This inspection took place on 7 and 12 December 2018 and was unannounced on the first day.

Barty House Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Barty House Nursing Home is registered to provide accommodation and personal or nursing care for up to 58 older people. Accommodation is provided over two floors and is wheelchair accessible with a passenger lift between floors. There are well maintained gardens and off-road parking. There were 51 people living at the service when we inspected.

At our last comprehensive inspection on 14 April 2016 we rated the service good. The Safe key question had been rated as ‘Requires Improvement’ as a breach of regulation 12 (1) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Medicine records had not been maintained to make sure people had received their medicines as prescribed. A follow up responsive inspection took place on 23 June 2017 to check whether the breach of regulation had been met. This inspection showed that improvements had been made and the safe key question was rated as ‘Good’.

At this inspection on 7 and 12 December 2018 we found the evidence continued to support the rating of good, with the Responsive key question improving to ‘Outstanding’. There was no evidence or information from our inspection and ongoing monitoring that demonstrated any risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good overall with the Responsive domain improving to Outstanding.

There was a registered manager in post at the time of our inspection. 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 received an individualised service that increased their self-worth and well-being. There was an innovative approach to supporting people to live a happy and fulfilled life. People’s dreams and aspirations were encouraged and fulfilled. People were supported to follow their likes and interests with a wide range of social activities within the service and out in the local community. People played an active role in their local community hosting events throughout the year.

People received person centred end of life care that encompassed their wishes and offered support to loved ones. People were treated with dignity and compassion at all times. The care team worked alongside health care professionals to ensure people could remain at Barty House and have a comfortable and pain free death.

Care plans were comprehensive and detailed the person’s wants and needs from their support. People’s care and nursing needs were assessed with them prior to receiving a service and these were kept under continuous review. People’s specific health care needs were met with the support from health care professionals.

People were treated with kindness and compassion. Staff understood the importance of promoting and respecting people’s privacy and dignity. People were encouraged and empowered to remain as independent as possible.

People received a service that promoted their safety whilst promoting their rights and choices. Potential risks had been mitigated. People were protected from the risk of infection with appropriate control measures. The environment and equipment had been maintained to promote people’s safety.

People received safe care from enough care and nursing staff. Nurses and care staff had been trained to meet peop

We carried out an unannounced comprehensive inspection of this service on 14 April 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Barty House Nursing Home on our website at www.cqc.org.uk.

Barty House Nursing Home is a care home providing accommodation for up to 58 older people who require nursing and personal care. The home is located in a rural area outside Maidstone. At the time of the inspection 53 people lived at the service.

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.

At our previous inspection on 14 April 2016, the service was in breach of regulation 12 (Regulated Activities) Regulations 2014. This breach was in relation to medicine management. We found medicines records were not always maintained to protect people's health and wellbeing in line with current legislation and guidance. We found gaps in people's medicine records. At this inspection improvements had been made and the service was no longer in breach of the regulation.

Nurses were signing people’s medicine records accurately. There were no identifiable gaps in people’s medicine records. The provider had introduced an electronic system to record when people were taking their medicines and nursing staff were also completing hand written medicine records.

Staff received appropriate training for moving handling. During our inspection we observed good moving and handling practices.

The provider had ensured that there were appropriate systems in place to identify and minimise risk for people living at the service. Risks to people's safety had been assessed and actions taken to protect people from the risk of harm.

There was sufficient staff to provide care to people. Staff had safety checks to ensure they were safe to work with adults.

People were protected from abuse by trained staff who could identify the forms of abuse and who they could report to. The provider had effective safeguarding systems in place.

The inspection was carried out on 14 April 2016 and was unannounced.

The service provided accommodation, personal and nursing care for up to 58 older people. There were 51 people living in the service when we inspected. People predominantly needed nursing care to assist them to manage chronic and longer term health issues associated with aging or after an accident or illness. This included compassionate end of life care.

People benefited from accommodation that was set in a picturesque rural location that had been adapted and modernised for the intended purpose. Accommodation was provided over two floors. A lift was available to take people between floors. 28 rooms had on-suite facilities and the remainder had a wash basin. People in rooms without on-suite facilities had access to nearby toilets and bathrooms.

There was a registered manager employed at the service. 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 policies in place for the safe administration of medicines. Nursing staff were aware of these policies and had been trained to administer medicines safely. However, the processes in place to ensure people received their medicines as prescribed were not always effective. Nurses were not always signing the medicines administration sheets when they administered medicines and the registered manager was not chasing this up in a timely manner after the errors had been identified through the service’s quality monitoring system.

