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Archived: The Barn House Inadequate

Reports


Inspection carried out on 7 January 2016

During a routine inspection

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 carried out on 16 July 2015

During an inspection looking at part of the service

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

We carried out an unannounced comprehensive inspection of this service on 21 April 2015. After that inspection we received concerns in relation to the risk management and safety of people. As a result we undertook a focused inspection on 16 July 2015 to look into those concerns. This report only covers our findings in relation to this topic.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

The service is run by a 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.

Staff did not have written information about risks to people and how to manage these in order to keep people safe. One person had a high risk of falls; other people had behaviours that challenged others. Risk assessments and care plans did not reflect the individual need of the person and how their mental health and physical needs affected their daily life or how the service managed the risks to the person or others.

Staff recruitment processes since our last inspection had not been robust. The provider had not undertaken the appropriate checks to ensure new management and nursing staff were recruited properly.

The provider had not undertaken the appropriate assessments to ensure the planning of care balanced the needs and safety of people with their rights and preferences. The registered manager had not undertaken appropriate risk assessments prior to people moving into the home to ensure that staff had enough information to support the person.

The provider and registered manager had not notified the relevant authorities about incidents that affected the health, safety and welfare of people. Notifications of incidents had not been submitted to CQC as required by law.

New staff were not appropriately supervised when they were learning new skills.

The provider and registered manager had not always protected people from abuse and improper treatment or actively worked with others to ensure that care and treatment remained safe for people. They did not have systems in place to investigate or respond without delay to the issues identified.

Inspection carried out on 21 April 2015

During an inspection looking at part of the service

The Barn House provides care and accommodation for up to 30 people and is registered to provide nursing care for people with physical disabilities, mental health issues and those who may be living with dementia. On the day of our inspection 25 people were living at the service.

The inspection took place on the 21 April 2015 and was unannounced.

The service is run by a 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.

People had different levels of understanding and communication in relation to their dementia. Staff did not show a level of understanding that people living with dementia have specialist needs.

Staff did not have written information about risks to people and how to manage these in order to keep people safe. One person had been diagnosed with epilepsy, but their care plan did not describe guidance to staff on how to manage the risks of this person having a seizure. Another person had been diagnosed with diabetes and their care plan did not specify the management of this. Risk assessments and care plans did not reflect the individual need of the person and how their dementia, mental health and physical needs affected their daily life.

Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. One staff member said they would report any concerns to the registered manager. They knew of the types of abuse and where to find contact numbers and knew about the local safeguarding team. However, we found the provider had not submitted notifications of safeguarding concerns to the Care Quality Commission (CQC) in a timely manner.

Staff did have awareness training for with caring for people who live with dementia; however the organisational culture did not support the development of staff’s practical and competency skills when working directly with people.

We saw staff were not effectively deployed as there were times when we found no staff available to assist people or keep them safe. For example, from the risks of falls, or to support someone if they became distressed. We observed when people were able to access the garden one resident fell off a garden chair as there were no staff to supervise them. This required intervention from the inspector.

The premises were not safe or well designed to enable people with mobility needs or dementia to be as independent as possible for as long as possible.

People spoke to us about living at The Barn House. One person said; “You get used to it. You're just here and that's it.” We did not observe staff consistently respecting people and treating them as individual’s, focusing on their needs, abilities and achievements. We heard staff ask people constantly about task focused activities, for example, “Come and have your dinner” and, “Take your medicines.”

Staff did not show an understanding of what people were interested in and what people could still do. We saw some people sitting for long periods of time without supportive interaction from staff. Supportive interactions are relationships and communications that we have with people that are affirming and help promote a person’s sense of self-worth. Best practice guidance shows one-on-one time is very important to having supportive and emotionally worthwhile social interactions.

Activities were limited to people who had capacity to become involved. We did not see any specific activities or pastimes which would be suitable or appropriate to people living with dementia. One member of staff said there were not enough activities. One person said, “I sit here and watch the television, that's all.” When asked what activities they would like if given the choice, they said, “Go in the garden.” We asked them how often they go into the garden and they told us, “Not much. They take us out in the summer. That's all.”

People were offered a choice of food. However, we observed that people were not supported to eat in a dignified way. Staff were not aware of people’s specialised dietary requirements such as the need for thickened fluids to reduce the risk of choking.

Medicine procedures for the safe administration of medicines were in place. However we identified some shortfalls in the recording of medicines on the medicine administration chart (MAR).

People were referred to some external health professionals when they needed extra support but not in a timely manner, or if they had specialised needs. One person said, “I don’t think the external professionals fully understand the complexity of my physical healthcare needs.”

Care plans did not reflect people’s current needs or individualised choices. They had not been reviewed on a regular basis and people were not involved with their own plan of care. One person said, “What's that? Never heard of it.”

