This inspection took place on 27 and 29 November 2018 and was unannounced. This meant the provider and staff did not know we would be visiting.

The service was last inspected in October 2017 and was rated requires improvement. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at that inspection, in relation to safe care and treatment (safety checks not being completed) and good governance. We took action by requiring the provider to send us plans and timescales for improving the service. At this inspection we saw improvements had been made to the safety checks in the home and the governance in relation to these.

Barrington Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Barrington Lodge accommodates up to 70 people across four separate areas, each area caters for a group of people with similar needs, such as for people living with a dementia or with nursing needs or with both.

At the time of our inspection 49 people were living at the service.

The service does not have 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. The last registered manager ended their registration, as the registered manager of this home, on 29 October 2018. There was a newly appointed manager in the home but they had yet to be registered with CQC.

We identified breaches of regulation in relation staffing, meeting nutrition and hydration needs and good governance which meant continuing and sustained improvements were needed.

People told us there were generally enough staff on duty and that their needs were attended to promptly. On occasion, however, people told us they had to wait for care. We observed there to be sufficient staff on duty during our visit to ensure people had their care delivered in a timely way.

People received their medicine safely and were supported to access the support of health care professionals when needed. We identified an issue with the safe storage of medicines that was rectified immediately.

Where risks were identified to people who used the service, or to the environment, these were assessed and plans put in place to reduce them. The environment was monitored to ensure its safety and cleanliness. Accidents and incidents were analysed to identify trends and reduce risks.

People’s needs had been assessed to identify their care needs. Assessments were detailed and covered all aspects of their care needs, however, we found one occasion where assessments did not contain accurate or current information about the person’s needs.

Staff did not always feel well supported and did not have regular formal support, such as supervision, so that they could discuss their performance and development. Staff received training but this was not always specific to the needs of the service.

People were complimentary about the meals provided. Adapted diets were catered for and choices offered, however, we found that processes did not always ensure people were having adequate food and fluid.

The environment did not always meet the needs of people using the service. Improvements to this were planned.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they thought the service was very caring and we observed compassionate and caring interactions between people and staff. People told us, and we observed, that

Barrington Lodge Care Home provides accommodation for people with nursing and personal care needs. The home can accommodate up to 70 people. At the time of our inspection there were 58 people using the service. The home is on two floors. People can access garden areas, communal lounges and dining rooms.

This unannounced inspection took place on 9, 10, 16 and 20 October 2017.

At the last inspection carried out in August 2015, we rated the service as overall “Good” and found the provider was meeting relevant regulatory requirements.

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 the time of the inspection there was no registered manager in post. A new manager had subsequently been appointed but had since left the service. The regional manager told us they were in the process of recruiting a manager. During our inspection, the home was being managed by one of the provider’s resident experience support managers. This type of manager provides support to care homes where there is no manager present.

We found fire checks and other maintenance checks had not been carried out as prescribed by the provider in order to keep people safe and ensure the home environment was safe. There had not been a maintenance person employed in the home for some months. The manager agreed to address this issue and begin the recruitment process for a new maintenance person.

Systems were in place to monitor the quality of the service. People were routinely asked for their views. Actions plans were put in place to improve the service when required. However, we found the daily monitoring of the service failed to identify the deficits with cleanliness, storage and the positioning of alarm bells that we found during the first day of our inspection. Following the first day of our inspection the manager addressed the shortfalls in cleanliness and they also ensured emergency pull cords in toilets and bathrooms reached floor level for people to use if they had experienced a fall, and bathrooms were no longer used as storage for equipment.

The food in the home was appetising. Staff knew what people liked to eat. At mealtimes staff were very busy serving meals to people both in the dining room and in people’s bedrooms. We found improvements could be made to the meal time arrangements so staff could support and encourage people to eat.

People were protected from the risk of abuse because the staff in the home understood their responsibility to keep people safe and the actions they needed to take if they were concerned a person may be at risk of harm.

People’s care plans were up-to-date and accurate. We found these were person centred and contained detailed information to enable staff to deliver personalised care to people living in the home. Staff regularly reviewed the plans.

The manager spoke with us about the numbers of staff they expected to have on duty. We reviewed the rotas and found there were enough staff on duty to meet people’s care needs.

