We inspected Barons Park Care on 13 February 2018. The visit was unannounced. This meant the staff and the provider did not know we would be visiting.

Barons Park Care provides nursing and accommodation for up to 46 younger and older people with complex, challenging and advanced forms of dementia and significant mental health care needs. Long term nursing care is also provided. On the day of our inspection there were 44 people living at the service. At the last inspection in January 2017, the service was rated ‘Requires Improvement’. At this inspection we found the service was ‘Good’.

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.

People told us they felt safe living at Barons Park Care. Relatives we spoke with agreed they were safe living there. People were kept safe from avoidable harm because the staff team understood their responsibilities. They had received training in the safeguarding of adults and knew what to look out for if they suspected someone was at risk of harm.

People’s needs had been identified and the risks associated with their care and support had been assessed and reviewed. There were arrangements in place to make sure action was taken and lessons learned when things went wrong, to improve safety across the service.

Appropriate pre-employment checks had been carried out on new members of staff to make sure they were safe and suitable to work at the service. Staff members had been suitably inducted into the service and relevant training had been provided to enable them to appropriately support the people living there. Suitable numbers of staff were deployed to meet people’s needs.

The staff team felt supported by the registered manager. They were provided with the opportunity to share their views of the service through, day to day discussion, supervision and appraisals. Team meetings were also held on a monthly basis.

People were supported with their medicines in a safe way. Systems were in place to regularly audit the medicines held and the appropriate records were being kept.

People were provided with a clean and comfortable place to live and there were appropriate spaces to enable people to either spend time with others, or on their own. The staff team had received training in the prevention and control of infection and the necessary protective personal equipment was available.

Plans of care had been developed for each person using the service and the staff team knew the needs of the people they were supporting well.

People told us the staff team were kind and they were treated in a caring and respectful manner. Observations made during our visit confirmed this. We observed the staff team treating people in a friendly, caring and considerate manner. They knocked on people’s bedroom doors before entering and if someone declined their offer of help, this was respected.

The staff team supported people to make decisions about their day to day care and support. They were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) ensuring people's human rights were protected. They supported people in making day to day decisions about their care and support. Where people lacked the capacity to make their own decisions, evidence was seen to demonstrate that decisions had been made for them in their best interest and in consultation with others.

People had access to relevant healthcare services and they received on-going healthcare support. Nutritional assessments had been carried out and people were supported to maintain a healthy, balanced diet. For people who had been assessed to be at risk of not getting the food and drink they needed to keep

This inspection took place on the 4 and 5 January 2017. The first day of our visit was unannounced.

Barons Park Care provides nursing and accommodation for up to 46 younger and older people with complex, challenging and advanced forms of dementia and significant mental health care needs. Long term nursing care is also provided.

The person managing the service was an acting manager. They were in the process of applying to be the 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.

Relatives of people living at Barons Park Care felt they were safe. The staff team were aware of what to do if they felt someone was at risk of avoidable harm and knew the process to follow should they feel that something needed reporting.

Risks associated with people’s care and support had been assessed. These assessments provided the management team with the opportunity to reduce and properly manage the risks presented to both the people using the service and the staff team.

Appropriate checks had been carried out when new members of staff had started working at the service. This was to check that they were suitable and safe to work there. An induction into the service had been provided for all new staff members and ongoing training was being delivered. This enabled the staff team to provide the care and support that people needed.

People’s feedback on the staffing numbers at the service varied. Some people felt that there were enough staff members on duty to meet people’s needs and keep them safe, others thought there were not. We noted during our visit that the staff team were not always suitably deployed to ensure that people’s needs were met in a timely manner.

People were receiving their medicines as prescribed by their doctor. Medicines were being appropriately stored and the necessary records were being kept. There were systems in place to audit the management of medicines and medicines were only administered by staff members who were competent and appropriately trained.

The staff team supported people to make decisions about their day to day care and support. Where people lacked the capacity to make their own decisions, we saw that decisions had been made for them in their best interest. The staff team were working in line with the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards.

Relatives we spoke with told us the meals served at Barons Park Care were good. People’s nutritional and dietary requirements had been assessed and a nutritionally balanced diet was being provided. For people who had been assessed to be at risk of not getting the food and fluids they needed to keep them well, records were kept showing their food and fluid intake. Though these were not always accurate.

