The inspection took place on 10 and 11 January 2017 and was unannounced on the first day. The home is a purpose-built, three-storey property set in its own grounds in a residential area close to the town centre. There were bedrooms on the ground and first floors. Communal areas were all on the ground floor, with staff and service areas in the basement. The service is registered to provide accommodation and nursing or personal care for up to 30 people and 22 people were living there on the first day of the inspection, and 23 on the second day.

We last inspected Barnston Court on 17 December 2015 and found that overall the home required improvement. We found a breach of Regulation 19 of the Health and Social Care Act 2008 because the provider had not always followed robust recruitment processes and made every effort to gather all available information to confirm that the person seeking employment was of good character.

The home had a manager who had applied to be registered with the Care Quality Commission. 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.

There were enough qualified and experienced staff to meet people’s needs and keep them safe. Some shifts were covered by agency staff. The required checks had been carried out when new staff were recruited.

We found that the home was clean and well maintained and records we looked at showed that the required health and safety checks were carried out. Medicines were managed safely and records confirmed that people always received the medication prescribed by their doctor.

Where appropriate, applications had been made to the local authority for Deprivation of Liberty Safeguards. People were happy with their meals and choices were always available.

The members of staff we spoke with had good knowledge of the support needs of the people who lived at the home. The staff we met had a cheerful and caring manner and they treated people with respect. Visitors who we spoke with expressed their satisfaction with the care provided. The service provided an accredited end of life care programme.

People were registered with local GP practices and had visits from health practitioners as needed. The care plans we looked at gave information about people’s care needs and how their needs were met.

There was a friendly, open and inclusive culture in the home and people we met during our visits spoke highly of the home manager. Monthly quality audits were completed and identified where improvements were needed.

The inspection took place on 17 December 2015 and was unannounced. The home is a purpose-built, three-storey property set in its own grounds in a residential area close to the town centre. There were bedrooms on the ground and first floors. Communal areas were all on the ground floor, with staff and service areas in the basement. The service is registered to provide accommodation and nursing or personal care for up to 30 people and 28 people were living there when we visited. The people accommodated were older people who required 24 hour support from staff.

The home had a manager who had applied to be registered with the Care Quality Commission. 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.

During the inspection we found a breach of Regulation 19 of the Health and Social Care Act 2008. You can see what action we asked the provider to take at the end of this report.

People we spoke with said they felt safe living at Barnston Court. We could not verify how recently all staff had received training about safeguarding, however a new training programme had been introduced and staff were working through this. There were enough qualified and experienced staff to meet people’s needs and keep them safe, with any shortfalls being covered by agency staff. The required checks had not always been carried out when new staff were recruited.

The members of staff we spoke with had good knowledge of the support needs of the people who lived at the home. The staff we met had a cheerful and caring manner and they treated people with respect. Visitors who we spoke with expressed their satisfaction with the care provided. The service provided an accredited end of life care programme.

We found that the home was adequately maintained and records we looked at showed that the required health and safety checks were carried out. We found that medicines were generally managed safely and records confirmed that people always received the medication prescribed by their doctor, however we noted some issues with the recording of medicines.

Most of the people we spoke with considered that they had choices in all aspects of daily living. They were happy with the standard of their meals. The need for improvement to the provision of social activities had been identified and was being addressed.

People were registered with local GP practices and had visits from health practitioners as needed. The care plans we looked at gave information about people’s care needs and how their needs were met, however the care notes were not always up to date or accurate.

There was a friendly, open and inclusive culture in the home and people we met during our visits spoke highly of the home manager. Quality audits had been completed consistently and in detail but had not always identified improvements needed.

We gathered evidence to help us answer our five 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.

Is the service safe?

Relatives told us they had no concerns over the safety or welfare of the people who lived there. We spoke with people who used this service who told us they had no concerns. They all commented the staff were very friendly and helpful. Staff were observed as being polite and caring.

The way in which staff were recruited was found to be correct and safe.

We saw one safeguarding meeting had been referred to the local authority from a complaint in the past year. We saw this was reviewed by a safeguarding panel and was resolved, the home was found not to be accountable.

