25 July 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. This was a comprehensive inspection.
This inspection took place on 5 June 2018 and was unannounced.
The inspection was carried out by an inspector and two Specialist Advisors. The specialist advisors had expertise in governance and the care of people living with a learning disability. Following the site visit an expert by experience contacted relatives by telephone. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. In this instance the care of people living with a learning disability.
Before the inspection we looked at information the registered persons sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also examined other information we held about the service. This included notifications of incidents that the registered persons had sent us since our last inspection. These are events that happened in the service that the registered persons are required to tell us about.
During the inspection we spoke with two people who lived at the service, two members of care staff, the area manager and the manager. Following the inspection we spoke with one relative by telephone. We also looked at three care records and records that related to how the service was managed including staffing, training and quality assurance.
25 July 2018
The Barn is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It provides accommodation for people living with a learning disability. The home can accommodate up to ten people. At the time of our inspection there were ten people living in the home.
At the time of our inspection there was a not a registered manager in post but an application for the manager to be registered with CQC was in progress. 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. In this report when we speak about both the company we refer to them as being, ‘the registered persons’.
At the last inspection the service was rated, ‘Good’. At the present inspection the service remained ‘Good’. At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. However improvements were required in the 'well led' domain. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
Medicines were managed safely. However, we found that staff had not followed their medicines policy when completing medicine records.
Where people were unable to make decisions arrangements had been made to ensure decisions were made in people's best interests.
Suitable quality checks were being completed and the provider had ensured that there was enough staff on duty. In addition, people told us that they received person-centred care.
There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. Background checks had been completed before new staff had been appointed.
There were arrangements to prevent and control infections and lessons had been learned when things had gone wrong.
Staff had been supported to deliver care in line with current best practice guidance. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.
People were supported to have maximum choice and control of their lives and to maintain their independence. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.
People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. Confidential information was stored securely.
Information was provided to people in an accessible manner. People had been supported to access activities and community facilities. The manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to in order to improve the quality of care.
There was a positive culture in the service that was focused upon achieving good outcomes for people. They had also taken steps to enable the service to meet regulatory requirements. Staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. People, their relatives and members of staff had been involved in the running of the service. The provider had put in place arrangements that were designed to enable the service to learn, innovate and ensure its sustainability. There were arrangements for working in partnership with other agencies to support the development of joined-up care.
Further information is in the detailed findings below.