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Inspection Report

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Barrowhill Hall

Barrow Hill, Rocester, Uttoxeter, ST14 5BX Tel: 01889591006

Date of Inspection: 10 July 2013 Date of Publication: July 2013

We inspected the following standards as part of a routine inspection. This is what we found:

Consent to care and treatment Met this standard

Meeting nutritional needs Met this standard

Cleanliness and infection control Met this standard

Management of medicines Met this standard

Safety and suitability of premises Met this standard

Staffing Met this standard

Assessing and monitoring the quality of service provision

Met this standard

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Details about this location

Registered Provider MOP Healthcare Limited

Registered Manager Mrs. Suzanne Scholz

Overview of the service

Barrowhill Hall can provide personal care and accommodation to 45 people, they are registered to provide nursing care. Barrowhill Hall can support people with mental health and dementia care needs.

Type of service Care home service with nursing

Regulated activities Accommodation for persons who require nursing or personalcare

Treatment of disease, disorder or injury

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Contents

When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'.

Page

Summary of this inspection:

Why we carried out this inspection 4

How we carried out this inspection 4

What people told us and what we found 4

More information about the provider 5

Our judgements for each standard inspected:

Consent to care and treatment 6

Meeting nutritional needs 8

Cleanliness and infection control 9

Management of medicines 11

Safety and suitability of premises 12

Staffing 13

Assessing and monitoring the quality of service provision 14

About CQC Inspections 16

How we define our judgements 17

Glossary of terms we use in this report 19

Contact us 21

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Summary of this inspection

Why we carried out this inspection

This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection.

This was an unannounced inspection.

How we carried out this inspection

We looked at the personal care or treatment records of people who use the service, carried out a visit on 10 July 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We sent a questionnaire to people who use the service, talked with people who use the service, talked with carers and / or family members and talked with staff. We received feedback from people using comment cards and talked with commissioners of services.

What people told us and what we found

This inspection was unannounced which meant the provider and the staff did not know we were coming. Thirty three people were in residence when we undertook our inspection. We spoke with four people living in the home, three visitors, three visiting professionals, five staff and the registered provider. People spoke well of the home, one person using theservice said, "I have settled here, it is very nice, the staff are friendly and kind."

We found people were safe because the staff were given clear instructions, support and guidance. One relative had recorded on a comment card, 'My relative is safe in your care because everything is excellent.'

We saw people were treated with care and compassion and the staff responded well to their needs or concerns.

We saw the home could demonstrate how arrangements to seek people's consent to care or treatment had been agreed in the person's best interests.

We looked at the cleanliness and suitability of the environment to ensure people lived in a home where the décor and infection control standards were appropriate. We found the home was clean, safe and well maintained.

We saw medicine was managed effectively and was stored, handled and administered safely.

We found the service was well led because the registered manager supported the staff team and managed risks to the service effectively.

You can see our judgements on the front page of this report.

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More information about the provider

Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions.

There is a glossary at the back of this report which has definitions for words and phrases we use in the report.

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Our judgements for each standard inspected

Consent to care and treatment Met this standard

Before people are given any examination, care, treatment or support, they should be asked if they agree to it

Our judgement

The provider was meeting this standard.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Reasons for our judgement

During our inspection we saw that staff gained verbal consent from people using the service for their day to day care. People were asked where they wished to sit and what they wanted to do. People who could speak with us confirmed that the staff asked their permission before supporting them to do something. One person we spoke with told us, "The staff are kind and spend time with me, they have a bit of banter too." This meant that the provider acted in accordance with people's wishes and people were asked for their consent prior to any care, support or treatment.

On the day of our inspection we looked at two Do Not Attempt Resuscitation records (DNAR) for people who did not have the capacity to make this decision. We looked at these records to review how people had been supported to make this specific decision. We saw that a capacity assessment had been carried out as required. A capacity assessment determines whether people are judged to have the capacity to make a specificdecision. This meant there was an assessment available to determine how this judgement about the person's capacity had been made.

