Barclay Services

Barclay Services is a ‘supported living’ service which provides personal care and support to people with learning disabilities and mental health conditions who were living in ‘supported living’ settings, so they could live as independently as possible.

At the time of the inspection five people lived separately in their own individual bungalows and four people lived in a house together which could accommodate six people. Each home provided 24/7 support for the person or people they looked after.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection seven people were supported in this way.

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

We found there were systems and processes in place to safeguard people from the risk of abuse. People were supported to make choices that could involve risks and these were clearly documented.The service was promoting a positive culture that is person-centred, open, inclusive and empowering, which achieves good outcomes for people. The management team were making changes following a difficult few months, however, they and staff were clear about their roles and regulatory requirement.

A new management structure was in place that was improving communication and engagement throughout the service and externally.

Medicines were managed safely; staffing and recruitment practices ensured safe numbers of staff to care for people.

Infection Control practices to prevent and control infection were in place.

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; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of key questions Safe and Well-Led, the service was able to demonstrate how they were meeting or working towards meeting the underpinning principles of Right support, right care, right culture. The resignation of several managers and team leaders prior to the summer months had disrupted the culture of the organisation. However there had not been a negative impact on people receiving a regulated activity. There was work in progress to ensure the ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives across the whole of the organisation.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

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 23 April 2019).

Why we inspected

We had received a number of concerns in relation to staffing shortages, poor oversight, safeguarding, poor communication and management. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in supported living services where we find 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 reviewed the information we held about the service. Concerns that had been raised we found to be either exaggerated or unsubstantiated. 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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Barclay Services on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

¿ People’s safety was promoted. Staff had received training in safeguarding and knew how to protect them from abuse. The provider had reported concerns about people’s safety to the relevant authorities and they continued to work with health and social care professionals to protect people from harm and abuse.

¿ Potential risks to people was continuously assessed, managed and regularly reviewed. Care plans provided staff with clear guidance to support the person safely.

¿ People continued to be supported to maintain good health. Staff supported people with their medicines, ensured they had enough to eat and drink and attended health appointments as needed.

¿ Safe staff recruitment practices were followed. The service continued to ensure there were enough staff to meet people’s care needs as planned with the use of agency staff whilst staff recruitment was ongoing.

¿ Staff had received training relevant to their role. Arrangements were in place to manage any overdue training to ensure staff were equipped with the skills and knowledge needed to support people with a learning disability and autism. Staff were well supported by the management team.

¿ 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 were encouraged to make decisions about all aspects of their care, where possible.

¿ People were involved in the planning and review of their care. People’s care plans were produced in easy read format using pictures and personalised to reflect their wishes about how they preferred to be supported.

¿ People’s privacy and dignity was protected, and their independence was promoted where possible.

¿ People were supported to develop new skills; maintain relationships with family and friends and take part in meaningful activities of interest to them.

¿ People knew how to raise a concern or make a complaint. There was a system in place to respond to complaints and advocacy support was available.

¿ People, their relatives and staff were encouraged to give feedback on the service and to influence how the service develops.

¿ The provider had policies and systems in place to monitor the quality of service and action was taken where areas for improvement had been found. Management team encouraged staff to share ideas to develop the service. Any lessons learnt from incidents, and feedback from the internal and external audits and inspections were shared with the staff team to.

¿ The management team and staff worked well with professionals and external organisations to promoted and improve people’s quality of life.

Rating at last inspection: At the last inspection the service was rated Good (report published 30 May 2017).

Why we inspected: This inspection was a planned inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Barclay Services is registered to provide personal care and support for people living in their own homes. At the time of our inspection there were two people using the service. People’s packages of care varied dependent upon their needs.

This is the first inspection of the service since it was registered in November 2015.

A registered manager was 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 is run.

Staff were trained, understood their responsibility to protect people from avoidable harm and provide safe and responsive care to people. Risks were managed so that people were protected from avoidable harm whilst promoting their choices and independence. Sufficient numbers of staff were on duty to meet people’s needs. Each person had a dedicated staff team that promoted safety and supported them both at home and whilst accessing the wider community were managed.

People were supported by trained staff in all aspects related to their medicines. People had enough to eat and drink and were involved in meal preparations. Staff supported people to access relevant health care support and services to meet their health needs.

People’s care plans were personalised and provided staff with clear information to ensure their care and support needs were met. People’s care needs and care plans were regularly reviewed to ensure the support provided remained appropriate. Staff had a good awareness of people’s needs, their health conditions and how to support them if they became upset or anxious. People’s preferences, interests and hobbies and choice of lifestyle were documented and known to staff. This meant people could be assured their care was personalised to their needs and their choices were respected.

Staff had undergone a robust recruitment process that ensured staff were suitable to work at the service. Staff were supported, trained and had their competency and practice checked to ensure they were safe to meet people’s needs effectively.

People’s rights were protected and respected. Staff worked with each other and collaboratively with people, their relatives and health care professionals to ensure decisions made were in people’s best interests. Advocacy support was made available to people.

People maintained contact with family and friends. Staff had developed positive support relationships with people and their relatives. Staff respected people’s privacy and dignity and promoted their independence. Staff used the knowledge gained from supporting people to continually review and update people’s care plans so that they were able to respond to people’s changing needs.

People and their relatives were involved or had opportunities to be involved in the development of the service. Information about how to make a complaint was available in a format that people could understand. A complaint process was in place and staff knew how to respond to complaints.

The provider was meeting their regulatory responsibilities. The management team provided good leadership and direction. The provider’s quality assurance systems in place monitored the quality of service and were used to develop the quality of the care provided.