Barrowhill Hall

Barrowhill Hall is a residential care home providing personal and nursing care to up to 74 people. The service provides support to people living with dementia, mental health concerns, sensory impairments and younger adults. At the time of our inspection there were 69 people using the service.

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

Governance systems had improved since the last inspection. However, many of the systems in place were newly implemented and needed time to ensure they would monitor risks effectively. These will be reviewed in the next inspection.

Lessons had been learnt since the last inspection. The provider improved risk monitoring and reporting systems. Visiting professionals told us the provider was working in partnership with them to address skin integrity concerns, review medicines and support people at risk of falls. Accident and incident forms were investigated by the management team to analyse patterns and seek support from health and social care professionals. Lessons learnt were shared with the staff team.

Medicines were managed safely by suitably trained staff and people were offered and received pain relief medication. Staff used personal protective equipment (PPE) effectively and attended infection prevention control training.

Staff were recruited safely and received regular supervision and training, including safeguarding training. Staff used personal protective equipment (PPE) effectively and attended infection prevention control training.

Relatives, staff and visiting professionals told us the service had improved. They told us they felt the culture was person centred and the care was provided by a competent and compassionate staff team and led by a confident and inclusive manager.

Staff told us they felt supported by the newly appointed manager and attended regular meetings. Relatives told us they felt included in the service and felt confident to raise concerns.

The provider and staff worked in partnership with other health and social care agencies to deliver good outcomes for people and ensure their needs were met and reviewed.

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.

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 12 September 2022)

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.

Why we inspected

We undertook this inspection to check whether the warning notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met regarding the safe management of the home and to check they had followed their action plan to ensure they now met legal requirements.

In addition, we received concerns in relation to a high number of people experiencing a fall. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last 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 have found evidence that the provider needs to continue to implement their improvements over time. Please see the well led sections of this full report.

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 inspection, by selecting the ‘all reports’ link for Barrowhill Hall 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.

Barrowhill Hall is a residential care home providing personal and nursing care to up to 74 people. The service provides support to Older people and those living with dementia, mental health concerns, sensory impairments and younger adults. At the time of our inspection there were 66 people using the service.

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

The governance and auditing systems had not identified issues with the quality of the service which meant actions had not been taken to ensure people received good quality care.

Relatives told us communication with the home was difficult and it was hard to speak with the registered manager when they needed to.

People were not consistently supported to manage risks to their safety. Some risks had not been assessed and planned for, and where updates were needed to management plans these had not been documented to guide staff.

Medicines administration records were not consistently completed in line with the policy. Incidents were not consistently reported for investigation and review and reports from staff sometimes lacked detail. Infection prevention control measures were in place and these were followed by staff.

People were supported by enough staff. Staff understood how to recognise abuse and how to report concerns.

Incidents and accidents were reviewed to enable action to prevent this from happening again. The registered manager ensured where things had gone wrong relatives were informed.

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.

Staff felt supported by the registered manager and provider in their role. Relative told us they were asked for their views and these were acted upon.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement 5 November 2021.

At our last inspection we found breaches of the regulations in relation to safe administration of medicines. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection, we found the provider remained in breach of regulations. This is the fifth consecutive inspection where a good rating has not been achieved.

Why we inspected

We received concerns in relation to people’s nursing care needs and leadership. As a result, we undertook a focused inspection to review the key questions of Safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed following this inspection.

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.

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

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.

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 and will take further action if needed.

We have found breaches in relation to how risks to people’s safety are managed and the governance arrangements in the home at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider ensured PPE (Personal Protective Equipment) practices were effective. For example, staff completed regular PPE compliance checks on each other throughout the day.

The provider ensured PPE supplies were plentiful and accessible throughout the buildings. We

saw staff were using PPE appropriately at all times.

The provider had alarms fitted in communal areas to alert staff when the room reached a high temperature. This helped support the ventilation within the home.

Barrowhill Hall is a care home providing personal and nursing care to 63 people at the time of the inspection. The service can support up to 74 people, many of whom are living with dementia.

