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

People told us they felt safe living in the home with the staff who supported them. However, people told us they did not always feel involved or included in the service. People told us they could take risks and had choice and control over their lives. The provider monitored risks safely and made referrals to other health professionals when required. People received their medicines safely. However, the safe storage of medicines required improved monitoring. There were enough staff on duty to keep people safe and staff were recruited safely. Lessons were learnt when things went wrong, and the provider monitored incidents and accidents safely. Visiting professionals told us the provider worked in partnership with them and followed their advice and guidance.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We received mixed feedback from people and relatives regarding safe systems and transitions. One person told us, “The staff don’t ask me questions about my care, but that’s okay.” However, another person told us they felt in control of the care and support provided. They said, “The staff help me. They help me to be independent. The staff always contact the doctor if I ask them to.” Relatives told us people’s care was regularly reviewed and they felt involved in their family member’s care. One relative said, “They always ask [my family member] about their care and they involve me. They asked me questions about my family member’s likes and dislikes”. However, another relative told us the provider was slow to respond to their concerns. Although, they told us their family member was safe living in the home. The registered manager responded to our feedback by carrying out a survey with people to gather their views and feelings. In addition, they carried out a resident’s meeting to encourage people to feedback into the service.

The provider worked in partnership with other health and social care professionals to ensure continuity of care. One staff member said, “We work in partnership with other organisations. We listen to people and encourage them do more.” Another staff member told us, “We all work together with other agencies to keep people safe. If an agency, such as the SALT team, make changes we are all told about it in handovers and team meetings.” The SALT (Speech and Language Therapy) team provide assessment and treatment for people with speech, language, communication and swallowing difficulties. The registered manager told us initial assessments were completed prior to people moving into the home. Referrals were made to health and social care professionals when people’s needs changed.

Visiting professionals told us the provider worked effectively in partnership with them and kept them informed of any changes. One visiting professional said, “The provider contacts my service for assistance, advice, and professional support when people’s needs change.” Another visiting professional told us, “I receive detailed information prior to planned reviews of people’s care, this information informs the review.” Visiting professionals told us the provider promptly raised concerns. One visiting professional told us, “I have been alerted to concerns in a prompt manner and positive actions have been taken, such as reaching out to the doctor for further referrals.” Visiting professionals told us the management team were knowledgeable and experienced. They said, “Having [named senior staff] with a good knowledge of nutrition, swallowing difficulties and best interests' decisions has been very helpful in maintaining a good working relationship with my service.” Another visiting professional said, “[Named senior staff] has developed high quality resources in response to falls. They have reached out to other professionals including the use of NHS community resources, non-pharmaceutical care and risk mitigation.”

The provider carried out initial assessments to ensure people’s care and support needs were safely assessed prior to moving into the home. When people’s needs changed, the provider sought advice from appropriate health professionals and raised referrals to other healthcare agencies.

People told us they felt safe living in the home. One person told us, “I do feel safe here, I’d tell the registered manager if I didn’t feel safe.” Another person said, “Of course I feel safe. The staff are all very pleasant here.” People told us they felt able to raise concerns. One person said, “I would tell a staff member if I wasn’t happy.” Relatives told us people were safe living in the home. However, some relatives felt the provider was slow to respond to their complaints. One relative told us, “We’re sort of happy with the care. We don’t leave here and worry about our relative’s safety. The biggest problem is that they are lackadaisical with [persons] property and following up on complaints.” Whereas another relative told us “They communicate with me very well. They ring me if anything is wrong.”

Staff received safeguarding training and were confident to raise concerns. One staff member said, “I would report all concerns to my line manager. If they did not do anything, I would go to the local authority safeguarding team.” Another staff member said, “I can raise concerns with the registered manager. They are a very good manager.” Staff told us people were safe living in the home. One staff member said, “I believe 100% people are safe. We all work together to keep people safe.”

We observed staff supporting people safely. During the first site visit we observed 2 incidents where people were unwell, we observed staff responding quickly and professionally during these incidents, seeking appropriate health professional support. Staff completed incident forms for these occasions, and the incidents were appropriately followed up by the management team. During the second site visit, 1 person told staff they were experiencing pain, the staff member reassured the person and promptly informed a nurse who attended to the person. We observed people who required 1:1 support from staff receiving the appropriate care and support and we observed staff supporting people to mobilise safely.

The provider raised safeguarding concerns with the local authority safeguarding team in accordance with their legal requirements. Incidents and accidents were recorded, and we reviewed minutes of staff meetings where lessons learnt were shared with the staff team. The provider investigated patterns of incidents and accidents and reviewed ways to reduce these from recurring, such as falls reduction strategies. The complaints, safeguarding and whistle-blowing policies were available on a notice board in reception for all staff and visitors to access.

People told us they could choose how to spend their day and staff respected their decisions. One person said, “They leave me to go to sleep and wake up when I want.” Another person said, “They ask me about my care and what I would like and what I need.” A further person told us, “They help me to shower, and I can have one when I want. My care is how I like it.” Relatives told us they felt involved when managing risks. One relative told us, “If [my relative] is refusing care they ask for my help because [my relative] allows me to help. They do try to involve [my relative] in activities but respect their choice if they decline.”

