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Inspection carried out on 19 August 2020

During an inspection looking at part of the service

Barclay House is a service providing support to people living with acquired brain injuries. Rehabilitation and longer term placements are offered. The service provides nursing and personal care for up to 29 people, and at the time of inspection 27 people were using the service.

We found the following examples of good practice.

¿ The registered manager completed a ‘business incident log’. This started several weeks prior to lockdown and noted significant updates, actions taken and decisions made as they occurred. It was often updated several times per week. This was a helpful chronology serving many purposes. One purpose was to understand and learn from decisions made to support infection control practices throughout the pandemic.

¿ A weekly summary of updates and important communications was collated and circulated by the provider to all managers. This ensured staff practice was in line with the latest guidance at all times. This helped reduce the risk of an outbreak of the virus in the service.

¿ The service actively engaged with a programme of regular testing as soon as it was available. Additionally, any new staff and any staff returning after an absence were required to take a Covid test. No-one was admitted to the service from hospital until their test result was confirmed.

¿ People using the service who were self isolating, for example if they had been discharged from hospital, took a Covid test several days before the end of the isolation period to confirm whether they had the virus. This reduced the risk of an outbreak in the service. A chart in the staff office monitored start and end dates for self-isolation periods, when tests were due and when the results were confirmed. This ensured effective monitoring of those who were most at risk of having the virus.

¿ A competition had been launched across all services to generate innovative ideas to improve infection control practice, along with a toolkit to support the development and testing out of ideas.

¿ From the beginning of the pandemic housekeeping staff shifted their duties to focus on enhanced cleaning in people’s rooms and communal areas most used by people living in the service. Responsibility for enhanced cleaning in other areas such as reception and the office were handed to staff who worked in those areas. This meant all staff were involved in ensuring good infection control practice was maintained.

¿ Inhouse specialist staff such as psychologists and speech and language therapists undertook individual work with people to support them cope with and adapt to the lockdown restrictions. This included considering different communication methods and assistive technology when people found it difficult due to staff wearing masks all the time.

Inspection carried out on 27 June 2019

During a routine inspection

About the service

Barclay House is a service specialising in the rehabilitation and longer term placements for people living with acquired brain injuries. The service provides personal and nursing care for up to 29 people including six placements which are for people detained under the Mental Health Act. At the time of our inspection, there were 24 people using the service.

People’s experience of using this service and what we found

People's safety was promoted; staff understood how to protect people from the risk of harm and understood potential signs of abuse. People were involved in assessments of potential risks to their safety and in identifying measures to keep them safe. Care plans provided clear guidance for staff to follow. People were supported by a consistent team of staff who were safely recruited. People received their medicines as prescribed and were protected from the risk of infections through staff working practices.

Staff received training, supervision and support so they could effectively perform their roles and meet people's needs. People were provided with care and support that ensured they had good nutrition and hydration and access to timely healthcare that maintained their health and wellbeing. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and those important to them were involved in the planning and development of their care and support. Staff were skilled at enabling people to communicate their choices and decisions. Staff were described as very caring, understanding, patient and supportive. Staff knew people well and used this knowledge to provide personalised care. Staff respected and promoted people's rights, including their right to be treated with respect and dignity.

People were supported through a rehabilitation pathway which focussed on developing daily living skills and communication and reducing the risk of social isolation. People were engaged in meaningful activities and had access to a range of specialist on-site therapies and services. Staff supported people to access the local community and maintain relationships with friends and family where appropriate. The provider welcomed complaints and used these to drive development within the service.

The registered manager supported people, visitors and staff to share their views about the service. They used this feedback, together with outcomes from robust audits and checks, to identify where improvements were needed and take the necessary actions to implement these. They were open and transparent in sharing information about actions taken and lessons learnt within the service. The registered manager and staff were passionate about ensuring people were provided with good care and support in order to achieve the best possible outcomes. They worked in partnership with a range of health and social care professionals to achieve this.

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

Rating at last inspection

The service was rated as Good at the last inspection, published on 1 March 2017.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Inspection carried out on 20 December 2016

During a routine inspection

This inspection visit took place on 20 December 2016 and was unannounced. This was our first inspection of the service since they registered with us.

Barclay House provides accommodation and personal care for people with an acquired brain injury, stroke or other neurological conditions. The service provides care and rehabilitation for people through an outreach service or through short and long-term rehabilitation placements with a view to returning home wherever possible. The service is able to accommodate up to 18 people and is situated close to the centre of Leicester. At the time of our inspection there were 12 people 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 2008 and associated Regulations about how the service is run.

There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate them. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe.

The registered manager made sure there were enough staff to meet people's needs as detailed in their care plans. The registered manager followed the provider's safe recruitment practices. This helped to ensure people were cared for by staff who were suitable for their role.

People were supported to take their medicines safely. However, we found further improvements were needed to the storage and recording of medicines to ensure people's medicines were stored and managed safely.

Staff told us they felt supported in their roles and the registered manager provided staff with clear guidance and leadership. Staff had completed the training and qualifications they needed and we saw they used this knowledge to provide people with safe and effective care.

Staff understood the relevant requirements of the Mental Capacity Act (2005) and how it applied to people in their care. People's individuality was at the centre of how their care was delivered. Where people had been assessed as having mental capacity, they were fully involved in making decisions about their care. Where people lacked mental capacity, further work was required to ensure all decisions made were in the person's best interests.

People had their health needs assessed and detailed care plans were put in place to meet their needs. Staff worked with a range of internal and external healthcare professionals to obtain specialist advice and support about people's care. Staff supported people to have sufficient to eat and drink and manage their complex health conditions. This meant that people received support to maintain their health and well-being.

Staff were caring, patient and attentive in their approach to meeting people's needs. Staff knew people well and took time to chat with them and provide assurance.

Staff maintained people's privacy and dignity whilst encouraging them to be as independent as possible. People were involved in making decisions about their own care.

People's care plans were person centred, detailed and written in a way that described their individual care and support needs in detail. There were regularly reviewed and changes made where required. Care plans were accessed by staff and internal health professionals. This meant everyone was clear about how people were to be supported and their personal objectives met. People and those important to them were involved in deciding how they wanted their care to be delivered.

People were able to access a range of therapeutic activities which were provided based on individual aspirations, needs and interests.

The provider had a clear complaints policy which provided people and their relat