Barleyfields House

About the service

Barleyfields House is a respite care service. It is registered to provide accommodation and personal care to a maximum of 5 people, at any one time. In total, 29 people accessed the service for respite care at different times throughout the year. At the time of the inspection, 5 people were receiving respite care at the home.

The accommodation is a single-storey building. There are 5 bedrooms and people have access to adapted bathrooms, communal spaces and a large garden.

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

Right Support:

People were mostly 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. However, records relating to consent and capacity needed improving.

When staff administered people’s medicines, they did not always follow best practice. The issues we found were rectified during our inspection.

The service gave people care and support in a safe, clean, well equipped, well-furnished, and well-maintained environment which met their sensory and physical needs.

Staff supported people to take part in activities and pursue their interests in the local area.

Right Care:

People received kind and thoughtful care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Culture:

The provider had processes in place to review compliance with the regulations, but we found some areas required improvement.

We did find lessons were learned when things went wrong, and the provider responded to any points identified during the inspection. People found the registered manager approachable.

Staff turnover was low, which supported people to receive consistent care from staff who knew them well.

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 5 March 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

At our last inspection we recommended the provider took action to update their policies and practice in line with the Mental Capacity Act 2005 Code of Practice and current NICE guidance on managing medicines in care homes. At this inspection we found this guidance had been considered, but records needed improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

Enforcement

We have identified a breach in relation to the governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

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

Barleyfields House is a respite care service. It is registered to provide accommodation and personal care to a maximum of five people, at any one time. At the time of inspection 48 people with learning disabilities access the service for respite care at different times throughout the year.

The accommodation consists of a single-story building. There are five main bedrooms and a sleep-in room for staff. People have access to adapted bathrooms, communal space and a large garden.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The service applied 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.

People’s medicine requirements were updated on a regular basis. However, the guidance in place did not always contain sufficient detail to ensure medicine was given as intended. We recommended the provider reviewed the guidance in place for each person, before their next visit, to ensure it was accurate.

Risks to people’s safety were assessed and action was taken to mitigate the risk of harm. Equipment used by people was assessed but there was not always clear instructions on how the person should use the equipment or to confirm checks had been made. For example, how often it should be used.

People were supported by sufficient numbers of staff and staff suitability was checked as part of the recruitment process. We found one staff file where a full employment history had not been gathered and the provider acted to rectify this.

The governance systems used by the provider had not identified the concerns we found as part of the inspection process.

People were protected from harm by staff who had been trained and felt confident raising concerns. Lessons were learnt when things went wrong, and staff maintained a high level of cleanliness in the home.

People’s care needs were assessed, and a care plan developed. Staff completed observations of how well people settled into the service as part of the assessment process. Staff received training to support them in their role and accessed specialised courses in subjects such as, Makaton.

People had access to sufficient quantities of food and drink of their choosing and, staff knew how to support people with differing eating habits. People were supported with any ongoing health issues and the accommodation was adapted to meet the needs of people with additional physical disabilities.

The provider worked with others to ensure people could continue to access services which were important to them. For example, college or day services. 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 were treated with kindness and staff ensured people and their families were involved in decisions about their care. Dignity and privacy were promoted, and staff encouraged people to complete tasks independently before offering additional support.

People's care was personalised to their needs as staff had a good understanding of people’s likes and dislikes. The accessible information standard was being met and various communication tools were seen around the home.

People were supported to maintain their relationships while receiving respite care and access activities in the community. People had access to a complaint’s procedure should they need to raise a concern.

Barleyfields House did not provide end of life care.

People were complimentary of the service and staff told us it was a good place to work. Staff told us the management team were approachable and new ideas were welcomed. The provider was able to evidence continuous learning and ongoing work with other agencies.

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 25 August 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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.

At the last inspection on 5 August 2015, the service was rated Good. At this inspection we found the service remained Good.

People continued to receive care, which protected them from avoidable harm and abuse. Risks associated with people’s care were managed positively and people were involved in managing these risks to help keep them safe. Staff met people's needs in a safe way and were available when people needed support.

