Background to this inspection
Updated
16 June 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
Two inspectors carried out the inspection.
Service and service type
Barley Close is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Barley Close is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was not a registered manager in post.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 3 May 2023 and ended on 24 May 2023. We visited the home on 12 May 2023.
What we did before inspection
We reviewed all of the information we held about the service, including statutory notifications. Statutory notifications include information about important events which the provider is required to send us. We sought feedback from the local authority safeguarding team who were working with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.
During the inspection
We met 7 people using the service; 3 people were able to talk with us about living at Barley Close. We also spent time observing staff supporting, interacting and communicating with people in communal areas of the home throughout the day. We spoke with 9 members of care staff, the acting manager and the provider’s operations manager.
We viewed all parts of the home and reviewed people’s medicine records and medicine storage facilities. We also looked at the senior’s medication book, the doctor’s book, at a selection of staff rotas and the staff communication book.
The acting manager sent us 4 people’s care records, the most recent medicine audit, learning from accidents and incidents including actions taken, details of current safeguarding issues, the latest update of the service’s action plan and copies of minutes from recent staff meetings.
They also provided contact details for people’s relatives. We spoke with 3 relatives to gain their views of the care and support provided to their family members; 3 relatives shared their views by email.
Updated
16 June 2023
About the service
Barley Close is a care home for up to 10 people with a learning disability and autistic people. At the time of our inspection there were 8 people living in the home.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
People's experience of using this service and what we found
The service was not able to demonstrate how they were meeting all the underpinning principles of right support, right care, right culture.
Right Support
People had not always received the care they needed to live safe, fulfilling and happy lives. There had been a strong focus on improving these areas in recent months.
People had not always been supported with their medicines in a safe, consistent and effective way. Medicine administration had improved and was the focus of ongoing improvements.
Risks to people were considered and planned for. People’s risk plans had not always been followed by staff. Risks to people had therefore been focused upon and staff practice was improving and being monitored.
People were supported to make as many of their own decisions as possible.
Recruitment processes were safe. The provider was taking active steps to recruit, mentor and retain staff.
Right Care
Staff had not always protected people from poor care, errors, abuse or neglect. The service was currently working with other agencies to ensure people’s safety and to improve the quality of care and support provided.
People who spoke with us said they were happy living at Barley Close. People told us, and we saw, they were treated respectfully and with compassion by staff. People clearly trusted staff; they were happy and relaxed in their company.
Right culture
People had not received high quality care and support. There had been a significant decline in the quality of the service. There had been a lack of clear, consistent leadership which had contributed to the decline and lack of structure, support and guidance for staff.
People's quality of life had not been enhanced by a culture of learning and improvement. Neither the provider nor the various managers had effective oversight of the quality of care, staff practice or risk management. This had led to people receiving poor or unsafe care.
People, and those important to them, were working with the acting manager and staff to develop and improve the service. Confidence in the service and in how it was managed was returning as improvements were made and sustained.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was good (published 25 January 2019).
Why we inspected
We received concerns in relation to safeguarding, risks to people, medicine administration, staffing levels and management of the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.
The provider had taken action to mitigate the risks and these were effective. A new management team had been brought in by the provider to stabilise and improve the service. There was current ongoing support from the local authority to ensure the service remained safe whilst improvements were being made. Staff had been given improved support, guidance and mentoring. The provider’s oversight of the service had been improved to ensure people received safe and effective care.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Barley Close on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to safeguarding, medicine management and governance at this inspection.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.