The DNAR's had been signed by the doctor as required and there was information available to demonstrate that other people had been involved in the decision making process. The provider may wish to note that records did not always clearly demonstrate that other people had the authority to do this. Records did not show whether the relative had lasting power of attorney (LPA) to enable them to make decisions about people's health and welfare as legally agreed. Where people do not have the capacity to make a specific decision an LPA can be authorised to make decisions on their behalf, as long as they are in the person's best interests, which is known as a best interest decision.

We saw the staff had received training on the Mental Capacity Act 2005. This Act sets out who can take decisions, in which situations, and how they should go about this. The staff we spoke with understood that an assessment needed to be carried out to determine a person's capacity and this assessment should only be related to a specific decision. This meant that staff had been provided with the necessary information to have an

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understanding on how to support people to make decisions.

We found that support and guidance had been offered to staff to help them better understand and manage behaviours that challenged the service. We found clear reporting or recording of incidents of behaviours that challenged the service and these were monitored. This meant individual's needed were fully considered.

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Meeting nutritional needs Met this standard

Food and drink should meet people's individual dietary needs

Our judgement

The provider was meeting this standard.

People were protected from the risks of inadequate nutrition and dehydration.

Reasons for our judgement

We observed the lunchtime experience and found that people were provided with a choice of suitable and nutritious food and drink.

Menus identified two choices of main course at lunch and two choices for the evening meal. Drinks were served at regular intervals throughout the day and we observed a rangeof hot and cold drinks were available.

People had their nutritional needs screened on admission and risk assessments were completed. Staff told us how they monitored people at nutritional risk. They also described how they involved other professionals and what actions they took to alter diets to accommodate treatment and advice. We saw that referrals to dietician's had taken place and visits from them were documented.

We saw information was available in the kitchen to demonstrate who required a fortified or pureed meal, or any known allergies and dislikes. This meant the staff had the information they needed to support people appropriately.

We observed the lunchtime experience and found that people were supported to eat and drink sufficient amounts to meet their needs. Staff supported people to eat in a sensitive way and at a pace appropriate for the person's needs. The provider may wish to note that the level of engagement differed, and some staff did not sit an on chair whilst supporting the person but knelt on the floor. This meant some people were assisted in the most appropriate way. We heard one member of staff say, "I have your fish pie here, with potatoes and vegetables, would you like me to help you?" They then continued with encouragement and support throughout the meal. This meant the person using the servicehad a positive and relaxed experience.

We saw that new menu boards had been provided with clear words and pictures to help people know what food was available each day. This meant people had suitable information to support them with choice.

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Cleanliness and infection control Met this standard

People should be cared for in a clean environment and protected from the risk of infection

Our judgement

The provider was meeting this standard.

People were cared for in a clean, hygienic environment.

Reasons for our judgement

We saw there were policies and procedures in place to support staff in maintaining a cleanenvironment. The staff told us they undertook infection control training on an annual basis and this was booked for July 2013. Staff we spoke with talked knowledgeably about the systems that they used to ensure good hygiene. The registered manager told us there wasan 'Infection control' lead for the home. This meant there were clear lines of accountability.

We spoke with the infection control lead who told us, "There is never any smell here, we have had a complete revamp, everything is new. It's lovely now and easier to keep clean. We all know what role we have to do, we have a staff meeting once a month and all work together."

We saw infection control audits took place and were recorded. Where action was needed this was documented and signed off when completed. This meant the provider could demonstrate improvements were made when required. The provider may wish to note that the system for cleaning the commodes could be improved upon to minimise the risk of cross infection.

We saw toilets and bathrooms were clean and adequately stocked with hand washing equipment, we saw foot operated bins were in place to minimise the risk of cross infection.This demonstrated that people were cared for in a clean, hygienic environment.

The environment was free of odours and rooms, equipment and carpets were clean. A visitor told us, "It is always clean. Someone is always mopping or cleaning whenever I come." A visiting professional said, "The home is so much cleaner, I have noticed a big improvement."

Cleaning schedules were in place and included daily and weekly tasks; these covered all areas of the home to ensure suitable standards of cleanliness were maintained. Staff we spoke with had a good understanding of hygiene practices and were aware of the need to use gloves and aprons to protect people from cross infection.

We visited the laundry area and saw there were designated clean and dirty areas as required. We saw skips, mops and buckets were colour coded so they were only used in

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the designated areas. Any laundry that was soiled or could not be handled was placed in appropriate bags and washed separately. This meant suitable systems were in place to manage people's laundry effectively.

