The inspection took place on 12 and 18 April 2016 and was unannounced. We previously inspected the service in August 2013 and found no breaches of regulations in the standards we looked at. Barley Close is registered to provide accommodation with personal care and support for up to ten adults. Seven people lived there when we visited, whose ages ranged from 23 to 65.
The service had 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.
People who lived at Barley Close had profound and complex learning disabilities, several people had autism, physical disabilities and were unable to verbally communicate with us. The service recognised the individuality of each person regardless of their level of disability or support they needed.
Staff developed exceptionally positive, kind, and compassionate relationships with people. People’s care was individualised, staff put them first and knew them really well, such as what made a good day for them. There was a relaxed, calm and happy atmosphere at the home with lots of smiles, good humour, fun and gestures of affection. People were relaxed and comfortable with staff who were attuned to their needs. Staff could recognise how a person was feeling from their non-verbal cues such as body language, gestures and vocal sounds and they responded appropriately. Staff spoke with pride about the people they cared for and celebrated their achievements.
A detailed communication plan identified each person’s preferred communication methods. Staff used a variety of non-verbal communication methods to help people to communicate effectively. For example, using a picture exchange system, Makaton (a form of sign language), and sensory objects. A ‘smiley face’ system was used to monitor people’s enjoyment of food and activities, so staff could be change and improve their approach in response to their feedback.
People enjoyed spending time in a newly developed sensory room, a special room designed to help them develop their senses through special lighting, music, and objects. One person looked relaxed listening to music and watching a light show, and another picked up their musical toy, held it to their ear, listened intently and smiled.
Each person had a support plan developed with the person, a relative or others who knew them well, which highlighted their positive attributes. Support plans identified family and friends important to the person’s emotional and psychological well-being. Each person had a key worker who took a lead role in the person’s care and was the main contact for relatives.
People received a consistently high standard of care because staff were led by an experienced, and proactive team. Staff were highly motivated and enthusiastic, and were committed to ensuring each person had a good quality of life. There was a clear management structure in place, staff understood their roles and responsibilities and were accountable.
The culture at the service was open and honest and encouraged staff to see beyond each person’s disability. Staff demonstrated the provider’s values of ‘passion for care, positive energy,’ and used their initiative to help people to succeed. The registered manager led by example, set high expectations and provided staff with a high level of support. They had an ‘open door’ policy, worked alongside staff using a coaching style of leadership and challenged them to continuously improve people’ s care and their quality of life. Professionals and staff consistently gave us positive feedback about the registered manager’s leadership, which they described as “brilliant.”
People's rights and choices were promoted and respected and staff explored new ways to help people make more choices and decisions for themselves. Staff understood the Mental Capacity Act (MCA) and used it confidently, its principles were embedded in the provider’s assessment framework and in day to day practice. Comprehensive records of ‘best interest’ decisions were kept including a register of decisions for each person.
The service had enough staff to support each person’s assessed needs and organised people’s care flexibly around their wishes and preferences. People pursued a range of hobbies, activities and individual interests. For example, baking, music workshops, arts and crafts, and swimming. The service had a wheelchair accessible minibus, car and some people used local buses and enjoyed trips to farms and animal sanctuaries, the cinema and the theatre. People were well known in their local community where they visited local cafes, shops and restaurants. Relatives said they appreciated that people were stimulated, enjoyed a range of activities, went out regularly and had holidays.
Staff treated people with dignity and respected their privacy, they were discreet when supporting people with personal care. The service had a 'dignity' advocate who championed dignity issues within the staff team. They raised awareness of best practice by making resources available, and encouraged staff to raise dignity issues and identify creative solutions at staff meetings.
Each person had a comprehensive assessment of their health needs and support plans had detailed instructions for staff about how to meet those needs. People were supported to improve their health through good nutrition and a healthy lifestyle. Staff encouraged people to eat a well-balanced diet, make healthy eating choices and be active. People improved their mobility through a regular exercise programme, and some people were on weight reducing plans, which could further improve their mobility. People enjoyed their meals and ate well and the food served looked appetising and smelt delicious.
Staff worked closely with local healthcare professionals such as the GP, local learning disability team and specialist professionals to improve people’s care. Each person had a health action plan and mobility plan, through which staff encouraged them to improve their health. Health professionals consistently praised staff and told us how people’s health had improved. They said staff were proactive, sought their advice and implemented it.
The provider used a quality and compliance audit tool based around CQC’s fundamental standards, to monitor the quality of care at each service. Regular audits of care records, medicines management and health and safety checks were carried out with action taken on areas that needed improvement. Quality monitoring reports demonstrated the service was consistently high performing within the provider group. The registered manager said the provider’s policies and procedures and quality monitoring systems were “excellent.” This was because they said they measured the right things and helped them identify areas for further improvement.
The service had a comprehensive training programme to ensure staff had the right knowledge and skills relevant to the needs of people they supported. For example, the service used positive behaviour support training, to support people with behaviours that challenged the service. The provider also employed a behaviour therapist, staff could access advice from to to help with meeting people’s emotional and behavioural needs. This increased staff skills and confidence to promote people’s freedom because staff felt more confident to support them to go into the community.
The environment of the home was bright and airy, with a calm and relaxing colour scheme and lots of interesting pictures and artwork. All ground floor areas of the home were accessible for people with physical disabilities, including wheelchair access to an enclosed garden. Relatives particularly commented positively on the facilities available.
People who lived at the home were not able to verbalise their feelings or thoughts in order to raise a concern or complaint. Day to day staff used ‘smiley face’ charts to check and record what they enjoyed and found difficult. Relatives knew how to raise concerns which were listened and responded to, with actions taken in response. The service had received no complaints and had several compliments from relatives.
The service continually reviewed evaluated and improved people’s care. People, families and visiting professionals were surveyed each year to get their feedback about the service. Responses showed they consistently reported positively about all aspects of care provided. An annual service review report was compiled to inform people and families them about further actions being taken to improve the service. For example, improving the garden for people by adding sensory planting and a vegetable patch.
People appeared happy and content in their surroundings. Relatives said they felt people were safe at the home because staff knew how to look after them. Personalised risk assessments balanced risks with minimising restrictions to people’s freedom. Equipment was regularly serviced and tested as were gas, electrical and fire equipment.
People received their medicines safely and on time from staff who were trained and assessed to manage medicines safely. Accidents and incidents were reported and included measures to continually improve practice and reduce the risks of recurrence.
Staff understood the signs of abuse and knew how to report concerns, including to external agencies. They completed safeguarding training and had regular updates. Where a safeguarding concern was raised, the registered manager took robust action to improve staff practice and safeguard the person.