We carried out a review of the data available to us about Barrow Hall Care Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Barrow Hall Care Centre, you can give feedback on this service.
Barrow Hall Care Centre is a care home registered to provide accommodation, personal and nursing care for up to 37 people who have mental health conditions or misuse drugs or alcohol across 3 adapted areas within the grounds. At the time of our inspection, 30 people lived at the service.
People’s experience of using this service and what we found
A system was in place to monitor the quality and safety of the service.
People were happy with the care they received, they felt safe and well looked after.
People had support from staff who had been safely recruited. Staff received training in safeguarding and understood their role and responsibilities to protect people from abuse. People and staff spoke positively about the management of the service. Staff receive guidance and support from management regularly and when required.
People were supported to take their medicines safely as prescribed.
Staff followed care plans and risk assessments which were in place for known risk, up to date, and regularly reviewed.
People were regularly asked their views on the service provided and action had been taken when suggestions were made.
People were supported to have access to healthcare services to monitor and maintain their health and well-being. People were encouraged to maintain a healthy diet, where people had specific dietary requirements, these were catered for.
The provider and staff worked in partnership with other health and social care agencies to deliver good outcomes for people and to ensure their needs were met and reviewed.
People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 18 September 2019) and there were breaches of regulation. 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 inspection of this service on 8 August 2019. 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 safe care and treatment and good governance.
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.
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 changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Barrow Hall Care Centre on our website at www.cqc.org.uk.
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.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Barrow Hall Care Centre is a care home providing personal and nursing care for younger or older people who misuse drugs or alcohol or have a mental health need. The service can support up to 37 people.
Care Homes
Barrow Hall consists of the main house for up to 25 people. It is a listed building and retains many of its period features. In addition to the main house there is 'The Mews' which consists of ten individual apartments each with a sitting area, bedroom, kitchenette and bathroom. There is further accommodation in The Lodge for two people. It is set in extensive grounds situated in the village of Barrow.
People’s experience of using this service and what we found
We found improvements were required regarding infection prevention and control. An electrical safety check had not been conducted in a timely way to ensure a safe environment was maintained. A range of quality checks and audits were undertaken to monitor the service. However, these had not been effective due to the shortfalls we found during the inspection.
People were protected from the risk of harm and abuse. Safeguarding procedures guided staff about the action they must take if they suspected abuse was occurring. People’s risk assessments identified hazards to their health or wellbeing. Action was taken to reduce risks but maintain people’s independence and choice. There were enough staff to meet people’s needs. Incidents and accidents were monitored, and corrective action was taken to prevent re-occurrence. Recruitment was robust.
Staff undertook training to maintain and develop their skills which helped them meet people’s needs. Supervision and appraisal were undertaken for staff.
People had their capacity assessed and 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.
Staff were caring and kind. People we spoke with confirmed this. Staff provided comfort and support if people became anxious or upset. Information was provided to people in a format that met their needs in line with the Accessible Information Standards.
Staff supported people to meet their health and nutritional needs. People were supported and encouraged to maintain their independence. Staff worked with health care professionals to maintain people’s wellbeing.
People felt able to raise concerns and were confident they would be addressed. A programme of activities was provided in line with people’s hobbies, preferences and interests. End of life care was provided at the service.
The registered manager supported the staff team and they all worked well together. Action plans were created to address issues at the service.
Rating at last inspection
The last rating for this service was requires improvement (published 22 September 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.
Why we inspected
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. The provider has acted to mitigate the risk. You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Barrow Hall Care Centre on our website at www.cqc.org.uk.
Follow up
We will seek an action plan from the provider to make sure the environment remains safe for people. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 of this service in June 2017 we rated it as requires improvement in safe and well-led, which meant the quality rating of the service was requires improvement overall. We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations, Regulation 18 Staffing. The provider had failed to ensure staff were deployed to provide assessed support that people required. This had not been found or addressed by the quality monitoring of the service,which meant there was a need for improvement with governance. At this inspection we found improvements had been made to meet the requirement, but that more improvement was needed with governance in respect of records.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well-led to at least good. At this inspection we found there were enough staff to meet people’s needs. Records were produced to help to monitor people’s one to one support and staffing levels were constantly reviewed by the management team.
The provider was not taking any new admissions to the service. The provider, management team and staff were working with North Lincolnshire Council and health care professionals to improve all aspects of the service.
