Archived: Barling Lodge

Barling Lodge is a residential care home providing accommodation and personal care to eight people aged 65 and over at the time of the inspection. Some people were living with dementia. The service can support up to 47 people in one adapted building. No people were residing on the first floor of the service.

People’s experience of using this service and what we found

This was a targeted inspection that looked at the service’s fire safety arrangements. The provider had a fire risk assessment in place and a designated fire officer. Improvements were required to ensure the service’s fire officer and other staff employed at the service were appropriately trained. The provider had updated the escape route floor plan for the service. Personal Emergency Evacuation Plans [PEEPs] were completed for people using the service but minor improvements were required to ensure these were consistently completed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 18 June 2021).

At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 12 [Safe care and treatment].

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 [Safe care and treatment] of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met relating to the service’s fire safety arrangements. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Barling Lodge is a residential care home and it was providing accommodation and personal care to nine people aged 65 and over at the time of the inspection. Some people were also living with dementia. The service can support up to 47 people in one adapted building.

People’s experience of using this service and what we found

The leadership, management and governance arrangements did not provide assurance the service was well-led. Quality assurance and governance arrangements at the service were not reliable or effective in identifying shortfalls in the service. The arrangements for learning lessons when things go wrong were unclear and inconsistent.

Risks to people were assessed and recorded but additional information was required to identify how risks posed were to be mitigated. Not all risks posed to people’s safety in the event of a fire emergency were identified. Our concerns relating to fire safety were raised with Essex Fire and Rescue Service.

The atmosphere at Barling Lodge was relaxed and calm and staff interactions with people using the service were positive. Staff spent time with people, either talking with them or supporting the person to participate in a social activity. The care and support provided by staff was not rushed and it was evident staff had a good relationship with the people they supported.

Staff knew how to safeguard people and raise concerns. People were comfortable in the company of staff who provided support. Staffing levels were appropriate to meet and respond to people’s needs. Staffs practice relating to medicines management showed staff undertook this task with dignity and respect for the people being supported.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published November 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding and staffing. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

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 have identified breaches in relation to risk and quality assurance.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Barling Lodge is registered to provide accommodation and personal care for up to a maximum of 47 people. The service is set over two floors, with a large courtyard garden. On the day of our inspection, there were 11 people living at the service who required support with their physical and mental health needs.

People’s experience of using this service and what we found

At this inspection, we looked at all of the key questions and checked whether the provider had made the necessary improvements to ensure people were safe and received good quality care.

Improvements had been made to the service. This included people’s risk assessments and care plans, the environment, staff skills and training, people’s nutrition and hydration, access to healthcare and specialist services, staff communication and engagement with people and audits and quality assurance. However, further improvements were needed.

A quality assurance processes was in place and being monitored. However, the provider had introduced a significant number of new systems and processes which needed to be fully embedded to evidence that these new systems would continue to work effectively, be sustainable and improve the quality of life for people using the service.

We made a recommendation in the last report that the provider source the provision of training for staff in the Mental Capacity Act 2005. Whilst staff had undergone training in areas relating to their role, the provider was still in the process of sourcing this provision so the recommendation we made at the last inspection remains.

We made a recommendation in the last report that the provider seeks guidance from a reputable source in relation to end of life care. Whilst staff had undertaken training in end of life care, care plans were in the process of being updated with relevant details. This recommendation is to remain until improvements have been made.

There were limited opportunities for people to participate, engage or be involved in group or individual social and leisure activities and for them to access resources in the community.

We made a recommendation that the provider consider best practice guidance and resources to support people to pursue social and leisure interests of their choice.

People told us they were safe using the service. Risks to people’s health and safety were assessed and recorded and staff knew how to manage them to keep them safe. People were supported by enough staff who had been safely recruited. People’s medicines were safely managed by staff who were trained and competent. People were protected from the risk of infection as prevention and control measures were in place.

Staff received an induction, training and supervision and had relevant skills and knowledge to do their job. Improvements to the environment continued to be completed through an ongoing improvement plan. People had access to a range of food and drink which met their needs and preferences. Referrals to health care professionals were made in a timely way to maintain people's health and wellbeing.

