Barleycombe

Barleycombe is a residential care home providing accommodation and personal care support up to 11 people in one adapted building, with a separate flat that can accommodate 2 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 11 people using the service, 1 of these people were in hospital and due to return to Barleycombe the week after our visit.

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

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.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support:

Staff knew how people preferred to take their medicines to achieve best possible health outcomes. People were supported with their medicines and received them as required.

Staff supported people to take part in activities and participate in the community they lived in.

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.

Right Care:

Staff promoted people's individuality and diversity and their views about how they wanted to receive support were valued and listened to. People received kind and compassionate care from staff who were knowledgeable about people’s individual needs.

People’s care records provided guidance to staff on the level of support they wanted and how to keep people safe from abuse and avoidable harm.

Right Culture:

The management team had worked to make improvements since our last inspection, this included monitoring and oversight and improvements being undertaken in the environment, which were ongoing. This provided a positive impact on people’s wellbeing. The service was empowering and inclusive, with regard to people’s preferences and choice.

People were supported by enough staff who were recruited safely. Staff told us they enjoyed their work, received training relevant to their role and felt supported by the management team. People were relaxed around the staff and their independence was promoted and respected.

The service was visibly clean, and people’s relatives could visit when they wanted to.

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 requires improvement (published 13 January 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider assess the intensity and level of responsibility of hours worked by staff to ensure the safety and well-being of staff and people. At this inspection we found the provider had made improvements.

Why we inspected

We carried out an unannounced focused inspection of this service on 30 November 2021. Breaches of legal requirements were found in relation to safeguarding, safe care and treatment, governance and person-centred care. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive and focused inspection, by selecting the ‘all reports’ link for Barleycombe on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Barleycombe is a residential care home providing personal care to 11 men at the time of the inspection. The service can support up to 11 people. The service is for autistic people and people with a learning disability. The premises is an adapted building, with a separate flat that can accommodate two people. Bedrooms are single occupancy with a wash hand basin. One bedroom has an en-suite. There is extensive land to the rear of the property.

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

Based on our review of key questions safe and well led:

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and setting did not maximise people’s choice, control and independence

The kitchen was locked and only with staff permission were people allowed to gain access. The laundry room was locked and only with staff permission were people allowed to access and use the facilities. Risks to people were not consistently assessed. For example, parts of the care home

were locked ‘for safety’, yet the care home back door was consistently ajar with a main road and heavy traffic in one direction and a large expanse of water in the other direction. Whilst we observed staff being kind and respectful their support for people’s choice and independence was not unconditional until proven unwise. Positive risk taking was not integral to ways of working at Barleycombe

Right care:

• Care is person-centred but did not always promote people’s dignity, privacy and human rights

People had to share bathing facilities that were stark and not well maintained. The heating system was inadequate, and some people required a portable heater and blankets in their room. The flat was poorly maintained throughout and did not promote independence. People consistently told us that they liked the staff and sought out their company.

Right culture:

• Ethos, values, attitudes and behaviours of care staff did not consistently ensure people using services lead confident, inclusive and empowered lives

Whilst staff were facilitating some good opportunities external to the care home, the practices within the everyday activities did not empower people, develop their skills and potential to lead their best lives. Not all people had person-centred, planned, proactive and coordinated care and support.

The registered persons had failed to operate effective governance systems, to consistently ensure the quality and safety of people’s care. Provider audits, risk assessments and safe systems checks were not consistently operated or ensured.

Accurate and complete records, were not always maintained for the quality and safety of people's care, related to the care and support provided or the management of the regulated activity. Formal systems were not operated, based upon latest guidance and best practice, on the service provided at Barleycombe for the purposes of continually evaluating and improving such services.

Staffing arrangements were sufficient. The current number of staff vacancies meant that some staff worked consistently long hours. One staff working over 70 hours a week frequently. We have made a recommendation the provider review these working practices.

Medicines were safely managed and regularly reviewed.

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

Rating at last inspection

The last rating for this service was good. (published 23 April 2018)

Why we inspected

The inspection was prompted in part by notification of a serious incident. Following which a person using the service was neglected. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the support of vulnerable people. This inspection examined those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Barleycombe on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

Follow up

We will meet with the provider and request an action plan following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Barleycombe provides care and accommodation for up to 13 people with learning disabilities. On the days of our inspection there were ten people living at the care home. In relation to Registering the Right Support we found this service was doing all the right things, ensuring choice and maximum control. Registering the Right Support (RRS) sets out CQC’s policy registration, variations to registration and inspecting services supporting people with a learning disability and/or autism.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager who was present throughout the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

This was the first ratings inspection for this provider, Lifeways Community Care Limited since they became registered on 15 December 2016. We found that the service provided to people was good.

People were safe at the service. People were protected from abuse because staff knew what action to take if they suspected someone was being abused, mistreated or neglected. Staff were recruited safely, and checks carried out with the disclosure and barring service (DBS) ensured they were suitable to work with vulnerable adults. There were enough staff to meet people’s needs.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe.

Risk assessments were in place to help support risk taking, and help reduce risks from occurring. People who had behaviour that may challenge staff or others had risk assessments in place which gave good guidance and direction to staff about how to support the person, whilst taking account of everyone’s safety. People received their medicines safely by suitably trained staff.

People were supported by staff who had received training to meet their needs effectively. Staff meetings, one to one supervision of staff practice and appraisals of performance were undertaken.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's health was monitored by the staff and they had access to a variety of healthcare professionals. Staff worked closely with external health and social care professionals, to help ensure a coordinated approach to people’s care.

People’s care and support was based on legislation and best practice guidelines which helped to enhance wellbeing and ensure the best outcomes for people. People’s legal rights were upheld and staff sought consent to care as much as possible. Care records were person centred and held full details on how people liked to be supported; taking into account people’s preferences and wishes. Overall, people’s individual equality and diversity preferences were known and respected. Information recorded included people’s previous medical and social history and people’s cultural, religious and spiritual needs.

People were treated with kindness and compassion by the staff who valued them. The staff, some who had worked for the company for a number of years, had built strong relationships with people who lived in the home. Staff respected people’s privacy. People, or their representatives, were involved in decisions about the care and support people received.

People were able to make choices about their day to day lives. The provider had a complaints policy in place and the manager said any complaints received would be fully investigated and responded to in line with the company’s policy. Staff knew people well and used this to gauge how people were feeling. Advocacy support was regularly available to people.

The service was well led. People lived in a home where the provider’s values and vision were embedded into the service, staff and culture. Staff told us of a registered manager who was very approachable and made themselves available. The provider had monitoring systems which enabled them to identify good practices and areas of improvement.

People lived in a service which had been adapted to meet their needs. The service was monitored by the provider to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service, as well as the ongoing quality and safety of the care support people were receiving.