The provider had a complaints policy in place. Complaints made to the service had been thoroughly investigated and a response had been provided to the complainant.

Work to implement the provider’s framework on dementia had yet to be started. The regional manager explained the plan was to implement the framework when a new manager was appointed.

We found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff approached people with kindness and engaged them in conversation using humour and banter. We found people’s dignity and privacy were respected by staff.

Records

The purpose of this inspection was to find out five key questions. 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. The summary is based on our observations during the inspection, seeking experience and views from people who used the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and 'in good hands'. The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application for Deprivation of Liberty should be made, and how to submit one. There were effective systems in place where people did not have capacity and best interest decisions were made through a multi-agency approach.

The service was not clean and hygienic. Appropriate guidance, equipment and facilities were not in place for staff so people were not safe and protected from the risks associated with cross infection. We have told the provider improvements are necessary.

Is the service effective?

People's health and welfare was not always protected and promoted although we do recognise the service had sought expertise and support from other health and social care services that people required, in order to meet their needs effectively.

People did not always receive appropriate care and support because there were not effective systems in place to assess, plan, implement, monitor and evaluate people's needs.

Is the service caring?

We saw that staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. We saw people were receiving care and support in a sensitive way during our visit however staff were not always able to manage behaviours that were complex or challenging.

The manager, deputy manager and staff were knowledgeable about people's lives before they moved into the home. There was interaction between staff and people in the home; everyone was relaxed, happy and comfortable in each other's company.

People were positive about their experiences. Comments included "They are all lovely and very kind", "It's not like being at home but it will do" and "The home is wonderful, I am very well looked after".

Is the service responsive?

Systems were in place to make sure that the manager, deputy manager and staff learnt from significant events including accidents and incidents. Audits helped determine why a particular incident may have happened and what further action was required to help prevent reoccurrence.

Is the service well-led?

The manager, deputy manager and staff continued to look at the needs of people who used the service and ways to improve these for people. It was evident the manger was committed to ensuring people received care which was safe and effective but we did find shortfalls in auditing and care planning which meant people's needs were not always met in a safe and effective way. We told the manager and provider improvements were necessary.

We asked people if they were asked for their consent to care and treatment. Comments included “They always ask first if it’s alright”, “If I need medication they always ask first” and “I get the best staff in here, they don’t do anything without my say so.”

People told us they were happy with the care provided. Comments included “Staff are very good to (relative’s name)”, “The home is as good as the staff and the staff are good”, “I am happy and I would not change a thing” and “The staff are smashing, I am happy here.”

People were satisfied with staffing levels. One person said “If I pull the bell they come straight away.” Another person said “The staff are in and out of (relative’s) bedroom all the time.”

We found the provider requested feedback from people who used its services, relatives and staff, and took action to address any concerns.

We found records were up to date and securely held.

At our last inspection carried out in October 2012 we identified concerns with the cleanliness of the home. During this follow-up inspection we looked around the home. This was to see if it was kept clean and cross infection minimised. We looked in the communal lounge and dining rooms and found they were clean. We looked at equipment such as wheelchairs and commodes that were provided to help meet people's mobility needs. We saw the majority of this equipment was clean. However, we saw one shower chair was stained underneath. We informed staff and it was cleaned immediately.

Two of the shower rooms had damaged tiles and flooring. The manager told us they were both due to be refurbished in the following weeks.

There were nominated infection control leads within the home. We spoke with staff and they were aware of the measures to be taken to reduce the risk of cross infection.

We spent time observing how staff supported people living at the home. We found staff were very respectful in their approach, treating people with dignity and courtesy. People we spoke with said they were happy with the staff, one person said “The staff are brilliant here, they meet (relative’s name)’s needs”, another said “I like the girls, they are very helpful”.

We had received some information of concern which suggested staff were getting people up and dressed in the early hours of the morning. We therefore began our inspection at 6.30am. We saw the majority of people throughout the home were still in bed at this time.

We had also received some information of concern relating to an ongoing problem with cases of Clostridium Dificile Infection (CDI). CDI is a type of bacterial infection that can be passed out of the human body and can survive for many weeks on objects and surfaces. During our inspection we looked around the home. This was to see if it was kept clean and cross infection minimised. We saw numerous areas of the home were unclean.

