Barrington House provides residential care for up to 21 people with learning disabilities. The home cared for adults and older people. However, most people were over 65 or close to this age group. People’s needs were varied and included support with general age-related conditions. Some people had more specialist needs associated with dementia, diabetes, autism and epilepsy. Whilst some people could tell us their experiences of living at Barrington House, others had complex communication needs and required staff who knew them well to meet their needs. We observed that people were happy and relaxed with staff. Accommodation was provided on the ground and first floor. Only ambulant people could use the first floor but the provider was in the process of getting quotes to have a stairlift installed.

The care service has been in operation a long time and the building was therefore not developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. The building could not easily be adapted so it is difficult for the service to meet these standards.

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.

This is the second time the home has been rated requires improvement. At the last inspection there were breaches of regulations 9,11,12 and 17 and requirement notices were issued. The breaches were in relation to a lack of assessment of people’s social needs, a failure to give appropriate consideration to Deprivation of Liberty Safeguards (DoLS) requirements, a lack of assessment of the risks to people’s health and safety and doing all that is reasonably practicable to mitigate any such risks and a failure to ensure that accurate record keeping was in place and to ensure actions were taken to mitigate risks. We asked the provider to complete an action plan to show improvements they would make, what they would do, and by when, to improve the key questions in safe, effective, responsive and well led to at least good.

This comprehensive inspection took place on 16 and 17 May 2018 to check the provider had made suitable improvements to ensure they had met regulatory requirements. We found the home was meeting legal requirements in relation to DoLS. However, we identified there were continuing breaches of Regulations 9,12 and 17. This was because we could not be sure people were receiving person centred care, recommended exercises had not been carried out, risks to people’s care were not always addressed and record keeping was not always up to date or accurate. We made a recommendation to ensure people’s dignity.

Since the last inspection the provider had introduced a new computer package and documentation had gradually been transferred since January 2018. Not all documentation was in place at the time of inspection. Staff had varying levels of skill in using the package. The result meant a distortion in record keeping in some areas so it was difficult to assess records as a reliable source of information and this affected the provider’s ability to monitor the service adequately. It was recognised that additional time was needed to ensure full training on the package and to fully embed progress made into everyday practices.

People told us they were happy and although we observed some negative practices we also observed staff interactions that were very positive and that staff treated people in a caring and kind manner. People told us they would talk to their keyworkers if they had any worries or concerns. The home ensured people’s spiritual needs were met. One person told us their keyworker was, “Very important to me. Tomorrow we are going into tow

Barrington House provides accommodation for up to 26 people with learning disabilities. There were 17 people living at the home at the time of our inspection. The home cared for younger adults and older people. However, most people were over 65 or close to this age group. People’s needs were varied and included support with general age related conditions. Some people had more specialist needs associated with dementia, diabetes, autism and epilepsy. Whilst some people could tell us their experiences of living at Barrington House, others had complex communication needs and required staff who knew them well to meet their needs. We observed that people were happy and relaxed with staff.

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.

At our last inspection in August 2014 we issued a requirement notice in relation to staff levels between 6-8pm. We received an action plan from the provider that told us how they would make improvements. At this inspection we found that although records did not show that there was always sufficient staff on duty, all staff confirmed that this was the case.

On the first day of our inspection we assessed that people’s dignity had been compromised. People’s hairbrushes were not clean and toothbrushes did not look as if they had been used. There was no effective system in place to monitor that people’s oral hygiene needs had been met. During our inspection new hairbrushes and toothbrushes were bought and by the second day of our inspection there was a new system to monitor daily that people’s hairbrushes were cleaned and that people’s oral hygiene needs had been addressed.

We identified further areas that required improvement. Some of the staff team had not received appropriate training to meet people's needs. This was particularly evident in relation to specialist training for diabetes, dementia and epilepsy. Although staff felt supported on an informal basis the systems for ensuring staff received regular supervision were not always effective.

