What life is like for people using this service:

• People were not always protected from harm because risks were not always assessed. It was not clear on care documents what action staff should take if people became unwell due to specific care needs.

• Safe recruitment practises were not always followed and staff did not always receive an induction when they started working at the service.

• Staff required additional training to be able to meet people’s changing needs. Many people in the service had advancing dementia and were becoming increasingly unwell. The training provided to staff did not reflect this changing level of need.

• The premises needed some improvements, the shower was not working and was full of linens and only one bath was working in the service. This was not accessible to all people using mobility aids as there was little space to move in the bathroom. Windows on the upper floor were not restricted posing the risk of people falling from a height.

• Quality assurance processes were not established or effective and did not pick up all the issues we identified. When concerns were noted by internal processes they were not always followed up on or learned from, to improve the service.

• People were not always supported to have maximum choice and control of their lives and were not always supported in the least restrictive way possible.

• People told us they sometimes would like more to do and more social contact. However, everyone we spoke with said they were happy living in the home and staff were kind and caring.

• Staff felt supported and listened to and spoke of working as a team and caring about people in the service.

• We found breaches in six legal requirements in areas relating to consent, safe care and treatment, premises, good governance, staffing, and recruitment.

• More information is in the detailed findings below.

Rating at last inspection: This service was rated good at the last inspection on 15 and 20 June 2016.

About the service: Barton Lodge is a residential care home providing personal care and accommodation to eight people over the age of 65 at the time of this inspection.

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

Enforcement: Please see the end of the report for any enforcement action.

Follow up: We have asked the service to provide us with an action plan with a specific deadline addressing the key concerns identified during this inspection. We will meet with the provider once this has been sent to us to check what improvements have been and are planned to be made.

Barton House is a small residential home in Dawlish that provides personal care and accommodation for up to 11 older people. There were nine people living at the service at the time of our inspection.

The inspection took place on 15th and 20th June 2016 and was unannounced. This was the service’s first inspection since change of registration to Libatis Limited in July 2015.

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 registered manager also managed Barton Lodge’s sister home, Barton House, which was situated close by. The registered manager was supported in running the home by the provider who was one of the owners of the service.

People expressed a high level of confidence in home. They told us they felt safe and happy living at Barton Lodge. One person said “I feel very happy. Staff are so kind. I wouldn’t change a thing about it”. Relatives also felt confident that their loved one was well looked after and safe. One relative said “It’s nice and relaxed and homely here. I am 100% confident Mum is safe and looked after”. We observed laughter and warmth between people and staff. The atmosphere of the home was calm and relaxed throughout our inspection.

People were supported by staff that knew them well. Staff were kind and caring and people spoke very highly of the care they received. One person said “Staff are wonderful. They’ll do anything to help. Nothing is too much trouble” and “its home from home. I love it here”. There were enough staff available to meet people’s care needs safely. Staff worked in a calm, unhurried way and had time for talking and supporting people with activities of their choice. People were encouraged to maintain their independence. Staff were genuinely fond of the people they cared for. One said “Lovely people live here. I enjoy coming to work in the mornings, talking with people and hearing their stories”.

There were robust recruitment processes in place to ensure that suitable staff were employed. Staff were supported by the registered manager through supervision and appraisal. High standards of care were encouraged through staff training and development. Staff participated in a wide range of training courses in topics relating to people’s care needs including diabetes, dementia and end of life care. Staff had received training in, and had a good understanding of, the Mental Capacity Act 2005 and the presumption that people could make decisions about their care and treatment.

Staff ensured people's privacy and dignity was respected at all times. They worked closely with people to ensure they understood their needs and preferences. People were involved in planning and reviewing their care and felt listened to by staff.

Care plans showed each person had been assessed before they moved into the home and any potential risks were identified. Where risks were identified there were detailed measures in place to reduce these where possible. Care records included a summary of people’s care needs and more detailed information where specific care needs had been identified. People were supported to maintain good health from a number of visiting healthcare professionals who expressed confidence in the home.

People all told us they liked the food and had a good choice available to them. Comments included, “I can have anything I want. There is lots of choice” and “The food really is excellent”. People confirmed they were able to continue with their interests and hobbies and enjoyed the activities available. The registered manager told us they encouraged people to have a fulfilling life and remain as independent as possible.

We observed medicines being administered a