People’s rights were protected through their involvement in decision’s about their care and included discussions and decisions about resuscitation if the circumstance’s arose. However, we noted that the lead nurse completing the do not attempt cardio pulmonary resuscitation forms had not always recorded the involvement of appropriate health and social care professionals in the process. For example, the senior clinician involved in the care, like the GP. We have made a recommendation about this.

Nursing staff assessed people’s needs and planned people’s care. They worked closely with other staff to ensure the assessed care was delivered. General and individual risks were assessed, recorded and reviewed. Infection risks were assessed and control protocols were in place and understood by staff to ensure that infections were contained if they occurred. End of life care was delivered by consent and mutually agreed with people and their families. Additional specialist end of life nursing guidance and training was provided by staff from a hospice.

The provider and registered manager ensured that they had planned for foreseeable emergencies, so that should emergencies happen, people’s care needs would continue to be met. Equipment in the service had been tested and well maintained.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

The registered manager had ensured that they employed enough nursing and care staff to meet people’s assessed needs. A robust agency back up system was in place. The provider had a system in place to assess people’s needs and to work out the required staffing levels. Nursing staff had the skills and experience to lead care staff and to meet people’s needs effectively and the registered manager provided nurses with clinical training

The inspection was carried out by one Inspector over six hours. During the visit we viewed all areas of the home; talked with people living in the home and some relatives; talked with the manager and staff; and examined documentation.

People in the home spoke very positively about their experiences of living there. Some of their comments included: “Everything is very good. The food is excellent. And the carers are very good. They always come straightaway if I want anything.” “We are very happy with everything, there is no question about that!” And, “I especially enjoy the coffee mornings when we all sit together and chat.”

We found that the staff explained the home’s assessment and monitoring processes to people at the time of their admission, and obtained their consent for their care and treatment.

We inspected medication management, and found that there were safe systems in place.

We examined some staff recruitment files, and found that there were robust recruitment procedures in place. This ensured that vulnerable people were cared for by staff who had been appropriately checked for their suitability.

We found that the home had on-going staff training programmes in place, which supported staff in providing reliable and effective care.

We saw that the home had a complaints procedure which was easily accessible. Concerns and complaints were followed through and addressed, to prevent future re-occurrence of these issues.

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 CQC inspector, who was joined by an Expert by Experience (people who have experience of using services and who can provide that perspective).

During the visit we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing people, to help us to understand people's experience of how their care is given.

We spoke with the registered manager and staff during the inspection. We talked with people living in the home throughout the visit, in communal areas and in their own rooms. People spoke very positively about the home.

Some of their comments included:

“I am very settled here. I can go where I please, when I please. The staff are always available if I want help.”

“It’s lovely here. I wasn’t sure about coming in, but I felt at home very quickly. There are lots of things to do if people want to.”

“I have lived here for many years, and I am so happy here. Everything is clean and nice and the staff are wonderful. I am able to go to church locally three times a week and they order my transport and make sure I am ready on time.”

“This is a most wonderful place to live. I am treated with the utmost care and my dignity is maintained at all times. The staff are kindness itself and are very respectful. I have so many health problems which they monitor and my medication is always given regularly and on time which is important for my condition. I could never explain how wonderful it is to live here. I am so glad I found Barty House.”

“We all have a good laugh together. It is such a happy place.”

People we spoke with were very complimentary about the service. We spoke with eight people who lived at Barty House. They told us: "The staff are very good, whatever you want you get." “This is a very good home.” “The food is very good, there is always a choice.” "There are always enough staff”. "The staff are very kind, they look after me very well" “We have been here for two years, it has always been very good, we have no complaints at all.”

People told us that they were very happy with the care they received. They told us staff always consulted them about their individual needs, explained what was happening and involved them in decisions about their care and treatment.

People said staff were always careful to protect their privacy and dignity when they were helping them with their personal care. We also spoke with a visitor who said, “ the home is always clean, light and airy. Staff are always helpful, friendly and welcoming.”

People we spoke with were very complimentary about the service. We spoke with eight people who lived at Barty House. They told us: "The staff are very good, whatever you want you get." “This is a very good home.” “The food is very good, there is always a choice.” "There are always enough staff”. "The staff are very kind, they look after me very well" “We have been here for two years, it has always been very good, we have no complaints at all.”