Some staff did not have a clear understanding of the Deprivation of Liberty Safeguards (DoLS) and whilst they knew some people had a DoLS in place or that one had been applied for, they were not clear about others. (A DoLS is used when it is assessed as necessary to deprive a person of their liberty in their best interests and the methods used should be as least restrictive as possible).

There was a lack of risk management in terms of fire safety and ensuring that people who needed support to leave the building in the event of a fire could do so safely. Risk assessments did not always included detailed information. For example, there was no advice in one person’s care plan about how staff should support the person if they displayed behaviours that challenged.

There was a lack of individual assessment and planning to ensure that some people’s recreational and social needs were met and there was a heavy reliance on the use of TV as an activity. When activities were provided they were not always recorded so it was not possible to accurately assess the numbers and types of activities available.

There was a lack of monitoring in place to identify that record keeping in many areas such as staff training and supervision, staff rotas, care plans and health and safety documentation were accurate and up to date. Some matters such as menus, and monitoring of personal care had been identified as areas to improve but the monitoring systems that had been put in place to address these areas had not been effective.

Despite these shortfalls people told us they were happy with the care they received. Staff were kind and caring and they had dev

We carried out this unannounced 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.

Barrington House provides care for up to 26 people with learning disabilities. At the time of our inspection there were 18 people accommodated. The home cared for younger adults and older people. However, most people were over 65 or close to this age group. People’s needs were varied and included support with general age related conditions. Some people had more specialist needs associated with dementia, autism and epilepsy. Although some of the people had communication difficulties and were not able to tell us their experiences, they were happy and relaxed with staff.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home and has the legal responsibility for meeting the requirements of the law; as does the provider.’ Barrington House was last inspected on 4 July 2013 and there were no concerns.

Staff levels were assessed as appropriate with the exception of a period of two hours four evenings each week when there were only two staff on duty. This limited the number of activities that could be offered to people on these shifts. Two people needed support from two staff with personal care which meant that if they required support there would be no staff in the lounge to assist other people.

We observed care in the dining room at lunchtime. A lack of consistency and continuous staff presence in the dining room at lunchtime meant that for one person the mealtime experience was disjointed and was not a pleasurable experience.

The manager provided good leadership and support to the staff. Throughout our inspection, staff were positive about the home, they said there was good teamwork and they felt supported.

Staff knew how to recognise any signs of abuse and how they could report any allegations. Any risks to people’s safety had been assessed and managed to minimise risks. People told us they felt safe. One person said, “I can talk to the manager if I have any worries, but the place is happy and that makes me happy. Me and the deputy manager get on so well and we all have a laugh.”

Staff attended regular supervision meetings and felt well supported by the management of the home. Staff meetings were used to ensure that staff were kept up to date on the running of the home and to hear their views on day to day issues. Staff were also able to feedback their views through annual questionnaires. All staff received training to fulfil the duties of their role and more specialist training was also offered to ensure that staff met the needs of people.

Care plans were comprehensive. They had been reviewed regularly and people confirmed that staff had read the care plans to them and made sure they understood the contents. Within each person’s care plan there was detailed information about how best to communicate with the person. Staff were knowledgeable about people’s needs and were clearly able to explain how they made sure they understood the choices made by people with limited verbal communication skills.

People were happy with the activities provided. Records showed that people had opportunities to participate in a wide range of activities and that regular entertainment was provided at the home. Some people attended day centres and people told us that they could participate in activities that they enjoyed. For example, one person enjoyed rug making and another enjoyed baking cakes.

Staff were caring and treated people with respect and dignity and it was evident that people and staff had good relationships. Feedback from visitors to the home on the day of our inspection was positive. For example, a complimentary therapist told us that there was a, “Good community feel to the home, people always seem happy and I’ve never had any concerns.”

There was a clear management structure and staff and people felt comfortable talking to them about any issues and were sure that any concerns would be addressed. There were systems in place to monitor the safety and quality of the service provided. People and relatives were regularly consulted by the provider using surveys and meetings.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.