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 who required support with decision making had access to advocacy services if required.

Staff were kind and caring and knew people well. Staff treated people with dignity and respect and maintained their privacy. People were encouraged to be as independent as possible and were supported to maintain important relationships.

People’s care are plans had been reviewed and updated and were more person centred. They outlined people’s physical, health and mental health needs, their wishes and preferences. Work was ongoing in updating and exploring people’s life histories. A complaints process was in place, with no outstanding complaints.

The director and their deputy manager were aware of their role and responsibilities and supported a consistent team of staff well.

Rating at last inspection

In November 2018, we undertook a comprehensive inspection and looked at all key questions. There were multiple breaches of the regulations. The service was rated as Inadequate and the report was published on 10 January 2019. We returned in February 2019 to follow up some concerns and Safe and Well led remained Inadequate. The report was published 14 May 2019. When we visited in June 2019, improvements had been made and Safe and Well led was rated as Requires improvement. The report was published 22 August 2019.

The provider completed an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The overall rating for the service has changed from Inadequate to Requires improvement. This is based on the findings at this inspection.

This service had been in Special Measures since 10 January 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Barling Lodge is registered to provide accommodation and personal care for up to a maximum of 47 people. The service is set over two floors, with a large courtyard garden. Barling Lodge does not provide nursing care. On the day of our inspection there were 13 people living at Barling Lodge, who required support with dementia and other physical and mental health needs.

People’s experience of using the service:

When we last inspected the service in February 2019, we were concerned for the safety and welfare of the people living at Barling Lodge. Therefore, at this inspection we checked whether the registered provider had made the necessary improvements to ensure people were safe and received good quality care. As a result, we undertook a focused inspection to review the ‘Key Questions’ of Safe and Well-led only. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

The quality of life of people living at the service had improved. The registered provider had addressed the areas of immediate risk which we had highlighted at our last inspection. However, the registered provider had not yet improved the checks they carried out on the safety and welfare of people at the service. We found there were areas of concern which had not been picked up, around the risk of choking, inconsistent care planning and continence care.

At our last inspection there had been a number of safeguarding concerns being investigated by the local authority. At this inspection, the number of alerts and concerns had reduced significantly. Many of the people with more complex needs and safeguarding concerns had now left the service. Therefore, the level of risk at the service had reduced.

Staff now involved people more in decisions about their care. However, they continued lack knowledge about the potential for unlawfully restricting people who lacked capacity to make decisions. We made a recommendation about improving skills and knowledge about the Mental Capacity Act (2005).

The registered provider had worked with the local authority to investigate safeguarding concerns. However, this was not yet a positive working partnership where the registered provider benefitted from best practice guidance and advice.

Staff knew people well. Care was more person centred and people were supported to remain active and stimulated. Care plans were being updated to provide more detailed guidance to staff.

There had been significant refurbishment to the premises, which helped minimise risk from the spread of infection. Although the property remained tired in some areas, the whole environment was more pleasant and comfortable. There was improved signage, to support people with memory loss living at the service.

Morale was positive at the service. Some staff had left, and new staff had been employed, who were helping drive improvements.

Rating at last inspection:

The service previously had a comprehensive inspection on 27 November 2018 and was placed into special measures with a rating of Inadequate. Special measures means we keep a service under review and, if we do not propose to cancel the provider’s registration, we re-inspect within 6 months to check for significant improvements. At the focused inspection of February 2019, the service was rated as inadequate in safe and well-led and continued to be in special measures. Since the last inspection we recognised that whilst the registered provider had started to address the most serious concerns some risks to people remained. There were continued breaches in some areas. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Why we inspected:

This was a focused inspection based on the previous rating of the service.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

People’s experience of using this service:

• People were not always being safely cared for. They were placed at risk of harm and abuse because there were not enough preventative measures taken to keep them safe.

• People who were dependent on staff to meet their needs were being failed by the service as the support provided did not always meet their needs.