On the first day of our visit we noted that some people’s experiences of mealtimes were better than others. This was because the staff team did not always interact well with those they were supporting. The second day however was better, with the staff team making sure that they spoke with the people they were supporting.

People were supported to maintain good health. They had access to relevant healthcare services such as doctors and opticians and they received ongoing healthcare support.

Relatives told us that the staff team were kind and caring and they treated their relative with respect. On the whole, we observed the staff team treating people with respect and when supporting them, did so in a kind and friendly manner.

Plans of care had been developed for each person using the service, though not all of these were up to date or accurate. The management team were in the process of reviewing the plans of care to address this is

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection. Barons Park Care provides accommodation and nursing care for up to 46 people. The service is divided into three areas and provides care for younger and older people with complex, challenging and advanced forms of dementia and significant mental health care needs.

At the last inspection in May 2013 the service was found to be fully compliant with the regulations we looked at.

On the day of the inspection there were 46 people living at the home. There was a registered manager in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs) and to report on what we find. We found the provider had acted in accordance with the DoLS legislation and had made appropriate applications to the supervisory body.

The service was taking action in recruiting permanent staff. Staff were deployed across the service and bank and agency staff used to cover shortfalls in the staffing levels. 

We found people had care plans and risk assessments in place and these were reviewed on a regular basis. People were supported to attend health appointments and the provider worked well with health care professionals. Information about how to meet people’s needs was person centred.

Throughout our inspection we observed staff to be caring and attentive to people’s needs. Staff showed dignity and respect and demonstrated a good understanding of people’s needs.

The provider made information available to people about how to make a complaint. Other useful and supportive information was available for people including information about advocacy services.

Activities were available and the staff and registered manager gave examples of how they intended to improve the activities available for people, this included a sensory room and reminisce work.

The provider had a range of quality audit systems in place that monitored the quality and safety of the service.

Many of the people using services had complex health and communication needs, but we were able to speak with four people. We used observation and the assistance of an expert by experience to seek people's views and comments. In addition we spoke with six visitors who were visiting their relatives.

The expert by experience reported everyone looked well cared for in terms of how they were dressed with clean clothes, good footwear and their hair combed, and where people wore spectacles they were clean. Clothing looked individual and people were dressed appropriately for the day. One person asked for a jumper and a member of staff quickly went to get one. Some people told us about their day, and that getting up and going to bed times were flexible. Some people told us about activities and outings they had been on in the mini bus. We saw a board displayed pictures that people had painted and a board with pictures and photographs of outings. People also told us about the greenhouse they had in the garden and how they were looking forward to grow tomatoes. One person was able to tell us that the catholic priest visited and others told me that they had a minister and hymn singing every few weeks. One person told us: "I really like the sing-alongs and the music and movement sessions we have, they help me to keep moving."

We spoke with five relatives and friends and two people using services. All the relatives and friends spoken with told us the care at Barons Park was good, staff and managers were excellent and had no complaints. One person told us they had just played dominoes with staff and were happy with their care.

We observed people in the home during the day. One person was having a manicure in one of the lounges. A member of staff was explaining the manicure to them and encouraging them to choose colours and talking and singing with the individual. Other people were seen drinking hot drinks independently or assisted by staff. We saw staff serve a hot and cold evening meal. People were helped to choose what they wanted and care was centred on their needs and preferences. The atmosphere was not rushed and staff were friendly and chatted to people as they served them.

Some people living at Barons Park Care had limited communication and were unable to answer direct questions about some of the essential standards we reviewed. We did speak with people in a general way and asked some questions. We spoke with two people and they told us that staff were nice and the food was good. We observed people and their interactions with each other and with staff.

Three visitors told us they were satisfied with the standard of care and cleanliness of the home and thought the food was excellent. They told us of regular social events organised by the home for relatives and carers. The next planned event was a cheese and wine evening. One visitor told us she found it useful to attend the Relatives Support Group as it gave her personal support. Another visitor told us how the home helped them with transport as they travelled a long way to visit their relative. They felt staff and managers were always helpful and approachable.