Old Court Barn Residential Care Home

The home was bigger than most domestic style properties. It was registered for the support of up to seven people. Seven people were using the service at the time of the inspection. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by how the building was used. There were no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff did not wear anything which suggested they were care staff when coming and going with people.

What life is like for people using this service:

• People enjoyed living at Old Court Barn had developed caring relationships with staff who promoted people’s rights to independence, dignity and privacy. Staff knew what was important to people and what interested them.

• Staff understood people’s safety needs well and supported them so their individual risks were reduced.

• People's communication preferences were supported and staff assisted people to make their own decisions about their day to day lives.

• There were sufficient staff to care for people and people were comfortable to ask for assistance from staff when they wanted this.

• People were supported to have their medicines safely. People’s medicines were regularly checked and reviewed.

• Staff supported people to have enough to eat and drink so they would remain well.

• People had access to health care and support from other health and social care professionals. This helped to ensure people had good mental and physical health outcomes.

• People's care preferences and needs and the views of their relatives were considered when care was assessed, planned and reviewed, so people’s needs continued to be met.

• People were supported to keep in touch with others who were important to them. Ways of working with people’s relatives were agreed which provided a consistent approach to the care people received.

• Staff received the training they needed and to develop the skills they required to care for people.

• The risk of infections and accidental harm was reduced, as staff used the knowledge and equipment provided to do this.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this.

• People had opportunities to spend their time doing things they enjoyed. This included maximising people’s opportunities to enjoy spending time in the local community.

• The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence, inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

• Systems were in place to take any learning from complaints and to further improve people’s care.

• The registered manager sought suggestions for improving people’s care further and suggestions were listened to and acted on.

• The registered manager and staff reflected on the care provided, so improvements in people’s care would be driven through. The registered manger planned to continue to develop the facilities at the home and to further develop their strategy for supporting people at the end of their lives.

•We found the service met the characteristics of a “Good” rating in all 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 Old Court Barn was published on 13 September 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

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.

The provider of is registered to provide accommodation for personal care for a maximum of seven people.

At the time of our inspection there was 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 2008 and associated Regulations about how the service is run.

People living at the home were looked after safely and care staff. were able to tell us how they kept people safe and the action they would take. There were enough care staff to support people with their personal care and social needs. People’s medicines were looked after by staff at the home and their medicines were recorded to show when they had received them.

Where people had not been able to consent to certain aspects or decisions about their care records of decisions had been completed. People received care from staff that had been trained and were knowledgeable about a range of care needs people who lived in the home had. People had their own healthcare professionals who provided treatment and the home had recorded those who were involved.. People enjoyed the food and were able to assist in making meals if they wanted. Staff knew the food people liked and where people had certain nutritional requirements.

The atmosphere in the home was calm and people were relaxed in the company of staff .People’s requests for assistance were answered by care staff who recognised people’s needs. Staff sought consent from people and waited for a response before care and support was provided. People’s privacy and dignity was respected and people were supported and empowered to be as independent as possible in all aspects of their lives. Staff anticipated people’s care needs and attended to people quickly in a gentle and unhurried way.

People’s needs were met and recorded in care plans. These had been developed with the person and their relative to detail the care and support needed. Care staff told us they updated the records as needed and they were reviewed regularly. People’s concerns or comments raised were responded to and the provider had taken action to resolve them.

The management team had kept their knowledge up to date and they led by example. The management team were approachable and people knew them. The provider ensured regular checks were completed to monitor the quality of the care that people received and look at where improvements may be needed and take action where required.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

When we visited we met five of the seven people who lived at the home. They were not able to tell us about their experience of living at the home due to their communication needs. We observed people being supported by the care staff and arranged for people's families to give us their views.

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?

Risks to people had been identified, assessed and kept under review. Staff had the skills and knowledge to know how to meet people's needs and keep them safe. They had undertaken training including fire safety and how to respond positively to people's behaviours.

We found that people who lived in the home were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no application had needed to be submitted there were policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

We found that people's on going needs were regularly assessed and the care and support provided for them was well planned and purposeful. Changes in how the care was provided were discussed with people when possible and their relatives and professionals involved in their care. Behaviour monitoring records were kept up to date and accurate. This provided reliable information to staff and professional's to ensure the support provided care met people's current care needs.

The systems in place to inform staff about changes in people's needs were effective. Staff meetings and supervision sessions were held regularly. Staff felt well supported and that their views were listened to and any concerns were taken seriously.

Is the service caring?

The staff team knew people's needs and preferences very well. We observed a relaxed, yet respectful atmosphere in the service. We saw staff treated people in a kind and caring way. They encouraged people to make choices in areas such as food and activities. Staff gave people positive feedback when they took part in a task or made a choice.

Feedback from people's relatives was positive about the care provided. One relative told us, 'We would like to express our gratitude and praise to the owners and staff at Old Court Barn for the care they give to our son. We always find the staff helpful and one has only to look at his bedroom to see the thought that has gone into it to cater for his interests. And it gives us great peace of mind to know that, his home is all that we could wish for'.

Staff discussed people's needs during their shift to ensure that there was a continuity of the care provided. Decisions were made in people's best interest after consultation with their relatives and professionals.

Is the service responsive?

We found that the management team were open to feedback, including complaints and took action to improve arrangements whenever possible.

Staff at all levels were supported to become well trained and skilled in their work. Information from training courses and staff's ideas were listened to and used to continually try to improve outcomes for people living in the home.

Professional advice was appropriately sought and this specialist advice was used in people's care plans to help improve outcomes for people in the home.

Is the service well led?

The registered manager requested feedback from people's relatives as part of the inspection process. Five families replied and all the feedback was positive. One relative wrote, 'I authentically feel that you're doing a brilliant job' and 'We continue to be appreciative of the high standard of care; the attention to detail; and the positive commitment to help develop X (person's name) to his potential.' Another family wrote, 'We are more than happy with O.C.B. and as X (person's name) is keen to return from about 6 a.m. Sunday, we assume that he is. He seems to have a wide range of activities and appears well fed, what more can he ask.'

We found the management team were committed to continually improving the service and outcomes for people living at the home. There were well developed quality assurance systems and risks to people's safety were kept under close review.

We found that people's needs had been assessed and their care was planned and then delivered in line with this plan. We saw that the staff supported people well and had a good understanding of how they communicated their feelings and needs. The support was given in a calm, attentive and friendly manner.

We found that the service was staffed with a team who worked regularly at the home. The staff we met were well informed about people's care and support needs. The staffing levels were suitable to support people while at home and in the community. The staff felt supported by the manager and they had been provided with appropriate training and supervision.

The manager had effective systems in place to manage the service that included a quality monitoring programme that was spread across the year. Meetings and audits lead to action points and these were followed up. Health and safety hazards were kept under review and routine safety checks carried out.

We found that people were well presented and the staff engaged pleasantly with them seeking their co-operation and consent for daily living tasks and planned activities.

People were provided with a nutritious and interesting diet. They were also encouraged to take part in some food and drink preparation.

Suitable systems were in place to support people with their daily medicines.

The staffing levels were adequate to support people while both at home and when out in the community.

One person's relative told us they had not had to make a formal complaint as the manager and staff were approachable and any issues could be raised and resolved at an early stage