The Barn

At the time of our inspection there was a not a registered manager in post but an application for the manager to be registered with CQC was in progress. 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. In this report when we speak about both the company we refer to them as being, ‘the registered persons’.

At the last inspection the service was rated, ‘Good’. At the present inspection the service remained ‘Good’. At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. However improvements were required in the 'well led' domain. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Medicines were managed safely. However, we found that staff had not followed their medicines policy when completing medicine records.

Where people were unable to make decisions arrangements had been made to ensure decisions were made in people's best interests.

Suitable quality checks were being completed and the provider had ensured that there was enough staff on duty. In addition, people told us that they received person-centred care.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. Background checks had been completed before new staff had been appointed.

There were arrangements to prevent and control infections and lessons had been learned when things had gone wrong.

Staff had been supported to deliver care in line with current best practice guidance. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have maximum choice and control of their lives and to maintain their independence. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. Confidential information was stored securely.

Information was provided to people in an accessible manner. People had been supported to access activities and community facilities. The manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to in order to improve the quality of care.

There was a positive culture in the service that was focused upon achieving good outcomes for people. They had also taken steps to enable the service to meet regulatory requirements. Staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. People, their relatives and members of staff had been involved in the running of the service. The provider had put in place arrangements that were designed to enable the service to learn, innovate and ensure its sustainability. There were arrangements for working in partnership with other agencies to support the development of joined-up care.

Further information is in the detailed findings below.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found-

Is the service caring?

We saw how members of staff treated people and observed care. We saw care was delivered well and in a respectful way. We saw staff were kind and attentive and encouraged people to be independent. We saw staff showed patience and gave encouragement when they supported people. We observed staff reassured people if they were upset.

We spoke with a relative who told us, "Extremely happy with xxx being there.”

Is the service responsive?

We saw people's individual physical, mental and social care and support needs were assessed and met. This included people's individual choices and preferences as to how they liked to spend their day. During our visit people were offered support and activities to meet their needs and preferences. For example, one person took part in a football training session with an outside agency.

We observed staff responded to people in a positive manner and respected their individual preferences. We observed that staff obtained people's consent before they carried out any care. For example, they asked people if they could enter their rooms.

Is the service safe?

Risk assessments regarding people's individual activities were carried out and measures were in place to minimise these risks.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards in place. Mental Capacity Act (2005) and Deprivation of Liberty Safeguards are laws protecting people who are unable to make decisions for themselves. At the time of our inspection three people had deprivation of liberty safeguards in place.

We found where people lacked capacity their best interests had been considered.

We saw where people's behaviour challenged that service plans were in place to assist staff to manage the issues and keep people safe from harm. People were protected against the use of unlawful or excessive control or restraint because the provider had made suitable arrangements. These measures helped to keep people safe from abuse and to promote their welfare

The service was safe, clean and hygienic. The home was undergoing refurbishment in some areas for example a kitchen area and a shower room.

Is the service effective?

Our observations found that members of staff knew people's individual health and wellbeing needs. There was a process in place to ensure staff were aware of people's changing needs.

We saw that people responded well to the support they received from staff members. We observed that staff responded to people's needs in a timely manner. For example, a person asked

Arrangements were in place to ensure people's physical health needs were met. For example, where people had specific issues with their health, such as epilepsy guidance was in place to support staff to provide effective care.

Is the service well led?

Staff said that they felt supported and trained to safely do their job.

Quality assurance systems were in place and people were listened to.

We also used a number of different ways to help us understand the experiences of other people who lived there. We spent time observing the care and support people received and we looked at a range of records. We also spoke with the manager and a number of staff members.

People told us they liked living within the home. They said they were involved in planning their care and support. They made comments such as, 'Yeah, it's great here, I get to do what I want' and, 'I can tell xxx and xxx [staff members] if there is anything wrong.'

We saw people were treated with respect and they could make their own choices and decisions where they were able to.

Care plans were detailed and personalised. They addressed people's assessed needs and wishes and helped them to maintain and develop their independence.

The environment was clean and tidy, and we saw people who lived within the home were encouraged to help with things like house work and laundry.

There were effective arrangements in place for recruiting staff to ensure they were suitable to work with vulnerable people. Records showed staff were trained to provide the care and support which people needed and wished for.

There were arrangements in place for people to raise any concerns they had or say if they were not happy with anything. One person said, 'Yes they [staff] take me seriously and listen to me.'

We saw people were supported in a respectful and dignified way, and staff closely followed the care that was set out in people's plans.

We saw people were given support to make choices and decisions for themselves' wherever they could do so, and staff clearly understood each person's way of communicating their needs, wishes and choices.

Staff had been given training and support that helped them to understand peoples' complex needs, and helped them to feel confident in carrying out their roles.