Barrowhill Hall accommodates people within two separate buildings. Within the main hall, there is also a separate household upstairs called Dove House. Churnet Lodge is a separate, purpose-built building.

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

Improvements were needed to ensure people always received their medicines safely. The current auditing system had not identified the issues we did, which meant the audits were not working to improve the quality and safety of the services provided.

People felt safe and were happy with the care they received. People risks were managed, and lessons were learned when things went wrong. There was enough staff to support people and despite the regular use of agency staff, the agency staff were consistent and knew people well.

Staff followed safe infection prevention and control practices, to help prevent the spread of infections. People were safeguarded from abuse and improper treatment and staff knew how to support people safely.

A new manager was in the process of registering with us. They understood their responsibilities and were in the process of making required improvements. Most staff felt the manager and provider were approachable and supportive. People are relatives were engaged and involved in the running of 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 requires improvement (published 2 May 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to staffing levels and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. This inspection was also planned based on the length of time the previous rating had been held.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at 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.

The overall rating for the service has stayed the same. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement in some areas. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Barrowhill Hall 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 the safe administration of medicines at this inspection. Please see the action we have told the provider to take at the end of this report.

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.

People’s experience of using this service: Since the last inspection, a large number of improvements had been made at the service. Some improvements needed to be further developed, embedded and sustained. Medicines management had improved but still required some improvement to ensure it was consistently safe.

People felt safe and were happy with the care they were receiving. There were enough staff to meet people’s needs and give people the time and reassurances they needed.

Staff were well trained and supported and knew how to protect people from abuse and avoidable harm and how to reduce people’s risks. Staff knew people well and catered for people’s preferences.

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 had access to activities they enjoyed and were encouraged to maintain their independence and participate in the running of the service when they wanted to. People were involved in developing their own care plans which were regularly reviewed.

There was a new registered manager since the last inspection and people, relatives and staff felt they were approachable and supportive. The provider was also accessible to people and staff, listened to feedback and had plans for further improvements at the service.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The service met the characteristics of Good in three areas but has been rated Requires Improvement overall; more information is in the full report.

Rating at last inspection: At the last inspection the service was rated Inadequate (supplementary report published 1 December 2018)

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor the intelligence we receive about this service and inspect again within 12 months. If we receive information of concern, we may bring planned inspections forward.

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

Barrowhill Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Care and support is provided over two buildings, Barrowhill Hall and Churnet Lodge. Barrowhill Hall is spilt into smaller ‘units’ with Dove House located upstairs. The service is registered to provide care support for up to 74 people. At the start of this inspection 66 people were using the service.

There was 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.

At the last inspection in December 2017, the home was rated as Requires Improvement overall. At this inspection, we found that improvements had not been made and the home was rated ‘Inadequate’ and is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There were not enough staff deployed effectively to keep people safe or to meet their needs. We told the provider about our concerns and they increased staffing levels but we still found that staffing impacted on the safety and quality of care people received, including their mealtime experience.

Risks to people's safety, health and wellbeing were not always suitably assessed, monitored and managed. There was a lack of clinical oversight and the systems in place did not support safe risk management.

We found that medicines were not managed safely and people were at risk of not receiving their medicines as directed by the prescriber.

The registered manager and provider had not operated effective governance systems to ensure that the safety and quality of the service were adequately monitored and improvements made when required. Some people did not know who the registered manager was and not all staff felt supported and involved.

Staff knew how to recognise and report abuse but the systems in place meant the provider could not be confident that people were kept safe from potential abuse and avoidable harm. People’s nutritional risks were not managed and mitigated though people told us they enjoyed the food on offer.

Staff teams did not always work effectively together. For example, handovers were not consistent and agency staff did not know the people they were supporting, their needs, risks or preferences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, decisions made in peoples’ best interests were not always appropriately recorded.

