Barrowhill Hall

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 assessment we rated this key question good. At this assessment 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 service was in breach of legal regulation in relation to providing safe care and treatment, medicines management, safeguarding people and in relation to governance and oversight of the service.

This service scored 59 (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 have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learned to continually identify and embed good practice.

There was mixed feedback from professionals about learning in the service. One professional told us, “There is a willingness to engage in discussions when things go wrong, but recurring issues suggest that learning is not always fully embedded.” Another professional told us the service were not proactive in trying to make improvements to some people’s care.

Staff recorded when things had gone wrong, such as when someone had a fall or 2 people had a disagreement which led to physical altercations. The management team would then review these records to make sure action had been taken to reduce the ongoing risk and to monitor for patterns or trends. Falls also had their own specific analysis to look for trends. A staff member told us, “Any trends from accidents or incidents are discussed in team meetings.” However, some incidents were missed from this analysis so trends may not always be identified, and learning may not always be shared. We saw an example following a serious incident where a person sustained an injury, learning was shared with staff and reminders given to staff about maintaining safety. However, the person’s care plan was not updated about the person’s behaviour or risk, so we could not be sure learning would be embedded into the person’s care.

When people used behaviour which may be agitated or distressed to communicate their feelings, staff recorded this on the provider’s electronic system. However, there was no proactive review of these incidents, so the provider failed to identify possible learning from these incidents to improve people’s care.

The provider listened to us and took corrective action following our feedback. We will check if this action has been effectively embedded at our next inspection.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

We received mixed feedback from professionals. One professional said, “The carers at all levels, are knowledgeable about the residents.” Another professional told us, “We have no reason to believe that people are unsafe at Barrowhill Hall. The staff are caring, and the overall atmosphere is calm and supportive.” However, they went on to say, “Staff are receptive and agree with the guidance provided. However, in practice, implementation is inconsistent.”

Another professional said, when we asked if they felt people were safe in the home, “Not really – I feel staff don’t recognise what they should be flagging [about people’s health]” and they went on to say, “They struggle to identify concerns.” The same professional also said, “Information is so inconsistent. A staff member will tell me one thing, then that staff member isn’t in, and we speak to a different staff member, and they tell me a different story. I then struggle to make a professional decision. It makes it difficult to put a plan in place.”

People were supported to access other health professionals. Care plans sometimes referred to these referrals, however the outcome of this professional input was not always incorporated into people’s care plans. One person’s records had a note referring to a health professional stating the person needed support to elevate their legs. This had not been incorporated into the person’s plan, and the provider was failing to evidence how they were attempting to support the person with this.

People in the service needed periodic support from a dental professional. One person had been described in records as having some issues with their oral health. Attempts had been made by the provider to source professional support for people in the home but had not been successful in a timely manner. The provider failed to adequately escalate this so 1 person had been left in potential discomfort for a prolonged period and the provider failed to recognise the seriousness of the concern.

Another person’s care plan referred to them needing support from staff in relation to a wound. However, this was no longer the case, and the plan had not been updated. They were also missing a plan about their personal, oral and foot care, despite needing support in these areas. This person was at increased risk in relation to their foot health due to a condition they had. This meant there was a risk they would be neglected as staff did not have guidance to follow.

The monitoring of people’s bowel movements was not always effective. We saw lengthy gaps between a person’s recorded bowel movements and there was no evidence this concern had been escalated for a health professional to review. We raised this concern with the registered manager who said the person went to the toilet independently so staff would not always be aware when the person had opened their bowels. However, this issue had not been identified prior to our feedback. Following our feedback the care plan was updated to accurately reflect the person’s needs.

We saw another person’s care plan regarding their health condition, which staff would need to respond to in an emergency, and this was detailed. People had their weights monitored to ensure they were not unintentionally losing weight which can be a sign of ill health. However, there were multiple omissions in relation to ensuring the guidance from professionals was incorporated into people’s plans.

The provider told us they had taken corrective action following our feedback. We will check if this action has been effectively embedded at our next inspection.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

People consistently told us they felt safe. One person said, “The best thing is meeting other people. I feel safe.” Another person told us, “The staff are brilliant. They support me to be independent.” Relatives also felt their loved ones were safe and felt staff treated people with dignity and respect. One relative said, “[My relative is] in safe hands.” Another relative said, “I go home and don’t worry.” Another relative told us, “The staff are very kind, caring and compassionate. They go above and beyond to make sure that they meet my relative’s needs.” Staff understood their safeguarding responsibilities and knew to report their concerns. There were documented incidents such as physical aggression between people living in the service which had been reported by staff. While many incidents had been referred to the local safeguarding authority, as needed, there were incidents which were not consistently shared. This showed a breakdown in the oversight of safeguarding and failure to recognise the severity of some incidents. We asked the management team to undertake a review of incidents and make referrals of incidents which had not been previously shared. They confirmed this was completed.The provider said they had made a substantial number of safeguarding referrals over a period of time, and it had only been 4 additional that were made following our feedback, which they had not previously sent to the local authority. However, information we gathered indicated there were at least 5 instances of alleged abuse which had been recorded as not being referred to the local authority. Therefore, we requested they complete a further review to ensure all instances of possible abuse were referred as required. This meant we continued to not have full confidence in the provider’s processes to ensure all necessary safeguarding referrals were made.