We looked at maintenance logs which were regular updated, such as equipment checks. This ensured safety and consistency in equipment being maintained and the environment being clean/clutter free. People who used this service corroborated that the home was always "very clean".

Is the service effective?

We looked at five care plans, all of which had a range of risk assessments, for example, mobility, nutrition and communication. We saw care plans were person centred and reviewed regularly. We saw nurses had completed care plans related to peoples long term illnesses and when asked we saw care assistants were very knowledgeable about these conditions. The four care assistants we spoke to said nurses would always take the time to teach them more about the people who used this service’ illnesses.

Is the service caring?

We saw staff being respectful of people’s privacy and dignity by knocking on the door before entering rooms and addressing people who used this service in a polite manner. We spoke to three people who used this service and six relatives of people who used this service who all also commented that staff were always “polite” and “kind”.

Is the service responsive?

We looked at the accident and incidents book. We saw falls records which included safety and injury assessments. We saw this was reviewed and people were referred on to other specialist services where need be, such as physiotherapy.

Is the service well-led?

We saw the provider conducted annual feedback questionnaires. The results from the November 2013 questionnaire were very positive. All of the people who completed this noted the care as “excellent”, the registered manager as “approachable” and commented “Complaints were dealt with promptly”. The four care staff we spoke to all told us they felt the registered manager would deal with any complaints promptly and that she was again “Approachable” and “Friendly”.

The four care staff we spoke to said nurses would always take the time to teach them more about the people who used this service’ illnesses. One said “We (care assistants) can question them (nurses) any time, they (nurses) will always take the time to explain”. The six relatives we spoke with agreed all the staff were knowledgeable about their respective relative’s conditions.

We found that people's care and treatment was assessed, planned and delivered in order to meet their needs. Care and treatment plans were documented and reviewed and people were informed and involved in their care and treatment. People who used the service and their relatives spoke highly of the service and felt they and their relatives were well cared for. They told us:

“I know my mother is well looked after here, I can sleep at night knowing she is looked after”,

“I think it’s great, more like a little family”,

“This is the best place I have ever seen, I am very happy”.

We found that there were suitable systems in place to gain consent when caring for people and for those who lacked the capacity to give informed consent themselves.

People were safeguarded from abuse as the provider had systems in place and staff were knowledgeable in what to do in the event of suspected abuse. We found there was a sufficient number of suitably qualified and experienced staff working at the home.

The provider had effective systems in place for monitoring the quality of services. Regular audits were undertaken, there was an effective complaints process and satisfaction surveys were undertaken.

We spoke with people living at the service and two visitors during our inspection. People living there were overall very positive. They made various comments such as:

“I like it here”; “I’ve been here a while and its good here, I’ve got everything I need. “ They all praised the staff who worked at the service; they had no issues or concerns about them. They were all complimentary about the activities officer and all the events she organised and got them involved with. Everyone was looking forward to their fundraising afternoon they had planned the day after our visit.

The activity programme was varied and included: board games; chair exercises; bingo; film day; manicures; fundraiser events; and visits from local ministers and trips out to the local British Legion.

Relatives told us “I can’t praise them enough they have been wonderful” and “We are very happy with the service.” People living at the service and their relatives indicated an easy going atmosphere. Visitors told us they were always offered a cup of tea.

During our visit we entered the building unannounced as the front door was unlocked. This raised potential concerns about the safety of vulnerable adults regarding unannounced visitors to the service. Following our visit the manager has advised they have installed a lock to the door and no one can access the building without staff letting them in.

People we spoke to told us they were very satisfied with the service provided at the home. They told us they were well cared for, treated well and had plenty of activities and entertainment. They said “Its absolutely brilliant here – I can’t fault it”, “Excellent care”, “Absolutely brilliant – look after mum very well”.

Relatives told us they were particularly pleased with the amount of good activities available to participate in. Those service users we spoke to expressed great satisfaction with living at the home. We were told staff always listened to their relative or themselves and took their views into account. They were explained everything that was being done for them. People told us they were always respected and their dignity and privacy maintained especially when having personal care needs attended to.