Barrowhill Hall

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People’s needs were assessed appropriately. However, some care plans contained outdated information. The provider monitored people’s health conditions. However, there were some gaps in monitoring which had not been identified during audits. People told us they were happy living in the home and their health needs were regularly reviewed by health professionals. Most relatives told us they felt involved in the service, however 1 relative told us about their concerns over care monitoring and told us they were not always updated following incidents. 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. Relatives and staff told us people’s health and wellbeing improved due to effective care and support. Visiting professionals told us the provider effectively communicated with them and supported people safely.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they received information and advice about their health, care and support. One person said, “I like to monitor my own health so I can eat healthily.” Other people told us about their appointments with the doctors, hospitals and dentists. However, some people said they did not feel involved in the service, although they felt happy with the care provided by the staff team. One person said, “I’m not involved with my care plan, but I’m not bothered about that. I’m happy with my care.” Relatives told us they felt involved in people’s assessments and reviews. One relative said, “I’m involved in my family member’s care. They consult me about everything.”

Staff knew people well and told us about people’s needs, wishes and choices. One staff member told us, “[Person’s name] needs to be repositioned every 3 hours, this is important to ensure we protect their skin and help them to be comfortable and not in pain. The registered manager makes sure we understand the importance of repositioning.” Another staff member told us about a person who experienced distressed behaviour, they explained how they supported the person during these times. Staff told us about the importance of reading care plans. One staff member said, “We read care plans to understand people. People’s needs change so it’s important we read any updates and stay informed.”

People’s health needs such as fluid intake, skin care, personal care and dietary needs were assessed using recognised tools and referrals were made to relevant professionals following concerns, such as dieticians, occupational therapists and the falls clinic. However, some people’s care plans contained outdated information. The registered manager responded to our feedback by updating the identified sections and made improvements to the auditing system in place. People who were identified as requiring end of life care were appropriately assessed. ReSPECT forms and advanced directives were recorded in peoples care plans. ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. The ReSPECT process creates a personalised recommendation for a person’s clinical care in emergency situations where they are not able to make decisions.

People told us they received safe care and treatment. One person said, “There’s always 2 staff to hoist me out of my chair. All the staff are good.” Another person said, “I use a crutch to walk with. Nothing here makes me feel unsafe.” We received mixed feedback from relatives regarding people’s care monitoring. One relative told us about concerns over the monitoring of their family member’s skin integrity. They told us staff sometimes missed concerns and did not always complete the necessary skin monitoring records. They also told us the provider had not been proactive when responding to environmental concerns they raised. The provider responded and made improvements to the auditing of skin integrity records, which they actioned during this assessment. The provider explained they had struggled to resource the materials needed to address the environmental concerns, although this was resourced and actioned during this assessment. Another relative praised the way in which the provider monitored their relative’s health condition. They told us how well the provider monitored their family member’s health and involved health professionals when they have any concerns. A further relative told us, "We are over the moon with [family member] being here. Nothing is too much trouble. [My family member] had a rash the other day and the staff were on it straight away."

Staff told us they regularly monitored people’s health conditions. Staff were able to tell us how they monitored people’s health without referring to documentation. Staff told us which people were at increased risk of harm due to their health, such as dietary requirements and skin integrity. The registered manager told us how referrals were made to health professionals following concerns such as a reduction in people’s fluid intake or increased concerns around people’s distressed behaviours.

The provider was not always effective when monitoring people’s health needs in accordance with their assessed need. One person was susceptible to bruising and skin tears due to their skin integrity and mobility. The provider assessed this person as requiring body maps taken daily by staff for on-going monitoring. Body maps are records which accurately reference which part of the body is undergoing treatment or experiencing a condition. There were occasions where body maps had not been completed by staff. On days where the body map was completed and skin concerns identified, follow-on action to these concerns were not always clearly recorded. The registered manager responded to our feedback and introduced new systems to monitor the completion of body maps and follow on action. A visiting professional who specialised in skin viability told us, “I have no concerns at all, they always follow advice and obtain professional support for anything they are unsure of.” People’s dietary and fluid intake was monitored clearly, and action was taken when concerns were raised. People with other conditions, such as diabetes were monitored safely in accordance with their assessed needs. Mobility risk assessments were completed and mitigation measures to reduce the risk of falls were clearly documented. People who required regular repositioning were monitored safely.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

People told us staff monitored their health and wellbeing safely. Relatives told us people’s health had improved, 1 relative said, “[My family member] is seeing a nutritionist and has been given protein drinks. [My family member] did have a pressure sore which they monitored and it’s improving now.”

Staff told us people’s health and wellbeing improved through supportive strategies. Three staff told us how 1 person who originally required 2:1 staff support due to the high number of incidents of distressed behaviour they experienced no longer required this level of support. Staff told us the person was much more settled and when the person did experience distressed behaviour, staff utilised supportive strategies to assist the person. We reviewed documentation which supported this. The registered manager showed us records and discussed how people’s skin integrity had improved and pressure sores reduced.

The provider monitored people’s health care and recorded improvements. Health care targets and goals were documented in people’s care plans. We reviewed examples of partnership working where the provider worked with other health and social care professionals to meet people’s targets and health care goals. For example, the provider was part of a pilot scheme to address skin integrity concerns and the provided worked closely with community mental health teams to support people with distressed behaviours.

People told us staff sought consent before carrying out any care tasks and they [staff] respected their choices and decisions. One person said, “They don’t make me do anything I don’t want to. They ask my permission first before doing anything.” Relatives told us staff respected people’s privacy and choices. One relative said, “[My family member’s] privacy and dignity are respected. They always knock on the door before entering.”

Staff understood the principles of the Mental Capacity Act. One staff member said, “Some people lack capacity and don’t understand risks. It’s important to respect people’s decisions and help them to make their own choices. Where needed we make best interest decisions.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. We checked whether the service was working within the principles of the MCA , and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met. 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. Assessments of people’s mental capacity and best interest meetings had taken place to ensure decisions made were appropriate and least restrictive. This related to the decisions concerning the use of sensor mats and covert medication.