People in Action - Barnfield

The service is registered to provide accommodation and personal care for up to five people. People who use the service have learning and physical disabilities. At the time of our inspection four people were living at People in Action - Barnfield. Staff members are on duty 24 hours a day.

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

Risks were identified and risk management plans were in place to support staff to mitigate the risks of harm people may face at home and in the community. Staff understood their responsibility to report any concerns they had about people's health or wellbeing. Infection control practices were well managed and followed to minimise the risk of the spread of infection. Medicines were appropriately managed which meant people were protected from unnecessary risks and harm.

There were enough staff to keep people safe, although staff vacancies meant some staff were regularly working extra hours to maintain safe staffing levels. Staff received an induction and training to ensure they had the appropriate knowledge and skills.

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.

Person-centred care plans were in place. Staff took time to know people, supported them to communicate their needs and advocated on their behalf. Staff encouraged people to remain active and engage in interests that were important to them

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Care is person-centred and promotes people's dignity, privacy and human rights.

Right support: Barnfield was set in a residential area and the provider’s model of care maximised people’s choice, control and independence.

Right care: The care provided was person-centred and promoted people's dignity, privacy and upheld their human rights.

Right culture: The values and ethos of leaders and well trained staff ensured people living in the home were leading more inclusive lives within their communities.

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

Rating at last inspection

The last rating for this service was good (published 3 May 2019).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

• People were encouraged to make decisions about the care they received, from staff who knew people’s preferred ways of communicating.

•Relatives praised the service and were complimentary of the care, support and friendships their family members experienced.

•Risks to people were managed in a way that kept them as safe as possible. Risks which affected people’s daily lives were recorded and followed by staff.

•People received their medicines as prescribed from staff who were trained.

•Training for staff equipped them to meet the needs of people using the service.

•Care plans were personalised, but needed improvements to reduce duplication and to make sure they corresponded with staff’s knowledge about each person.

•People were supported to make daily living choices. Staff used assistive technologies and picture cards to help people make an informed choice.

•Staff knew people’s needs could change, and understood when to seek advice and involve other health care professionals and services.

•Through the setting of goals and objectives, people’s daily life skills and experiences were increased and in some cases, people moved onto other services where they had less care interventions and could live with reduced support.

•Staff knew how to keep people protected from poor practice or abuse.

•People were treated respectfully. Staff were keyworkers for people which helped them get to know people well, especially their individual communication styles.

•Staff encouraged people remain as independent as possible.

•The registered manager and acting service manager were complimented by staff for their support, approach and how they helped develop the service people received. Staff said this helped them all work well as a team to benefit people in their care.

•Governance systems were operated and managed effectively to ensure good care outcomes for people continued to meet their needs.

We found the service met the characteristics of a “Good” rating in five areas. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good. The last report for People in Action Barnfield was published on (11 October 2016).

Why we inspected: This was a planned and announced inspection based on the rating at the last inspection. The previous ‘good’ service provided to people had remained consistent.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

This service was last inspected on 29 May 2014 and we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Barnfield is registered to provide accommodation and personal care for up to five people with a learning and/or physical disability. At the time of our inspection five people lived at the home.

The home is required to have 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager who had been in post since July 2016. The registered manager told us they managed another service and split their time between both services. The registered manager had a system where staff could contact them in emergency or when required.

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People received care that enabled them to live their lives as they wished and people were supported in line with their agreed care plan decisions. Relatives told us they were involved in care plan reviews and were kept informed when their relations needs changed.

Care plans contained relevant information for staff to help them provide the individual care people required. However some care plans required improvement to ensure some important information was easily identified so staff could provide consistent care and support.

People’s care and support was provided by a consistent, experienced and knowledgeable staff team who knew people well.

People were encouraged and supported by a caring staff team. Relatives told us they felt their family members were safe and well cared for at Barnfield and staff knew how to keep people safe from the risk of abuse. Staff and the registered manager understood what actions to take if they had any concerns for people's wellbeing or safety. Staff received training in how to safeguard people, and had access to the provider's safeguarding policies and procedures if they had any concerns.

People were administered medicines by staff that were trained and assessed as competent to give

medicines safely. Medicines were given in a timely way and as prescribed. Regular checks of medicines helped ensure any errors were identified and action taken as a result.

Staff received training to meet people’s needs, and effectively used their skills and knowledge to support people and develop trusting relationships.

