Barnford House

At the last inspection on 20 January 2016 this service was rated good in all five key questions, and before that the home has a history of compliance with legal requirements. At this inspection we found the service remained Good.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. People living at Brookfields could live a life as fully as they were able in a domestic styled homely environment that had been created to meet their needs.

On the day of our inspection visit there was 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 was run.

The service was well led. There was a person-centred ethos which meant that people were empowered to have some choice and control over their lives. The registered manager provided stable leadership and clear direction to the staff team and staff felt supported.

There were effective systems to monitor the quality and safety of the service provided that placed an emphasis on the quality of people’s lives. These systems were used to continue to drive improvements in the service and the care people received.

Brookfield’s provided person-centred care. We saw that people and relatives were treated with kindness by a staff team. Staff supported people with dignity, and had developed some positive relationships with people that were based on respect and trust.

People could maintain relationships with people who were important to them. Relatives we spoke with felt their views and opinions about their loved one’s care were listened to so that they felt involved in their loved one’s care.

Staff sought consent from people before caring for them and they clearly understood and followed the principles of the Mental Capacity Act, 2005 (MCA). Where people were deprived of their liberty, processes had been followed to ensure that this was done lawfully. Where medicines were given covertly the best interests processes hadn’t been followed. Staff understood people’s unique communication styles and ensured that the views of people with communication difficulties were listened to and acted upon.

People were protected from the risk of harm because there were robust processes to ensure their safety. Staff all knew and understood their responsibilities in relation to protecting people from abuse and had received the training they needed to do this. People were protected from harm because the risks to their safety were clearly identified and measures in place to reduce these risks.

People were supported by enough well trained and competent staff who knew people well. The registered manager followed robust recruitment checks to ensure that staff employed were suitable to support people using the service with all aspects of their care. People’s medicines were managed safely and people were protected from the risk of infection.

People were supported to have enough to eat and drink, to manage their health needs and saw health professionals regularly as needed. Staff implemented the guidance that was provided by health care professionals to support people to meet their health needs and stay well.

At our last inspection in July 2013 the provider was meeting all of the regulations that we assessed.

The provider is registered to accommodate and deliver nursing and personal care to six people who lived with a learning disability and/or an associated need. Six people lived at the home at the time of our inspection.

The manager was registered with us as is required by law. 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.

Where people received support from staff with taking prescribed medicines records were up to date and accurate to confirm that they had been given to people as they had been prescribed.

Staff knew the procedures that they should follow to ensure the risk of harm and/or abuse was reduced.

Kind and caring staff in sufficient numbers were available to meet people’s individual needs.

Staff received induction training and the day to day support they needed to ensure they met people’s needs and kept them safe.

Staff felt that they were trained and supported to enable them to care for people in the way that they preferred.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This ensured that people received care in line with their best interests and would not be unlawfully restricted.

People were enabled and encouraged to make decisions about their care. If they were unable to their relatives were involved in how their care was planned and delivered.

Staff supported people with their nutrition and dietary needs to promote their good health.

All people received assessments and/or treatment when it was needed from a range of health care and social care professionals which helped to promote their health and well-being.

Systems were in place for people and their relatives to raise their concerns or complaints.

People and their relatives felt that the quality of service was good. The management of the service was stable. The registered manager and provider undertook regular audits and took action where changes or improvements were needed.

Because some of the people living at the home had complex needs, not everyone was able to tell us about their experiences. We used a number of different methods to help us understand the experiences of these people, which included observation.

We spoke with three people who lived at the home although communication with some people was very limited. One person said, 'I do like it here. I like the staff'. Another person said, 'Yes it is good here'. We also spoke with two relatives. One relative said, 'You will not find a better home than this one. I have no worries at all'. The other relative said, 'It is a wonderful place. They have improved so much since they have been here'.

We saw that people's needs had been assessed by a range of health professionals including; specialist doctors, the dietician and the optician. This meant that people's health care needs had been monitored and met.

We found that people were offered varied and nutritious food. Where concerns had been identified referrals had been made to health care professionals to prevent malnutrition.

We found that although some work was to be completed, the premises were safe and maintained which made the home a pleasant place for people to live in.

We determined that staffing levels were mostly adequate but in need of frequent assessment. Frequent assessment of staffing levels against needs would make sure that people were not being placed at risk of harm through inadequate supervision and care provision.

We saw that complaints processes were in place and were accessible to people to use if they were not happy with the service provided.

We carried out this inspection to find out if improvements had been made and found that they had. Our observations showed that there was a marked improvement in the overall decoration inside the home and the garden had received the attention it required. During our inspection we spoke to two staff. These staff confirmed our findings from our observations that improvements had been made. One staff member said, 'The redecoration has made the home look much better'.

Since our May 2012 inspection we had been made aware of concerns regarding the care provided to one person using the service. During this inspection we looked at this issue and found that the situation had been dealt with and any concern had decreased.