This inspection took place on 22 and 25 October 2018. The first day was unannounced.

Barton Brook Care Home provides nursing, personal care and accommodation for up to 120 older people. The home is owned by HC-One Oval Limited. Accommodation is provided in four single storey units with each unit housing up to 30 people. The units are called Moss (Residential Dementia), Monton (General Residential), Brindley (General Nursing) and Irwell (Intermediate Care). There is a large car park available at the front of the building.

At the time of the inspection there were 116 people living at the home, across each of the four units.

Barton Brook is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home was previously owned by Bupa and was sold to HC-One Oval Limited in February 2017 and ultimately re-registered with CQC; however the home retained its inspection history.

Our last inspection of Barton Brook took place in July 2017 when the home was rated as Requires Improvement overall and for the key questions Effective and Well-led. Safe, Caring and Responsive were rated as Good. At that inspection, we identified breaches of the regulations regarding safeguarding people from abuse and improper treatment and good governance (two parts of this regulation). We were sent an action plan following this inspection, which detailed improvements which would be made within the home to address the concerns.

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.

Medicines were managed administered, stored and recorded safely.

We found there were enough staff working on each of the units to care for people safely. Some staff spoken with said they felt more staff were needed on the units, however they felt this did not impact on the care people received.

The premises were being well maintained, with regular servicing checks of equipment and the building carried out. The home was clean and tidy throughout, with infection control procedures followed as required.

People who used the service and their relatives told us they felt the service was safe. There were appropriate risk assessments in place for people, with guidance on how to minimise risk. Staff recruitment was robust with appropriate checks undertaken before staff started working at the home.

We found staff received sufficient training, supervision/appraisal and induction to support them in their role. The staff we spoke with told us they were happy with the training they received and felt supported to undertake their work.

We found the home worked closely with other health professionals and made appropriate referrals if there were concerns. Details of any visits from other professionals were recorded within people’s care plans.

Appropriate systems were in place regarding deprivation of liberty safeguards (DoLS) and the mental capacity act (MCA).

People told us they enjoyed the food and we saw people being supported to eat and drink, throughout the day.

We received positive feedback from people we spoke with about the care provided at the home. Visiting relatives said they had no concerns with the care being delivered at the home. People said they felt treated with dignity and we observed staff treating people with respect during the inspection.

There were a range of different activities available to participate in and people told us there was enough to keep them occupied during the day.

We found complaints were responded to appropriately, with compliments also collated

We carried out this unannounced inspection of Barton Brook Care Home on 12 and 14 July 2017. This was the first inspection of Barton Brook Care Home since it had been re-registered with the Care Quality Commission in January 2017. The re-registration had taken place as a business entity to reflect changes to the providers named responsible people. This did not create any changes to the overall registration of the home.

Barton Brook Care Home is a large care home with 120 beds operated by Bupa. The home consists of four different units, each with 30 beds. Each of the units are known internally as Moss (Residential Dementia), Irwell (Nursing and Intermediate Care), Brindley (General Nursing) and Monton (General Residential). The home is situated in the Eccles area of Salford, Greater Manchester and at the time of the inspection, there were 119 people living at the home.

At the time of the inspection the home 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.

The feedback we received from staff and some visiting relatives was that staffing levels were not sufficient to meet the needs of people living at the home, particularly on the Brindley, Irwell and Moss Units. We were told there were enough staff on Monton unit. We have made a recommendation about staffing levels in the detailed findings of this report.

We found the home to be clean with appropriate infection control processes in place, with the home achieving a score of 93% during their last audit from Salford City Council. All of the toilets and bathrooms contained appropriate hand hygiene equipment and guidance, with personal protective equipment (PPE) readily available and worn by all staff when necessary.

Each person we spoke with told us they felt safe. Relatives were also satisfied with the safety of their family members, commenting positively on the good standard of care provided. The home had detailed safeguarding policies and procedures in place, with clear instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

The home had systems in place for the safe storage, administration and recording of medicines. The completion of the medication administration records(MAR) was done consistently and the home had effective systems in place for the administering of topical medicines. Staff authorised to administer medicines had completed the necessary training and had their competency assessed. Safe systems of working were also in place with regards to the administration of controlled drugs.

All staff demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We found DoLS applications were not always made in a timely manner when staff had identified that people lacked the capacity to make their own choices and decisions This presented the risk of people being detained or restricted without lawful authority.

Overall, staff were complimentary about the training provided by the home, regarding both induction and on-going refresher sessions. An online system was available which allowed staff to complete additional training in their own time. Staff told us they received reminders when refresher training was required to keep their skills and knowledge up to date.

Staff on the Brindley unit told us due to the care needs of two people living on the unit who presented with mental health needs, that training in this area would be