Archived: Barnfield House Liskeard

The service is required to have a registered manager and at the time of our inspection there was no registered manager in post. A registered manager is a person who has registered with the CQC 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 and associated regulations about how the service is run. The provider had appointed a new manager in the last two months and they had contacted the commission to commence the registered manager application.

There had been four changes in manager over the last two years at the service and this has caused some instability in the service. This has meant that people and staff have felt insecure and some systems and processes were not robust.

The manager was aware that some records and procedures needed to be amended to ensure compliance with the regulations. The manager had identified that the service needed to review care documentation to ensure that people's care needs were accurately identified.

The manager also identified that there were gaps in recruitment and training records for staff. For example in the areas of staff induction process, supervision, training and recruitment. The manager had also identified that the service’s policies and procedures needed to be updated and had started to review some of these, for example the recruitment process. As the manager recognised the shortfalls of the service she appointed an administrator to assist her to put more robust systems in place, for example in the area of recruitment and training. This then allowed the manager time to get to know people, staff and to review care documentation. It is acknowledged that the manager has been in post for a short time and it is to her credit that she has identified these issues quickly and is actively trying to address the issues raised.

People told us they were pleased with the appointment of the new manager and were complimentary about her approach and the changes that had already occurred at the service. People were complimentary about the manager saying she was “brilliant", “fantastic “she really cares and listens” and “we want her to stay.” We received positive comments about the staff team from people, saying they are “Caring” and “Kind.” One person said "I am happy here, the staff are kind and have time to listen to me.” People were invited to attend residents’ meetings so that their views on the service could be heard.

Staff echoed this view and said they were pleased with the changes that the new manager had already made to the service, for example reviewing care plans, training and supervision. One member of staff said “I enjoy coming to work now”. Staff were pleased that induction, supervision and training were being looked at and that their views were being sought on the running of the service.

People told us they felt safe living in the service. The majority of people we spoke with said they got on with each other well. Some people had lived at Barnfield House for many years and had developed firm friendships with others in the service. People told us they were completely satisfied with the care provided and the manner in which it was given.

We saw staff providing care to people in a calm and sensitive manner and at the person’s pace. When staff talked with us about individuals in the service they spoke about them in a caring and compassionate manner. Staff demonstrated a good knowledge of the people they supported. People’s privacy, dignity and independence were respected by staff. We saw many examples of kindness, patience and empathy from staff to people who lived at the service.

The majority of people who used the service who we spoke with told us they did not want to participate in any activities. People said they were happy to organise their own time and gave examples of going out for a walk or getting a taxi into the town centre.

The manager had a good understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves, had their legal rights protected. Where people did not have the capacity to make certain decisions the service involved family and relevant professionals to ensure decisions were made in the person’s best interests.

Staff felt there was enough staff on duty. The manager reviewed people’s dependency levels regularly and told us of an occasion when staffing levels were increased so that people received the support they needed. The manager had undertaken some shifts at the service which helped her get to know people, staff and how the service was run.

We saw the service’s complaints procedure which provided people with information on how to make a complaint. People told us they had no concerns at the time of the inspection and if they had any issues they felt able to address them with the manager or staff team.

We found three Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the end of the full version of the report.

We were able to speak with eight people who used the service all of whom were happy living in the home. People said staff were helpful and respectful, they enjoyed the food and were happy with their accommodation. We were able to speak with two staff members who both said they thought a good service was provided at Barnfield House.

On the day of the inspection the accommodation was furnished, decorated and maintained to a good standard. The home was very clean and there were no offensive odours.

There were satisfactory numbers of staff on duty. Delivery of staff training was generally satisfactory although training for some staff members needed improvement.

For those who chose to go out in the community it was near the town centre and several public houses. Some people chose not to leave the home. This was understood and accommodated. Essential services were made available within the home.

Several people told us that they preferred to live in the care home rather than in the community saying "I am not a lazy person, but things don't work out in the community do they?" and "I want to live where there is always support. In the community you have to be there when the staff come, and sometimes that is not convenient...If you get wet you have to wait till someone comes. Here there is always someone".

There was inconsistency between the action of staff and the home's policy on issues of capacity and consent and the mental health act. Therefore people may not understand how to change any decisions about care and treatment that has been previously agreed.

Smoking was an important activity for many of the people who lived at Barnfield House. This activity dominated the communal areas. People needed to be tolerant of this if they chose to live, or work, at Barnfield House.