We carried out this unannounced inspection on 30 August 2017.

Barham Care Centre is a nursing home which provides accommodation and support to older people and those living with dementia. The service can accommodate a maximum of 44 people. On the day of our inspection there were 27 people using the service and two of those people were in hospital.

Our last inspection of 13 May 2016 we rated the service as requiring improvement overall. This was because we found the service was not meeting the requirements in relation to safety, providing an effective service and we had concerns about how the service was led. We received an action plan from the service explaining how the service would resolve these issues which we used to plan this inspection and check that the improvements had been made.

At this inspection we found the service had taken the necessary action to resolve the issues identified in 2016.

The service had 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.

Since our last inspection the registered manager had established themselves into their management position. They had addressed the issues identified with medicines administration and recording, safe recruitment practice, standards of cleanliness in the kitchen and ensuring quality and safety systems were established and operated effectively.

The registered manager used a dependency tool to identify the number of staff required to be on duty to meet the assessed needs of the people using the service. We found there were sufficient staffing of qualified nurses and care staff to meet people’s identified needs. Nursing staff with the support of the team leaders organised the care to be provided to each person by the staff team.

Risks to people’s safety were identified and managed. Staff had received training in managing risk and how to provide a safe environment for people.

Staff received training in safeguarding and were aware of what actions they should take to safeguard people from potential, actual abuse and knew what actions to take to promote people’s safety and well-being.

There was now a robust staff recruitment policy and procedure in operation. This was operated to ensure only suitable staff were employed. Once employed staff were supported by an induction and regular supervision and appraisals were provided. Training was organised to develop and maintain staff skills including the nursing staff who had all revalidating their qualification. The management team were supported by regular visits from the company director.

There were suitable arrangements for the safe storage, management and disposal of medicines. There was a process and procedure in place for the recording of topical creams and lotions. All of the staff administering medicines had received training in the administration of medicines.

The service had been extended and refurbished since our last inspection including the renovation of the kitchen. There were regular environmental checks in place in operation for the entire service.

Staff were knowledgeable with regard to Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service had made referrals and worked with the local authority to support people who used the service with regard to MCA and DoLS.

People had their nutrition and hydration needs met through effective planning and delivery of nutritious menus. Menus were varied and took into account people’s dietary preferences.

The service had built up an effective and supportive relationship with the general practitioner service.

People’s privacy and dignity were respected by staff who were familiar with their needs and took into acc

This inspection took place on the 13 May 2016 and was unannounced.

Barham Care Centre is a nursing home which provides accommodation and support to older people and those living with dementia and other specialist care needs including nursing. The service can accommodate a maximum of 34 people. On the day of our inspection there were 24 people who were using the service.

There was 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.

At our last inspection in August 2015 we had moderate concerns about the safe handling of people’s medicines and the lack of robust and effective audits which would identify and respond to medication errors. We asked the provider to send us an action plan describing how they would make improvements. The provider sent us an action plan which described the action they would take to ensure compliance.

At this inspection we found some improvement. There were improved systems in place with clear records and regular management monitoring audits of stock against administration records. Where previous errors had been identified there was a clear system for logging, reporting and actions described in responding to errors in a timely manner. We found that there were detailed medication profiles in place which described the medicines prescribed, the reasons for this and a description of how people chose to receive their medicines including information as to any allergies people might have. However, further work was needed as we were not assured that people prescribed topical creams and lotions had received their medicines as prescribed.

The provider did not always operate safe and effective recruitment procedures which would ensure that all satisfactory checks had been completed and satisfactory before staff started their employment.

Care staff appeared knowledgeable about the care needs of the people they supported. They demonstrated their understanding of the needs of people living with dementia and what to do when people became distressed and reacted in a way that may present a risk to themselves or others.

Infection control monitoring within the service was satisfactory as control measures had been introduced in some areas. However, people were not protected and others from the risks associated with the unsafe management of food and ineffective cleaning regimes in the main kitchen.

People and their relatives were positive when describing the culture of the service. People told us staff treated them with kindness and compassion and that they had positive relationships with their care workers. They also expressed confidence in the management of the service.

There was sufficient staff available to meet the needs of people. Staff had access to training relevant to the roles they were employed to perform. Staff received regular supervision including nursing staff clinical supervision and regular staff meetings.

The provider did not have effective systems and processes in place to ensure the quality and the safety of the service was effectively monitored. The provider’s system for auditing the quality and safety of the service did not identify the shortfalls we found at this inspection.

The management team and provider expressed a commitment to develop the service. This was evident during our feedback to the provider and immediately following our inspection where the provider sent us information describing the actions they had taken in response to shortfalls we identified.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version

This inspection took place on the 5 August 2015 and was unannounced.

Barham Care Centre is a care home with nursing which provides accommodation and support to older people and those living with dementia and other specialist care needs. The service is registered to accommodate a maximum of 34 people. On the day of our inspection there were 27 People living at the service.

The service 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.

