About the service: Barling Lodge is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided. On the day of inspection 30 people were using the service

People’s experience of using this service:

• People were not always being safely cared for. They were placed at risk of harm and abuse because there were not enough preventative measures taken to keep them safe.

• People who were dependent on staff to meet their needs were being failed by the service as the support provided did not always meet their needs.

• The provider's systems for monitoring and improving the quality of the service had not been effective, because people were not always receiving a good quality of service and risks had not been mitigated.

• The provider did not always act in accordance with the Mental Capacity Act 2005. Therefore, people had not consented to their care and treatment and decisions had not always been made in their best interests.

• The provider did not always comply with the terms and conditions of their registration by reporting significant events to us which they are required to do by law in a timely way.

• The service remains inadequate in keeping people safe, providing effective care and well-led.

Rating at last inspection: Inadequate (report published 10 January 2019)

Why we inspected: We undertook an unannounced focused inspection of Barling Lodge on 14 and 20 February 2019. We inspected the service against two of the five questions we ask about services: is the service well led and is the service safe.

At the time of the inspection, third parties informed us they were investigating another incident where there were concerns about the safety of a person. This information indicated potential concerns about whether the systems in place to protect people from the risk of abuse were sufficiently robust.

This inspection examined those risks. We also looked at quality assurance and governance systems. At this inspection we found continued breaches of Regulations 12, 13, 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; plus, a continued breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the last comprehensive inspection in November 2018 we identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was placed in special measures.

Enforcement: During our inspection we found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report.

Follow up: The overall rating for this registered provider remains 'Inadequate'. This means that it remains in 'Special Measures' by CQC.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will have contact with the provider and registered manager following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

What life is like for people using this service:

The provider had not identified any of the concerns we found in this inspection which meant their quality assurance system was not robust enough to ensure quality and safety. Risk assessments based on recognised evidence were not used to prevent people being at risk of avoidable harm. These systems need to work together to improve the safety and quality of the service. There was a failure to ensure that people were protected from the risks associated with inadequate fire safety systems and processes. This meant that the safety and welfare of people using the service was at risk and the provider was failing to provide a safe service. In response to our findings we asked the provider to inform us immediately of the actions they would take with immediate effect to protect people and raise standards. During the inspection process we notified relevant stakeholders such as the local safeguarding authority and Essex Fire service of our findings.

Safeguarding procedures were not followed and appropriate referrals were not made to local authority. Staff we spoke with were not able to describe the different types of abuse and the signs they would look for that might indicate that a person was being abused and what they would do in response such as escalating concerns to the relevant authorities.

The provider was responsible for analysis of the accidents and incidents to identify patterns and trends and prevent a reoccurrence. However, we found that they had not identified or taken action to address the concerns found during our visit.

People's rights were not protected. The service did not always follow the Mental Capacity Act principles. Mental capacity assessments for specific decisions had not been completed and correct legal authorisation had not been updated when new restrictions were added to deprive people of their liberty.

People were not always supported by staff that had the necessary skills and knowledge to meet their needs.

Care plans did not always contain information related to people’s nutritional needs. People we spoke with were happy with the food.

People had care plans and risk assessments in place to support socialisation and engagement in activities. However, throughout our inspection we found a lack of interaction and stimulation for people.

We have made a recommendation that the service seeks appropriate guidance to ensure information is captured on care records related to people's preferences at the end of their life.

Staff we spoke with were positive about the registered manager. They told us they felt well supported and that the manager was approachable and always available to lend help and support.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 9 Regulated Activities Regulations 2014 - Person centred care

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Regulation 18 Regulated Activities Regulations 2014 - Staffing

Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Regulation 18 Registration Regulations 2009 – Notification of other incidents

Regulation 11 of the Health and Social Care Act HSCA 2008 (Regulated Activities) Regulations 2014.- Need for consent

Rating at last inspection: Good (report published 26 July 2016)

About the service: Barling Lodge provides accommodation for up to 47 persons who require personal care without nursing. This includes people living with dementia, learning difficulties and mental health issues. At the time of inspection 38 people were using the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: Action provider needs to take (refer to end of report).

Follow up: Due to level of risks identified from this i

The Inspection took place on 27 and 29 June 2016 and was unannounced.

Barling Lodge is registered to provide accommodation and personal care without nursing for up to 47 persons who may be living with dementia and/or mental health issues. There were 38 people living in the service when we inspected.

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.

People’s care and support was provided in a manner that ensured their safety and well-being. Staff had been safely recruited and employed in sufficient numbers to ensure that people received the care they needed. People were cared for by well trained and supported staff. People received their medication as prescribed and there were systems in place for receiving, administering and disposing of medicines.

The registered manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and had made appropriate applications when needed. Staff knew how to protect people from the risk of harm or abuse. They had received training and had access to guidance and information to support them with the process of safeguarding people. Risks to people’s health and safety had been assessed and the plans to manage them were appropriate to meet people’s needs. The service had care plans and risk assessments in place to ensure people were cared for safely.

