CQC report explained · a nursing home
What the CQC found at Barons Down Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risks were not always kept up to date or properly followed up. Medicines management, staffing levels and some emergency equipment arrangements were not always safe.
- Effective?
- Good
- This key question was not inspected during this focused inspection, so no rating was given in this report.
- Caring?
- Good
- This key question was not inspected during this focused inspection, so no rating was given in this report.
- Responsive?
- Good
- Care plans had improved and were more personalised. Activities, communication support, complaints handling and end of life care were described positively, although some work remained on consistent oral care and communication aids.
- Well-led?
- Requires improvement
- The provider's audits and governance systems had not identified or managed important problems. Records, staff supervision, role clarity and oversight of risks were not consistently effective.
What inspectors found, July 2023
Barons Down Nursing Home was rated Requires Improvement; inspectors found serious gaps in risk management, medicines and oversight, although care was responsive.
Inspectors visited unannounced on 6, 12 and 15 June 2023. They spoke with people, relatives, staff and health professionals. They reviewed care records, medicines, staff files, training, rotas and management records.
The home was not always safe. Risks were not always properly assessed or followed up. Medicines records and the handling of some medicines were not always safe. Staffing levels and staff support were also not always enough.
The home was rated Good for Responsive. Care plans had improved, activities were available, complaints were investigated and end of life care was described as respectful. The home was clean and infection control procedures were being followed.
The overall rating remains Requires Improvement. Safe and Well-led were both rated Requires Improvement. The home has held this overall rating for the last three inspections. The provider took some immediate action, but remained in breach of Regulations 12 and 17.
Kind and respectful staff
People told inspectors they felt safe and that staff were kind. Staff treated people with respect, including people receiving end of life care.
“People received support from staff who had been appropriately recruited, trained to recognise signs of abuse or risk.” from the report
Improved personalised care
Care plans and treatment plans had improved since the previous inspection and included more information about people's individual needs.
“Care plans and treatment plans reflected people's individual care needs.” from the report
Responsive service
People were offered activities, complaints were investigated, and the home worked with health professionals to provide end of life care.
“We saw complaints had been responded to and actions taken as necessary.” from the report
Clean home and infection control
Inspectors found the home clean and well maintained, with infection prevention procedures being followed.
“The home was clean and well maintained. Infection control procedures were being followed.” from the report
Risks and incidents were not followed up
seriousThere were many incidents involving injuries, but records did not show enough analysis or action to prevent them happening again. Some care plans and risk assessments were out of date.
“The overview of incidents/accidents was not robust, there was no initial record of any action taken to prevent re-occurrences, tracking times or places/equipment involved to monitor trends or themes.” from the report
Medicines were not always managed safely
seriousMedicine records were poorly completed, some prescribed medicines could not be confirmed as given, and monitoring of medicines given when needed was incomplete.
“The provider had not ensured the safe management of medicines. This is a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Staffing and staff support
seriousInspectors found staffing levels were not always enough, particularly at night and at busy times. Some staff had missed supervision or lacked support in areas such as medicines and wound care.
“There were not always enough suitably qualified, competent, skilled, and experienced persons deployed to support people safely.” from the report
Weak management oversight
seriousAudits had not identified important problems, and records about care, food and fluids, incidents and staff support were not consistently complete or up to date.
“The provider had failed to assess, monitor, and improve the service. The provider had failed to assess, monitor, and mitigate risks to people.” from the report
- 01What changes have been made to medicines records, PRN medicine monitoring and the checking of returned medicines?
- 02How many staff now work on each floor during the night and at busy times?
- 03How are falls, injuries and other incidents reviewed, and what actions are taken to prevent them happening again?
- 04How do you make sure care plans, risk assessments, food and fluid records and wound records are kept complete and up to date?
- 05What supervision and clinical support do newly qualified nurses and other new staff now receive?
This was a focused inspection of Safe, Responsive and Well-led; the overall rating also used ratings from the previous inspection for key questions not inspected. This explanation was written from the published report of 14 July 2023 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, May 2022
Rated Requires Improvement; inspectors found kind staff and safe medicines, but concerns about personalised care, cleanliness and record keeping.