There was also a failure to take action following some safeguarding incidents to reduce the risk of a reoccurrence. For example, 1 person was found in another person’s bedroom and was physically aggressive towards the person. This had posed a serious risk to the other person. The risk of this was not updated in the person’s care plan as a possible risk following the incident, so we could not be sure the risk would be reduced as it had not been recognised.

One person’s plan referred to the person having uninhibited behaviour at least daily and they could become aggressive. However, there was no detail about what caused this person to become upset, how they displayed this behaviour or how staff should respond when the person was distressed. The same person’s plan mentioned the person ‘frequently’ needed sedation. As staff had no personalised information about how to support the person in times of distress, the provider was not doing all reasonably practical to reduce the need for sedation, which could be a restriction.

Another person’s plan referred to their difficulty in verbally communicating. The person’s plan goes on to say they had a sedative as a last resort, and their frustration/agitation could stem from the fact they struggled to communicate. However, there was no detail about how staff were to support the person to communicate, such as using communication tools. The provider was not doing all reasonably practical to reduce the need for sedation.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.

In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA and whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met.

A DoLS tracker was in place to ensure the service remained complaint in this area. People sometimes had the mental capacity assessed in relation to their care needs, such as in relation to having bed rails in place, which were a restriction. However, there were 2 instances where people did not have a capacity assessment in place about where they were residing in the service. Records showed both people’s relatives were aware of the decision. However, the provider had not fully recorded the person’s ability to contribute to a decision about their own care.

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

People and relatives consistently said they felt safe, supported and well cared for. One person said, “It’s quite good here, staff help me.” A relative said, “There are pressure mats either side of the bed. My relative’s bed is lowered so they don’t hurt themselves.” People were supported safely with moving and handling. A person told us, “Staff help me move from A to B.” A relative said, “The staff come straight away if my relative needs help and equipment is always available.” A staff member said, “Over time we get to know the residents really well.” Our observations confirmed this. One professional said, “We believe staff know residents well.”

However, the provider failed to consistently assess and do all that was reasonably practicable to mitigate risks to people. People’s care plans did not contain information about risks to people and did not have guidance for staff about how best to support people. Staff knew people well when we spoke with them. Staff told us about people’s needs and different behaviours people displayed. However, some of this information was not included in people’s care plans, so we could not be sure staff were consistently supporting people in the same way.

For example, staff told us 1 person does often not sleep, so walks around the household and sometimes sleeps in chairs in communal areas. None of this was reflected in the person’s care plan.

One person had visible support needs with their teeth and nails, but this had not been identified in their care plans. This meant there was a risk the person’s oral and nail care would be neglected as staff did not have guidance to follow.

A person’s care plan contained conflicting information about their falling risk. In 1 plan it stated they had not had any falls, but in another place, it referred to them having 2 falls. However, we reviewed falls records and there were 10 recorded falls for the person.

Another person’s plan referred to them needing to be checked on by staff every 30 minutes, however the care plan did not detail why this check was needed. There was conflicting information about the falls risk to the person and their plan referred to them using a walking stick, but this was not correct.

A person was at risk of attempting to leave the service independently through fire exits. We observed staff responding to the door alarm when this did occur, but this risk was mentioned nowhere within the person’s care plan.

Another person’s plan referred to them needing regular checks. The records show this was not always being recorded in line with the person’s care plan, so the provider could not evidence this was being completed. The registered manager looked into this and found the checks at night time were being completed on a less-frequent basis. However, no one had identified this until we raised this.

Multiple other people’s care plans had omissions demonstrating the provider had failed to recognise and evidence they were acting on risk to people. Whilst staff knew people, there was an increased risk of inconsistent care as staff did not have access to a source of complete and correct guidance to follow.

Despite these concerns, people told us they felt safe living in the service. One person who was able to tell us about their experience of care said, “We do what we want to, staff are nice, and I am happy.” A relative told us, “My relative appears happy, well cared for and is treated with dignity and respect, by all staff.”

The provider worked to make corrections and put missing care plans in place in response to our feedback. We will check if this action has been effectively embedded at our next inspection.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The home had information boards to help orient people to the day or time of year, but this was not in use on the day of our first visit. We were told it usually was completed for people.