People told us that staff treated them with kindness and compassion. However, people were not always offered the reassurances they needed because staff did not have time to spend with them. People’s dignity was not always respected and promoted, though they had access to privacy when they wanted it.

People were supported to consider their wishes for end of life care and the service were working with a local hospice to help improve this area of care.

People were protected from the spread of infection and the design and adaptation of the service met their needs. The provider had plans in place to further the design, adaptation and facilities available.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We inspected this service on 18 December 2017. It was an unannounced inspection. Barrowhill Hall is a care home which accommodates 74 people in two buildings, some of whom are living with dementia. In the main hall, 50 people with nursing needs are supported in three separate households, arranged over two floors. Each has a communal lounge and dining area. Churnet Lodge is a separate, purpose built building which supports 24 people with residential needs in accommodation arranged on one level, with an open plan communal lounge and dining area. On the day of our inspection visit, 69 people were living at the home.

The service 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.

At our last unannounced inspection on 3 November 2016, we rated this service as Requires Improvement. This was because the provider was not meeting all the regulations; improvements were needed to ensure that risks associated with people’s care were always safely managed and that there were sufficient staff on duty to meet people’s needs at all times. We asked the provider to complete an action plan to show what they would do and by when. At this inspection we found that the provider had taken action to meet the regulations but some further improvements were

needed.

Improvements were needed to ensure people always received their medicines as prescribed and that the legal requirements and good practice were always followed when people lacked the capacity to make decisions about taking medicines.

Risks to people had been identified and staff understood how to support people to reduce risk and protect them from potential harm whilst maintaining their independence. However, improvements were needed to ensure staff supported people in a consistent manner when they presented with behaviours that challenged.

People had been consulted about how they wanted to be supported and had care plans which reflected their needs and preferences. These were kept under review to ensure they remained relevant. Recruitment checks were made to confirm staff were suitable to work in a caring environment and sufficient staff were available to meet people's needs.

People felt safe living at the home. The staff knew how to protect people if they suspected they were at risk of abuse or harm and how to report concerns. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff knew people well and provided care that met their preferences. Staff promoted people’s independence and maintained their privacy and dignity at all times. People were supported to eat a healthy diet and had regular access to healthcare professionals. People were offered opportunities to take part in activities and follow their interests.

People and their relatives felt there was a positive, inclusive atmosphere at the home. They knew how to raise any concerns or complaints and were confident these would be acted on. People were offered opportunities to take part in activities and follow their interests. The registered manager and provider carried out checks to ensure the quality and safety of the service and encouraged people, relatives and staff to give their feedback to make improvements where needed.

This is the second time the service has been rated Requires Improvement.

This inspection took place on 3 November 2016 and was unannounced. At the last inspection on 5 November 2015, the service was rated as Good overall, but we asked the provider to make improvements to ensure people’s medicines were managed safely. The provider sent us an action plan on10 December 2015 which stated how and when they would make improvements to meet the legal requirements. At this inspection, some improvements had been made but further action was still needed. We also identified that improvements were needed to ensure risks associated with people’s care were managed safely and staff were deployed effectively to meet people’s needs at all times.

Barrowhill Hall has recently been extended and now provides accommodation, personal and nursing care for up to 74 people. The service is provided across two units, the main hall, which accommodates up to 50 people on two floors, and the newly built Churnet unit, which accommodates up to 24 people. At the time of our inspection, 51 people were using the service, some of whom were living with dementia. There was a registered manager at the service. 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.

At the last inspection we asked the provider to take action to ensure people’s medicines were managed safely. At this inspection we found improvements had been made and people received their medicines when needed. However, further action was needed to ensure staff took a consistent approach when administering medicines prescribed on an as and required basis.

The provider had not made the required improvements to the deployment of staff. Staffing levels were not sufficient to meet people’s needs in some areas of the home and people did not always receive timely support. Risks to people were not always well managed and some people’s care and treatment was not consistently planned and delivered in a way that ensured their safety and welfare.

Improvements were needed to ensure the manager’s quality monitoring checks were consistently effective in identifying shortfalls and making improvements where necessary.