This was an unannounced focused inspection on 29 March and 4 April 2022. One inspector spoke with people, relatives, staff and health professionals. They observed care and reviewed care plans, medicines records, staff files, rotas and management records.
The home had enough suitably recruited and trained staff on the inspection days. Medicines were managed safely, risks were usually assessed, and people were supported to make choices. Staff and relatives generally spoke positively about the new manager and the direction of the home.
However, areas of the home and some equipment were not clean. Personal care, oral care, communication support and activities were not always planned or delivered around people's individual needs. Some care, food and fluid records were incomplete or inconsistent, and audits had not always led to improvements.
The overall rating was Requires Improvement. Safe, Responsive and Well-led were also rated Requires Improvement. Effective and Caring were not assessed during this focused inspection, so their previous ratings were used in the overall rating.
Safe medicines
Inspectors found that medicines were stored, given and disposed of safely. Staff who administered them had suitable training and competency checks.
“Medicines were stored, administered and disposed of safely. Medicines were ordered in a timely way.” from the report
Recruitment and training
The home carried out identity, employment, reference, DBS and nursing registration checks. Staff training was up to date and agency staff information was available.
“The provider undertook checks on new staff before they started work.” from the report
End of life support
Care plans recorded people's end of life wishes, and staff worked with health professionals to provide comfort and support families.
“Staff support people and their families with great care when people are at the end of their lives.” from the report
Complaints handled
People and relatives knew how to complain. Records showed that complaints were investigated and actions were taken where needed.
“We saw complaints had been responded to and actions taken as necessary.” from the report
Personalised care
seriousCare plans and daily records did not always explain people's personal care, communication and activity needs. Some people staying in bed had no clear plan for activities or regular wellbeing checks.
“The provider had not ensured that peoples' care and treatment was appropriate to their needs or reflected their needs and preferences.” from the report
Cleanliness
needs fixingCommunal bathrooms, commodes and some ensuite bathrooms were not clean and hygienic. A deep clean was arranged immediately, but cleanliness problems had already appeared in audits without effective follow-up.
“There were areas of the home and equipment that were not clean and hygienic.” from the report
Incomplete records
seriousRecords about personal care, food and fluids were not always complete or accurate. Fluid charts included duplicated entries and different recorded cup sizes, making it harder to identify dehydration risks.
“We found records relating to individual care delivery were not all complete and up to date.” from the report
Staffing and continence care
seriousStaffing rotas were consistent, but there were concerns about housekeeping shortages and delayed care. Some people on continuous bedrest had not had their continence needs checked since staff began their shift.
“It raised some concerns regarding continence care as some people on continuous bedrest had not had their continence needs checked since the day staff arrived on duty.” from the report
- 01What specific changes have been made to personal care plans, including continence, oral care, foot care and people's preferred routines?
- 02How do you now make sure people staying in bed or in their rooms receive activities that match their interests?
- 03What communication aids or call systems are available for people who cannot use a standard call bell?
- 04How are food and fluid records checked for accuracy, and what action is taken if someone is not drinking enough?
- 05How do you check that cleaning problems are acted on and that improvements are sustained?
This was a focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 26 May 2022 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 Barons Down Nursing Home
6 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- July 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2022Requires improvementstayed Requires improvementSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- July 2021Requires improvementSafe: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2020Inspected but not ratedSafe: Inspected but not ratedWell-led: Inspected but not rated
- January 2020Requires improvementdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- April 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2016Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2020
Registered with the Care Quality Commission on 25 March 2020.
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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19 live-in carers within about an hour of East Sussex
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,000 to £1,400 a week. 13 can care for a couple. 10 years' experience on average.
“When he point blank refused to go into hospital for a life saving blood transfusion she talked him through the situation and agreed to go in the ambulance with him and stayed until he was settled.”
“Una felt safe, secure and loved in her time with Debbie which is a gift that I am eternally grateful for.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.