Smugglers Barn

Smugglers Barn is a residential care home providing personal care to 9 people at the time of the inspection. The service can support up to 9 people. The home is comprised of 2 separate houses in close proximity, Smugglers Barn and Little Smugglers, these are both under the same registration with CQC.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support

Staff supported people to take part in activities and pursue their interests in their local area and to interact online with people who had shared interests. Whilst some people were supported to achieve goals, staff did not always focus on people’s strengths or promote what they could do, so people could have a fulfilling and meaningful everyday life. There were missed opportunities to apply active support approaches. 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.

Right Care

People’s needs and preferences were known by caring staff, but inconsistencies in the oversight of peoples care plans meant that information was not always updated and correct. People were supported by staff who delivered kind and compassionate care. Staff promoted equality and diversity in their support for people. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff understood how to apply the principles of safeguarding people, and how to recognise and report abuse. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Culture

Managers and staff were working together towards improving the culture of the service. The service had experienced a number of management changes since the last inspection. Whilst staff and people’s relatives said that positive elements had resulted from the current management, the inconsistency and uncertainty of leadership since the last inspection had impacted on the service fully addressing concerns previously raised about people’s support. Positive steps had been taken by leadership to address these concerns although this required consistent management to be in place to fully implement and embed them.

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 5 July 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, although some improvements had been made and the provider was no longer in breach of regulations, some improvements were still needed.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We carried out an unannounced focused inspection of this service on 11 and 15 February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

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.

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 remained 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 Smugglers Barn 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.

Smugglers Barn is a residential care home providing personal care to nine people at the time of the inspection. The service can support up to nine people. The home is comprised of two separate houses in close proximity, Smugglers Barn and Little Smugglers, these are both under the same registration with CQC.

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

Risks to people’s health had not always been properly assessed to ensure they remained safe. Staffing levels were inconsistent and not always sufficient to meet people’s needs. People’s positive behaviour support was not always adequately managed.

People were not always supported with meaningful occupation and activities. Some people were supported to follow interests close to them and measures were in place to encourage people to access the community, although many were unoccupied and lacked structured routines. We have made a recommendation about the organisation of activities for people at the home.

Feedback about the management of the service was mixed. Staff and relatives said that communication was poor and lacked a willingness to work together. One staff member said, “We have not had consistent leadership.” Quality assurance systems were in place but had not always identified issues that were found at the inspection.

Peoples medicines were administered safely and infection and prevention control procedures were well managed.

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.

Based on our review of Safe, Responsive and Well-led, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture

Right Support

Some people’s needs had not always been properly assessed to ensure they were protected from avoidable harm. The model of care and setting did not maximise people's choice, control and independence. People were not receiving person-centred care due to the systems in place and staffing issues. Some people's specific support needs were not always clearly identified and met.

Right Care

People’s needs and preferences were known by caring staff, but consistent shortfalls in staffing levels meant that people did not always have access to meaningful occupation or receive the amount of support according to their assessed need.

Right Culture

People did not receive planned and coordinated person-centred support that was appropriate and inclusive for them. Leaders were not always transparent and did not promote an open culture at the service.

People were supported by staff who followed systems and processes to administer, record and store medicines safely. Staff ensured that people were protected from infection throughout the COVID-19 pandemic. People's communication needs had been assessed, and their care plans included information and guidance on how staff could communicate with them effectively. Staff and management worked with other professionals and specialists to support people’s care when required.

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 10 December 2019).

Why we inspected

We received concerns in relation to an increase in safeguarding issues, management of peoples distressed behaviours and the governance of the service. As a result, we undertook a focused inspection to review the key questions of Safe, Responsive and Well-led.

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.

We also undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

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 good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this 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 Smugglers Barn on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 identified breaches in relation to safe care and treatment and governance 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 work alongside the provider and 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.

Smugglers Barn and Little Smugglers accommodates eight people with learning disabilities and autism in two adapted buildings.

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.

The service was registered for the support of up to nine people. Eight people were using the service at the time of this inspection.

