Barnfield Manor Care Home

Barnfield Manor Care Home is a residential care home providing personal and nursing care to up to 39 people. The service provides support to adults of all ages and people living with dementia. At the time of our inspection there were 15 people using the service.

Barnfield Manor Care Home accommodates people in one purpose-built building across 2 floors. The home has several communal areas and an accessible garden with outdoor seating.

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

Medicines were not always effectively managed. There were inconsistencies in the recording of medicines administered and the ordering system was not effective as still prescribed medicines were being disposed of creating unnecessary and costly waste.

The management team had a medicines action plan in place to make improvements in this area, however the areas identified required implementing and embedding to evidence sustained good practice

People were protected from the risk of abuse, safeguarding incidents had been correctly reported, recorded and investigated. Risks which affected people's daily lives, in relation to their mobility, skin integrity and weight were documented and known by staff.

We received mixed opinions from staff and relatives about the staffing level, we raised this with the provider who told us at busy times support was available from the management team, the provider also told us of the of their plans to make the manager more accessible.

Systems and processes were not always effective in monitoring and mitigating medicine risks in a timely and sustained way.

The provider had made improvements in the recording and managerial oversight of accidents and incidents and health and safety. The service had an improvement plan in place which was regularly reviewed and updated. People’s care plans had been reviewed and updated following our previous inspection. We found these contained person centred information on people’s preferences and choices.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 February 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 29 September 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

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 to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Barnfield Manor Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Barnfield Manor is a residential care home providing personal and nursing care to 21 people at the time of the inspection. The service can support up to 39 people. The service supports people across two floors in one building.

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

People were not always protected from abuse as the systems and processes in place were not always effective in identifying incidents.

People were at risk of neglect due to the staffing levels within the location. Staff and relatives told us of incidents when people’s personal care, emotional and medicines needs and had not been met in a timely manner as there was not enough staff available.

People, staff and visitors were not protected from risk of infection. We found that cleaning records for high touch areas had not been completed for the majority of September.

Risk to people had not been consistently assessed and medicines were not always safely managed.

Staff had been recruited safely and environmental risks were well managed.

Monitoring processes were not effective. Shortfalls in cleaning records and medicines management were not identified or actioned.

People and their relatives had regular opportunities to suggest improvements to the service through questionnaires and meetings with the manager.

Staff meetings regularly took place and staff told us communication is good.

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; however systems in the service did not support this practice.

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 18 May 2018)

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels. A decision was made for us to inspect and examine those risks.

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 to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. 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.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing levels, safeguarding, person centred care, safe care and treatment and governance. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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.

At the last inspection, in 23 November 2015 the service was rated overall as ‘Good’. At this inspection we found that the service remained ‘Good’.

Since our last inspection there had been a change of registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were supported by a staff team who understood their role and responsibilities to protect them from abuse and avoidable harm. The registered provider had systems, policies and processes to support staff in safeguarding people. Staff had received appropriate safeguarding training.

Risks to people’s safety, including the environment had been assessed and were monitored and reviewed.

People’s medicines were administered, stored and managed safely.

The service was clean and hygienic and staff had received training in the prevention and control of infections and a policy and procedure was available to support staff.

People’s needs had been appropriately assessed and staff had information of the support people required to effectively manage their needs. Staff had received induction, training and support. Some gaps were found in staff training, this had been already identified in some areas and training booked.

People received a choice of meals and drinks and their dietary needs were known and understood by staff. People were supported to access primary and specialist health services to monitor their health needs. Staff worked with external healthcare professionals to secure good outcomes for people. The internal and external environment was appropriate for people’s individual needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice. This included how they wanted to spend the time towards and at the end of their life.

People were supported by a staff team that knew them. Staff were caring and provided a person centred approach. Independence was promoted, dignity and privacy respected and people were involved in their care and support. People had access to independent advocacy information should they have required this support.

Staff supported people with their interests and hobbies and people or their representative contributed to planning the care and support they received. People’s communication needs had been assessed and planned for. The provider’s complaints procedure had been made available for people and was presented in an appropriate format. People’s end of life wishes had been discussed with them.

People, relatives and staff were positive about the leadership of the service. People received opportunities to share their experience about the service they received. Systems and processes were in place to monitor the quality and safety of the service people received.

At our last inspection of Barnfield Manor on the 29 April 2013 we found that people were not consistently receiving care that met their needs and protected their health and wellbeing. We also identified on-going concerns around the management of people's medicines. Staff were not receiving support to deliver care and treatment safely and to an appropriate standard.

There were 22 people living at Barnfield Manor at the time of our inspection. We found that improvements had been made to all aspects of the care people were receiving. We observed that people were being asked for their consent before receiving support and that people, and their relatives, were being involved in decisions relating to their care.

People were receiving care, treatment and support which met their needs and their care plans were being kept up to date. Staff had received additional training and were undertaking regular supervision and an appraisal.

There were effective systems in place to assess and monitor the quality of service that people received.

During our last inspection in January 2013 we found that people's care and treatment was not always planned in a way which met their individual needs. We also found that the provider did not have appropriate arrangements in place for the management of medicines.

There were 27 people living at Barnfield Manor at the time of our inspection. This included one person who moved into the home on the day of our visit. We observed that people were not always receiving appropriate support and supervision from staff.

We found that people's care and treatment were not consistently planned and delivered in a way which met their needs or protected their safety and welfare. People's care plans did not always reflect changes to their needs.

We also found that most of the improvements that had previously been made in the safe handling of medicines had not been sustained. We found that people did not always received their medicines because they were out of stock and that people's medicines records were not completed correctly.

There were 24 people living at Barnfield Manor at the time of our visit. During our visit we found that some improvements had been made with regards to people's involvement in their care and the way people were receiving their medicines. However we found that the arrangements for the management of medicines did not protect people living in the home.

We found that since our last visit, the new manager and staff had spent time with people living at Barnfield Manor discussing their care and where possible obtaining their views. This had been done in a way which ensured that, as far as possible, people expressed their views and were involved in making decisions about their care and treatment.

There were 24 people living at Barnfield Manor at the time of our visit, plus one person who was receiving respite care. We found that the atmosphere throughout the home had improved since our last visit in June 2012. We observed that over lunchtime it was much more relaxed and everyone sat at tables and ate their meals without becoming distressed or anxious.

We spoke with the relatives of three people living in the home. One person said 'the home has improved, there are still a few niggles like with laundry, but (the provider) seems to be addressing them'. Another person told us 'I've been in to review (my relatives) care plan and they're keeping us informed.'

A pharmacist inspector from the Care Quality Commission also visited the home. We found that some minor improvements had been made but overall people were still not protected against the risks associated with the unsafe use and management of medicines.