The Cyder Barn

The Cyder Barn is a residential care home providing personal care to 28 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

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

People were supported to take their medicines in a safe and caring way. Staff were trained in administering medicines and day staff had had their competency checked regularly. However, some areas in the management of records for medicines needed to be improved. For example, the information for staff about when to give as required medicines was not always completed.

People could look after their own medicines if they wanted to and this was risk assessed by staff to ensure it was safe for them to do so.

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 17 January 2020).

Why we inspected.

We undertook this targeted inspection to check on a specific concern we had received about the safe management of medicines. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

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.

The Cyder Barn is a residential care home providing personal care to 28 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

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

People received care and support that was safe. People told us they were happy living at the Cyder Barn and that they felt safe. The provider had a robust recruitment programme, which meant all new staff were checked to ensure they were suitable to work with vulnerable people. All staff had received training in recognising potential abuse and how to raise concerns. Medicines were managed safely. Staff were trained in administering medicines and their competency checked regularly.

People received effective care from staff who were well trained and demonstrated a good knowledge of people’s needs, likes and dislikes. People enjoyed a healthy balanced and nutritious diet based on their preferences and health needs. The meal time experience was relaxed and a social event in the home.

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.

People received care from staff who were kind and caring. Staff always respected people’s privacy and dignity.

Staff encouraged people to be involved in their care planning and reviews. People were supported to express an opinion about the care provided and were involved in the day to day running of the home.

People received responsive care and support which was personalised to their individual needs and wishes and promoted independence. There was clear guidance for staff on how to support people in line with their personal wishes and specific needs. All staff had received training in supporting people to maintain a good dental hygiene routine.

People were supported by a team that was well led. The registered manager demonstrated an open and positive approach to learning and development. Everybody spoken with said they felt the registered manager was open, approachable and they could see them around the home most days. Staff said they felt they were valued and well supported. They told us they felt their ideas were listened to when they had a suggestion about working practices in the home.

There were systems in place to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people’s views. Records showed where short falls were identified action was taken. The provider responded to concerns and complaints in a timely manner and learnt from the issues raised.

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 09 June 2017). However, the safe domain was rated requires improvement. At this inspection we found improvements had been made.

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.

The Cyder Barn is registered to provide accommodation and personal care for up to 40 people. At the time of our inspection there were 23 people using the service.

There is a registered manager in post. 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.

There were good arrangements for the management and administering of prescribed medicines. However, the use of topical creams and ensuring they were used regularly to protect people's skin needed to be improved. People spoke of having their medicines regularly and people, where safe to do so, were able to manage their medicines which helped to maintain their independence.

At our last inspection we had identified the need to improve how people were involved in their care planning. At this inspection there had been some improvement. However, whilst some people told us they were aware of their care plans and had been involved in talking with staff about their care needs and care plans others were not. One person said, "I feel I do not really know about my care plan." Another person said, "No, I don't really know about my care plan." This was therefore an area for continued improvement.

People told us they felt safe living in the home. They spoke of how they had confidence in the staff being "well trained". One person said they felt safe because "Staff know what they are doing and are around to help me when I need it." Another person told us it was because they were "Well cared for."

Staff demonstrated their knowledge of abuse and responsibilities to report any concerns about possible abuse. Staff were confident the registered manager would act to protect people if told of any such concerns. The registered manager had acted to protect people and responded professionally to any concerns or incidents, which had placed people’s health and welfare at risk.

The registered manager had, as required, made applications under the Mental Capacity Act 2005 and obtained authorisations under Deprivation of Liberty Safeguards (DoLS) arrangements. Where people lacked capacity their rights were upheld and their health and welfare protected.

Arrangements for making decisions on people's behalf where they lacked capacity (known as best interests decision) had improved since our last inspection. This was of importance where equipment was needed to protect people from potential harm such as risk of falls and monitoring people's movement to ensure they were safe.

People could be confident that the arrangements for the recruitment of staff followed guidance and the necessary checks about the suitability of perspective employees were undertaken. Staff received training so they had the necessary skills and knowledge to meet people's needs.

People spoke very positively about the meals provided in the home. One person said, "The food is lovely I always enjoy my meal and there is always a lovely choice." A relative commented "You can see there is food and drink available at all times if need be. My relative is very pleased with the food." There was a relaxed and social atmosphere when people had their lunchtime meal. Staff were available to support people where this was needed.

People told us they found staff caring and respectful of people's privacy and dignity. One person said, "The staff are kind and responsive." Another person told us "Our rooms are ours so they act like they are our guests." People were able to make choices about their daily routines and their choices were respected. One person spent most of their time in their room. They told us "I chose to be in my room and that is not a problem. Staff know that is what I like."

People told us there were no restrictions on having visitors. One person told us "Staff are very friendly and always welcome my family when they visit. It is lovely I can keep in touch." A visitor said, "I tend to visit whenever I like except at mealtimes and it is never a problem. I am always made to feel welcome and nice to see smiling faces."

People received care and support which was personalised to their needs and wishes. People told us their preferences were respected for example where they preferred only a female staff member to help them with personal care. Staff demonstrated a knowledge of people's individual needs and spoke of being able to meet those needs. One staff member saying "It is about providing care which is what the person wants: individual care."

People spoke positively about the activities available. One saying "I enjoy the things we do always a good choice my favourite are the quizzes." The home had recently introduced evening activities such as pub nights which had proved very popular.

