8 Acres

8 Acres is a residential care home providing personal and nursing care to 18 people aged 18 or over, living with multiple needs including: physical and or learning disability or mental health need. At the time of the inspection the home was full supporting 18 people in individual bungalows and in the main house on site. Each accommodation had its own facilities including kitchen and en-suite and there was also access to communal spaces both indoors and out.

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

People have not always received a consistently good service or been supported by staff who were sufficiently familiar with their needs.

The COVID- 19 pandemic reduced people’s opportunities to do activities they enjoy and maintain regular visits from and to family. Opportunities for people to go out was increasing but the service was not fully utilising people’s commissioned hours or evaluating the benefit of different activities.

People were not fully supported to develop important life skills. Activities were restricted due to the availability and skill mix of staff and the limited transport available for people. More in house activities were being developed to try and provide additional stimulation which should not replace one to one support.

Communication across site and with external agencies and family was poor and record keeping was not robust. Two registered managers, two area managers and the service manager had all left within the last two years which had destabilised the service.

Some of the management team were new to post and both the registered manager and service manager were still within their probationary period. Additional skills training was being provided to enable seniors and team leaders to successfully fulfil their job roles. Staff competencies were not firmly embedded in all aspects of the service delivery.

Governance systems and management oversight had improved but there were continued breaches of regulation.

Training statistics were good, but training was not firmly embedded. Regular staff supervisions took place but spot checks on staff practice were not robust. Only one-night audit had taken place since the last inspection and there was insufficient oversight of people’s night support.

Repeated medication errors put people at risk of harm. Delays in either seeking appropriate health care or failing to effectively communicate changes in people’s needs placed them at unnecessary risk of harm. Day to day monitoring had improved from a management perspective but records needed to improve to increase accountability.

Vast improvement had been made in terms of people’s accommodation and the site in general which was being refurbished and remodelled.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to fully demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Reduced activities meant people were not having fulfilling lives and on- site activities were not fully developed. People’s records provided limited information about what people were doing or how activities were in line with people’s needs, wishes and care objectives. We saw the same routine activities being provided and could not see if they made a positive impact on people’s mental and physical health.

We were confident that the service was evolving and that leaders had the right attitude and were committed to empowering people using the service. Changes were being made to promote a more person -centred culture and ensure staff were all working to the same high standard. Daily management walkarounds provided an opportunity to monitor standards of care and give/ receive feedback. However, some of these changes were only just being made which meant over time, people need had not been prioritised.

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

The last rating for this service was Inadequate (published 27/07/2021) and there were multiple 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 but the provider was still in breach of regulations.

This service has been in Special Measures since the previous inspection 2 March 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 assurances that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements under the key questions of safe and well led to ensure all continued regulatory breaches are addressed.

The overall rating for the service has changed from inadequate 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 8 Acres 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing, medicines, and governance and oversight at this inspection.

Follow up

We will meet with the provider 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 with the 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.

Westward Barns in the process of being named Eight Acres provides care and support to up to 18 people, 18 to 65 who have a learning disability, physical disability, autism and or mental health need. At the time of inspection there were 14 people with two in hospital. Accommodation was on a large site with offices, and individual dwellings, a barn converted into flats, a house converted into flats and a number of self-contained units. Staffing was provided on a 1-1 one basis and occasionally 2-1 staffing.

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

The service had previously been rated as good but in the last year had seen a lot of changes. This included changes to both operational and registered managers. There had also been a change in company which had meant a period of instability which had not been effectively communicated and staff felt they had not been sufficiently supported through the changes. There had been a number of staff who had left and other staff who were working long hours to cover vacancies. Agency usage meant people did not always receive predictable care and support from staff who knew them well. Staff sickness was also affecting service delivery.

At the time of our inspection the service was being overseen by an area manager who had been in post for six weeks. We were impressed with the actions they took immediately following the concerns we raised and the actions they had taken since. A robust action plan was in place which gave us confidence in the service moving forward. However, we found issues across all key questions and a number of breaches of regulation.

Risks were not always effectively managed and communicated across the organisation including risk relating to the environment, distressed behaviours or how staff would deal with an emergency situation.

We were concerned about staffing levels, staff were not always on time and it was not clear that staff were informed about or had the necessary skills to meet people’s needs. This included staff competence in relation to the administration of people’s medicines.

