Barclay Services

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last rating inspection (publication date 24 May 2024) we rated this key question Good.

At this inspection the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider was previously in breach of the legal regulation in relation the management of people’s medicines. Overall, there were enough improvements found at this inspection and the provider was no longer in breach of this regulation.

This service scored 56 (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 had a positive culture of safety based on openness and honesty. Staff listened to concerns about safety. However, lessons were not always learnt to continually identify and embed good practice.

At the last inspection, we identified there were a lack of systems and processes that analysed incidents to enable themes, patterns and lessons learnt. At this inspection, there continued to be a lack of incident analysis. The management team told us new and improved systems and process were being implemented. We saw an example of how the new procedure would be used. However, we were unable to judge the effectiveness at this inspection.

Staff told us, and records confirmed, following a person’s fall an internal investigation had been completed and lessons learnt had been identified and shared with all staff.

Staff used daily handovers, care records and regular staff meetings as a method to share information about accidents and incidents. A staff member said,” Following a person falling, we had meetings and talked about what we would do differently. We’ve been guided and instructed if a similar incident was to occur again what we should do.”

Relatives told us they found communication with the service was good, including being kept informed of any incidents and accidents.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. However, we identified guidance for staff was not consistently detailed. This meant there was a potential risk that people may not receive consistent care and support.

The management team agreed further improvements were required with record keeping and oversight. The risk was reduced due to people being supported, in the main, by a regular core group of staff.

Whilst no new person had transferred to the service since our last inspection, the management team told us of the assessment process. This included transition plans that were individualised to the person’s needs and preferences.

The provider had systems and process of sharing important information with others, such as ambulance and hospital staff, to promote consistency in care.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Relatives told us they were confident their loved one was cared for safely. A relative said, “Yes, [name] is 100% safe. We’ve got a lot of faith in the staff who are very solid and vigilant with them. They ring us with any doubts. The house seems safe and secure as well.”

Staff had received ongoing safeguarding training and had access to the provider’s safeguarding policies and procedures. Staff demonstrated a good understanding of their responsibilities to protect people from abuse and avoidable harm. A staff member said, “I stay alert to signs of neglect or risk. Safeguarding is everyone's job and training ensures we act quickly and appropriately. People's safety and dignity come first always.”

The provider had made safeguarding information available in easy read and staff had discussions with people about what safeguarding means.

At the time of the inspection, no person had an active Community Deprivation of Liberty Safeguard authorisation. Renewals had been submitted and outcomes of assessments were due. Support plans were used to inform staff of the reason for the authorisation and the timescales.

Following the last inspection, the provider had implemented a new Deprivation of Liberty Safeguarding policy relevant to community services.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks associated with people’s emotional needs lacked important information. Staff had received training in the use of restrictive physical intervention (RPI) to be used as a last resort to protect peoples’ and others safety. At the last inspection, we identified RPI risk assessments had not consistently been completed to ensure people’s known health conditions had been considered. We found this was a reoccurring shortfall. Whilst no person had come to harm, this was a potential risk.

We also identified some confusion if people had Positive Behavioural Support (PBS) plans or not. Whilst the management team told us these were not in place, a person’s behavioural support plan guided staff to see the person’s PBS for further information. We also identified whilst behavioural plans followed a PBS approach, guidance varied in detail. New behaviours had not been sufficiently assessed and lacked clear strategies. Following the inspection the management team told us they planned to contact the local authority PBS team for guidance and support.

The provider ensured people were supported to maintain their tenancy, to report any repairs to the housing provider and to monitor health and safety, to enable people to live in a safe environment.

Relatives were positive how their loved one was supported with their accommodation and environment. A relative said, “[Name] accommodation is wonderful! It’s their own little flat that’s amazing. It’s lovely and they’re so at home. They’re a different person because it’s their home.”

Staff told us, and records confirmed, there were systems and processes to support people to live in a safe environment. This included staff completing health and safety checks and monitoring.

Our observations confirmed people’s accommodation met their individual safety needs and preferences.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. However, some improvements were required to ensure staff training and supervision were consistently kept up to date.

Relatives confirmed their loved one received the level of support they had been assessed as required to keep them safe and meet their individual needs. We received a mixed response about the competency of staff. Overall, relatives were positive about the staff. A relative said, “Yes, staff are well trained, because they [name] can be challenging, but staff all know how to handle them.” Whilst another relative said, “The main issues are staff turnover and what they’re not doing with [name] really. We’ve lost some amazing carers over the years through people leaving or being sacked. The understanding of autism needs to be better as well from some staff.”

The provider’s supervision information showed overall staff were receiving supervision at the frequency set by the provider. We asked to see information related to staff appraisals, but this was not provided. It is therefore difficult to ascertain if staff had received an annual appraisal.

The training matrix showed some shortfalls in the expected compliance rate set by the provider. We were not provided for a reason for this. Whilst staff who were responsible for the administration of medicines had their competency assessed, there were no other competency assessments completed on staff practice. It was not clear how the provider assured themselves that staff provided care inline with training and best practice guidance.

At the time of the inspection, no person was receiving delegated health care tasks. However, records confirmed a person had been earlier in the year. In our discussions with the registered manager, we were not sufficiently assured they understood their role and responsibility in relation to health delegated tasks. This included ensuring staff received training from a health care professional and their competency assessed. The management team told us they would take action to upskill their awareness and understanding in this area.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff had received training in infection prevention and control. This included having access to the provider’s policy and procedure.

Staff were aware of their responsibility to reduce the risk of infection and cross contamination. Staff confirmed they had access to personal protective equipment (PPE). Our observations confirmed staff wore PPE as per best practice guidance.

No concerns were raised by relatives about staff supporting people to maintain a clean and hygienic environment.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

At the last inspection, we identified improvements were required in the management of medicines. At this inspection, whilst we identified improvements had been made, we also identified some issues that the provider’s audits and checks had not identified. This is reported in the Well-led key question. No person had come to harm and the management team took immediate action to address these.

Staff supported people to order, collect and store their medicines safely. Staff had received training in safe handling of medicines and their competencies were tested regularly. Records and staff confirmed this. People’s medicine records confirmed they had received their prescribed medicines when required.

Relatives were confident their loved ones medicines were managed safely. A relative said, “I have no concerns. I understand that all the staff are trained to give [name] their medicines.”

People’s care records confirmed their medicines were reviewed by the GP. Whilst the management team were aware of STOMP - stopping over medication of people with a learning disability and autistic people is a national NHS England work programme to stop the inappropriate prescribing of psychotropic medicine medications, staff were not aware of this initiative.