The Care Quality Commission
  • Care Home
  • Care home

Archived: Barnetts

Overall: Good read more about inspection ratings

Frant Road, Tunbridge Wells, Kent, TN2 5LR (01892) 542983

Provided and run by:
Avante Care and Support Limited

All Inspections

26 and 27 May 2015

During a routine inspection

The inspection was carried out on 26 and 27 May 2015 by two inspectors and an expert by experience. It was an unannounced inspection. The service provides personal care and accommodation for a maximum of 39 older people. There were 28 people living there at the time of our inspection, 27 of who lived with dementia. Most of the people living in the service were able to express themselves verbally, others used body language.

There was a manager in post who was registered with the Care Quality Commission (CQC) on 11 March 2015. A registered manager is a person who has registered with the CQC 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.

At our last inspection on 17 February 2015, we found that appropriate records for people were not always maintained and some records were not accessible. We asked the provider to take action to make improvements to the service’s records and documentation and at this inspection we have found that all remedial action had been taken.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of re-occurrence could be reduced. There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. There were safe recruitment procedures in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

All fire protection equipment was serviced and maintained. People’s bedrooms were personalised to reflect their individual tastes and personalities.

Staff knew each person well and understood how to meet their support needs. People told us, ““The staff know what I like” and, “They [the staff] understand me”.

Staff’s training was renewed annually, was up to date and staff had the opportunity to receive further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions and were scheduled for an annual appraisal to ensure they were supporting people based on their needs and to the expected standards.

The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005 requirements.

Staff sought and obtained people’s consent before they helped them.

The service provided meals that were in sufficient quantity and met people’s needs and choices. Staff knew about and provided for people’s dietary preferences and restrictions.

Staff communicated effectively with people, responded to their needs promptly, and treated them with kindness and respect. People were satisfied about how their care and treatment was delivered. One person told us, “The staff are so kind they listen and are very respectful”.

People were involved in their day to day care. People’s care plans were reviewed with their participation and relatives were invited to attend the reviews and contribute.

Clear information about the service, the facilities, and how to complain was provided to people and visitors. Menus and the activities programme were provided for people in a suitable format which made them easy to read.

People were able to spend private time in quiet areas when they chose to. People’s privacy was respected and people were assisted in a way that respected their dignity.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People’s individual assessments and care plans were reviewed monthly with their participation and updated when their needs changed.

People were involved in the planning of activities. A broad range of activities and outings was available.

The service took account of people’s feedback, comments and suggestions. People’s views were sought and acted on. The registered manager sent annual satisfaction questionnaires to people’s relatives or representatives, analysed the results and acted upon them. Staff told us they felt valued under the manager’s leadership.

The registered manager notified the Care Quality Commission of any significant events that affected people or the service. The registered manager kept up to date with any changes in legislation that may affect the service and carried out comprehensive audits to identify how the service could improve. They acted on the results of these audits and made necessary changes to improve the quality of the service and care.

17 February 2015

During an inspection looking at part of the service

Our inspection team was made up of one inspector and followed up on areas of non-compliance in relation to records identified during our last inspection on 19 May 2014. The provider wrote to us and told us they would take action to address the shortfalls by 30 September 2014. During the inspection we spoke with two staff, one person who lived at the service and one relative. The registered manager of the service was not present during the inspection.

We considered all the evidence we had gathered under the outcome we inspected which included areas of non-compliance. We used the information to answer the following questions; is the service safe? Is the service effective? Is the service responsive? Is the service well led?

Below is a summary of what we found.

Is the service safe?

There were recording systems in place to monitor health and safety within the service. Records showed that annual fire risk assessments were carried out at the service. The service had a procedure to follow in the event of foreseeable emergencies.

People were not always protected from the risks of unsafe or inappropriate care and treatment because records such as care plans and risk assessments were not always maintained.

Is the service effective?

People's individual preferences were recorded and taken into account when activities were arranged. One person told us they liked to walk around in the garden. This was written in the person's care plan.

Where people preferred not to take part in activities, this was documented accordingly.

People were not always asked for their consent as part of the care planning process.

Records were not always kept to show people's end of life wishes.

Positive feedback from people using the service demonstrated that the service was effective.

