Barrowhill Hall

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance and oversight of the service.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture. The provider wanted to do a good job and deliver excellent care. However, in practice this was not yet fully in place and embedded.

People and relatives were complimentary of the staff team and management. One person said, “I am happy here, staff aways help. I was a stranger when I came, now feel part of them.” Relatives also likened it to being part of a big family. A relative told us, “I can’t praise the staff enough, it’s like one big happy family.” A relative said, “If I needed to go into a care home, I would want to come here.” A staff member told us, “All work as a team and understand each other.” Another staff member said, “It's really okay here, all staff are helpful. I'm not stressed like the last place I worked.” An agency staff member said, “I like working here.”

People told us they were happy living in the service. One person said, “The best thing is I have no worries it’s a nice place to be.” Another person said, “The staff are lovely.” The provider shared with us a copy of feedback they had received from a relative about exceptional care they felt their loved one had received. We observed at lunch time, people often did not want to sit at a table for their meal and would often get up and leave the room or spend time moving around the room. Staff were respectful and caring in their approach in encouraging people to eat so people could have their lunch at a time that suited them, which may be over an intermittent period. We observed lots of caring interactions between people and staff throughout the day and staff remained patient.

The provider had inclusive leaders at all levels. However, the provider did not demonstrate effective leadership or robust quality assurance in their oversight of the quality and safety of care. Leaders had not recognised the deficiencies within their own service and that their systems and processes were not identifying areas of concern or areas for improvement.

Despite this, relatives felt confident in the management team and registered manager. A relative told us, “As a family we have a really good relationship with the home and feel very confident that if we have any queries around my relative’s care that we will be listened to and jointly resolve any worries.” The same relative went on to say, “The registered manager is very approachable and has an open-door policy if you need to speak to them.The registered manager is very passionate in making the lives of the residents and their families the best it can be.” Another relative said, “I think [the registered manager] is great, always happy and asks if I am happy. The registered manager makes a lot of effort.”

The staff team were also positive about the management team. One staff member said, “The registered manager is good, they are approachable, they are open to discussion and listens when we share concerns. They will act on concerns.”

The registered manager was responsive to our feedback and dedicated to addressing deficiencies and improving the service. The registered manager told us, “These actions reflect our commitment to high-quality, person-centred care, and to maintaining clear, reliable records that evidence the support we provide.”

We will check whether actions the provider and registered manager have taken in response to our findings have been effective and sustained at the next inspection.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. Staff felt able to raise concerns. One person said, “I know where to find [the registered manager’s office and, in the past, we have sat down and had a chat.” A relative told us, “I reported [a concern] to the [registered] manager who dealt with the matter and spoke to me about it.” Another relative said, “The registered manager is very nice, they always stop to check all is ok.” A staff member said, “I feel comfortable to go to the registered manager.” Another staff member told us, “I like the managers, I have no problems and I’m happy, I can approach the managers at any time.” An agency staff member told us, “I like working here. I know who to go to if I had concerns, I would go to the team leader, if nothing was done then I'd go to the registered manager or higher.” Staff told us there were team meetings and handovers so things could be discussed there, too. Staff meetings covered topics such as training, risks to people and areas to improve, for example. There were also meeting with people who used the service and relatives, and included discussions about activities, events and the registered manager asked if people felt safe, and people responded positively to this.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. There were staff from a range of backgrounds working in the service. One staff member said, “It’s all very friendly – it doesn’t matter which background we come from we are all family.” Staff told us they felt treated fairly at work and were supported in their role, through supervisions, which we saw were recorded.

The provider did not always have good governance. They did not always act on the best information about risk, performance and outcomes.

The provider’s governance systems failed to adequately assess, monitor and mitigate risk to people. The provider failed to have effective systems in order to identify concerns and therefore was not rectifying concerns. People’s care plans often contained conflicting information, incorrect information or a lack of detail about how to best support people. For example, there were missing care plans which no one had identified, risks to people had not been considered, such as behaviours of distress or anger towards others. There was conflicting information about some people’s falls, a person’s wound, equipment needed to support people and whether this was required or not and the risk of leaving the service unaccompanied. Professional advice for 1 person had not been incorporated into their plan. People’s plans lacked information about how best to support them during times of distress or with their communication need.

