Archived: Barleycroft Care Home

Barleycroft is a care home that provides accommodation, personal and nursing care to 70 people aged 65 and over at the time of the inspection. Barleycroft accommodates up to 80 people across three separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia.

People’s experience of using this service:

The provider had made improvements to the service after our last inspection.

People spoke positively about the care and support they received. They felt safe using the service. Staff had a good understanding of what constituted abuse and how to report any concerns to keep people safe.

Risks associated with people’s care and support had been assessed and there was guidance in place to keep them safe.

The service had an efficient system to manage accidents and incidents and learn from them, so they were less likely to happen again.

There were systems in place for the monitoring and prevention of infection.

There were sufficient numbers of staff to meet people’s needs and staff recruitment processes were robust.

Staff received appropriate training, support and development which enabled them to meet people’s needs effectively.

People were supported to receive their medicines safely. They had access to health care services and professionals when they needed them.

There were assessments undertaken and care plans developed to identify people’s health and support needs. Systems were in place to ensure staff were up to date about people’s needs and were aware of people’s preferences.

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 practice.

People had the privacy they needed and were treated with dignity and respect at all times. They were supported to be as independent as possible and to make choices with regard to their daily lives.

Staff were knowledgeable about people they supported. People commented that staff had good relationships with them.

There was a complaints procedure which provided information on the action to take if someone wished to make a complaint and what they should expect to happen next.

There were systems in place to manage, monitor and improve the quality of the service provided. The provider always welcomed suggestions on how they could develop the service and make improvements.

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

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 21 May 2018).

Previous breaches:

Following the last inspection, we found that the service was in breach of three regulations in relation to staffing, fit and proper persons employed and good governance. We asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider is no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

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

Barleycroft is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Barleycroft is a purpose built 80 bed service providing accommodation and nursing care for older people, including those living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. For example, hoists and adapted baths are available. 54 people were using the service when we visited.

The service did not have a registered manager but a new manager had been in post since February 2018 and had started the process to register with CQC. 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.

At the last inspection on 22 and 23 February 2017, we found two breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The lack of consistent and specific information about people's needs placed them at risk of not receiving the care they required and wanted. The registered person had not adequately monitored, assessed and improved the quality of the services provided. Following the last inspection, the provider completed an action plan to show what they would do to improve the service and meet the requirements.

At this inspection, we found that action had been taken. Care plans had been reviewed and improved to better reflect the care people needed. Some further development was needed to make them clearer and to support further consistent practice and this formed part of the services future action plan.

Systems to monitor the service provided had been changed and strengthened. However, further work was needed to ensure people received a good quality of service and legal requirements met.

Staffing levels and deployment were not sufficient to meet people’s needs and to enable them to be supported in a way that they wished. Staff training was not always up to date and therefore did not ensure staff the necessary skills and knowledge to meet people’s assessed needs.

The provider’s recruitment process was not always operated effectively to ensure staff were suitable to work with people who need support.

Staff were aware of their responsibilities to ensure people were safe and action was taken if there were any concerns or possible abuse. People told us they felt safe at Barleycroft and were supported by kind and caring staff. Systems were in place to minimise risk and to ensure that people were supported as safely as possible.

People were encouraged to do things for themselves and staff provided care in a way that respected people's privacy and dignity.

Systems in place supported people to receive their prescribed medicines safely and they were supported to receive the healthcare they needed. If there were concerns about their eating, drinking or weight, this was discussed with the GP and support and advice were sought from the relevant healthcare professional.

Staff supported people to make choices about their care and systems were in place to ensure they were not unlawfully deprived of their liberty. Systems were in place to ensure that decisions made in people’s best interest protected their human and legal rights.

Staff and relatives were positive about the changes implemented by the new management team.

We saw that staff supported people patiently, with care and encouraged them to do things for themselves.

People’s nutritional needs were met and they were happy with the food provided. We recommend that catering arrangements be reviewed with a view to facilitating people receiving meals that meet their cultural preferences.

Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.

Staff felt the management team were and supportive and gave them clear guidance.

Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in an environment that was suitable for their needs. Ongoing work was taking place to improve the environment and make it more homely and dementia friendly.

A complaints procedure was in place and relatives knew how and who to complain to when needed.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service does not have a registered manager. 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. A new manager has been in post since 12 December 2016 and has started the registration process.

