the new management; communication had got better. A relative told us, “I am always informed of any medication or medical changes.”

The new management team had adopted a fresh approach and encouraged staff to speak up; staff we spoke with supported this. Staff were comfortable to do this, both with unit managers or senior management. One member of staff told us, “Before I didn’t know who to go to (with a problem); now I do.” Staff told us they knew how to report accidents and incidents through the electronic system. This included incident reports and Antecedent Behavioural Consequence (ABC) records where people became agitated. Staff were aware of safeguarding and whistleblowing procedures.

Incidents and ABC reports could be viewed from within people’s care plans. The nurse and unit manager reviewed incident forms, checked people’s families had been informed and ensured any action had been taken to reduce the risk of a re-occurrence. Processes and policies were in place to aid managers identify any shortfalls in the service. Any subsequent changes in practice were communicated to staff.

People told us they were referred onto other health support services. One person told us, “If I feel unwell, I would talk to one of the staff I know and they would get the GP and call my family.” People were admitted into hospital if warranted or referred to their GP for other support from external community health professionals, such as community nursing team or occupational therapists.

Staff told us they received information about people’s needs before they moved in. This was verbally from the nurse or unit manager, and through initial care plans. Nurses and unit managers spoke with people’s families when they moved in about their care needs and preferences. Staff reported any concerns about people’s health to senior staff and unit managers for monitoring or reporting to a GP.

Social care professionals told us the home had improved. Feedback we received was positive. A local authority professional told us, “[The] new manager has been instrumental in removing the operational safeguard that was in place for the home and worked very hard to bring about a large number of improvements.” They had no concerns regarding the safety or the management of the home. Referrals into the service were being dealt with in a timely manner; admissions into the home were being managed to ensure people remained safe and staff were not overwhelmed.

Initial assessments and care plans were completed. As staff got to know the people when they moved in these were further developed. Where specific risks were identified, referrals were made to relevant health professionals such as falls team, tissue viability nursing team, speech and language team. People’s medicines records, care plans and risk assessments were sent and shared with hospital staff in the event of an admission, so people continued to receive the right care.

People and their relatives were more confident at this assessment concerns they had would be acted upon and investigated, if warranted. Information was shared more readily as management were more open.

Staff were able to explain the safeguarding process and outlined the different types of abuse. Staff understood their responsibilities to keep people safe and were aware how to report any suspected abuse. Whilst staff were aware of the deprivation of liberties safeguards (DoLS) and how this impacted on care, they were less familiar with any conditions that might be attached to DoLS. Staff had received training in safeguarding vulnerable people. The provider had worked collaboratively with the local authority safeguarding team since the last inspection to implement and embed safeguarding arrangements.

We observed staff deploying strategies to reduce people’s heightened moods and levels of agitation; this ensured people safe. Staff used positive distraction techniques to gently remove a person from the communal lounge area, as this was in their best interests. We heard staff offer people choices, such as meal choices, activities and whether they wanted to join others or spend time alone.

Safeguarding concerns were reported to the host authority safeguarding team, to commissioners and to the Care Quality Commission (CQC). Safeguarding outcomes were reviewed and actioned; any lessons learned were shared across the wider organisation. We found an issue with a condition on a DoLS not being recorded or met; this involved medication. Following the inspection the manager improved processes to ensure any conditions were recorded and reviewed at regular intervals.

People told us how staff supported them to stay safe; one person said, “The staff help me in and out of the wheelchair; they never hurt me and know what they are doing.” People were involved in managing risks and specialist equipment was used to help reduce the risk of falls, for example sensor mats and pendant alarms.

Staff and leaders understood people’s individual and specific risks. Staff were provided with guidance about how to support people in line with their assessed risks. Staff were confident in explaining what people’s support needs were and explained ways they best supported people to ensure they remained safe. Staff had received training

We observed during our site visits people were kept safe. During the inspection we observed doors to satellite kitchens were not always closed as staff were in the area. Whilst we deemed the risk to be low, a small cupboard housing thickeners was accessible as keys were at times on show. The manager dealt with this and bought new cupboards with coded locks to ensure people’s safety. We saw staff using prescribed thickener in drinks for those people at risk of choking in line with SaLT instructions; staff recorded when it had been administered. People were supported with specialist moving and handling equipment, such as hoists and wheelchairs.

Risk assessments and electronic care planning systems outlined the risks posed to people. We identified more details were needed for distraction and de-escalation techniques in care plans for people who may become agitated. Care plans reflected the equipment needed to be used by staff to help maintain people’s safety. Risk assessments were reviewed regularly by managers and referrals made to external health professionals in response to people’s changing needs. Systems were updated to reflect any changes so that staff remained informed.

People told us they were supported in a safe environment; comments included, “I’m ok here; I feel comfortable and safe,” “I’m safe; the building is secure.” Relatives also considered people were safe. A relative told us, “It is a good, safe environment for [relative].”

The home had a dedicated maintenance team. Systems were in place for staff to formally record and report any issues with the environment or equipment. Maintenance staff would then rectify minor concerns promptly or contact external contractors. Staff had taken part in fire drills and were aware of procedures to follow in the event of the fire alarm sounding. Staff told us the maintenance team were pro-active and had contributed to the recent improvements around the home.