Barrow Hall Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
Barrow Hall nursing home provides personal and nursing care for up to 37 people with a mental health need. Barrow Hall consists of the main house for up to 25 people. It is a listed building and retains many of its period features. In addition to the main house there is 'The Mews' which consists of ten individual apartments each with a sitting area, bedroom, kitchenette and bathroom. There is further accommodation in The Lodge for two people. It is set in extensive grounds situated in the village of Barrow.
The service has 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Staff had undertook a lot of training in the last few months to improve their skills. The effectiveness of this training was still being assessed and the management team continued to look at training in other subjects to enhance the staff's skills. The majority of appraisals had not been undertaken but were scheduled for August 2018.
Some people’s care records were still being reviewed and re-evaluated. Computerised care records were being created for everyone living at the service to enable staff to monitor people’s care more effectively. Further work was required to ensure people's records reflected their full and current needs. Shortfalls in care records and medicine ordering was corrected during the inspection. Staff were undertaking training to make sure they used appropriate words in people’s care records.
We received mixed feedback about the staff's skills and knowledge. There were concerns people may not be receiving the care and support they required. This information was shared with the regional manager so that corrective action could be taken, if necessary.
The registered manager, regional manager, staff and provider had worked hard to improve the service over the last few months. They were open and transparent and were willing to work with the local authority and other professionals to improve the service. Quality assurance checks and audits were taking place and were monitored. A new electronic care record system was being introduced to give staff more time to spend with people and to ensure people’s care records were kept up to date. The management team agreed more time was required to undertake this work.
We received mixed feedback from health care professionals about the quality monitoring of the service. Although they stated improvements had been made.
Safeguarding training was provided for staff. Safeguarding issues were reported and investigated to help protect people from harm and abuse. Staffing levels were monitored to ensure there were enough staff to meet people’s needs. Accidents and incidents were monitored and emergency plans were in place to help protect people’s health and safety. Safe recruitment procedures were followed. General maintenance was undertaken. Staff undertook training in safe medicine management. Infection control audits were undertaken and issues found were being addressed. Staff were aware of people’s behaviour that may challenge each other or the service.
People’s rights were respected and care was provided with consent or in people’s best interests. Staff monitored people’s dietary needs to help maintain their wellbeing. People were prompted or assisted to eat and drink and the benefits of eating a healthy diet was promoted.
People’s preferences for their care and support were recorded. People were treated with dignity and respect. Care records were personalised and people’s communication needs were known by staff. Risks to people’s wellbeing were monitored and staff encouraged people to maintain their independence, where possible. Staff contacted health care professionals for help and advice to help to maintain people’s wellbeing. The environment had been improved for people living at the service and further work was planned.
People’s mental capacity was assessed. We found care and support was provided in line with the Mental Capacity Act 2005. Staff encouraged people to make choices about how they wished to live their life, where possible.
Staff treated people with kindness and their diversity was respected. The provider had a confidentiality policy in place for staff to follow. Care records were stored securely in line with the Data Protection Act.
People were provided with information about the complaints procedure in a format that met their needs. Advocates (independent people) were available to help people raise their views.
Visiting was permitted at any time. People were supported and encouraged to take part in activities, if they wished. Outings and events took place and people’s relations and friends were invited.
Statutory notifications were sent to the Care Quality, as required by law.
This is the second consecutive time the service has been rated Requires Improvement.
At the last comprehensive inspection in 24 February 2016 the registered provider met the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. The service was rated as good in all domains. During this inspection the overall rating of the service became requires improvement.
Barrow Hall nursing home provides personal and nursing care for up to 37 people with a mental health need. Barrow Hall consists of the main house for up to 25 people. It is a listed building and retains many of its period features. People have access to two large lounges and a dining room as well as communal toilets and bathrooms. In addition to the main house there is ‘The Mews’ which consists of ten individual apartments each with a sitting area, bedroom, kitchenette and bathroom. There is further accommodation in The Lodge for two people with bedrooms, lounges and communal kitchen. The home is set in extensive grounds situated in the village of Barrow. There is easy access to local shops and facilities. A choice of single and shared accommodation is available.
At the time of the inspection visit thirty three people lived at the home.
The service was in the process of changing managers. The current registered manager was retiring from the home and the deputy manager was applying to become registered with CQC. The new manager was an experienced member of staff who had been part of the management team for some time. This reduced the impact of the change on people who used the service.
People told us staff were friendly and helpful and they felt safe at Barrow Hall. Procedures were in place and risk assessments completed to reduce the risks of abuse or unsafe care.
We looked at how the home was staffed. We saw two people had been assessed as needing one to one staffing for individual support. This was included in the general staffing rather than specifically for the individual. Therefore people may not have been always getting the hours allocated to them.