Is the service responsive?

People's preferences were recorded and acted upon and people were actively encouraged to pursue interests and hobbies.

Records were kept of people's activities. This showed that people were involved in various activities at the service and trips out.

We found that people's needs were not always assessed before they moved into the service.

Is the service well-led?

We found that senior managers did not always respond to concerns that had been documented which they were aware of, such as the monitoring of toilet cleaning and the updating of care plans.

There were systems in place to monitor people's health and the safety of the service. Audits of people's care records were completed.

There were recording systems in place to monitor staff training and when updates needed to be completed.

Records were kept of resident's meetings and staff meetings. People's feedback was recorded using surveys and there was a process in place to take people's views into account to improve the quality of service provided.

19 May 2014

During a routine inspection

Our inspection team was made up of two inspectors. We considered all the evidence we had gathered under the outcomes we inspected that included an area of non-compliance identified during previous inspections. We used the information to answer the five questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found

Is the service caring?

Our observations showed that people had a positive experience of their care and appeared happy, settled and relaxed. They were provided with the support they needed and were able to seek assistance from staff when they needed it.

Staff used touch in an appropriate way to provide warmth and reassure people who were distressed or confused. A relative we spoke with told us 'The staff are very pleasant and kind to me and my [relative]'. A visiting healthcare professional told us that the staff were 'Saints', adding 'They are all very patient and look after them well'.

Is the service responsive?

We saw that people's needs were assessed before they moved into the service. We saw that staff recognised and responded to people's needs, for example a staff member went to get a pillow to place to the side of a person who was leaning to make them more comfortable.

One person's records we looked at showed that their doctor had recommended monitoring their fluid intake to ensure they took a certain amount of fluid. This was in response to a health need. The fluid monitoring charts had been completed consistently.

There was flexibility in staffing levels depending on people's dependency. For example, one person had needed additional support from staff for a period of time and records showed that this was provided by the service to ensure the person's needs were met.

There was evidence that learning from incidents and investigations took place and appropriate changes were implemented.

Is the service safe?

There were systems in place to monitor health and safety within the service. Records showed that regular checks related to fire safety were carried out at the service. People were cared for in a clean, hygienic environment. We saw the most recent infection control audit carried out on 25 April 2014. An action plan had been developed to address identified shortfalls and we saw that work was underway to address these. There were enough qualified, skilled and experienced staff to meet people's needs.

People were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained and therefore not always able to be located promptly.

Is the service effective?

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Staff respected people's choices in relation to their care. One person's records showed that they often chose not to go to bed until the early hours of the morning. The records showed that staff had respected their decision and made them comfortable in the lounge.

People's care was planned and delivered in line with their individual care plan. One person's care plan showed how a doll was to be used to provide the person with comfort and how they liked to be involved in domestic tasks. We saw the person caring for the doll during the inspection.

Is the service well led?

There were systems in place to monitor the quality of service delivery. These included meetings with people living at the service, their relatives and staff. We saw that there was a complaints process in place and this had been followed. There were systems in place to monitor staff training and competency.

25 February 2014

During a themed inspection looking at Dementia Services

At the time of our inspection there were 31 people using the service, all of whom had a diagnosis of dementia. In addition to the dementia themed inspection to look at outcomes 4, 6 and 16 we also checked on two compliance actions that had been issued at a previous inspection. The first was for outcome 4 for the management of dehydration risks, falls risks, pressure area risks and responding to behaviours that challenge. The second was for outcome 8 for the management of the risk of infection in the service. We had also received information of concern about the management of medication and therefore included outcome 9 in this inspection.

During the inspection we spoke with eight people that used the service, seven members of staff and three visitors. Everyone using the service, that was able to speak with us, told us that they were happy and felt safe in the service. One visitor told us 'It is a nice atmosphere here, it's busy with people to watch and see'. Our observations found that people were treated with respect and staff were responsive to their needs. Staff knew people well and knew what was important to them.

We found that people had their needs assessed and planned for in a way that ensured their welfare and safety. The care provided was individualised and met people's needs, taking account their right to dignity and privacy. There were systems in place for monitoring the quality of areas of the service and the risks to people had been assessed and managed effectively. There were improvements to the way falls, the risk of dehydration and the risk of pressure areas were managed.