The legal framework around the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) had not been followed. The provider and staff did not consistently understand the requirements of the Act and how it affected their work on a day to day basis. Three staff had an understanding and was able to describe some of the residents needs appropriately. They said they had training in MCA. However the registered manager had not completed the necessary MCA two-stage assessment or applications to the local authority as required by the DoLS. This meant people without capacity had not been supported in agreeing to choices made about their care.

The registered manager did not have a satisfactory system of auditing in place to regularly assess and monitor the quality of the service or manage risks to people in carrying out the regulated activity. We found the registered manager had not undertaken actions suggested in external risk assessments for example signs in the corridors. And to make sure improvements to practice were being made.

People’s views had not been obtained by holding residents meetings and sending out an annual satisfaction survey.

Confidential and procedural documents were stored safely. We saw copies of the services contingency and emergency plan and the registered manager was able to explain the process in the event of an emergency.

Staff recruitment processes were robust to help ensure the provider only employed suitable people.

Staff had mixed views on the management of the service generally said they felt supported. Staff said they had received regular supervisions. One staff member said, “The registered manager makes me feel confident and supported.” However other staff felt the registered manager could be, “Very sharp and that some staff were afraid to speak.”

People said staff were caring, and that visitors were welcome at any time.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered person has a rating of ‘Inadequate’ for the key questions ‘safe’ and‘ well led’ at the last inspection and this inspection. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 26 November 2013

During an inspection looking at part of the service

This inspection was to follow up on the findings from our previous inspection of 29th May to assess if action had been taken with regards to the concerns we identified.

We found that the provider had taken action to address concerns around the lack of personalised detail in people's assessment records and care plans and the lack of supported activities available to people who used the service. One person who used the service told us �Oh yes, there has been quite a lot going on�.

We also found that appropriate action had been taken to ensure people's consent to their care and treatment had been gained and evidenced or where appropriate a capacity assessment had been completed, as well as individual risk assessments being completed for people around activities such as going out of the house.

Inspection carried out on 29 May 2013

During a routine inspection

People�s records did not show evidence they had participated in activities or any alternative activities run specifically to meet their needs and choices. Some people who used the service told us that activities were limited and they had limited choice. We spoke to three people who used the service and they told us �I�d like to get out more�.

One relative we spoke to told us �they treat it like it is their (my relative�s) home�. Another relative told us �(staff are) competent carers who give careful handling of the physically challenged�.

We saw no records of mental capacity assessments or records to confirm that best interest meetings had been held for the individual which had included the people who best knew and understood them. One relative told us �They just ring me if my relative needs anything�.

We saw that feedback surveys were distributed annually to gain the views and experiences of people who used the service and their relatives as well as staff in the way the service was provided and delivered. Most people had said they were satisfied or very satisfied. One person we spoke to told us �I feel comfortable giving my opinion. I am definitely listened to.�

The records regarding people's health needs were kept up to date in order to help staff deliver safe and appropriate care to each individual.

Inspection carried out on 31 October 2012

During an inspection looking at part of the service

People told us that they could choose how they spent their time at the home and that staff were available when they needed them. Most people told us that they enjoyed the food provided by the home and that they had sufficient choice about the food they ate. One person told us, �The food is good� and another said, �I choose from the menu what I want to eat.� Another person told us that their meal was �Excellent.�

Two people told us that they were unhappy that they were not able to lock their bedrooms when they left them unoccupied. One person told us that other people living at the home sometimes entered their bedroom when they were not there and that they were unhappy about this.

Inspection carried out on 30 August 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live in The Barn House. They described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service.

People told us that they could choose how and where they spent their time at the home but some people said that they were restricted in the choices available to them by the routines of the home. Many of the people we spoke with were unaware of the content of their care plans and most said that they were not asked about their preferences regarding their care.

Comments made by people using the service about the food provided by the home were mixed. Some people told us that they enjoyed the food whilst others said it was of poor quality. One person said of the food, �It�s very good � I�ve got no complaints at all.� Another person told us, �The food�s poor, it�s terrible.�

Comments made by people using the service about the support provided by staff were also mixed. One person told us, �The staff are very good here, they treat the people well.� Another person said, �A lot of them [staff] don�t seem that interested, to be honest.�

Inspection carried out on 12, 13 July 2011

During an inspection in response to concerns

Some service users spoken to told us that they liked living in the home. They told us the staff were kind and caring. Someone said that they liked to go out every day and staff ensured that this was possible. Another said that he liked his newspaper and that staff were working to ensure he gets this early before he hears the news. People said the food was good and that they eat well.

Some people were more aware of their care plans and told us that they know what care to expect.

Reports under our old system of regulation (including those from before CQC was created)