People said there were enough staff to provide practical care but not always enough staff to support them in activities, particularly activities in the community. People told us they were disappointed when they did not happen. Staff spoken with said some days they were understaffed and rushed and unable to spend ‘quality time’ with people.
This was breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider had failed to ensure staff were deployed to provide assessed staffing support.
We found systems and procedures were not always operated effectively to ensure appropriate staffing levels and compliance with the regulations.
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.
Staff managed medicines safely. People told us they felt staff gave them their medicines correctly and when they needed them. We saw they were given as prescribed and stored and disposed of correctly.
We looked at the recruitment of three recently appointed members of staff. We found appropriate checks had been undertaken before they had commenced their employment. This reduced the risk of appointing unsuitable staff.
Staff had been trained and had the skills and knowledge to provide support to people they cared for. They received regular support and supervision from senior staff.
People were positive about the meals and told us the meals were usually good and there was always choices of food.
Records were available confirming the environment and equipment used complied with statutory requirements and was safe to use. Most areas of the home were clean and staff used gloves and aprons when providing personal care and at mealtimes.
We observed staff providing support to people during the inspection visit. We saw they were kind and attentive and cared for people safely. One person told us, “Everything is good here. The staff are good and care.”
We saw staff acted promptly to manage people’s health care needs. Care plans were personalised, involved people and where appropriate their relatives and were regularly reviewed.
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.
People said they knew how to complain if they needed to. They said any comments or complaints were listened to and action taken.
People told us the registered manager and staff team were approachable and supportive and listened to their views. They sought the views of people they supported through informal discussions and satisfaction surveys.
We carried out this unannounced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.
Barrow Hall is a Grade 1 listed building and retains many of its period features. The home is set in extensive grounds in the village of Barrow, providing easy access to local shops and facilities. Barrow Hall offers personal and nursing care for up to 37 people with mental health needs. The service is owned by St Phillips Care Limited, which is a large national organisation. A choice of
single and shared accommodation is available.
We previously visited the service on 28 and 31 of July 2014. We found the registered provided did not meet the regulations that we assessed in respect of infection control. Following the inspection the registered provider sent us an action plan telling us about the improvements they were going to make. At this inspection we found that appropriate action had been taken to make the identified improvements.
We found the service had been cleaned effectively and all areas with the exception of the smoking lounge to be odour free. New work schedules were in place which showed the daily cleaning routines and deep clean schedules. These were seen to be signed and commented on by staff as work was completed.
Improvements had been made to the environment including the refurbishment of bathrooms and shower rooms and the provision of new sluices on each floor of the service. A step had been removed and replaced with a slope to support easier access to those people with mobility problems. The clinical room had been extended to provide a separate clinical room and work area.
The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC); they had been registered since 9 December 2010. 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.
People who used the service told us they thought the staff were caring and would be able to answer their questions and help them if needed. They told us they felt staff treated them with respect, never spoke down to them and spoke in a calm manner. All of the interactions we observed supported this statement.
We found people who used the service were provided with a balanced diet. People told us they enjoyed the food and the choices available. At our last inspection staff told us the budget was tight and they fund raised to provide ‘extras’ for example birthday cakes. At this inspection we found the budget had been increased.
Staff involved people in choices about their daily living and treated them with kindness and respect. With the exception of two people, everyone looked well-presented and cared for.
People who used the service were seen to have the opportunity to engage in a variety of activities both within the service and the local community.
We found the home was meeting the requirements of the Deprivation of Liberties Safeguards (DoLS). These safeguards provide a legal framework to ensure that people are only deprived of their liberty when there is no other way to care for them or safely provide treatment.
Staff we spoke with had a good understanding of the Mental Capacity Act 2005 and knew how to ensure the rights of people who lacked capacity to make decisions for themselves were respected.
People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include preferences, likes and dislikes. People who used the service received additional care and treatment from health based professionals in the community.
Medicines were stored, administered and disposed of safely. Training records showed the staff had received training in the safe handling and administration of medicines.
People lived in a safe environment. Staff knew how to protect people from abuse and equipment used in the service was checked and maintained. Staff made sure risk assessments were carried out and took steps to minimise risks without taking away people’s rights to make decisions.
Staff received regular supervision and had access to a range of training. Where people’s needs changed additional training was provided to staff to support them to meet their changing needs People told us there were enough staff on duty to give them the support they needed and our observations confirmed this.
