About the service: Barrock Court Care Home is a residential care home that provides personal care and support for up to 28 people. At the time of the inspection, 28 people were living at the service.

People’s experience of using this service: People and their relatives were positive about the service, however we found a range of issues which needed to be addressed.

Medicines were not managed well. Including their administration, storage and recording.

Concerns had been raised over the care of people’s skin. We found mattresses which were not fit to be used and pressure relieving equipment which was not always being used. We also observed people sitting for extended periods with no evidence of being moved.

Safeguarding systems and processes were in place, but these were not robust or monitored fully.

Audits and checks had not found what we had during the inspection.

The provider had not met their legal obligation to send the Care Quality Commission (CQC) all incidents which were notifiable. Staff had received training to protect people from various forms of abuse. Not all incidents had been recorded fully by staff or reported accordingly to the registered manager.

There was a registered manager in place, who was kind and caring. However, we had some concerns over their knowledge and ability to lead the service. They did not have a clear oversight of the care provided and there were mixed views on their visibility within the service.

We received mixed views from staff on the support offered by management. Staff said they felt supported, but that the registered manager did not always fully deal with issues arising.

The service was clean and tidy with no odours. However, we found urine soaked mattresses which were replaced after being found in need of renewal.

There was not enough staff in place to support people to meet their needs. Staff told us that safe recruitment procedures were followed when they applied to work at the service, including vetting checks and reference checks. Staff had received training in various topics, however further training had been organised to take place, including in connection with consent and skin management.

Care records were in the process of being fully reviewed, with new paperwork being implemented. In some cases, detail was missing or contradictory. Archived records were not secure or appropriately stored. We were unable to gain access to some records requested.

People’s dietary needs were met, including those with special requirements. People were complimentary about the meals prepared.

There was a welcoming and homely atmosphere at the service and people and their relatives were happy and felt safe with the care provided and said staff were kind and caring.

A variety of activities took place at the service, but on occasions the activity coordinator was diverted to other duties to support the service which impeded on their availability.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in connection with safe care and treatment, safeguarding service users from harm and abuse, staffing and good governance. We also identified a breach in Regulation 18 of the Care Quality Commission (Registration) Regulations 2009, notification of other incidents. We are dealing with this matter outside of the inspection process.

More information is in the full report below.

Rating at last inspection: Good (Report published on 27 September 2017).

Why we inspected: The inspection was brought forward due to information of risk and concern regarding poor care standards, we had received from the local authority and healthcare professionals.

Follow up: Following the inspection we referred our concerns to the local authority responsible for safeguarding. In addition, we requested an action plan and evidence of improvements made in the service. This was requested to help us decide what regulatory action we should take to ensure t

Barrock Court Nursing Home is purpose built and is situated near Low Heskett. The building is on one level, divided into three units The home provides residential care for older people. One unit, unit three, provides care and support to people living with dementia. Car parking facilities were available.

At the last inspection in July 2015 the service was rated Good. At this inspection we found the service remained Good.

This inspection visit took place on 24 August 2017 and was unannounced.

The registered manager had procedures in place to minimise the potential risk of abuse or unsafe care. Staff spoken with were able to identify different types of abuse and had received training in safeguarding adults.

Medicines were stored in a clean and secure environment. We observed staff followed correct procedures when they administered medication and fully completed records.

We found staff had been recruited safely, received ongoing training and, were supported by the management team. They had the skills, knowledge and experience required to support people in their care.

The management team had sufficient staffing levels in place to provide support people needed. We found by our observations staff members could undertake tasks supporting people without feeling rushed. People who lived at the home told us staff were responsive to their needs. One person who lived at the home said, “A very good staff team who know what they are doing.”

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes were recorded.

People who lived at Barrock Court told us they had choices of meals and there were always alternatives if they didn’t like what was on the menu. We observed at lunchtime people who required support were attended to in a sensitive manner. Comments were positive about the quality of food and included, “The food is very good. I like the home made cakes they make.”

People who lived at the home had access to healthcare professionals and their healthcare needs were met. We saw the service had responded promptly when people had experienced health problems.

People who lived at the home told us staff were all caring, kind and respectful. Relatives also commented in surveys how caring staff were.

Staff knew people they supported and provided a personalised service in a caring and professional manner. Care plans were organised, updated when required and had identified the care and support people required. We found they were informative about care people had received.

The service had a complaints procedure which was made available to people on their admission to the home and their relatives. People we spoke with told us they were happy and had no complaints.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff and resident meetings. In addition relative surveys were collected to seek their views about the service provided.

This inspection took place on the 26th June 2015 and was unannounced.

Barrock Court Nursing Home is located to the south of Carlisle near the village of High Hesket. The service provides support for up to 28 people who may require nursing care and may also be living with dementia.

The service 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 service had sufficient staff to meet people’s needs.

The staff knew how to identify abuse and protect people from it.

The service had carried out risk assessments to ensure that they protected people from harm.

Medicines were ordered, stored, administered and disposed of correctly.

Staff had been trained to an appropriate standard.

People enjoyed the food provided and were supported to take a good diet that was based on an assessment of their nutritional needs.

Staff had developed caring relationships with people who used the service.

Support plans were based on thorough assessments and were written using a person centred approach.

The registered manager provided good leadership. The provider had systems in place to ensure the delivery of good quality care.

When we visited Barrock Court Nursing Home on July 4th 2013 we found that people who lacked capacity who had Do Not Attempt Cardiopulmonary Resuscitation orders (DNACPR's) in place had not been properly assessed using Mental Capacity Act (MCA) guidelines. We therefore judged that they were non-compliant.

We returned to the home on March 19th 2014 to follow up this area of non-compliance. During this inspection we found that the home had significantly improved this part of their service and there was clear evidence that they were not only following MCA guidelines but were observing a high standard of practice. We judged that they were now compliant.

People told us they were happy living in the home. One person said, "This is for me, I’m looked after, cared for." Another person said, "It's like home.” We looked at care records which showed people's needs were assessed and monitored appropriately.

We observed staff respecting people's right to consent to care and treatment. However, we looked at records which indicated where people did not have capacity to consent the provider had not acted in accordance with legal requirements.

We spoke to staff who said they felt supported to provide care to people and were happy with the training they received. We found the manager had effective procedures in place to monitor the quality of service that people received, and that complaints were dealt with appropriately.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service and a practising professional.

During the visit we carried out a "Short Observational Framework Inspection" which is a

method of observing the ongoing life in the home over a set period of time.

The registered manager was available during the inspection and we gave feedback to him and the deputy manager at the end of the visit.

People living in the home told us,

"Staff come promptly when I use my buzzer".

"My own clothes come back from the laundry quickly as they have my name on".

"We are having a residents' and family meeting today without any staff. We can discuss our care and any activities we would like".

"I can go out for a walk up the drive whenever I want. It is about a mile and tree-lined".

"No one makes you do anything you don't want to. We can please ourselves".