• The provider's systems for monitoring and improving the quality of the service had not been effective, because people were not always receiving a good quality of service and risks had not been mitigated.

• The provider did not always act in accordance with the Mental Capacity Act 2005. Therefore, people had not consented to their care and treatment and decisions had not always been made in their best interests.

• The provider did not always comply with the terms and conditions of their registration by reporting significant events to us which they are required to do by law in a timely way.

• The service remains inadequate in keeping people safe, providing effective care and well-led.

Rating at last inspection: Inadequate (report published 10 January 2019)

Why we inspected: We undertook an unannounced focused inspection of Barling Lodge on 14 and 20 February 2019. We inspected the service against two of the five questions we ask about services: is the service well led and is the service safe.

At the time of the inspection, third parties informed us they were investigating another incident where there were concerns about the safety of a person. This information indicated potential concerns about whether the systems in place to protect people from the risk of abuse were sufficiently robust.

This inspection examined those risks. We also looked at quality assurance and governance systems. At this inspection we found continued breaches of Regulations 12, 13, 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; plus, a continued breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the last comprehensive inspection in November 2018 we identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was placed in special measures.

Enforcement: During our inspection we found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report.

Follow up: The overall rating for this registered provider remains 'Inadequate'. This means that it remains in 'Special Measures' by CQC.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will have contact with the provider and registered manager following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

The provider had not identified any of the concerns we found in this inspection which meant their quality assurance system was not robust enough to ensure quality and safety. Risk assessments based on recognised evidence were not used to prevent people being at risk of avoidable harm. These systems need to work together to improve the safety and quality of the service. There was a failure to ensure that people were protected from the risks associated with inadequate fire safety systems and processes. This meant that the safety and welfare of people using the service was at risk and the provider was failing to provide a safe service. In response to our findings we asked the provider to inform us immediately of the actions they would take with immediate effect to protect people and raise standards. During the inspection process we notified relevant stakeholders such as the local safeguarding authority and Essex Fire service of our findings.

Safeguarding procedures were not followed and appropriate referrals were not made to local authority. Staff we spoke with were not able to describe the different types of abuse and the signs they would look for that might indicate that a person was being abused and what they would do in response such as escalating concerns to the relevant authorities.

The provider was responsible for analysis of the accidents and incidents to identify patterns and trends and prevent a reoccurrence. However, we found that they had not identified or taken action to address the concerns found during our visit.

People's rights were not protected. The service did not always follow the Mental Capacity Act principles. Mental capacity assessments for specific decisions had not been completed and correct legal authorisation had not been updated when new restrictions were added to deprive people of their liberty.

People were not always supported by staff that had the necessary skills and knowledge to meet their needs.

Care plans did not always contain information related to people’s nutritional needs. People we spoke with were happy with the food.

People had care plans and risk assessments in place to support socialisation and engagement in activities. However, throughout our inspection we found a lack of interaction and stimulation for people.

We have made a recommendation that the service seeks appropriate guidance to ensure information is captured on care records related to people's preferences at the end of their life.

Staff we spoke with were positive about the registered manager. They told us they felt well supported and that the manager was approachable and always available to lend help and support.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 9 Regulated Activities Regulations 2014 - Person centred care

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Regulation 18 Regulated Activities Regulations 2014 - Staffing

Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Regulation 18 Registration Regulations 2009 – Notification of other incidents

Regulation 11 of the Health and Social Care Act HSCA 2008 (Regulated Activities) Regulations 2014.- Need for consent

Rating at last inspection: Good (report published 26 July 2016)

About the service: Barling Lodge provides accommodation for up to 47 persons who require personal care without nursing. This includes people living with dementia, learning difficulties and mental health issues. At the time of inspection 38 people were using the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: Action provider needs to take (refer to end of report).

Follow up: Due to level of risks identified from this inspection, we wrote to the provider under Section 31 of the Health and Social Care Act 2008, to request for provision of an action plan to address our concerns. We will continue to monitor progress made against this action plan and any regulatory action as an outcome of this full inspection report.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Barling Lodge is registered to provide accommodation and personal care without nursing for up to 47 persons who may be living with dementia and/or mental health issues. There were 38 people living in the service when we inspected.

