Barclay Services

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last rated inspection (publication date 24 May 2024) we rated this key question Good. At this inspection the rating has remained Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

At the last inspection, we identified inconsistencies in the level of guidance and detail in people's support plans, with examples of missing information. At this inspection, we found similar issues. For example, a person had a health condition that meant they were at greater risk of having urine infections and needed to drink plenty. Whilst their food intake was consistently recorded their fluid intake was not. This person also had a specific physical health condition that had no support plan to inform staff of what the heath condition was and how it impacted the person.

Whilst the risk was reduced because the person was mainly supported by a stable staff team who knew them well, this was a potential risk.

People’s individual communication needs had been assessed and planned for. We observed staff communicating effectively with people using their preferred communication methods.

Relatives told us they were aware of their loved ones support plans and were involved in discussions and decisions about their care. A relative said, “I’m very happy with the care (support) plan. They [staff] do discuss everything with me.”

Assessment tools were in place where necessary to assess and monitor people’s needs such as weight. This enabled staff to identify unexpected weight loss or gain.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Following the last inspection, the provider had updated their policies to ensure they were relevant to the type of service they were providing. Following this inspection, the management team told us they were going to seek support and guidance from the local authority Positive Behaviour Support team, to further enhance their approach and methodology in supporting people with their emotional needs.

he provider had effective systems and processes to share information with staff. This supported staff to continually be up to date with new information. Staff demonstrated a good awareness and understanding of people’s individual routines and preferences. This included any changes to care and support needs.

Recognised communication systems were used such as PECS – picture exchange communication system, a Now and Next strategy that provided a visual prompt to move from one activity to another, and Makaton, a form of sign language.

People’s dietary and hydration needs were assessed and planned for. People were supported with planning, shopping and cooking meals. From speaking with staff and reviewing care records, healthy eating was promoted. A staff member said, “We support [name] with their menu planning and food shopping, we sit down with them and show them a picture chart of food to help them to be involved in the development of the menu.”

Where people were on weight loss plans as recommended by the GP, staff were supporting people effectively and people were achieving positive outcomes.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Systems and processes were in place to share information with external health and social care professionals. Care records confirmed referrals to external healthcare professionals for further assessment and or guidance, were made in a timely manner and recommendations made by others were implemented.

The provider had effective communication systems for the exchange of information between staff teams. Staff were positive about the different communication procedures, advising these worked well. Staff consistently reported how well they worked together as a team and told us how they were able to easily address any conflicts.

An external professional told us they had a positive experience of working with the staff in supporting a person to achieve positive outcomes. Communication was described as good.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People’s health needs had been assessed, however, as described in the Safe key question, improvements were required to ensure staff had detailed guidance of known health conditions.

People were supported to access health services and screening. For example, people received an annual health check, and monitoring of oral and sight health needs.

Care records confirmed how staff worked with external healthcare professionals and how recommendations made were implemented. Health appointments and outcomes and actions were documented.

Relatives were positive about how their loved one was supported with their health needs. A relative said, “Yes, [name] had their annual review recently.” Another relative said, “Yes, they [staff] have called the doctor out a couple of times for various things.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People’s care records confirmed their care needs were regularly reviewed. Where people had experienced a change in their health needs, the staff had worked with external healthcare professionals to improve people’s health outcomes. For example, an occupational therapist worked with staff to support a person to regain their mobility following a fall and injury.

The management team gave an example of a multi-disciplinary team approach in supporting a person with a change of needs, including a period of hospitalisation. This collaborative approach supported the person with their clinical and emotional needs. The person’s staff team was increased by the provider, to enable them to experience the best outcome opportunity.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. We were aware from reviewing care records, the provider’s service improvement plan that this had been an area of development and concluded further improvements were required.

Mental capacity assessments were not fully completed in line with the Mental Capacity Act 2005 (MCA). MCA assessments and best interest decisions had been completed for specific decisions about a person’s care and support where the person lacked capacity to consent. Whilst we saw examples of detailed and well recorded assessments, we also found some shortfalls. For example, some specific decisions did not have a MCA assessment or best interest decision. Records stated consent had been given by others such as relatives. However, people did not have lasting power of attorney that enabled others the legal authorisation to give consent.

Relatives confirmed they were involved and consulted in discussions and decisions about care and treatment needs.

Staff were aware of the principles of the MCA and had received relevant training and had access to the provider’s policy. A staff member said,” If a person lacks capacity to make a decision, best interest decisions have to be made, staff can make low level decisions, but bigger decisions are made by consulting others such as family and professionals.”

Our observations of staff engagement with people were positive. Staff promoted choice and sought the person’s consent before care and support was provided.