The provider followed procedures to ensure staff were suitable to work in a caring environment and staff understood their responsibilities to protect people from the risk of abuse. Staff had received training to know how to support people and maintain their wellbeing but improvements were needed to ensure they received ongoing support to fulfil their role. People were supported to make their own decisions and where they needed help, decisions were made in their best interest and involved people who were important to them. Where people were restricted of their liberty in their best interests, for example to keep them safe, the required legal authorisations had been applied for. However, improvements were needed to ensure staff fully understood the requirements of the legislation.

Staff knew people well and encouraged them to have choice over how they spent their day. Staff had caring relationships with people and promoted people’s privacy and dignity and encouraged them to maintain their independence. People had sufficient to eat and drink and were able to access the support of other health professionals to maintain their day to day health needs. People were offered opportunities to join in social activities and were encouraged to follow their hobbies and interests. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes.

People and their relatives felt able to raise any concerns or complaints and were asked for their views on the quality of the service. Staff felt supported by their colleagues and the management team.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

The service provides support to 50 older people, some of who may be living with dementia. At the time of the inspection there were 45 who used the service.

There was a registered manager in the service. 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.

Medicines were not always managed safely as we saw some medicines were given to family members to administer. The provider had not assessed the risk and staff did not check these had been administered and recorded correctly. Some medicines we saw were touched by staff or broken in half without necessary standards being maintained to ensure the integrity of the tablets were not compromised and risks were minimised in handling medicines. Improvements need to be made in this area.

The provider had reviewed the staffing levels to meet the needs of people who used the service. We saw there were sufficient staff working although at certain times of the day, especially at lunch time the way staff were deployed meant that staff were busy and were not always able to meet people’s needs in a timely manner.

People told us they felt safe and were confident that staff supported them in a manner which protected their welfare. Staff understood what constituted abuse or poor practice and there were systems and processes in place to protect people from the risk of harm.

People’s care needs were planned and reviewed regularly to ensure their care continued to meet their needs. Staff received training to meet identified needs to ensure they could effectively met people’s identified needs.

People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. Staff sought people’s consent before they provided care and support. Where people were not able to make decisions for themselves, they were supported to make decisions that were in their best interests with the help of people who were important to them. Where restrictions were placed upon people these had been assessed and applications made to appropriate authorities to ensure any restriction was lawful.

People were supported to eat and drink and breakfast time was flexible so people could arise at a time that suited them. Specialist diets were catered for and alternative meals could be provided upon request.

Health care professionals visited the service regularly to provide additional healthcare services to people. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

People told us the staff were kind and treated them with dignity and respect. People’s care was tailored to meet their individual needs. Care plans detailed how people wished to be cared for and supported.

People were confident they could raise any concerns with the registered manager or staff and were complimentary about the registered manager and staff. They told us the registered manager was always available and was approachable. They were encouraged and supported to provide feedback on the service. The provider had effective systems in place to review the quality of the service provided.

You can see what action we told the provider to take at the back of the full version of the report.

We found people were safe because the staff were given clear instructions, support and guidance. One relative had recorded on a comment card, 'My relative is safe in your care because everything is excellent.'

We saw people were treated with care and compassion and the staff responded well to their needs or concerns.

We saw the home could demonstrate how arrangements to seek people's consent to care or treatment had been agreed in the person's best interests.

We looked at the cleanliness and suitability of the environment to ensure people lived in a home where the d'cor and infection control standards were appropriate. We found the home was clean, safe and well maintained.

We saw medicine was managed effectively and was stored, handled and administered safely.

We found the service was well led because the registered manager supported the staff team and managed risks to the service effectively.

On this inspection we only looked where non compliance was evident previously. We found improvements had been made, the service was compliant in the outcome area we looked at. The provider could demonstrate they had informative care records in place to ensure the home provided good care, treatment and support for the people who lived there.

We spoke with four people using the service, four staff and the registered manager. No visitors were available to speak with us during our inspection.