Background to this inspection
Updated
30 March 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
Two inspectors, a member of the CQC medicines team and an Expert by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Barnes Lane is a ‘care home’. People in care homes usually receive accommodation and nursing or personal care as a single package under one contractual agreement. In the case of Barnes Lane, people’s care and housing are provided under separate contractual agreements as the accommodation is owned by a housing association. For the reason, this inspection only looked at people’s care and support.
The service did not have a manager registered with the Care Quality Commission. A registered and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before inspection
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We sought feedback from a local authority who commissions care from the service. We used all of this information to plan our inspection.
During the inspection
We communicated with three people who used the service and four relatives about their experience of the care provided.
We are improving how we hear people’s experience and views on services, when they have limited verbal communication or don’t use words. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. In this report, we used this communication tool with two people to tell us their experience.
We spoke with nine members of staff including the manager, deputy manager, director of adult services, care staff, an agency worker, human resources officer and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We spent time observing the mood and engagement of people at Barnes Lane and the quality of staff interactions. These observations were carried out over multiple days and a range of times.
We reviewed a range of records. This included four people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at surveys and agency worker profiles. We spoke with a health professional who visits people at the service.
Updated
30 March 2022
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.
About the service
Barnes Lane is a residential service that provides 24-hour care and support to autistic people living in three interconnected terrace houses. Only two of the houses were being lived in by people when we inspected. Each of the houses accommodates two people. At the time of our inspection there were four people using the service. People’s care and housing are provided under separate contractual agreements. CQC does not regulate the premises as it is owned by a housing association; this inspection looked at people’s personal care and support.
People’s experience of using this service and what we found
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
• The provider had not ensured that medicines records were accurate. This was a breach in the management of the service. The service had identified some improvements were required in the safe management of medicines and some action had been taken to address this. However, documents sent to us during the inspection showed that improvements were still required.
• People had not always had a consistent team of staff working with them due to staff turnover and shortages of permanent staff. Recruitment efforts were ongoing.
• COVID-19 practice was not always consistent which had the potential to increase risks of infection for people and staff.
• People had a choice about their living environment and were able to personalise their rooms. One person proudly showed us their room which they had decorated to their taste.
• Staff enabled people to access specialist health and social care support in the community.
Right Care
• Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.
• Staff, people and those important to them worked together to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.
• People could take part in activities and pursue interests that were tailored to them. This had included visits to a farm, car racing event, swimming pool and growing vegetables.
• People received support from staff who were appropriately skilled and well trained.
• People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. One person said, “They help me well. With everything.”
Right culture
• Staff turnover had been high in the last year, which affected the consistency of care people received.
• People and staff had experienced significant managerial change. Reflective team meetings had taken place to support better communication between management and care staff.
• People and those important to them were involved in planning and reviewing their care.
• Records and our observations confirmed staff placed people’s wishes, needs and rights at the heart of everything they did.
• Staff evaluated the quality of support provided to people, involving the person, their families and relevant professionals as appropriate.
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 27 March 2019).
Why we inspected
We received concerns in relation to staffing levels and consistency, missed medical appointments, lack of food, inadequate checks of agency workers and lack of management support. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement.
Please see the safe and well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
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 toCOVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.
Enforcement
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 a breach in relation to Good 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.