We found that improvements had been made to the way the risk of infection was managed in the service, but there were still shortfalls identified in the cleaning of commodes.

We found that people were supported to manage and take their medicines in a safe way.

8 November 2013

During an inspection looking at part of the service

Following our previous inspection the provider submitted an action plan to tell us how they were going to improve the service. They told us that this would be achieved by the 31 December 2013.

We issued a warning notice which we told the service they must be compliant with by 22 October 2013. The provider wrote to us and told us this would be the case. We issued the notice because we had concerns about the care provided to people using the service. This included concerns about adequate nutrition, managing aggressive behaviour, reducing the risk of falls, meeting people's healthcare needs and effectively planning their care. The purpose of this inspection was to check that the provider had taken action following the warning notice. We found that although they have made some progress towards addressing the issues in the warning notice, they had not met them all. Some of the people whose care we raised particular concerns about in the warning notice no longer lived in the home. We have asked the provider for an updated action plan and we will carry out a further inspection to determine their compliance with the whole of this outcome.

20 September 2013

During an inspection in response to concerns

This was a responsive inspection following information of concern that we received about the care that was being provided to people who use the service. We had also identified areas of non-compliance at our previous inspection that we wanted to check the service had complied with.

At our previous inspection in May 2013 we found that the care records did not contain a comprehensive plan of the care that should be provided to ensure that people's needs were met. At this inspection we looked at five care records. We found that although the care plans had been reviewed, they did not take account of people's needs and there were gaps in assessments and care plans, such as for falls and managing aggressive behaviour, that put people using the service at risk.

At our previous inspection in May 2013 we had concerns about the management of infection control in the service. At this inspection we found that although the service had taken steps to improve infection control, there were still concerns about adequate cleaning procedures, and effective systems to reduce the risk of cross contamination.

The provider had previously notified us that the registered manager had been absent since January 2013, and this continued at the time of our inspection.

10 May 2013

During a routine inspection

We weren't able to speak directly to people using the service about their experience because of communication difficulties created by their dementia. We gathered evidence of people's experiences of the service by observing care. We saw some positive examples of staff engaging with and respecting people.

There was a flexible programme of activities that encouraged people to engage. This included music and dancing. We saw that people's healthcare needs were met. However, it was not always clear from the care records what their care plan was, and if this had been updated to ensure people got the correct care when their needs changed.

There were processes in place to reduce the risk and spread of infection. However, there were gaps and inconsistencies in these that may put people at risk.

There were enough skilled and experienced staff to meet people's needs.

29 June 2012

During a routine inspection

We were not able to speak with people about their care, because they had complex needs which meant they were not able to tell us directly about their experience of using the service. We gathered evidence of peoples' experience of the service by observing the care they received and speaking with some relatives.

We used a number of different methods to help us understand the experiences of people using the service as some people had complex needs which meant they were not always able to tell us about their experiences themselves. As well as speaking with people we observed how people interacted with staff, we spoke with staff and the registered manager, and read documents and records including care plans and health records.

We observed and were told by relatives that people's care needs were attended to. The relatives we spoke with said that the home contacted them when there were changes to their family member's condition. We observed that people were treated with respect by staff.

On the day of the inspection a band performed in the home, and many of the people using the service, and some of their relatives, attended. We observed people showing positive body language, which included smiling and laughing to show they enjoyed the music. One person told us they liked going to the Cog Club, which was run by the day service and provided activities for people with dementia.

Most people in the home had a single room, many of which were personalised with photographs or belongings. A relative told us that they had brought in furniture for the person to have in their room in order to help personalise their personal space.

The people we spoke with and their relatives were positive about the staff, and said that they were helpful and friendly. One of the relatives we spoke with said that the staff always seemed to be busy, but there was usually someone available if you wanted to speak with them.

23 November 2011

During a routine inspection

People who lived in the home experienced dementia and were not able to engage directly with the review process. People who we spoke with told us they liked being in the home.

During our visit to the home we observed and spoke with people in communal areas to see how people experienced life in the home. We found that overall people had positive experiences. The staff supporting them knew what support they needed and they respected their wishes if they wanted to manage on their own.