People received care and support that was effective in meeting their needs. Staff received training and support to give them the skills needed to support people's specific needs. Staff respected people's right to consent to and make their own decisions about their care and treatment. Where people did not have capacity to make their own decisions, systems were in place which would ensure these made were in their best interests.

People were treated with kindness and compassion by a staff team that knew them well. They were kept involved in their own care and staff made sure they had choices in all aspects of their daily life. Staff respected people's privacy, treated them with dignity and encouraged them to be as independent as they could be.

People's care and support continued to be individual to them. People were supported to spend their time how they wanted to and were encouraged to maintain their routines and social interests when they stayed at Barleyfields House. People had opportunities to give feedback on their experiences of the care they received.

Staff continued to work for the benefit of the people who lived at the home and supported a positive and open culture. People and relatives felt involved in what happened and gave positive comments about the quality of care that was delivered. The provider had systems in place that continued to be effective in assessing and monitoring the quality of the service provided.

Further information is in the detailed findings below

There were comfortable and well furnished dining, lounge and activity areas. The kitchen was well set out to allow the people to participate in meal preparation. All the areas were clean and well maintained. The building was light and people had space to move around.

We saw many photographs in the building of the people and staff participating in a wide range of trips and activities. In the main rooms there were lots of games and activities for the people. Throughout the building accessible information and pictures were displayed. The garden area was well maintained.

We met four of the five people who were staying at Barleyfields house. The people had limited communication but two of the people were able to tell us that they liked to stay at Barleyfields House. One person told us they had been staying there for five years. 'it's great and I enjoy it'. They said the food was good and they went out for an ice cream, bowling and on trips. They told us they went out for Sunday lunch and liked to make cakes.

We observed the staff on duty interacting with the people. When people arrived they were greeted in a warm and friendly way. The staff showed that they understood people's needs well. The people were communicating with the staff and the staff understood them. Everyone seemed to have a good relationship and was comfortable in each other's company. We were told about the way the people had fun with the staff and teased them.

The two members of staff we spoke to told us how their previous work experience had helped them in the present jobs. They said the majority of the staff had worked at Barleyfields House for many years. They worked as a team and helped each other. They demonstrated to us that although many people stayed at Barleyfields House, they knew everyone very well. They were able to tell us how they supported the people to have active and full lives during their stays at Barleyfields House.

One member of staff told us 'It's fantastic. The people enjoy their stay and they often don't want the time to end'. We were told that sometimes the work could be difficult as people have different personalities and different needs. But there was always something different for them to do and space if people want to do different things.

They told us how they took the people out to do what they wanted. They told us how people had choice in their activities and always could change their mind.

They told us how they had been supported with thier training and had gained qualifications. They said that their manager liked people to be trained up well and always found ways to do this. They told us that they had regular supervision and an annual appraisal.

One member of staff told us that the people were encouraged to do as much as they could for themselves. They were supported to make their own decisions. Sometimes it took time to sit down with the people and give them the opportunity to make choices.

We were told by one staff member how they were always thinking of ways to improve the service. They told us how important it was for all the staff to know as much as possible about a person before they came to Barleyfields. This information helped the staff to understand how best to support them.

They told us they felt very well supported by the management and their colleagues. The manager and deputy were always there or could be reached on the telephone. They said they were able to talk to their manager and report any concerns and these would be addressed.

of our inspection. We spoke with five staff which included the manager and two relatives. People who were able to told us that they enjoyed staying at Barleyfield House.

People's likes and dislikes were documented and considered in relation to the care and support they received. We saw staff treat people with dignity and respect and people were supported to maintain their independence.

People told us they were well cared for and were involved in planning and reviewing their care and support. Staff were knowledgeable about the individual needs of the people they supported. They met people's care and support needs in ways that they preferred.

People told us the staff were, 'Nice' and treated them well. Staff were confident to recognise and report abuse. They had received training on protecting vulnerable adults and were confident to speak out if they observed poor or abusive practice.

Staff told us they were provided with, 'Very good' training opportunities to keep people safe and meet their individual needs. This enabled them to offer effective care and support to the people who used the service.

People said if they were not happy they would tell the staff. Relatives and staff told us they were familiar with the complaints process. The provider had systems in place to monitor and review people's experiences and complaints.