The provider shared a care plan with us that they felt was a good example of a care plan. Whilst the plan did contain more detail than the multiple other plans in place we reviewed, there were still issues such as conflicting information about diet, weight monitoring, the reason for the use of some equipment and what setting equipment should be on was not referred to.

None of the provider’s systems had identified these omissions. There were checks in place to ensure a particular care plan was in place, but these did not evidence a check on the content or quality of the care plan being reviewed. Two people were being supported in a way that may infringe upon their privacy and checks should have been made on whether they consented to this type of care and what measures needed to be in place to minimise any privacy infringement. This had not been referenced in their care plans so we could not be sure this had been considered.

Other professionals shared instances where they felt staff behaviour, whilst not intentionally harmful, was not always appropriate towards people. We observed instances of undignified terminology being used by staff, such as infantilisation where a staff member said to a person ‘good boy’. Two different staff used the term ‘feeding’, rather than the more dignified term ‘supporting people to eat’, for example. In records relating to a person using behaviour to communicate their feelings, staff did not always use positive or supportive language to describe this, such as referring to the person being ‘attention seeking’. While these comments were not made with harmful intent, using respectful and empowering language is essential to promote dignity and foster an inclusive environment. We saw after our feedback the registered manager shared learning with the staff team to address poor terminology.

Systems to monitor medicines were also not fully effective. The provider shared examples of instances when medicine errors had been identified and reported to the local safeguarding authority. However, the provider’s systems had failed to identify the issues we found. Guidance for ‘when required’ medicines were sometimes missing or not detailed enough, ‘when required’ medicines were being given as a regular dose, and this had not been reviewed. Staff were not always recording the reasons for the administration of ‘when required’ medicines, or the effect these medicines had, and the provider’s audits had not identified or resolved this. People who had covert medicine did not always have sufficient guidance in place and the provider’s systems did not review this to remedy it.

Accidents and incidents were not always effectively reviewed, as some incidents were missed from this analysis, appropriate referrals had not always been made and changes or improvements to people’s care plans and risk management had not happened as a result of an incident. Some incidents were not reviewed, such as those incidents involving people communicating their distress with their behaviour.

The registered manager was responsive to feedback and provided us with an action plan addressing points in our feedback. This offered us some reassurance about things they had resolved, or were in the process of resolving, and the sharing of positive feedback we also shared. The provider was also responsive to feedback and wanted to ensure the service was run effectively.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate effectively for improvement.

There was mixed feedback about partnership working. One professional told us, “We work very well with the home, and I have no concerns regarding the care, staff or residents.” One professional said, “Management is approachable, responsive, and open to feedback. However, despite mutual agreement during discussions, follow-through on actions is not always sustained. This inconsistency can affect the overall effectiveness of our collaborative working.” Another professional told us, “We generally have a good working relationship with Barrowhill Hall. The processes we have in place work well, and communication is usually good. The main frustration is around lack of consistency from some staff and occasional non-adherence to agreed processes.” Another professional said, “Managers definitely don’t work in partnership with our service. It’s hard to make any lasting changes there as that is not echoed from management. They can’t make changes as there isn’t buy in from management.” Two professionals also gave us examples of delays in responding to professional requests for further information.

The provider shared evidence of engagement with the GP surgery which supported the home, showing they were willing to engage with partners to review whether processes were working.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The provider had not been able to embed and sustain good practice in the service as it has not managed to retain a good rating overall. The service has been rated good on 2 occasions but had been rated less than good on 6 further occasions.

The provider took action to address concerns as they were identified by us, or by other statutory agencies, however this improvement was not sustained. Professionals we spoke with as part of this inspection confirmed to us learning was not always embedded. We found the provider’s systems were not always identifying areas of concern, so they were not making continuous improvements.