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

People and their relatives told us they felt safe. We saw there were safe policies and procedures in place that protected people from harm or abuse.

A new process for recording people’s needs and risks was in place that informed people's care plans and provided guidance for safe staff practices.

Staff recruitment practices were safe and appropriate staffing levels meant that people received appropriate support.

Medicines continued to be administered safely.

Good infection policies and procedures meant people were helped to be protected from the spread of infections.

The recording format for accidents and incidents included analysis that enabled the manager to learn from where things went wrong and put in place strategies to prevent re-occurrences.

Staff were not always supported appropriately with supervision. The provider recognised this and put in place a revised procedure that meant staff should now get appropriate support in this way.

Staff training was comprehensive and covered all the necessary areas of staff’s work with people.

People were supported to eat healthy and nutritious food and to drink enough to keep well hydrated.

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.

The manager and staff spoke about the people they supported with care and kindness.

Assessments and care plans included details of their preferences and wishes for care and support. People and relatives told us they were involved in the assessment and care planning process.

The provider had systems in place to ensure concerns and complaints were responded to in an appropriate way.

The provider had systems and processes in place to monitor the quality and safety 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 Good (02 May 2017).

Why we inspected:

This was a planned inspection in line with our inspection schedule. We found the service met the characteristics of a "Good" rating in all areas.

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.

inspection was given to ensure that the people we needed to speak to were available

Smugglers Barn is a care home for a maximum of nine adults with learning disabilities and complex needs including autism and challenging behaviour. Smugglers Barn consists of two separate neighbouring houses which are next door to each other, Smugglers Barn and Little Smugglers Barn. On the day of the inspection seven people were living at the service.

At the last inspection on 10 February 2015, the service was rated Good. At this inspection we found the service remained Good.

People and a relative told us they felt the service was safe. One person told us “I like living here, safe oh yes”. A relative said “I am happy with the service. My relative has 1:1 when he is out. The lovely garden is enclosed and is so safe. Being supervised they walk to the bus stop on the main road”.

The provider remained to have arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine safely when they needed it. People were supported to maintain good health and had access to health care services.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. 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. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People and their relatives felt staff were skilled to meet the needs of people and provide effective care. Staff were happy with the training and development that was provided. One member of staff told us “I have worked with our manager before and really liked her way of working. I was happy with the induction, lots of training. I was able to follow my own pace and develop confidence”.

People’s individual needs continued to be assessed. Care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

People remained encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and caring. People and also said they felt listened to and any concerns or issues they raised were addressed. One person told us “Yes I talk to the manager who sorts it out”.

Staff supported people to eat and drink and they were given support to prepare meals of their choice. People’s nutritional needs were met and people reported that they could choose food and drink of their choice. One person told us “Yes I choose and do shopping weekly”. The person also told us how they cooked a meal one evening a week.

Staff felt fully supported by management to undertake their roles. Staff had regular meetings, supervision and development opportunities. People, staff and a relative found the registered manager approachable and professional. One person told us “Yes, I like the manager she talks to us”. A member of staff told us “It is a good place to work with good relationships and good support”.

Further information is in the detailed findings below:

Staff told us that Smugglers Barn was a 'good home' and they said that the people living there were active, happy and well cared for by the staff who promoted their independence and autonomy. We also observed that there was a high level of respect for the people living in the home and staff were patient with people and supported them to achieve their goals. Whilst we were at the home we saw how staff worked with the people to accommodate their wishes and to resolve their concerns or issues.

One of the relatives we spoke with said, 'I have no qualms about the place. The staff work tirelessly and never give up, even when his behaviour is difficult'.

We met five staff during our inspection and interviewed three of them, including the registered manager. Staff told us that Smugglers Barn was a good place to work and that people had genuine choice and control over their lives. Staff said that they believed people experienced "A good quality of life" at Smugglers Barn. Staff also told us that they felt well supported in their jobs with access to appropriate training and guidance from their manager.

We looked at a range of records and found that these were well maintained. It was evident that both staff and management understood the importance of keeping records accurate and up to date. This meant that staff were able to support people consistently and effectively.