We observed communal areas that were clean and fit for purpose. Whilst there was some signage to help people with dementia orientate around the units there was more to be done. Improvements were noted to the grounds and to 2 units; there was a schedule for on-going improvements to others, including redecoration.

Processes were in place to ensure any required repairs to the premises were escalated to the appropriate people, either maintenance staff on site or external contractors, to help ensure people’s health and safety was maintained. The nurse call system had been identified as needed to be changed and a new system was scheduled to be fitted. Internal and external checks of the environment were completed by competent people at regular intervals. Where improvements had been identified, these were actioned. All equipment including firefighting systems, nurse alarms, emergency lights, gas and electrical safety had been regularly serviced in accordance with manufacturers’ instructions.

People’s feedback about the number of staff on duty was mixed. Most considered there were enough staff and were complimentary about staffing levels. Comments included, “There are always plenty of staff on duty”, “There are staff around me all the time” “There are always staff when you need them”. One person considered there weren’t enough daytime staff and that staff were ‘overworked’. Whilst relatives judged there had been some improvements, they felt some units were much busier than others. One relative told us, “The nursing care has been brilliant. All the staff are very good but there don’t seem to be enough. They are constantly busy and on the go.”

Staff told us, staffing levels were mainly manageable, however some units were busier than others. Unit managers had been appointed across the home and supported the manager. The manager was keen to continually develop and invest in the staff team. Staff we spoke with had mainly positive things to say about staffing levels and the training on offer but some staff considered staffing levels could be further improved. The staff team were consistent, and the service relied less on agency staff. Staff we spoke with felt better supported and listened to.

We judged staffing levels during our assessment were satisfactory, although some units were busier than others. We observed staff were quick to respond to people’s needs with one exception. One person was unable to use the buzzer and called out wanting support. Staff attended after a short wait, having been busy attending to other people. People were not waiting excessive amounts of time to receive care and support.

Safe recruitment processes were in place and all relevant pre-employment checks had been done. Any gaps in employment had been explored with any reasons recorded. Interview notes had been recorded in 3 of the 4 files we reviewed. Staff had started to receive supervision from unit managers or seniors, but this needed to be extended to all staff. New staff received induction when they started and on-going training to support their job role. Competency checks of staff were carried out and there was improved oversight of this from management. Rotas showed a consistent staff team were on duty with minimal use of agency staff. Staff were involved in regular handover, unit and staff meetings to share information in the best interests of the people they were supporting.

People and their relatives regarded the home to be clean. One relative told us, “The home is always clean.” A negative comment we received from a second relative regarding poor hygiene standards they had witnessed was shared with the manager to address.

Staff had access to supplies of personal protective equipment (PPE) and there were no issues with the supply of cleaning products for the home.

House-keeping staff followed cleaning schedules to ensure the environment was clean; records were completed. We detected a slight odour when entering the home on the first day of assessment; this was dealt with by housekeeping staff. Kitchen areas were clean, and the home had a 4-star ‘good’ food hygiene rating. We observed staff accessing, using, and disposing of personal protective equipment appropriately.

Staff received training in infection, prevention, and control during their induction and refresher training at regular intervals. Schedules were completed by housekeeping staff and the team was managed by a head housekeeper. Staff tried to encourage people to maintain good hand hygiene but more regular checks were needed to promote good infection control.

During the assessment we saw medicines being administered respectfully by staff. One person’s protocol did not state the minimum time gap required between the regular dose and extra “when required” dose of the same medicine. We also saw for two people that the required gap between doses of medicines was not always left. Guidelines for staff about people’s medicines to be given when required were mostly in place and contained person centred information for staff to follow. People’s allergy status and how they liked to take their medicines was recorded. People were supported to self-administer their medicines when they wished to do so, and appropriate risk assessments had been completed, although care plans did not always reflect this. Medicines storage facilities were clean and tidy. We observed on two units thickening powder, added to drinks for people who are at risk of choking, was not always stored securely. Appropriate action was taken by the manager to address this. The time a medicine was administered was documented for time sensitive medicines. However, for two people we found that the prescribed interval between doses for some medicines had not been observed. This means we could not be assured that medicines were always being given safely.

Staff could explain the homes procedures for storing, recording, and checking medicines. On two units we found that although medicine fridge temperatures were being monitored staff had not escalated the issue or taken any action when they were found to be outside of the recommended range. Staff told us that they worked with healthcare professionals to review people’s medicines. For example, the GP attended the service weekly. Staff could explain the process for reconciling medicines when people were transferred between services and were trained and competent to manage medicines.

On three units we found several gaps in medicine administration records. For one person we found that a medicine that had been stopped was given in error for two days. This means we could not be assured that people always received their medicines as prescribed. Medicines that are controlled drugs were managed safely. On one unit we found a discrepancy in the balance of a controlled drug and staff took immediate action to rectify it. Although the service was carrying out monthly audits the issue of staff not escalating fridge temperature concerns had not been identified. The manager responded by purchasing new medicine fridges for each unit. For people prescribed medicines to be given covertly (hidden in food and drink) there were instructions for staff to follow and the appropriate assessments had taken place.