At our comprehensive inspection on 19 and 20 July 2016, we found that people’s healthcare needs were not consistently met, some care plans contained contradictory instructions or were not sufficiently detailed and management systems had not ensured that required improvements had been made. At this inspection, we found action had been taken and people’s healthcare needs were monitored and addressed. Action had also been taken with regard to care planning and quality improvement. New quality monitoring systems were gradually being embedded, some care plans were more detailed and plans were in place to review and improve the remainder. Further work was needed to fully meet the breaches in regulations identified at the comprehensive inspection and there was an action plan in place to do this.

Staffing levels were sufficient to meet people’s needs.

People told us they felt safe at Barleycroft and that they were supported by kind, caring staff who treated them with respect. One person told us, “Yes, I do feel safe, the staff always come and cheer me up.”

Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in an environment that was suitable for their needs. In one unit, the carpets had been replaced and redecoration was taking place.

Staff received training and support to carry out their duties and felt that this was the right training for the job they did. Not all staff training was up to date but this was being addressed by the manager.

Systems were in place to ensure that people were not being unnecessarily or unlawfully deprived of their liberty. However, evidence was not always in place to support that decisions were made in people’s best interests.

People were supported by kind, caring staff who treated them with respect. Relatives had written positive comments including, “Thank you so much for looking after our [family member] so well. It's a great comfort to know they were in such caring hands.”

People were encouraged to do things for themselves and staff provided care in a way that promoted people’s dignity.

People were happy with the food provided and their nutritional needs were met. If there were concerns about their eating, drinking or weight, this was discussed with the GP and support and advice were sought from the relevant healthcare professional.

The arrangements for administering medicines were safe and people received their medicines as prescribed.

Systems were in place to safeguard people from abuse and staff were aware of how to identify and report any concerns about people’s safety and welfare.

Staff were trained to identify and report any concerns about abuse and neglect and felt able to do this.

The provider’s recruitment process ensured staff were suitable to work with people who need support.

Social and recreational activities and events were available and most people were happy with the activities offered.

A complaints procedure was in place and relatives knew how and who to complain to when needed.

Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Barleycroft is a purpose built 80 bed care home providing accommodation and nursing care for older people, including people living with dementia. When we visited 62 people were using the service.

The service does not have a registered manager. 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. A new manager has been in post since 26 September 2016 and is not registered.

People were no longer placed at risk of harm from unsafely managed medicines. Unused and unwanted medicines were safely recorded, stored or disposed of. Guidance from the pharmacist had been followed and medicines were safely administered.

The process for obtaining cover for staff absences had been reviewed and strengthened to help facilitate cover being put in place at short notice. People told us that there were still occasions when cover could not be found but the situation had improved.

The system for accessing cleaning and personal care items had been changed and sufficient stocks were available and accessible at all times.

There was an action plan in place to address shortfalls in the service. The provider had increased their visits to the service to monitor the quality of care provided and to ensure that changes were being made.

New care plans were being introduced and about 40% had been changed. The new care plans were more detailed and covered people’s needs. They had been reviewed and updated when necessary. This lessened the risk of them receiving inconsistent or unsafe care that did not meet their needs.

There are two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 identified at the last comprehensive inspection. You can see what action we told the provider to take at the back of the full version of the report.

This unannounced inspection took place on 19 and 20 July 2016. Barleycroft is a purpose built 80 bed care home providing accommodation and nursing care for older people, including people living with dementia. When we visited 65 people were using the service.

The service has a registered manager. 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 last inspection on 4 September 2015 we asked the provider to take action to make improvements with regard to medicines, monitoring and improving the quality of the service and care planning. The provider sent us an action plan detailing the action they were taking to meet these requirements. They said that this would be completed by 31 January 2016. However, these actions have not been completed.

The arrangements for administering medicines were not safe. Unused and unwanted medicines were not safely recorded, stored or disposed of. Guidance from the pharmacist had not been followed and medicines were not safely administered. This placed people at risk of harm from unsafely managed medicines.

The provider had systems in place to monitor the service provided and people were asked for their feedback. However, internal audits and monitoring had not identified the issues found during the inspection. In addition the management systems had not supported the necessary improvements to address the shortfalls identified at the last inspection.

People’s individual files contained information about their life history, likes, dislikes, and religious beliefs. However, care plans were not always in place to meet all of their needs. For example, for epilepsy management. Also some care plans contained contradictory instructions or were not sufficiently detailed. This placed people at risk of receiving inconsistent or unsafe care that did not meet their needs.