The lift had no signage adjacent warning people not to use this in the event of a fire. The provider told us the lift signage was installed following our feedback. We will check if this action has been effectively embedded at our next inspection.

However, overall, the home was well maintained. People and relatives were consistently complimentary of the home environment and extensive grounds. One relative said, “It has lovely scenery, spacious and relaxed.” Another relative said, “The home is always clean and tidy.”

There were safety measures in place, such as window restrictors and alarms on doors to sound if someone were to leave the home. Checks were made on the safety of the home, such as electrical checks and water hygiene checks. The fire alarm sounded during our visits to the service, and staff responded until it was confirmed as a false alarm. The grounds were well maintained so people could access these, with support from staff.

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.

People and relatives told us, and our observations confirmed, people did not have to wait long for support. A relative said, “I think there are enough staff. There’s always plenty about.” Agency staff were used when there were not enough permanent staff. Agency staff tended to be regular, so they worked in the home multiple times. One staff member said, “There are enough staff on duty, we don’t have to rush.” One person did say, “Sometimes it feels like the staff are rushed especially at mealtimes.” However, we observed the lunch time experience was calm, and people received their meals promptly.

In the Churnet household, an additional staff member was available as a relative was visiting a person who needed 1-1 support from a staff member. Therefore, while the relative was present, the 1-1 staff member was able to support other people and support the rest of the staff team. However, this additional support would not be available all the time and staff told us they felt that staffing was better when they had the additional support.

Staff received training. A relative commented, “Staff seem well trained.” Staff feedback and training records confirmed this. Agency staff confirmed they had training too, an agency staff member said, “I had an induction when I first started. I have completed the care certificate, moving and handling training and safeguarding training - during induction I was shown everything, all the equipment. I was shown how to use all the equipment safely.” Staff had their competency checked to ensure they understood their training, such as with moving and handling. There was a training matrix in place to monitor staff completion of training. Staff had completed a range of training courses, including regarding learning disabilities and autism, as required.

Staff were recruited safely. Checks were made on staff suitability to work with people who used the service, such as previous employment, references, right to work in the UK and checks on criminal records. Checks were also made on agency staff in the form of a one-page profile to verify they had the necessary checks and training in place.

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

In one household there were false eyelashes which had been left in a communal area in the vicinity of where staff based themselves. This was not appropriate as people could have picked these up and they could pose an infection control risk. These were removed following our feedback.

People told us staff wore Personal Protective Equipment (PPE), such as gloves and aprons, while they staff were supporting them with personal care. One person said, “Staff wear gloves when helping me.” Staff told us they received training in this area, too.

The home was generally clean, tidy and with no lingering malodours. We observed the cleaning of touchpoints. However, there was a build up of dust within radiators and there was staining and damage to some chairs and pressure cushions. We were told there was a replacement programme of chairs so they would be replaced over the coming months. The provider also told us the radiators were deep cleaned and added to their ongoing audit tool to ensure they were checked, following our feedback. We will check if this action has been effectively embedded at our next inspection.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

There was mixed feedback about medicines. People told us they did not always get an explanation about what their medicine was for, and our observations confirmed this. However, some people did feel they’d received an explanation. One person said, “Staff tell me about medication. I have recently changed my medication. Staff discuss this and reassure me.” Another person told us, “I take tablets for inside my chest” whereas another person said, “I’m not sure what medication is for.”

People’s covert medicines were not always appropriately managed. Covert medicine is when it is hidden in food and drink, so people don’t know they are taking it. Records about the decision to administer medicines were not always complete and advice from a pharmacist as to the best way to administer the medicine safely had not always been sought. Different food and drinks can change the efficacy of some medicines, so it is important to ensure they are given in a safe way. It could put people at risk if their medicines were not safely administered.

We found 1 tablet in a communal area of the service, which could not be accurately accounted for.

People’s ‘when required’ medicines were not always safely managed. One person’s stock count for medicines used to support them when they were distressed could not be reconciled as there was poor recording, so we could not be sure this was administered appropriately. One person’s medicine record showed the dates ‘when required’ medicine to help them when anxious was administered to them. However, this did not always match their behaviour records, so it was not always clear why the medicine had been administered. Protocols for staff to follow about when to administer PRN medicines were not always clear. Staff were not always recording the reasons for administration of ‘when required’ medicines, or whether the medicine had been effective or not. Some ‘when required’ medicines were being given as a regular dose, and this had not been followed up to check this was ok. This lack of monitoring and evaluation placed people at risk, as it remained unclear whether the medicine achieved its intended outcome or whether further intervention was needed.

Medicines were being stored appropriately, with checks being made on the room and fridge temperatures to ensure they remained in a safe range. However, the documenting of this was not always clear. Medicines that required extra checks and security were stored appropriately.

The provider told us improvements were made to medication records and processes following our feedback. We will check if this action has been effectively embedded at our next inspection.