Staff knew people well and told us about their risk assessments. Staff told us about people’s care plans and people's likes and dislikes without referring to documentation. One staff member told us about a person being of high risk of falls, another staff member told us about a person requiring their food soft due to the risk of choking. Staff told us risks to people's health and well being were discussed and reviewed. One staff member said, “We discuss people’s risks in team meetings and during handovers.”

People moved around the home freely and were not restricted by staff. We observed staff speaking to people about risks and respecting their choices. For example, 1 staff member discreetly requested a person accompanied them to be supported with personal care in their bedroom. The person declined and the staff member walked away respecting their decision. A few minutes later a different staff member encouraged the person to accompany them, the person agreed. This showed staff member’s used different strategies to support people whilst respecting their choices. We observed staff member’s engaging in activities with people in communal areas and encouraging people with communication and mobility difficulties to engage in sensory activities.

Mental Capacity assessments and best interests’ decisions were in place to manage risk. For example, we reviewed best interest decisions for people who required sensor mats and bed rails to reduce the risk of falls. Risk assessments were completed and accessible to staff. Care plans detailed risk to people from health conditions such as diabetes and documented how staff were to respond to concerns safely.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us there was enough staff to support them safely. One person said, “There are definitely enough staff here. I go to bed when I want. I wake up when I want.” Another person told us, “I think there’s enough staff as I don’t really have to wait a long time for staff to provide me with care. When I ring my buzzer, they [staff] come.” Relatives told us staff knew their family member well. One relative said, “All of the staff know my family member by their name and I’m including the maintenance staff, the painters, and the cleaners. They are all brilliant.” Relatives told us there were enough staff to care and spend time with their family member safely. One relative said, “There’s plenty of staff here, fewer on a weekend, but still enough.” Another relative told us, “The carers all have enough time to talk to [my family member], they like that.”

There was a broad range of training courses available to staff. However, some staff had not completed all the training courses despite working in the home for several months. Most staff had completed the core mandatory courses. However, the specialist courses such as courses focusing on people’s health conditions, received lower completion rates. The registered manager responded to our feedback and set dates for all staff to complete their training. Staff told us they received training and guidance to safely carry out their roles, 1 staff member said, “Training is very good. There are a lot of hands-on training which is good.” Staff told us there was enough staff on duty to keep people safe. One staff member said, “There are enough staff on duty. We have regular supervision with our line managers, any problems or risks to people are discussed.” Another staff member said, “Staffing levels are 1 of the best levels when compared to other places I have worked.”

There were enough staff on duty to support people safely. We observed staff responding promptly to people and sitting with people to enjoy a conversation or engage in an activity, such as a game of chess or completing arts and crafts. Some people required 1:1 support from staff. We observed 1:1 staff supporting people safely and in accordance with their care requirements.

The provider used a training matrix to record staff attendance on training. This identified most staff had completed all their mandatory training. However, the matrix highlighted several staff had not completed some of the specialised courses. The registered manager responded to our feedback and introduced a new training audit to monitor staff training more effectively. The provider used a dependency tool to work out the number of staff needed on duty to keep people safe. A dependency tool is used to collate information about the needs (or dependency) of people who need care and support, how many staff are needed. We reviewed the rotas; the provider was working in accordance with their dependency tool. There were additional staff working as supernumerary to relieve pressure during busy times, such a lunch or responding to accidents or incidents. Staff were recruited safely. The provider carried out preemployment check to ensure only suitably checked and qualified staff were employed.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they received their medicines safely, one person said, “They [staff] bring me my tablets daily, they [staff] have never forgotten them or missed them.” Another person told us, “They [staff] give me my medicines 3 or 4 times daily. The staff don’t ever forget.” Relatives told us people received support to manage their health conditions and their conditions were reviewed by health professionals. However, 1 relative raised concern regarding their family member missing medication. This had been reported to the safeguarding team by the provider and action taken by the provider to address the recommendations from the safeguarding team.

Staff received safe handling of medicines training and their competencies were regularly checked. One staff member told us about how certain medicines must only be used as a last resort and in accordance with the person’s best interest. We received feedback from a visiting health professional who informed us the provider was involved in a project alongside the mental health team and doctor to reduce the number of people on medicines which may have increased the risk of falls. The visiting professional told us staff received training on best use of non-pharmacological approaches to support people when they experienced distressed behaviours.

A safe handling of medicines policy was in place. However, medicines were not always stored safely in accordance with this policy. For example, the medicines fridge was not being monitored in line with the policy. Whilst the temperature of the fridge was being taken daily and remained within safe limits, the provider was not recording the maximum and minimum temperatures. Therefore, the provider could not be assured the temperature remained within the safe limits throughout the day. The provider responded to our feedback and changed their recording system to record maximum and minimum fridge temperature. People received their medicines in a dignified way. There were clear protocols in place for people who received 'taken as required' medicines, for example when the person experienced pain or constipation. People who required their medicines hidden in food or drink (covert medicines) had best interest decisions made with health professional consultation.