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Archived: The Barn House Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 22 April 2016

The Barn House is registered to provide nursing care and accommodation for up to 30 people with complex mental health issues, physical disabilities and people who may also be living with dementia. On the day of our inspection 23 people were living at the service, one of these people was in hospital.

The inspection took place on the 7 January 2016 and was unannounced. The inspection followed the Special Measures process to identify if the improvements required had been made.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Barn House is owned and managed by the registered providers; one of the providers is also the registered manager, who was present on the day of the inspection visit. 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.

The registered provider, registered manager and staff did not show an understanding of the needs of people with mental health issues, dementia and complex physical needs. The information the provider has placed on care websites states the service is a specialised service in supporting people with mental health needs.

Staff did not have written information about risks to people and how to manage these in order to keep them safe. They did not reflect the individual needs of the person and how their dementia, mental health or physical needs affected their daily life. One person had been diagnosed with epilepsy, but their care plan did not describe guidance to staff on how to manage the risks of them having a seizure. Another person experienced hallucinations but their care plan did not specify how these symptoms could be managed or what staff could do to provide support. At the last inspection, we asked the provider to take action to make improvements on assessing the risks to people’s safety; this action had not been completed.

People were not protected from the risk of abuse and improper treatment because staff were not always able to identify situations that constituted ill-treatment. People were left isolated in their rooms without social interactions. People’s changes in needs had not been identified which could place them at risk of harm

Inspection areas

Safe

Inadequate

Updated 22 April 2016

The service was not safe.

Risks to people�s health and welfare were not always minimised effectively.

The provider had not always protected people from the risk of abuse and improper treatment.

The environment was not a safe environment for people with dementia or mobility needs. T

The provider had not carried out appropriate checks to help ensure they employed suitable people to work at the service or make appropriate referrals to other regulatory bodies when needed.

Medicines were stored and administered safely.

Effective

Inadequate

Updated 22 April 2016

The service was not effective.

Staff were not effectively monitoring people�s physical or mental healthcare needs, particularly when their needs changed.

Staff did not have the necessary training to support people living with dementia or mental health issues and had not received regular supervision.

The registered manager did not understand their responsibilities under the Mental Capacity Act 2005 or Deprivation of Liberty Safeguards. People�s freedom was being restricted and there was no system in place to identify if people could make decisions about their care and treatment.

People were not given a choice about what to eat and their mealtime experience was not a positive one.

Caring

Inadequate

Updated 22 April 2016

The service was not caring.

Staff did not always take time to speak with people and to engage positively with them.

People were not consistently positive about the care they received, and this was supported by our observations.

People were not always treated in a dignified way.

Some staff showed concern for people in a caring way; however practical action was not always taken to relieve people�s distress.

Responsive

Inadequate

Updated 22 April 2016

The service was not responsive

Care plans were not person centred and had not been reviewed to help ensure staff had up to date guidance on people�s individual needs.

People had not been supported in contributing to planning their own care.

People were not always supported to take part in activities and there were no individualised activities for people who were at risk of isolation

Well-led

Inadequate

Updated 22 April 2016

The service was not well-led.

The registered manager had not ensured that effective quality assurance systems were in place to identify and remedy areas of concern or risk in a proactive manner.

The registered manager and provider did not understand their legal responsibilities or have a good understanding of the key challenges, achievements, concerns and risks for people.

Notifications of incidents were not submitted to the CQC as required by law and the inspection rating was not clearly displayed.