We spoke to seven staff, they told us without exception they felt supported. They said they felt able to approach management if they had any concerns or training needs and were listened to. One person said “I feel able to ask if I want more training”.

People were made aware of the complaints policy. There was a copy on display in the reception area and it was also stated within the Service User guide.

People and their visitors commented positively on the care service provided at this home. One relative said, “The staff are always friendly. They always take time to talk to me and my mum about her care.”

Relatives were pleased to be able to continue in sharing the care of the people who lived here. One visitor told us, “I come everyday and they are happy for me to feed her at mealtimes. It gives me a chance to still be involved in her care.”

One person told us, “The service here is marvellous.” Another person told us, “The staff are always popping into my room to see if I want anything.”

People told us that the care service had improved their health. One person said, “It’s the first time in a long time that I’ve been able to gain a bit of weight. The food is lovely.”

A visitor told us, “This home was highly recommended to me because of the standard of care. They know each person and how to care for them, even when they are distressed or angry.”

One relative described improvements to the service since the home worked towards a special award for dementia care service, called the PEARL award. They said, “It’s significantly changed over the past year – it’s much quieter and people seem to be more settled. Staff spend more time with people.”

The people we spoke with made positive comments about the accommodation. One person said, “I’m very pleased with my room. It’s just the right size for me. I’ve got some of my own things and pictures of my family.”

People and their visitors made many positive comments about the staff. One visitor told us, “We wanted a place here because we had heard good things about the nursing care, but all the staff here are well trained.”

One person said, “Staff always make time to talk with me.” Another person said, “The staff are lovely – very friendly and very patient.”

People told us that they were always asked for the views about menus, activities, and future events. Some people said that they had been asked for their views more formally through surveys from the provider.

People and their visitors told us that they had information about the home including how to make a complaint if necessary.

This inspection took place on 20 and 21 August 2015 and was unannounced. This meant the staff and the provider did not know we would be visiting.

Barrington Lodge Care Home is located on the outskirts of Bishop Auckland, County Durham. It provides nursing and residential care and can accommodate up to 70 people. On the day of our inspection there were 63 people using the service. The home was spacious and suitable for the people who used the service. The home was clean, tidy and well maintained, with no unpleasant odours.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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.

On 8 May 2014 we completed an inspection and informed the provider they were in breach of a number of regulations including care and welfare, cleanliness and infection control and assessing and monitoring the quality of the service. The provider submitted an action plan in June 2014.

Whilst completing this visit we reviewed the action the provider had taken to address the above breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that the provider had ensured improvements were made in these areas and these had led the home to meeting the above regulations.

People who used the service and their relatives were complimentary about the standard of care at Barrington Lodge Care Home. Without exception, everyone we spoke with told us they were happy with the care they received.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Training records were up to date and staff received supervisions and appraisals.

There were appropriate security measures in place to ensure the safety of the people who used the service. The provider had procedures in place for managing the maintenance of the premises.

The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home and there were plans to ensure the home was more suitably designed for people with dementia type conditions including improved lighting, signage and colours.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We looked at records and discussed DoLS with the registered manager, who told us that there were DoLS in place and in the process of being applied for. We found the provider was following the requirements in the DoLS.

We saw mental capacity assessments had been completed for people and best interest decisions made for their care and treatment. We also saw staff had completed training in the Deprivation of Liberty Safeguards.

People were protected against the risks associated with the unsafe use and management of medicines.

We saw staff supporting and helping to maintain people’s independence. People were encouraged to care for themselves where possible. Staff treated people with dignity and respect.

People had access to food and drink throughout the day and we saw staff supporting people in the dining room at meal times when required.

The home had a programme of activities in place for people who used the service.

All the care records we looked at showed people’s needs were assessed. Care plans and risk assessments were in place when required and daily records were up to date. We saw staff used a range of assessment tools and kept clear records about how care was to be delivered.

We saw people who used the service had access to healthcare services and received ongoing healthcare support. Care records contained evidence of visits from external specialists.

The provider consulted people who used the service, their relatives, visitors and stakeholders about the quality of the service provided.