Whilst the service carried out risk assessments which identified people at risk of falls, malnutrition and acquiring pressure ulcers there was insufficient guidance with actions for staff to take in monitoring and mitigating risks to people’s health, welfare and safety.

We found medicines were stored safely for the protection of people who used the service. However, the management of people’s medicines was found to be inconsistent in ensuring people received their medicines as prescribed and assessed to ensure they received their medicines according to their needs, wishes and preferences.

People were treated with kindness, compassion and respect and staff protected people’s right to privacy.

People were protected from the risk of abuse as staff had received training, understood how to respond and report appropriately where they had concerns. Risks to people had been assessed but care planning with guidance and actions for staff was limited in planning to mitigate the risks to people from pressure ulcers.

There was no effective system in place to record that checks of call bells had been carried out. We were therefore not assured that steps had been taken to ensure people were able to summon help at all times if they needed it.

Staff received training in recognising abuse and were able to describe various types of abuse and how they would respond if they had concerns. The registered manager understood the responsibilities of their registration with the Care Quality Commission (CQC) and local safeguarding protocols in accordance with the requirements of their registration.

Feedback was sought from people and their relatives and used to improve the care people received. People knew how to make a formal complaint and complaints were taken seriously and addressed in a timely manner.

We spoke with four people who used the service. One person told us, “I feel well looked after, the staff are good and the food is OK”. One person told us, “It is alright here, but I can’t be bothered to join in activities, I prefer to spend my time in my room”. We received mixed feedback about the quality of the food. Three out of the four people spoken with told us that the food was OK. One person told us that they did not like the meals as they were used to having traditionally cooked meals, made from scratch and using fresh ingredients”. Three people told us that there cups of tea was served cold.

We spoke with three relatives about the quality of the service their relatives received. One relative commented, "Overall, I am very happy with the care, I have no issues, good care and nice staff who treat my relative well”. Another person told us that, “This is a good service, the staff are very good, really caring and helpful, my Mum hasn’t looked so well for ages”. They commented, “On the whole it is a lovely little home”. A third relative commented, “The nurses and staff are lovely”. Two relative’s told us that the new manager had listened and had taken action to resolve issues that they had raised with them about their relative’s care. They also told us that staff were good at keeping them informed about their relatives health.

Overall we found that people who used the service had their privacy and dignity respected and experienced care and support that met their individual needs. Where people did not have the capacity to consent to care, the provider had acted in accordance with legal requirements set by the Mental Capacity Act (MCA) 2005.

Although we found that there were enough qualified, skilled and experienced staff on duty, people spoken with and their relatives told us there were times when they could not find a member of staff. One relative stated that, “They could do with more staff at certain times of the day, such as meal times”. Another relative told us that staffing was an issue at the home, as “Sometimes I am unable to find a member of staff, and my relative waited so long for a member of staff to answer their call bell they had not been able to get to the toilet in time, which they had found very distressing”.

We spoke with nine people using the service and four relatives. People said they were able to choose how and where they spent their time and were generally satisfied with their care. One person told us that staff, “Respect my right to make my own choice of how I spend my time”. This person told us that they were kept informed about health matters and that they were involved in decisions about their care.

One person, who had recently moved to the service, told us that staff had helped them to feel safe. They told us that the staff were very nice and that they, "Couldn’t fault the service”. One person told us, “I enjoy being at Barham Care Centre. One person told us, “I am happy here and the staff are really good”.

A relative told us that they felt their next of kin looked so much better than when they had arrived a few weeks before and was obviously well cared for. One relative was very positive in their view of the service. They described the care and support their relative had received “As a positive experience” following an emergency admission to the service. They said that, “My next of kin has regained their confidence and has improved so much since being here, the staff do as much as possible to make them feel secure and supports them to make choices about their own care”. The relative told us that, “Staff were accessible and ready to discuss any concerns”. One relative commented, "The standard of care at Barham Care Centre as very high".

Three people told us that they were happy with the service they received at Barham Care Centre. Comments included, “The food is good and I am well looked after” and “The staff are polite and more than nice to me”. One person commented that, “The food is alright and I have nothing to complain about”.

A relative told us “The carers are very caring”. However, they told us that they felt there could be more activities, as there was not a lot of stimulation. Although, they said, “Today was lovely with the bell ringers”. They also commented that, “My relative would like to be involved in a reminiscence group, as they used to enjoy talking about the past”. One relative commented on the amount of people who sat in wheelchairs during the day. They commented, “I can’t see why they can’t be transferred into comfortable arm chairs”.

We observed that staff were genuinely caring and demonstrated genuine affection for the people they were supporting. It was clear from our discussions with staff that they enjoyed their work and wanted to do their best for the people living there. Despite this, we found care records were not being audited or reviewed. This meant that people were at risk of receiving care and treatment that was inappropriate or unsafe.

The people that were spoken with during a visit to the home stated that they were happy with the care and that they felt that the staff looked after them well.

Family members spoken with during a visit to the home confirmed that staff provide good care that relates to the individual person and are very helpful