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Management of medicines Met this standard

People should be given the medicines they need when they need them, and in a safe way

Our judgement

The provider was meeting this standard.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Reasons for our judgement

We looked at the way medicines were managed to check that people were receiving their medicines safely and as prescribed. The service had secure systems in place to demonstrate medication was managed in a safe and suitable manner.

We saw staff administering medicines after lunch in a safe way. They offered the medicines, and watched the person take them before signing the medication administration record (MAR).The medication trolley was brought to the dining room so that the medicines could be administered close to where people were sitting. This meant potential risks were minimised.

We looked at the medication record for people who had 'as and when required' (PRN) medication, and saw that a protocol was in place. These demonstrated the decision making processes for PRN medication, to validate when medicines were administered. Providing a protocol ensured the staff had clear information on why and when to provide certain medication. This meant the staff had clear instructions to follow.

We checked two people's records and found the records and the amount of medication in the home tallied. This meant the provider could be confident the amount of medication recorded was available in the home and a suitable auditing system was in place. The provider may wish to consider purchasing a device to assist in knowing how many tablets were available within the bottle. Presently the staff have to count the tablets by eye, which may not be accurate.

We saw the room temperature in the medication storage area was recorded and within therequired temperature range. This meant that staff could be certain that medication had been stored as required by the manufacturer. We saw medication was also safely stored inthe fridge within the correct temperature range; bottles had been labelled when opened. This meant the staff knew how long the medications could be used for.

We checked two people's controlled drugs records and saw information was accurate. Thismeant controlled medication was suitably recorded and managed.

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Safety and suitability of premises Met this standard

People should be cared for in safe and accessible surroundings that support their health and welfare

Our judgement

The provider was meeting this standard.

People who use the service, staff and visitors were protected against the risks of unsafe orunsuitable premises.

Reasons for our judgement

We found the atmosphere in the home was welcoming and people using the service were positive and happy.

We saw the environment had improved significantly over the last 12 months. A visiting professional told us, "There is a better feel here, there have been many change. It is so much cleaner and well appointed." People informed us their bedrooms were comfortable and personalised, lockable facilities were provided. This meant people had rooms decorated to their preference and privacy was maintained

The home offered colour coding in areas of the home to support people with dementia, and signage and pictures were available to assist people to various areas of the home. Wesaw there was orientation available for people to ensure they knew where they were. This meant people using the service were supported within the environment to feel safe and orientated.

We saw information was offered to people in written and pictorial format, including the menu and activities provided. We saw the information was accurate and reflected what occurred on the day of our inspection. This meant the information was up to date and meaningful.

We saw maintenance checks were carried out and servicing such as hoists, water testing and portable appliance tests were completed as required. This meant people were living ina safe and well maintained environment.

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Staffing Met this standard

There should be enough members of staff to keep people safe and meet their health and welfare needs

Our judgement

The provider was meeting this standard.

There were enough qualified, skilled and experienced staff to meet people's needs.

Reasons for our judgement

We saw there were enough qualified, skilled and experienced staff to meet people's needs. During the inspection there were seven care staff on duty, one nurse, the registered manager, and two clerical, domestic and kitchen staff. This meant there were sufficient staff to support people using the service in a relaxed and calm manner.

We observed the staff throughout the day and saw there was always staff available in the lounge areas, people were supported discreetly and in a compassionate and caring manner. This meant people using the service did not have to wait or become distressed if they required care, support or treatment.

We asked, one person how quickly the staff answered their call bell. They said, "They come quickly, I don't have to wait long at all." Another person told us, "The staff look after me, I like them." A visitor said, "I'm impressed, it's been the right choice, all the staff are lovely."

During lunch, we observed there were sufficient staff to support people who required assistance with their meal. The staff also took time to sit with people and we heard some of the staff engage in polite and meaningful conversation. This meant people using the service were given the time, encouragement and support necessary to enjoy their meal.

