Archived: Barton Brook Care Home

We found the following examples of good practice.

The building was clean and well-maintained. Where possible windows were open to provide ventilation, and good use was made of the large garden areas. There were comprehensive cleaning and disinfection schedules in place to help minimise the risk of infection transmission.

All visitors to the home were screened for COVID-19. This included having their temperature and oxygen saturation levels taken, and taking a lateral flow covid test (LFD) prior to entry. Information was displayed throughout the buildings to remind people to be careful about infection transmission, to wash their hands and to comply with government guidance around wearing personal protective equipment (PPE).

Appropriate arrangements were in place for new admissions to the home. This included a detailed assessment, confirmation of a negative COVID-19 test, and a period of isolation on arrival at the service.

Staff had received infection prevention and control training. This included training on the correct use of PPE. There was an ample supply of PPE and we observed staff wearing it correctly.

All staff and people living at the service were regularly tested for COVID-19, in line with current government guidance. There had been a good take up of the vaccination from staff, and everyone who lived at Barton Brook had received two doses of the vaccine.

The manager had an ‘open door’ management approach and was on hand to offer emotional support to staff. The provider’s counselling service was available for anyone who needed additional help.

The service supported people to receive visits from family and friends, in line with local public health guidance. Designated visiting rooms were provided. In addition, people were helped to stay in touch through phone and video calls.

We found the following examples of good practice:

During our inspection, we visited two of the units at the home which were Monton and Brindley.

At the entrance of the home and on each unit, information was displayed to inform visitors about any infection control procedures to be followed. Temperature checks were taken and questionnaires completed, asking people about any possible symptoms of COVID-19, or if they had felt unwell. Lateral flow (a COVID-19 test where the results can be obtained quickly) testing was carried out as needed. Visitors entering the home were required to wear appropriate PPE once a negative test had been confirmed.

Various methods had been used to enable people to keep in touch with their family and friends during the pandemic. This included video calls and window visits. A ‘Visiting pod’ had been installed, enabling people living at the home to see members of their family in a safe environment, whilst also following government guidelines regarding COVID-19.

Zoning arrangements were used when people had tested positive for COVID-19 and needed to self-isolate in certain areas such as bedrooms within select corridors of the home. COVID-19 testing was in place for staff and people using the service. People living at the home, where they had chosen too, had received their first dosage of the COVID-19 vaccination.

Appropriate arrangements were in place for new admissions to the home, such as requesting confirmation of a negative COVID-19 test before moving into Barton Brook.

Enough personal protective equipment (PPE) was available and we saw staff wore it at all times during our visit. Hand sanitizers and donning/doffing (putting on and removing PPE) stations were distributed throughout the building to support correct infection control practices.

We observed the home to be clean and tidy, with domestic staff carrying out their duties throughout the day. Windows were opened at various times during the day to assist with ventilation and outdoor facilities were used when better weather allowed.

There were enough staff to care for people safely and infection control training had been provided for staff by both HC-One and Salford local authority. Counselling services were available for staff to promote their wellbeing and we were told good support had been provided to the home by HC-One throughout the pandemic.

Risk assessments were completed where certain groups may be at higher risk of contracting the virus. An appropriate infection control procedure was in place and regular infection control audits were undertaken to ensure standards were maintained.

Barton Brook Care Home provides nursing, personal care and accommodation for up to 120 older people. The home is owned by HC-One Oval Limited. Accommodation is provided in four single storey units with each unit housing up to 30 people. The units are called Moss (Residential Dementia), Monton (General Residential), Brindley (General Nursing) and Irwell (Intermediate Care). There is a large car park available at the front of the building.

At the time of the inspection there were 116 people living at the home, across each of the four units.

Barton Brook is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home was previously owned by Bupa and was sold to HC-One Oval Limited in February 2017 and ultimately re-registered with CQC; however the home retained its inspection history.

Our last inspection of Barton Brook took place in July 2017 when the home was rated as Requires Improvement overall and for the key questions Effective and Well-led. Safe, Caring and Responsive were rated as Good. At that inspection, we identified breaches of the regulations regarding safeguarding people from abuse and improper treatment and good governance (two parts of this regulation). We were sent an action plan following this inspection, which detailed improvements which would be made within the home to address the concerns.

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.

Medicines were managed administered, stored and recorded safely.

We found there were enough staff working on each of the units to care for people safely. Some staff spoken with said they felt more staff were needed on the units, however they felt this did not impact on the care people received.

The premises were being well maintained, with regular servicing checks of equipment and the building carried out. The home was clean and tidy throughout, with infection control procedures followed as required.

People who used the service and their relatives told us they felt the service was safe. There were appropriate risk assessments in place for people, with guidance on how to minimise risk. Staff recruitment was robust with appropriate checks undertaken before staff started working at the home.

We found staff received sufficient training, supervision/appraisal and induction to support them in their role. The staff we spoke with told us they were happy with the training they received and felt supported to undertake their work.

We found the home worked closely with other health professionals and made appropriate referrals if there were concerns. Details of any visits from other professionals were recorded within people’s care plans.

Appropriate systems were in place regarding deprivation of liberty safeguards (DoLS) and the mental capacity act (MCA).

People told us they enjoyed the food and we saw people being supported to eat and drink, throughout the day.

We received positive feedback from people we spoke with about the care provided at the home. Visiting relatives said they had no concerns with the care being delivered at the home. People said they felt treated with dignity and we observed staff treating people with respect during the inspection.

There were a range of different activities available to participate in and people told us there was enough to keep them occupied during the day.

We found complaints were responded to appropriately, with compliments also collated where people had expressed their satisfaction about the care provided.

Staff meetings took place, giving staff the opportunity to discuss their work and raise any concerns about practices within the home. We observed a staff handover taking place, where an update was provided about people’s care needs from that shift.

Staff spoke positively about management at the home and said the manager was supportive and approachable.

The registered manager was involved in a number of initiatives within the local community and worked closely with other organisations as required.

Policies and procedures were in place and were being reviewed regularly to ensure the information was still current.

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.