People received their medicines as intended but a lack of sufficiently trained staff meant shift planning was difficult and some staff said shifts were busy which increased the risk of medicine errors. Audits helped to determine that people received their medicines as required but we identified a number of gaps.

Staff knew how to raise concerns but there was poor oversight of this. Accidents and incidents had not been adequately recorded to show if they had been effectively managed and there was insufficient governance to monitor events affecting the safety of staff and people using the service.

People’s health care needs were mostly met particularly where people had complex needs and a core team of staff supporting them. Some staff were not working consistently in line with specific guidelines provided by other health care professionals. or with best practice.

People were not supported to have maximum choice and control of their lives and staff supported did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service didn’t always consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. We found people had a lack of choice and control, in terms of their staff and how their day should be organised. We found for another person they had poor choices in terms of moving in and limited inclusion. Some practices were restrictive.

Staff worked hard and show a commitment to the people they were supporting. We found however the service was not sufficiently personalised or peoples care needs set around clearly defined objectives and goals. People went out regularly, but we were not assured that the service took every step to maximise people’s independence.

Complaints were not adequately responded to and we found there had been poor engagement with staff, relatives and the new company. People were asked by staff about their preferences and choices but communication across site was fragmented and recent surveys had not been issued to ascertain people’s views.

The service was not well led but we were encouraged by actions being putting in place by the provider to help ensure systems and processes were effective and to stabilise and manage the service.

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) 15 September 2017.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements across each key question. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. Please see the list relevant key question sections of this full report. We have identified breaches in relation to safe care and treatment, person centred care, consent, staffing, good governance and other incidents.

You can see what action we have asked the provider to take at the end of this full report.

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.

Westward Barns provides accommodation and residential care for up to 18 people. People have their own flats which are fully equipped but they also have shared communal facilities should they wish to use them. At the time of our inspection, the service was providing support to 18 people. The home had a registered manager in post. 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.

The service provided individualised support to people with a wide range of needs and did this successfully. Staff were knowledgeable and competent and the service worked well with other health and social care agencies.

People had one to one support around their individualised needs and wishes. The service was fully staffed and managing to cover staff sickness and holidays.

Medicines were administered as prescribed and given by staff who were sufficiently trained and assessed as competent.

Risks to people’s safety were clearly identified and attention was paid to how to reduce risk whilst not stifling people’s independence.

Staff recruitment was satisfactory but people using the service could be more involved in the recruitment process. The recruitment and selection process did not always fully explore potential staff’s employment history so that people were protected as far as reasonably possible.

Staff had the necessary skills and competencies for their job role and their professional development was encouraged. Staff received good support and the opportunity to discuss all aspects of their employment.

Staff understood the Mental Capacity Act 2015 and supported people appropriately. They gained people’s consent before offering or delivering support. Where people lacked capacity to make day to day decisions or more complex decisions, staff acted in their best interest.

People were supported to eat and drink sufficiently and make their own dietary choices. Staff were mindful of people’s specialist dietary needs and any risks associated with people’s needs. Guidance was in place to ensure people’s support was provided safely.

Staff were skilful in meeting people’s health care needs. Staff monitored people’s health and supported people to stay well and have treatments as required.

Care and support plans were detailed and staff used these to inform them of the person’s needs. Care and support was highly individualised and people were supported to identify how they wanted to spend their time and what they wanted to do.

There was an established complaints procedure and the service took into account feedback from people using the service to enable them to improve the service and people’s experiences.

The service was caring. Staff developed positive, meaningful relationships with people they were supporting. They encouraged people’s independence and respected their rights, wishes and rights to self-determination.

The registered manager was committed to running a good quality service and making improvements. The service gave people the opportunity to discuss their care and wider issues affecting their experiences. Annual surveys collated feedback from health care professionals, people using the service and their family. Recently residents meetings were being held. Staff received regular opportunity to discuss their progress.

Westward Barns provides accommodation and residential care for up to 17 people. At the time of our inspection, the home was providing support to 17 people. The home had a registered manager in post. 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 felt their privacy was respected, but the providers system for monitoring people’s safety significantly intruded upon people’s privacy in their own flat.