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Assessing and monitoring the quality of service provision

Met this standard

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care

Our judgement

The provider was meeting this standard.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

Reasons for our judgement

People using the service and their representatives were asked for their views about the care and treatment they received. We saw that surveys and meetings had been used to seek the views of people using the service and their representatives. One person wrote, 'It is an outstanding professionally run establishment.' Another questionnaire recorded, 'Sincethe care home was taken over, the manager has made many improvements and continuesto do so.'

We saw the survey responses had been analysed by the registered manager. The provider may wish to note that the action plan following the analysis should be made available to people using the service to demonstrate any changes made to improve outcomes for people.

We spoke with one relative who told us when issues were raised they were responded to. They said, "If I have been concerned over anything it is always discussed. I can go to any of the staff, they always want to try and make it right. Communication is very good."

We saw a newsletter was offered on a regular basis to keep families and people using the service updated. This covered events, new staff, birthdays and other important information. This meant people felt involved and included. We spoke with five staff who all spoke positively about the registered manager. Their comments included, "The manager has turned it around. We all know what is going on andunderstand things so much better. We get brilliant support." Another staff member said, "I get absolute support, the manager is positive and engaging. I am so happy here; it is the best place I have ever worked." This meant staff felt included and supported and were wellled by an effective manager.

We saw that the registered manager analysed accidents and incidents to identify any common themes or trends and could offer examples of how action had been taken to improve outcomes for people.

We saw the provider offered plenty of literature and information to support people using the service and their families. The homes statement of purpose, information on local

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support groups, and leaflets about dementia, deprivation of liberty and the Mental CapacityAct 2005 were available in the foyer. This meant people were able to keep fully informed and received signposting to other professionals.

We found evidence that the staff checked records on a daily basis and were given the timeto read people's care records. This meant staff were provided with the information they needed to deliver consistent care and regular checks to ensure records were up to date were carried out.

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About CQC inspections

We are the regulator of health and social care in England.

All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care.

The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as "governmentstandards".

We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming.

There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times.

When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place.

We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it.

Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to re-inspect a service if new concerns emerge about it before the next routine inspection.

In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers.

You can tell us about your experience of this provider on our website.

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How we define our judgements

The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection.

We reach one of the following judgements for each essential standard inspected.

Met this standard This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made.

Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action.We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete.

Enforcement action taken

If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range ofactions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecutinga manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people.

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How we define our judgements (continued)

Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact.

Minor impact – people who use the service experienced poor care that had an impact ontheir health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly.

Moderate impact – people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly.

Major impact – people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly

We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards.

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Glossary of terms we use in this report

Essential standard

The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant numberof the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe theessential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are:

Respecting and involving people who use services - Outcome 1 (Regulation 17)

Consent to care and treatment - Outcome 2 (Regulation 18)

Care and welfare of people who use services - Outcome 4 (Regulation 9)

Meeting Nutritional Needs - Outcome 5 (Regulation 14)

Cooperating with other providers - Outcome 6 (Regulation 24)

Safeguarding people who use services from abuse - Outcome 7 (Regulation 11)

Cleanliness and infection control - Outcome 8 (Regulation 12)

Management of medicines - Outcome 9 (Regulation 13)

Safety and suitability of premises - Outcome 10 (Regulation 15)

Safety, availability and suitability of equipment - Outcome 11 (Regulation 16)

Requirements relating to workers - Outcome 12 (Regulation 21)

Staffing - Outcome 13 (Regulation 22)

Supporting Staff - Outcome 14 (Regulation 23)

Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10)

Complaints - Outcome 17 (Regulation 19)

Records - Outcome 21 (Regulation 20)

Regulated activity

These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided.

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Glossary of terms we use in this report (continued)

(Registered) Provider

There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'.

Regulations

We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009.

Responsive inspection

This is carried out at any time in relation to identified concerns.

Routine inspection

This is planned and could occur at any time. We sometimes describe this as a scheduled inspection.

Themed inspection

This is targeted to look at specific standards, sectors or types of care.

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Contact us

Phone: 03000 616161

Email: enquiries@cqc.org.uk

Write to us at:

Care Quality CommissionCitygateGallowgateNewcastle upon TyneNE1 4PA

Website: www.cqc.org.uk

Copyright Copyright © (2011) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with thetitle and date of publication of the document specified.