People had sufficient amounts of food and drink to meet their individual and complex needs. People’s care needs had been fully assessed and their care plans provided staff with the information needed to meet their individual needs and preferences and to care for them safely. People’s healthcare needs were monitored and staff sought advice and guidance from healthcare professionals when needed.

People were cared for by kind and caring staff who knew them well. Staff ensured that people’s privacy and dignity was maintained at all times. People expressed their views and opinions and they joined in the activities of their choosing. People were able to receive their visitors at any time and their families and friends were made to feel welcome. Where people did not have family members to support them advocacy services were available. An advocate supports a person to have an independent voice and enables them to express their views when they are unable to do so for themselves.

People were confident that their concerns or complaints would be listened to and acted upon. There was an effective system in place to assess and monitor the quality of the service and to drive improvements.

The inspection took place on the 30 December 2014 and was unannounced.

Barling Lodge provides accommodation for up to 47 persons who require personal care without nursing. This includes people living with dementia, learning difficulties and mental health issues. At the time of our inspection 35 people were using the service.

The service has 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 the last inspection on 1 August 2014, we asked the provider to take action to make improvements to the safety and suitability of premises and to their quality monitoring. During this inspection we looked to see if improvements had been made and progress sustained

People were cared for safely in an environment that had been recently refurbished.

Staff had been recruited safely after appropriate checks had been completed.

Records were regularly updated and that staff were provided with the information they needed to meet people’s needs. People's care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were safeguarded from the potential of harm and their freedoms protected. The registered manager was up-to-date with recent changes to the law regarding DoLS and knew how to make a referral if required.

Staff were attentive to people's needs. Staff we spoke with were able to demonstrate that they knew people well. Staff treated people with dignity and respect.

People were provided with the opportunity to participate in activities which interested them. From talking to people and staff we saw that these activities were diverse to meet people’s social needs.

The service worked well with other professionals to ensure that people's health needs were met People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including a doctor, chiropodist and district nurse.

People knew how to make a complaint, any complaints were resolved efficiently and quickly.

The service had a number of ways of gathering people’s views from talking with people, staff, and relatives and from using surveys.

The manager carried out a number of quality monitoring audits to ensure the service was running effectively and to drive improvements.

Prior to our inspection we received concerns relating to people's care and welfare particularly relating to do with the provision of fluids. We also received concerns about the environment.

The people using the service at the time of our inspection had complex needs which meant that they were limited in being able to tell us about their experiences. We spoke with two people using the service, five relatives and one visiting healthcare professional during our inspection.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service the manager greeted us and noted our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

Appropriate measures were in place to ensure security of the property, although we found concerns around the safety of the external environment. People had access to garden areas where they could spend quiet time, however these areas were not in all cases well maintained. We saw a range of equipment for people needing support and records showed us that these were maintained and serviced regularly to ensure they were safe to use.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service was aware of new changes in the law with regard to DoLS. Where applications had needed to be submitted, appropriate actions had been taken to safeguard people's rights. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People's care records showed that care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. People’s health and care needs were reviewed which meant that staff were provided with up to date information in relation to any changes in people’s needs to ensure they could meet them effectively.

From our observations and time spent at Barling Lodge we saw that the people staying there were receiving the care and support they needed in an individual way and wherever possible staff tried to facilitate choice.

Is the service caring?

The people we spoke with were happy with the care and support they were receiving and said they enjoyed staying at Barling Lodge. They said they were looked after well and the staff were very nice.

Records showed that people's healthcare needs were being met and that the staff acted promptly when any concerns were identified.

We saw that the staff interacted with people in a caring, respectful and professional manner. Staff understood people's individual needs and cared for their wellbeing. We saw that staff were patient and attentive to people's needs throughout our inspection; they interacted positively with people and gave them time to respond.

Is the service responsive?

During our inspection we saw people were engaged and interacted well with staff. They received care and support in accordance with their preferences, choices and diverse needs.

Is the service well-led?

The service had a registered manager in post. Staff told us that they felt well supported and were able to work towards additional qualifications in care. Records showed that staff received regular training relevant to their role.

Arrangements were in place that ensured there were sufficient staffing numbers, with appropriate skills, to meet the needs of people.

There were quality assurance systems, audits and records in place, however the manager had failed to recognise the issues relating to the environment. People and their carers were provided with the opportunity to feed back any information about the service.

Regular informal staff meetings were held every month and the staff and the provider told us that a range of topics were discussed and covered to improve delivery and quality of care for people, including any actions required from audits undertaken. However when we asked to see the minutes of these meetings we were told that minutes were not taken. The provider and manager might like to note that not taking notes of these meetings makes it very difficult to refer/reflect back on issues if problems subsequently arise. It also shows us when and where effective and sustained actions had been taken.