The inspection took place on 5 and 6 April 2017 and was unannounced.
Hill Barn is registered to provide care for up to 26 people. At the time of the inspection 21 people were living at the home. The home supports older people, some of whom are living with long term conditions. The accommodation comprised of a series of refurbished barns and an extension over one floor, set in a large garden.
There was a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. For the purposes of this report we will refer to the registered manager as the manager.
At our last inspection in April 2016, we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to the safe care and treatment of people who were living at the home. We found issues with how people’s medicines were administered and stored. We found the medicine audits were not effective. We also found that staff had limited guidance about how to meet people’s needs.
At this inspection on 5 and 6 April 2017 we found improvements had been made in these areas, so the service was no longer in breach of this regulation for these reasons. However, at this inspection we found two new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the end of our report.
Some communal areas of the home were unclean and some staff used unsafe practice that increased the risk of the spread of infection. People’s medicines were kept secure however; people’s prescribed thickeners for drinks were not kept in a secure place. This was a risk to people’s safety.
The manager and provider did not always have robust quality monitoring systems in place. We found issues relating to the monitoring of the hygiene of the home, and how staff interacted with people who lived at Hill Barn. We also found issues with how staff and the manager protected people’s confidential information. The manager also did not have effective systems to monitor staff knowledge and practice.
Staff did not have enough time to spend chatting to people or to engage with them in a social way throughout the day. The manager had not considered ways to encourage social stimulation within the home. There were no real plans in place to ensure people’s individual social needs were going to be met. People had not been consulted with about their social needs with action taken to meet these needs.
The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service had made applications for authorisation to the local authority DoLS team. However, there was a lack of understanding around when a DoLS was required.
We have made a recommendation about the management of the home seeking advice and guidance about DoLS.
People received their medicines in a safe way. The administration of people’s medicines was audited and checked. The manager and staff were proactive in responding to a change in people’s health needs. The manager and staff knew about the risks which people faced and how to respond to these. The manager ensured that the equipment used was safe.
People spoke positively about the food and drinks they had. The chef had a good knowledge of people’s likes and dislikes and people’s specialist dietary needs. People also had good access to drinks and snacks.
People were supported to meet their spiritual needs and there were times when people were supported in a way which met their social and emotional needs.