We carried out this unannounced inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, this was also part of a pilot for a new inspection process being introduced by CQC and to provide a rating for the service under the Care Act 2014.
Barrow Hall is a Grade 1 listed building and retains many of its period features. The home is set in pleasant grounds in the village of Barrow, providing easy access to local shops and facilities. Barrow Hall offers personal and nursing care for up to 37 people with a mental health need. The service is owned by St Phillips Care Limited, which is a large national organisation. A choice of single and shared accommodation is available.
The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.
This inspection was unannounced. The last inspection of the service took place on 4 October 2013 when no issues were identified.
People and their relatives told us they were happy with the care provided at the home and their care and social needs were being met. From our observations, and from speaking with staff, people who lived at the home and relatives, we found staff knew people well and were aware of people’s preferences and care and support needs.
On the first day of our inspection we found the home required some improvement in the management of people’s privacy and dignity. We found some people’s curtains had been removed from their windows. However, this had been rectified by the second day of our inspection.
We found the home had not been cleaned effectively and was dirty in places. The problems we found with the prevention and control of infection breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the report.
People who used the service received a balanced diet. People told us they liked the food and choice was offered but staff told us the budget was very tight which meant they were unable to supply people who used the service with extra items such as birthday cakes.
We found the home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). These safeguards provide a legal framework to ensure that people are only deprived of their liberty when there is no other way to care for them or safely provide treatment. Staff we spoke with had a good understanding of the Mental Capacity Act 2005 and knew how to ensure the rights of people who lacked capacity to make decisions for themselves were respected.
The registered provider had robust recruitment processes in place, which protected vulnerable people from unsuitable or unsafe staff.
Staff involved people in choices about their daily living and treated them with compassion, kindness, and respect. Everyone looked clean and well-cared for. However, people had access to a limited range of activities.
People told us there were enough staff to give them the support they needed and our observations confirmed this. The majority of staff had received training considered to be essential and had also received specialised training on mental health issues.
We observed care was responsive to people’s needs and preferences.
People knew how to make a complaint and we noted the home openly discussed issues so that any lessons could be learned. People felt they were able to express their views at any time and they told us they were listened to and acted on.
Leadership and management of the service required improvement. There were systems in place to monitor the quality of the service. However, we felt the management team did not effectively use the results to drive a culture of continuous improvement. In addition, some staff expressed concerns the service had a low budget for food. However, we saw that people’s weights were recorded regularly and showed weight loss was not a specific issue in the service.
During our inspection we looked at the additional outcome of nutrition after a person who used the service told us 'we can't have seconds any more'.When we spoke with the manager and staff we found that a new supplier for food had been arranged by the provider and the current food budget did not allow for additional portions of food to be purchased and prepared.
We also found that the current budget and purchase order system did not support people who used the service, with the opportunity to purchase and prepare their own food.
The deputy manager confirmed they would complete an assessment if people's capacity to make informed decisions was in doubt and a best interest meeting would be held.
People told us that they were aware they had a plan of care which they felt very much involved in. Comments included 'We all communicate well, we help each other out.' and 'We all get on well together; the staff are good to us.'
People were happy with the care they received and told us they saw a range of health professionals for advice and treatment. Comments included, "I see my GP when I need to or ask to.'
We saw that people who used the service had free access to the grounds and the building and that there were positive interactions between them and staff.
We found that staff helped to make sure health and social care was coordinated when provided by a range of professionals.
During a tour of the building we found the environment was in need of further repair and refurbishment. Areas of the building were also found to be in need of a deep clean.
We found that all staff employed in the service had had all the required employment checks prior to starting work in the home.
Appropriate records were maintained of the care people who used the service received and for the running of the service.
People said they liked the home and there were plenty of activities and entertainment available to keep them occupied. One person told us about a recent holiday that they had been on and outings which they particularly enjoyed to different venues including Hull fair, Dignity day and the recent jubilee celebrations.
Some people told us that they preferred to engage in more individual activities with the activity coordinator, rather than engage in group activities.
People told us that they could see their GP when required. Comments included ,'The staff are lovely', ' They are really nice and kind to us',' You can always talk to them and get what you need or reassurance',' We are treated very well.'
People who used the service told us that staff listened to them and helped them to make choices about the support that was provided and commented, " I can come and go as I please, I just need to tell someone that I am leaving the building", " Staff help me to stay in contact with my family" and " You can't fault it, it is a really nice place.'
We spoke with people who used the service who told us they were asked their views about the home and that they could make suggestions. People told us they felt able to make complaints and said they would speak with the manager if necessary sort out any problems for them.