People were supported to pursue their hobbies and interests which enabled them to strengthen and build relationships within the home and wider community. Potential risks were considered positively so that people did things they enjoyed and kept in touch with those people who were important to them. Where potential risks to people's safety were identified, staff had relevant information that helped protect people from risks which helped keep them safe.

There was enough staff to meet people's needs, numbers of staff were increased to support people effectively and when people had planned appointments or activities away from the home.

Some people were considered to lack capacity to make day to day decisions such as what to eat, what to drink, what to wear. This had been assessed so staff knew how much support people needed with decision making. Staff had a good understanding of the Mental Capacity Act, and the need to seek informed consent from people wherever possible.

Staff treated people with dignity and were respectful of people’s decisions, when they decided if they wanted to be involved or not.

People had meals and drinks that met their individual requirements and people received support from other healthcare professionals that ensured any risks related to eating and drinking were minimised.

Relatives told us they could raise concerns or complaints if they needed to because the registered manager and staff were always available and approachable. Relatives felt confident they would be listened to and actions would be taken.

The provider had quality monitoring processes which included audits and checks on medicines

management, health and safety checks and care records. Recommended actions were clearly documented and acted upon. Additional checks through unannounced provider visits checked improvements had been made.

Prior to our visit we reviewed all the information we had received from the provider. During the inspection we observed the care and support provided to the five people living at the home. The five people who lived at the home had little or no verbal communication so they were unable to tell us directly how they felt about their service. We spoke by telephone with a relative and asked them for their views. We also spoke with the assistant manager and three care staff. We looked at some of the records held in the service including the care files for the five people and carried out a tour of the building.

The summary below describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found;

Is the service safe?

People's needs had been assessed and individual care plans drawn up to meet their needs. The assessments and plans included consideration of risks to the person and how these could be managed to keep the person safe.

There were arrangements in place to deal with foreseeable emergencies. We were told by staff members we spoke with that they were able to contact a manager when they needed to.

The provider carried out checks on staff before they started working at the home to ensure they were suitable to work with people. We found the provider ensured any agency staff used were suitable to work with vulnerable people.

Medication was managed safely. Staff followed the provider's policies and procedures.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The provider had not submitted any applications, however relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We observed that people willingly accepted the care and support that staff provided and that their needs had been met. A relative told us they were happy with the care and support received. It was clear from what we saw and from speaking with staff that staff understood people's care and support needs and that they knew them well. Staff had received training to meet the needs of the people living at the home.

We saw in care plans that risk assessments had been completed that promoted people's independence and protected their dignity. We found staff worked in accordance with these assessments when they supported people to mobilise. We also saw people were supported to be involved in their local community.

Is the service caring?

We found that staff talked with people in a respectful manner and used non-verbal communication consistent with people's individual care plans. The home had made sensory equipment available to people.

We saw staff took care to ensure people had enough to eat and drink. We saw that activities were planned and that people's involvement was monitored to ensure they received the sensory stimulation appropriate to their needs.

Is the service responsive?

We found that each person's needs were regularly reviewed and their care plans were updated if needed. Records showed that people were supported in line with their plans.

People had access to activities and had been supported to maintain relationships with their relatives. We found that relatives were encouraged to visit whenever they wished.

We found that people's own rooms were personalised and reflected their own tastes and interests.

Is the service well-led?

The provider had quality assurance processes in place. People's views had been obtained by the provider along with the views of family representatives and staff. The provider had taken action as a result of people's comments.

A relative told us they would feel able to raise any concerns they had with the provider and were confident their concerns would be dealt with.

We found that quality checks were carried out by the provider and risks to people's health and safety were minimised.

People's needs were assessed and care and support were planned and delivered in line with their individual care plan. Risks to people's health and welfare were identified and staff minimised the risks because they understood people's individual needs.

We saw that the whole staff team was pro-active in keeping the house and equipment clean and tidy. Care staff we spoke with told us they had training in infection prevention and control. The manager told us about their refurbishment plan for one room which would make sure the environment was easy to keep clean.

Care staff told us they felt supported in their role because they had a thorough induction, good training and regular one-to one meetings with the manager. Care staff told us, 'The one-to-one meeting is beneficial, I take a lot from it' and 'It's the best job I've had. I really want to come to work.'

People's personal records and staff records were kept in the manager's office so they could be accessed when needed. Staff kept a daily record for each person, which meant changes in people's needs and abilities were identified promptly.