Barnfield Manor Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to staffing.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst systems were in place to report, review and analyse accidents and incidents, not all behaviour related incidents were included in the overall analysis. This meant there was potential for themes, trends and actions to improve safety to be missed. Leaders assured us that they had booked additional training on the digital recording system, which would ensure behaviour incidents were appropriately logged and accurately pulled through for analysis going forward.

Overall, people and relatives were satisfied with how safety events were managed. One relative shared, “[Person] has fallen a couple of times. Staff reacted quickly to that.” And, “[Person] has got a sensor mat by the side of their bed, if it goes off, staff come running.”

Staff could explain the process for managing accidents, incidents and falls in line with the relevant policies and procedures. Staff demonstrated a good understanding of measures in place for people at high risk of falls to help manage this risk. Staff told us they received updates and debriefs following accidents, incidents and falls. One staff told us, “The debrief is usually discussed during handover for example details of residents who’ve fallen and what actions have been taken.”

People were not always supported to transition into the service safely, and comfortably. For example, we observed 1 person who was new to the service had minimal appropriate clothing with them to keep them warm. It wasn’t until our inspection team highlighted this as a concern that this was addressed.

A pre-admission assessment was carried out prior to people moving into the home and key information was shared with staff. This ensured people’s needs were understood and could be safely met. The manager had plans in place to ensure people’s preferences and backgrounds were collated to improve continuity of care. One relative told us, “[Manager] asked for family of residents to tell them a bit about the resident’s backgrounds. I thought that was a very good thing. There will be things that surprise them about relative's past. We have sent that in, their likes and dislikes.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff had received safeguarding training and understood their responsibilities to recognise, and report concerns about abuse. Relevant policies and procedures were in place and leaders worked with appropriate agencies to ensure people were protected from the risk of abuse.

Relatives expressed confidence in the provider’s ability to keep people safe and respond appropriately to concerns. Feedback included, “I think [person] is safe, they are very kind, patient and I’ve never heard anyone speak horribly to anyone, nothing negative at all.” And, “The home is very safe, they are very caring. There were a few incidents when [person] first went there that were dealt with quickly and procedures were followed.” During our inspection we observed kind and patient interactions between staff and people. People were observed to be comfortable in the presence of staff.

The manager had made appropriate applications for deprivation of liberty safeguards (DoLS) where people required this level of protection to keep them safe.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Some care plans and risk assessments did not provide sufficient guidance to support people’s risks safely. For example, where people communicated signs of distress, their positive behavioural support (PBS) plan was not completed fully, or in line with recognised PBS framework. Furthermore, when people had been prescribed medicines to be given on a, ‘when required’ basis to manage behaviour, detailed person specific care plans were not in place to support consistent management and administration.

Daily records of care did not always demonstrate that people had been supported in line with their assessed needs. For example, there were some gaps in charts for fluid monitoring and bowel monitoring. This increased the risk of missing early signs of health deterioration. Leaders assured us this was a recording issue, and planned training on the digital recording system would improve recording of interventions.

Some staff fed back that care plans and risk assessments required more information to support them in carrying out their roles. One staff told us, “Not at the moment, some of them do not have enough detailed information and this is being added now.” Leaders were working through a clear and prioritised action plan to ensure care plans and risk assessments were accurate and up to date.

We received mixed feedback on people and relative involvement in writing and reviewing care plans. Some were aware of their loved one’s care plans; others told us they had not had sight of theirs. However, most relatives were assured the manager was in the process of setting up systems to ensure regular involvement.

People were not always supported in an environment which met their full range of needs. For example, there was a lack of signage to support people to navigate around the home. We also observed overflowing outdoor waste bins during our inspection, increasing risk of infection. Leaders assured us the bins were due to be emptied.

The provider was working through an environmental service improvement plan. People were involved in picking colours and décor, and we saw some areas which had been recently decorated. People had access to well-maintained specialist equipment and records showed routine health and safety checks were carried out.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

During our inspection, whilst staffing levels were in line with the assessed dependency needs for the home, staff were observed to be busy and overstretched. For example, staff supported people to sit down for lunch at 12:30 but due to unforeseen circumstances, the meal was delayed until 1:15. This led to some people becoming unsettled, requiring additional support from staff. However, this took staff away from other people and tasks leading the mealtime experience to feel rushed.

We were not fully assured the provider’s tool to calculate safe staffing levels, took into consideration people’s full support needs and other factors which impacted on staffing. For example, where people required increased observations following falls, or the layout of the building. This placed people at risk of not having their support needs met promptly, and staff becoming overstretched.

Feedback on staffing levels from relatives included, ““If I’m truly honest no [staffing levels are not sufficient], when there is a lot going on I think sometimes they are spread too thin.” And, “I think they could do with a few more staff. If [person] needs to go to the toilet, they need 2 people and if staff are dealing with someone else, they can’t do it. At bedtime if they are putting someone else to bed, they can’t see to anyone else.” Another relative told us, “Sometimes there’s not enough staff, staff are so busy.” One person told us they had to sometimes wait for support.

Staff told us, “I would say that they’re not looking at the dependencies enough, they are looking at numbers.” And, “There have been times when it hasn’t been great due to needs of residents exceeding what we can manage. A lot of the time the dependency is not taken into account just the number of residents.” Also, “We need extra to enable us to give the best care as there’s only so much, we can do.” Another staff shared, “In the morning everyone needs the same things at the same time, like toileting for example and this makes it difficult. I don’t like telling residents to wait a minute and find it frustrating.”

Staff had received training to carry out their roles safely. Leaders carried out observations on staff competencies to ensure safe and consistent practice. We observed safe moving and handling manoeuvres carried out by staff.

The provider did not always assess or manage the risk of infection. During our inspection there were some malodours present, and spillages were not always cleaned up promptly. We received some feedback that people were not always supported to maintain personal hygiene as often as required. Due to some gaps in daily records, we could not be fully assured people’s personal hygiene needs, such as nail care, were regularly met.

However, overall surfaces and equipment were clean and well-maintained. People’s bedrooms were tidy, and equipment, including mattresses, were in good condition. Staff were observed to wear personal protective equipment (PPE) in line with best practice guidance.

People and relatives were satisfied with the cleanliness of the home. One relative told us, “Their bedroom and bathroom are always immaculate. Staff constantly use hand gel, aprons and gloves if needed.” And, “Staff wear PPE when taking [person] to the toilet. The cleaners are there all the time.” Another shared, “They are very good; they always wash their hands and wear gloves. It’s always clean and tidy, as is the toilet. They change the bedlinen regularly.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Records were kept of medicines prescribed for and given to people. These showed that people received their medicines at the times that they needed them. Medicines that need to be given at specific times were given at or close to the specified times.

Medicines that people were allergic to were identified on their records.

External medicines, such as creams and patches, were applied and recorded correctly. The use of body maps supported staff to do this safely, showing the site of application and of rotation to appropriate sites for the use of patches

Thickeners, to help people swallow drinks, were safely stored, recorded and administered.

There was a process for medicines to be administered covertly, including completing mental capacity assessments and obtaining pharmaceutical advice from an appropriate healthcare professional.

Medicines were stored securely and at the correct temperature. Controlled drugs were stored securely and recorded correctly.

Staff received medicines training and were assessed as competent to provide medicines support. We observed staff administering medicines and saw that people were given their medicines safely and at the right time.

There were clear policies and procedures describing how medicines were to be managed in the home. Medicine audits were completed, and action take to sort any issues found.