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’s care and support was provided in a manner that ensured their safety and well-being. Staff had been safely recruited and employed in sufficient numbers to ensure that people received the care they needed. People were cared for by well trained and supported staff. People received their medication as prescribed and there were systems in place for receiving, administering and disposing of medicines.

The registered manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and had made appropriate applications when needed. Staff knew how to protect people from the risk of harm or abuse. They had received training and had access to guidance and information to support them with the process of safeguarding people. Risks to people’s health and safety had been assessed and the plans to manage them were appropriate to meet people’s needs. The service had care plans and risk assessments in place to ensure people were cared for safely.

People had sufficient amounts of food and drink to meet their individual and complex needs. People’s care needs had been fully assessed and their care plans provided staff with the information needed to meet their individual needs and preferences and to care for them safely. People’s healthcare needs were monitored and staff sought advice and guidance from healthcare professionals when needed.

People were cared for by kind and caring staff who knew them well. Staff ensured that people’s privacy and dignity was maintained at all times. People expressed their views and opinions and they joined in the activities of their choosing. People were able to receive their visitors at any time and their families and friends were made to feel welcome. Where people did not have family members to support them advocacy services were available. An advocate supports a person to have an independent voice and enables them to express their views when they are unable to do so for themselves.

People were confident that their concerns or complaints would be listened to and acted upon. There was an effective system in place to assess and monitor the quality of the service and to drive improvements.

The people using the service at the time of our inspection had complex needs which meant that they were limited in being able to tell us about their experiences. We spoke with two people using the service, five relatives and one visiting healthcare professional during our inspection.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service the manager greeted us and noted our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

Appropriate measures were in place to ensure security of the property, although we found concerns around the safety of the external environment. People had access to garden areas where they could spend quiet time, however these areas were not in all cases well maintained. We saw a range of equipment for people needing support and records showed us that these were maintained and serviced regularly to ensure they were safe to use.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service was aware of new changes in the law with regard to DoLS. Where applications had needed to be submitted, appropriate actions had been taken to safeguard people's rights. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People's care records showed that care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. People's health and care needs were reviewed which meant that staff were provided with up to date information in relation to any changes in people's needs to ensure they could meet them effectively.

From our observations and time spent at Barling Lodge we saw that the people staying there were receiving the care and support they needed in an individual way and wherever possible staff tried to facilitate choice.

Is the service caring?

The people we spoke with were happy with the care and support they were receiving and said they enjoyed staying at Barling Lodge. They said they were looked after well and the staff were very nice.

Records showed that people's healthcare needs were being met and that the staff acted promptly when any concerns were identified.

We saw that the staff interacted with people in a caring, respectful and professional manner. Staff understood people's individual needs and cared for their wellbeing. We saw that staff were patient and attentive to people's needs throughout our inspection; they interacted positively with people and gave them time to respond.

Is the service responsive?

During our inspection we saw people were engaged and interacted well with staff. They received care and support in accordance with their preferences, choices and diverse needs.

Is the service well-led?

The service had a registered manager in post. Staff told us that they felt well supported and were able to work towards additional qualifications in care. Records showed that staff received regular training relevant to their role.

Arrangements were in place that ensured there were sufficient staffing numbers, with appropriate skills, to meet the needs of people.

There were quality assurance systems, audits and records in place, however the manager had failed to recognise the issues relating to the environment. People and their carers were provided with the opportunity to feed back any information about the service.

Regular informal staff meetings were held every month and the staff and the provider told us that a range of topics were discussed and covered to improve delivery and quality of care for people, including any actions required from audits undertaken. However when we asked to see the minutes of these meetings we were told that minutes were not taken. The provider and manager might like to note that not taking notes of these meetings makes it very difficult to refer/reflect back on issues if problems subsequently arise. It also shows us when and where effective and sustained actions had been taken.