The registered manager and provider used a series of checks and audits to monitor and improve the quality and safety of the service. There was evidence that this system of quality assurance had delivered improvements but it had failed to identify the issues we found during this inspection.

The atmosphere in the service was warm and lively with people able to participate in a range of activities and the premises were well equipped. People were referred to healthcare professionals to promote good health and visiting professionals told us that staff made appropriate referrals.

Staff had developed positive relationships with people and treated them with dignity and respect. Although there were no records of people being involved in planning their care, we saw that people were involved in day to day decisions and that staff knew them well.

People living at the home told us that the registered manager was approachable and that they responded promptly to any issues they had raised. There was a complaints policy and procedure in place and people were supported by staff when they wished to make a complaint.

Medicines were managed, stored and administered safely.

There were enough staff to support people safely. Staff had received the training they needed to perform their role. The registered manager had taken steps to address shortfalls in the safe recruitment of staff that had been identified previously. Staff said that they enjoyed their work and felt well-supported by the registered manager.

Staff obtained consent from people before offering or delivering support, and some people had appropriate best interest decisions made on their behalf where they had been assessed as not having capacity to make some decisions. Although staff and managers had completed training in the Mental Capacity Act, some staff we spoke did not have an understanding of this or how it applied to their role.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People told us that they liked living at Westward Barns. The environment was safe, clean and hygienic. There were enough support staff on duty to meet the needs of the people who lived at the service. Managers and team leaders were available during each day and the out of hour's system ensured that a member of the management team was available on call in case of emergencies.

Staff personnel records contained all of the information required by the Health and Social Care Act 2008. This meant that all of the necessary recruitment checks had been completed. This ensured that the staff members employed were suitable and had the qualifications, skills and experience needed to support people who lived at the service.

There was a process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS). Applications had been submitted when needed and records, policies and procedures were held. Staff had been trained and relevant staff knew how to submit a DoLS application.

Is the service effective?

People's health and care needs were discussed and assessed with them. Specialist dietary, mobility and equipment needs had been identified in support plans when required. Relatives told us their family member received the care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that the staff understood the care and support needs of each person. One person told us. 'It is nice here. The staff will do anything to help you.' Staff had received training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that support workers were patient and encouraged people to be as independent as possible. Our observations confirmed this. A visitor told us. 'I am so happy with the care given to my family member by their core staff team. The members of staff are so respectful and they really know my relative well.'

Is the service responsive?

Care, risk, behaviour and communication assessments had been completed before people moved into the home and had been reviewed again if their needs had changed. A record was held of people's preferences, interests and diverse needs. Relatives told us that staff members consulted their family member and encouraged them to make their own decisions. People had access to a range of planned activities and outings. They had been supported to maintain relationships with their friends and relatives.

Is the service well led?

Staff spoken with had a good understanding of the ethos of the service and quality assurance processes were in place. Relatives told us that they were asked for their feedback on the service their family member received and that they had filled in a customer satisfaction survey. Visitors and staff said that they had felt listened to when they had made a suggestion or raised their concerns. People told us that the management of the home had consulted with them before changes had been made to the staff team and environment. They said that their views had been taken into consideration.

We had not been informed when events happened at the service that affected the health and safety or welfare of the people who lived there. This meant that the provider could not demonstrate that appropriate action, had been taken by staff, when a person injured themselves and had to attend the hospital. A compliance action has been set for this and the provider must tell us how they plan to improve.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations and decision making. We saw that people were offered daily activities that stimulated and interested them.

We found that plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

Relatives told us that people received the care and support they needed and that staff were brilliant.

Medication was administered, recorded and stored accurately and safely.

Adequate numbers of staff members were provided to ensure that the individual care and support needs of each person were met.

Relatives told us that they had no complaints and that their wishes were listened to and adhered to. We found that there was a complaints system in place that met the needs of people living in and visiting the home.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations, decision making and activities.

The support plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

People who used the service and their relatives told us that people received the care and support they needed and that staff were very kind.

Staff were trained and were supported to provide an appropriate standard of care and support. However, improvements were being made to ensure that all support staff received regular supervision and a yearly appraisal and took part in planned staff meetings.

There were effective quality assurance systems in place that monitored and reviewed the standard and quality of the service provided. People who used the service, their representatives and staff were asked for their views about the care and support provided and suggestions for improvements were acted on.