At the last inspection on 4 September 2015 we also asked the provider to take action to make improvements with regard to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and this had been completed. Systems were in place to ensure that people’s human rights were protected and that they were not unlawfully deprived of their liberty.

Staffing levels were sufficient to meet people’s needs but we have recommended that the process for obtaining cover for staff absences be reviewed and strengthened to enable cover to be put in place at short notice.

During our inspection we noted some cleaning and personal hygiene items were not readily available, and we found that there was not any toilet paper or soap in one toilet, and no hand cleanser in the pump in the clinic room or nurses’ station. This was remedied straightaway and we have recommended that the system for managing cleaning and personal care items be reviewed so that sufficient stocks are available and accessible at all times.

People told us they felt safe at Barleycroft and that they were supported by kind, caring staff who treated them with respect. One person told us, “I’m quite well looked after. I don’t feel threatened, I feel safe.”

The provider’s recruitment process ensured that staff were suitable to work with people who need support.

Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in an environment that was suitable for their needs. In one unit the carpets needed replacing and this had already been identified for action by the registered manager and the provider

People nutritional needs were met and they were very happy with the food provided. They said the chef was very helpful and accommodating.

Staff said they received the training they needed to provide to meet people’s needs and a plan was in place to ensure that training would be up to date by the end of December 2016.

Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.

Arrangements were in place to meet people's social and recreational needs and people told us they enjoyed these.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During this visit we found that improvements had been made with regard to people's care and welfare and also the monitoring of the service. People who used the service and their relatives were happy with the improvements made and had 'every confidence' in the new manager. One person told us 'he (the manager) is tough and he sorts things out then and there. There are enough staff now and they are very good.' Another said 'it's much improved and the manager is on the ball. He comes in at all different times to check on things.' The required standard was met and the condition of registration has been removed.

The issues identified at the previous inspection with regards to the administration of warfarin had improved. However new medication issues were identified. For example we found missed doses of medication and mistakes on hand written entries on medication charts. People were not protected against the risks associated with medicines.

Most people we spoke with felt that the staff team worked very hard and were caring and helpful. One person told us 'it's smashing. Nice staff and nothing is too much trouble." However, they also told us that they were concerned about staffing and nursing levels. One person said 'I am contented here but they need more staff. They're too busy, so you just agree with them all the time. They have no time for discussion or for us to be difficult.' A relative said 'there used to be two nurses on this floor and now there is only one. How can that be right when you can see how poorly people are.'

We found that there were not enough qualified and skilled staff to meet people's care and welfare needs in a timely and safe manner. When one person was very unwell there was a delay in assessing the severity of the problem and summoning the emergency service. The systems for the administration of medicines were not robust and did not support people to receive their prescribed medication safely. Although the provider had a quality monitoring system in place it was not effective. For example, the manager informed us that weekly medication audits took place but we found that in some cases these had not been carried out since July 2013. This issue and the other concerns highlighted during the inspection had not been identified via the provider's quality monitoring of the service.

At the time of our inspection the provider did not have a registered manager in post.

We also found that people were protected from the risks of unsafe or inappropriate care because accurate and appropriate records were maintained. Records had been reviewed and updated and staff had received training to assist them in completing records appropriately.

We found that staff had been appropriately recruited and checked to ensure that they were suitable to work with vulnerable people. There was a structured induction process in place to ensure that they received the training and guidance needed to carry out their duties safely. Medication was stored safely and people received their prescribed medication appropriately. However people's records were not always accurate or up to date and did not indicate the care and support they had received. This placed them at risk of receiving unsafe or inappropriate care.

Overall people felt that the quality of care provided at Barleycroft had deteriorated and that their care and welfare needs were not being met. They said that there had been little continuity of care due to a high staff turnover recently and also a reliance on agency staff. One relative said 'over the last year the care has gradually deteriorated. Attention to detail has been missing and X has not always been kept comfortable. They lost a lot of good regular staff. We raised this at a meeting with the company and have given them a couple of months to improve things. It has been a little bit better lately.' Another told us 'there are a lot of staff vacancies and a lot of agency staff have been used. They don't know people and sometimes have not known how to use equipment properly or safely. I feel that staff are not always noticing things and have a lack of understanding. Care has gone downhill.' At a recent relatives meeting people had strongly expressed their concerns about the service. The provider had acknowledged these concerns and agreed that there was a lot of work to be done to identify and address gaps in the service.