CQC report explained · a nursing home
What the CQC found at Barking Hall Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found improvements in risk assessments, staffing and call bell response times. Medicines, recruitment, infection control and safety checks were described as well managed.
- Effective?
- Good
- People had suitable assessments, trained staff, food choices and access to health professionals. Inspectors noted that one person was poorly positioned during a meal and that end of life care planning still needed improvement.
- Caring?
- Good
- People said staff were kind and caring. Staff knew people as individuals, respected privacy and dignity, and supported independence.
- Responsive?
- Good
- Care plans included people's preferences and the home offered a range of activities, including weekly trips. End of life planning needed to better follow recognised best practice.
- Well-led?
- Good
- Inspectors found a more open management structure and stronger quality assurance. The manager was visible, listened to feedback and acted on shortfalls.
What inspectors found, March 2019
Barking Hall Nursing Home was rated Good after improvements; inspectors found kind, safe care, but end of life planning and some mealtime support still needed work.
Inspectors made an unannounced visit on 12 February 2019. They spoke with 14 people, one relative and staff. They observed care and reviewed care records, staff files, medicines, recruitment and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough suitably trained staff, prompt responses to call bells, kind care, good activities, nutritious food and appropriate support from health professionals.
The service had previously been rated Requires Improvement in January 2018. Inspectors found sufficient improvements in staffing, risk assessments, care planning, capacity assessments and management oversight for the overall rating to become Good.
Enough trained staff
Inspectors found sufficient suitably trained staff and saw people's requests answered promptly. Extra staff were available at busy times such as meals.
“People who live at Barking Hall have their needs met by sufficient numbers of suitably trained staff.” from the report
Kind and personal care
Staff treated people with kindness and compassion. They knew people well and supported their privacy, dignity and independence.
“It was clear from our observations and discussions with staff that they knew people well and had taken time to get to know them as individuals.” from the report
Activities and choice
People could take part in activities that matched their interests, including weekly trips. Staff were available for both group and one-to-one activities.
“There was a range of activities on offer to suit people's preferences, including weekly trips.” from the report
Improved leadership
A new manager and deputy manager provided a more consistent management presence. Quality checks covered care records, staff practice, maintenance, infection control and competence.
“Since the last inspection, the new manager had implemented robust quality assurance systems” from the report
End of life planning
needs fixingEnd of life care plans were in place but did not yet fully reflect best practice guidance. The manager had identified this and planned further training and improvements.
“End of life care planning was in place but needed to be improved to ensure it met best practice guidance such as the Gold Standards Framework.” from the report
Mealtime positioning
needs fixingIn one area, a person was not positioned appropriately to eat and struggled. Another person was supported from a lounge chair in a way that did not promote dignity.
“However, in another area we observed one person was not positioned appropriately in their chair to eat, and this meant they struggled.” from the report
More detail in life histories
minorLife histories were available but could contain more information to help staff understand people better.
“However, these could be further expanded upon to enhance the level of detail within them and assist staff to better understand people.” from the report
- 01How will you make sure people are positioned safely and with dignity during every meal?
- 02What changes have you made to end of life care plans since this inspection?
- 03How do you use each person's life history to guide their daily care?
- 04How do you check that call bells are answered promptly during busy periods?
- 05How are people and relatives involved in reviewing care plans and giving feedback?
This was an unannounced planned inspection of the overall quality of care, covering all five CQC questions and both the premises and care provided. This explanation was written from the published report of 6 March 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2018
Rated Requires Improvement; inspectors found kind care and better medicines records, but staffing, care records and oversight were not reliable enough.
This was an unannounced, comprehensive inspection on 31 October 2017. Inspectors spoke with people living in the home, relatives and staff. They reviewed five care records and observed care, including support for people with dementia.
The home had improved its medicines records and equipment checks since the previous inspection. Staff were kind, people were involved in their care, and activities and complaints arrangements were in place.
However, people sometimes waited too long for help because staffing was not always sufficient. Care plans and risk assessments did not always give staff enough information, and records about fluids, dressings and mental capacity were incomplete or inaccurate.
The overall rating was Requires Improvement. Safe, Effective, Responsive and Well-led were also rated Requires Improvement. Caring was rated Good. This was the third inspection in a row where the home received Requires Improvement.
Medicines records
Medicines administration records were detailed, including photographs and allergy information. Records of blood glucose checks and insulin administration had improved since the previous inspection.
“Each person had a medicine administration record (MAR) chart which was detailed with an up to date photograph of the person and a record of any allergies.” from the report
Kind and respectful care
Inspectors saw staff speaking kindly, listening to people and respecting their choices, privacy and dignity.
“We saw caring interactions between staff and the people they cared for.” from the report
Staff recruitment and training
Recruitment checks were carried out, including references, DBS checks and professional checks for nurses. Staff also had regular training, supervision and appraisals.
“The recruitment files showed the procedure had been worked through in an orderly fashion checking at each step that the potential member of staff was suitable to work at the service.” from the report
Activities and complaints
The home provided activities in the morning, afternoon and evening, including outings. It had a complaints process and recorded compliments from relatives.
“We saw that there were activities arranged for the morning, afternoon and evening of each day.” from the report
Not enough staff
seriousPeople and staff reported that staffing was sometimes too low, leading to long waits for call bells and care. Agency staff did not always know people's needs well.
“This meant there were not always sufficient numbers of suitable staff on duty to keep people safe and meet their needs.” from the report
Incomplete care and risk records
seriousSome care plans did not contain enough detail about moving and handling, swallowing risks or people's consent and capacity. This meant staff could lack clear instructions.
“Two people's care plans did not have a completed manual handling risk assessment.” from the report
Wound care records
seriousRecords showed gaps in planned dressing changes for people with pressure ulcers. Inspectors said this placed people at potential risk.
“This meant that people with pressure ulcers were placed at potential risk because pressure ulcers were not managed in line with the risk assessment and care plan in place.” from the report
Weak quality checks
seriousThe home's audits did not reliably find or correct problems with care plans, fluid monitoring, risk assessments and wound care records. This was a continued breach.
“This lack of oversight and timely action was placing people at risk.” from the report
Lack of consistent management
needs fixingThe home did not have a registered manager. The relief manager was also managing another service, and inspectors said the lack of consistent management affected improvement.
“The lack of consistent management had impacted upon this services ability to improve and come back up to standard in a timely manner.” from the report
- 01How do you now make sure there are enough care staff on every shift, including when regular staff are absent?
- 02How do you check that agency staff understand each person's needs before providing care?
- 03How often are care plans and manual handling risk assessments reviewed, and can we see an example of the updated guidance?
- 04How do you record and check fluid intake and planned wound dressing changes?
- 05Has a permanent registered manager now been appointed, and how are quality checks followed up when they find a problem?
This was an unannounced comprehensive inspection covering all five key questions, with the previous inspection ratings used as a comparison. This explanation was written from the published report of 30 January 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Barking Hall Nursing Home
4 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- March 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- December 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Good
- May 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- November 2011
Report published without a new overall rating.
- June 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 23 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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