Archived: Hunters Oak Barn

We last visited Hunters Oak Barn on the 6, 7, and 11 April 2016 and found breaches to legal requirements. These breaches related to the environment, staffing, person centred care and quality monitoring. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to Regulation 9, 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

During this inspection we found the provider had taken action and significant improvements had been made. However further improvements are required and we have made recommendations regarding this.

The service Hunters Oak Barn is registered to provide nursing and personal care and support and accommodation for 12 people who have a mental health diagnosis. The property Hunters Oak Barn is a converted barn situated in a rural area of Burnley. Facilities include single occupancy bedrooms, lounge and recreational areas and a swimming pool. There are two bungalow type properties on site for people preparing for independent community living. At the time of our visit there were 4 people accommodated at the home.

There was a registered manager in post. 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.

We noted risk assessments had been carried out on the environment. Action had been taken to reduce the level of risk through modification of the environmental hazards identified at our last inspection.

People living in the home said they felt safe with the staff who supported them. There were enough staff on duty; however there were times when support from a Nurse was provided by a two tier contact system for out of hours.

Safeguarding adults’ procedures were good and staff understood how to safeguard the people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

People's medicines were managed appropriately and people received their medicines as prescribed by health care professionals. People were supported to manage their medicines safely.

Risk assessments were in place to keep people safe and these were kept under review. Staff had a good understanding of risk management. People were encouraged to live their lives the way they chose and were supported to recognise this should be done in a safe way.

People were cared for by staff who had been recruited safely and was trained and supervised in their work.

The registered manager and staff had training on the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was familiar with the process to follow should it be necessary to place any restrictions on a person who used the service in their best interests.

People were encouraged to take control in meeting their nutritional needs. They were involved in menu planning, food preparation and cooking as part of their rehabilitation. Staff had been trained to care for people with an eating disorder.

We saw significant improvements in respecting people’s privacy. People could no longer access other people’s rooms and the management of people’s property in their absence was good. Therapeutic one to one sessions were held in private.

Each person completed a Values and Planning in Social Care, referred to as VALS planner, with staff. This acknowledged people as individuals and helped them to plan their support in a holistic way and placed them at the centre of their care and support. These were kept under review.

We found staff were respectful to people, attentive to their needs and treated people with kindness and respect in their day to day care. Care plans were written with sensitivity to reflect and to ensure basic rights such as dignity, privacy, choice, and rights were considered at all times. Staff were knowledgeable about people’s individual needs, backgrounds and personalities

Confidentiality was a key feature in staff contractual arrangements. This helped to make sure information shared about people was on a need to know basis.

People told us about the type of activities they took part in with staff support. The range of activities on offer was impressive and staff helped people to acquire new skills that would prepare them for independent living and give them confidence. For example, workshops were arranged to support people to apply for jobs and charity work was encouraged.

People considering moving into the home had an assessment of their needs prior to staying at the home. We found improvements were needed to ensure that care is given when determining the suitability of a person referred to the service to avoid a breakdown of the placement.

People were given additional support when they required this. Referrals had been made to the relevant health and social care professionals for advice and support when people’s needs had changed.

People told us they were able to raise any issue of concern with the manager and staff and that issues they raised would be looked at. People were not always confident issues they had raised were taken seriously, however we saw evidence the registered manager followed the complaints procedure to resolve the issues they had raised. People had also been encouraged to express their views and opinions of the service through regular meetings, care reviews, and during day to day discussions with staff and management.

We found significant improvements in how the systems in place to monitor the quality of the service to ensure people received a good service that supported their health, welfare and safety were conducted. We found regular quality audits and checks were completed to ensure any improvements needed within the service were recognised and appropriate action taken in a timely way.

Policies and procedures needed updating to include first aid that included a mental health focus and an admission policy. The service user guide needed updating to reflect accurately as to the arrangements in place for nursing care being provided.

The registered manager expressed commitment to the on-going improvement of the service. Issues we found as concerns during this inspection were acknowledged and the action planned to bring about an improvement was discussed.

The service Hunters Oak Barn is registered to provide personal care and accommodation for 12 people who have a mental health diagnosis. The property is a converted barn situated in a rural area of Burnley. Facilities include single occupancy bedrooms, lounge and recreational areas and a swimming pool. There are two bungalow type properties on site for people preparing for independent community living. At the time of our visit there were 2 people accommodated at the home.

During our last inspection we found breaches to legal requirements. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to Regulation 12 and regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to risk management and the skills and deployment of staff to ensure adequate support for people during their mental health recovery, and the management oversight of the service to ensure safe, effective and responsive care was delivered. During this inspection we found the provider had taken action to make some improvements however additional improvements were still needed.

The service was managed by 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 2008 and associated Regulations about how the service is run.

During this inspection visit we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safety and suitability of premises, safe care and treatment, privacy and dignity, person centred care and good governance. You can see what action we have asked the provider to take at the back of the full version of this report.

We saw good evidence to demonstrate improvements we asked the provider to make in supporting people with staff support to managing risk in relation to self-harm. Risk management intervention plans were in place to ensure people were being supported during critical times in a sensitive manner and in line with guidance in their care plan.

We found evidence that the recruitment and selection of staff had improved and the service followed safe procedures to ensure appropriate staff were employed.

People had their medicines when they needed them and they were supported to manage their own medicines with staff support. We found improvements had been made to make sure staff administering medicines had been trained and their competence level checked before they carried out this task.

People’s capacity to make decisions was assessed and by using a mental health recovery star approach to managing mental health care needs this supported people to be self-reliant. We found improvements had been made to make sure staff had formal training provided on the use of the mental health recovery star tool and its application in practice.

People’s care and support was kept under review, and people were given additional support when they required this. Referrals had been made to the relevant health and social care professionals for advice and support when people’s needs had changed. Health care professionals told us the service followed their plans and worked well with them.

People were cared for by staff who received regular training. We found some improvements had been made regarding staff induction training and supervision.

Staff we spoke with were aware of the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safe Guards (DOLS) and best interests decisions. The registered manager was familiar with the process to follow should it be necessary to place any restrictions on a person who uses the service in their best interests.

The complaints procedure was displayed in the home and we found processes were in place to record, investigate and respond to complaints. People could access advocacy services if they wanted support and advice from someone other than staff.

We noted risk assessments had not included environmental issues in relation to self-harm. We saw records of people barricading themselves in rooms, using ligatures, setting light to papers and attempted suffocation. Actions required following an environmental audit of potential hazards and ligature risk assessments had not been adequately addressed.

We found water temperature monitoring highlighted variances with the temperature at the point of contact and we have made a recommendation about this.

People were cared for by staff with varying degrees of skill and knowledge that meant at times people were at risk of not receiving the right level of support that they might need.

People’s privacy was not always respected. People had access to other people’s rooms and we saw the management of people’s property in their absence was not good. No inventory of their property was taken and we found people’s property and possessions in disarray.

People who were considering moving into the home had an assessment of their needs prior to staying at the home. We found their introduction into the service was structured, however we saw one person had not had a full induction to aide them with the move and settling in period in accordance with the service own admission process.

There had been three managers registered with CQC since 2014 which did not provide continuity in leadership at the service. Some issues we found as concerns during this inspection were acknowledged. However the assessment and monitoring of the quality of the service was not robust enough to ensure the safety and wellbeing of people who used the service.

The overall rating for this service is ‘Requires Improvement’ and the service is therefore 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.