There were opportunities through meetings for people to express their views and make suggestions about the quality of the care they received. People were confident of voicing concerns or making complaints and having their feelings and views listened to and action taken.

The management team promoted an open and accessible culture where people and staff were able to voice their views. Arrangements were in place to monitor and audit the quality of care and address areas identified for improvement.

There was a positive environment where staff were valued and the management team recognised the need for ongoing improvement.

' 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 found from our observations and talking with people the service was caring. People told us staff were "friendly and there when you need them", and "we get treated very well and I get the care I need". One person told us "I can choose what I want to do, staff respect me and it is my choice". We observed staff supported and assisted people in a respectful, dignified and professional manner. We saw staff responded to an individual's distress in a sensitive, calming and re-assuring manner.

Is the service responsive?

The service was responsive to people's choices and wishes and responded to the needs of people using the service. People told us they were able to make choices about their daily lives. One individual who was able to leave the home independently told us "I can pretty much go out when I want". Other people told us they could choose when they got up and went to bed. For some people their choice was to remain in their rooms and they told us this was respected. Some people told us there could be more activities. We noted how there were limited opportunities for people to be involved in an activities or spend time with staff. This was identified by the manager as an area for improvement so the service could be more responsive to people's social needs.

We read a number of care plans and they contained comprehensive information and guidance about meeting people's care needs. Assessments were regularly reviewed to ensure they accurately reflected people's needs. We saw people had been referred to specialist support such as a community nurse and podiatrist so their specific needs could be met.

There were assessments in place which identified areas of risk for individuals such as environment, falls and moving and handling. They provided instructions to staff as to how to respond to risks and provide care in an effective and safe manner.

Staff told us they attended daily handovers and there were daily records completed which staff referred to so they were informed of people's needs and any changes. Staff told us they would report any concerns about people's care needs to a senior or the care co-ordinator.

Is the service safe?

We found the service to be safe because they had a range of policies and procedures in place to protect people's health and welfare. People we spoke with told us they felt safe in the home. They told us if they had any concerns or worries they would tell a member of staff. One person told us "if I was not treated how I wanted to be treated I would tell one of the staff and I know they would do something about it". Another person we spoke with told us they had never seen anything that had worried them. The staff we spoke with had a good understanding of their responsibilities about reporting any concerns about possible abuse. One member of staff had reported a concern to the deputy and this was being investigated.

We noted that the service's policy on the "safeguarding of service users" from abuse failed to accurately reflect good practice. It failed to state the manager's responsibility to report any concern initially, before any other action, to the local authority safeguarding team. Staff had received the necessary safeguarding of vulnerable adults training. They were aware of their rights under whistleblowing to report any concerns to an outside body such as social services.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

The service identified, assessed and managed risks to people's health, safety and welfare. Care plans included individual risk assessments and provided guidance to staff about how to respond and minimise risks. There were arrangements in place to safeguard people in the event of an emergency or evacuation of the home.

We noted there had been improvements in the staffing arrangements of the home. Dependency assessments had been completed to help in making an informed judgement about the level of staff needed to meet people's needs. Additional staff had been recruited so there was greater consistency and continuity of staff. We saw there were some inconsistencies in relation to weekend staffing of the home. This potentially could impact on the ability of the service to meet people's needs safely and effectively. However people told us staff were available when they needed them and responded promptly to requests for assistance and support.

Is the service effective?

We found the service to be effective because people's care and support achieved good outcomes. We also found people's rights and choices were respected. We saw where people had been identified as requiring specialist support and this had been provided. This showed the service was able to act professionally and in the person's best interest to ensure specialist or complex care needs were being met.

The completion of daily records which set out how people's needs had been met enabled the service to review people's needs and ensure care planning was accurate and up to date.

Is the service well led?

This service had a manager who was registered with CQC and supported by a newly recruited deputy manager. We saw there were inconsistencies about how the service was being led and in the arrangements for the monitoring the quality of the service. Staff told us that whilst they respected the manager they were not confident communication was as effective as it should be. This applied specifically where staff may have raised issues with the manager. They were not always informed about what had happened about the concern or issue they had raised. Some staff told us they felt the manager was not always acting "as a leader". We noted improvements were needed in providing regular individual supervision to staff.

Whilst there were systems in place to monitor the quality of the service they were not always robust. The manager did not undertake any quality audits so they could be directly informed about the quality of the service. There was a lack of auditing in relation to care plans to make sure they consistently reflected people's care needs accurately. The medicines audit was not comprehensive and failed to fully audit arrangements for the management of medicines. This meant any improvements or shortfalls could not be identified. There were limited opportunities for people to express their views about the service they received.

We spoke with five people who lived in the home, seven staff members, one visitor and two visiting health professionals. Everybody spoken with told us the standard of care in the home was good. However with the exception of the two health professionals everybody told us the staffing levels were low in the afternoons and some nights.

One person spoken with told us, 'I can't complain they look after us well, but they are rushed off their feet some days. I really don't know how they manage it.' Another person told us, 'I am really happy living here; I've seen some changes and the staff are really good they do a grand but difficult job.' One visitor spoken with told us, 'They look after X really well. My only observation is when the activity person goes there is nothing for them to do and not enough staff around to occupy them.'

Records kept in staff personnel files showed us all appropriate pre-employment checks were carried out. This meant people were protected by an effective recruitment process.

We found that staff received training and support which enabled them to meet the needs of people who lived in the home.

The provider had quality assurance systems in place that ensured people were safe and changes could be made to improve the service provided.