Barnfield House

Barnfield House is a residential care home providing personal care to up to 18 people. The service provides support to people with mental health needs. At the time of our inspection there were 14 people using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The service was registered to provide care and support to people with a learning disability, however at the time of the inspection, the location did not provide care or support for anyone with a learning disability or an autistic person and intended to remove this service user band from their registration. We will monitor the service to ensure this is completed.

People were safe living at the service and staff understood how to protect them from abuse. Staff were confident raising concerns about people’s health or welfare and reporting accidents and incidents. Where necessary, people were referred to external professionals.

Risks to people and related to the physical environment had been assessed and guidance put in place to mitigate the risks.

Staff had been recruited safely and there were enough staff to ensure people received the required support. Staff undertook training regularly to help ensure they stayed up to date with best practices.

Medicines were managed, stored and administered safely. We have made a recommendation about guidance on when to administer people’s ‘as required’, (PRN) medicines.

Appropriate infection prevention and control practices were in place.

There was little information to show that staff were tailoring opportunities to some people’s interests and preferences. We have made a recommendation about this.

Staff knew people well and regularly checked they were happy with the service.

People were unable to go into the kitchen. This meant they could not prepare or cook food. The manager told us they would investigate installing a kitchenette people could use. We have made a recommendation about this.

People told us they liked the food and could make choices about what, when and where they ate and drank.

The service was working within the principles of the MCA. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Some people did not do much during the day but there was little evidence to show this was their choice. People were not always encouraged to increase or maintain their skills and independence. We have made recommendations about this.

The manager and provider knew the service well and had a clear plan to improve the service and upgrade the environment.

People and staff were positive about the service. Staff told us there was a positive atmosphere in the service.

For more details, please see the full report, which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 3 November 2017).

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Why we inspected

We inspected to provide an up-to-date rating of the service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections, even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Recommendations

We have made recommendations in relation to ‘as required’ (PRN) medicines, how staff encourage and support people’s skills and independence, the opportunities offered to people, how people are enabled to take part in cooking and food preparation and the refurbishment of the service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We carried out this announced inspection on 10 October 2017. This was the first inspection since the provider registered as a new legal entity in March 2017.

There was a registered manager in post who was responsible for the day-to-day running of 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 and associated Regulations about how the service is run.

People, and their relatives, told us they were happy with the care they received and believed it was a safe environment. Comments included, “I like living here, I feel safe”, “I like it here and I like my room” and “No cause for concern.”

On the day of our inspection there was a calm, relaxed and friendly atmosphere at the service. We observed people had a good relationship with staff and each other. There were plenty of friendly and respectful conversations between people and with staff. The staff team had developed kind and supportive relationships with people using the service.

Care and support was provided by a consistent staff team, who knew people well and understood their needs. People were able to make choices about their daily lives including accessing the local community. Staff supported people to live as independently as possible. Risk assessment procedures were designed to enable people to take risks while providing appropriate protection.

There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse.

People were supported to eat and drink enough and maintain a balanced diet and were involved in meal planning. Menu planning was done in a way which combined healthy eating with the choices people made about their food.

People were supported to maintain good health, have access to healthcare services and receive on-going healthcare support. Staff helped people to arrange and attend appointments to see their GP and other necessary healthcare appointments.

Care records were up to date, had been regularly reviewed, and accurately reflected people’s care and support needs. People were involved in decisions about their support and consented to the care provided.

Where people did not have the capacity to make certain decisions staff acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People and their families were given information about how to complain. The registered and deputy managers were visible in the service, regularly working alongside staff to provide care and support for people. There was a positive culture within the staff team and staff said they were supported by the management. Comments from staff included, “It’s great here, we do what we can to improve people’s lives”, “Good atmosphere working here. We are one big relaxed family” and “Staff and management all work together as a team.”

Relatives and healthcare professionals told us they had confidence in the management of the service. Comments included, “The registered manager is focussed on improving the care and quality of life for residents at Barnfield” and “The change in management has been for the good. The new manager understands people's needs.”

There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. People and their families were involved in the running of the service and were regularly asked for their views through on-going conversations with staff, ‘residents meetings’ and surveys.