We inspected Barkby Road on 29 October 2018 unannounced and returned announced on 30 October 2018. Due to further information of concern being received we returned unannounced on 26 November 2018.At our last comprehensive inspection on 30 May 2018 rated the service as Requires Improvement overall. The provider was in breach of five regulation, relating to per-son centred care, safe care and treatment, staffing levels, premises and equipment and good governance. The provider was required to submit action plans demonstrating how they were to achieve compliance with the regulations.
At this inspection we found the service had made some of the required improvements. However, we found continued breaches in all five regulations.
Barkby Road is registered to provide residential and personal care for up to 11 people. Nine people are accommodated in the main house, three people live in two bungalows in the grounds of the service. At the time of this inspection there were 11 people living in the service. There were people using the service who could not always express their needs and wishes because they had a mental health condition or because their ability to communicate was impaired. Many of the people using the service had complex needs which, at times, needed one to one or two to one support from staff who were trained in specific and specialised areas of care delivery. During our inspection it was not evident that support was being provided to the level people needed, to provide both meaningful activities or ensure their safety.
The service had a registered manager. 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. The current registered manager is on maternity leave and an interim manager has been recruited. The operations officer was also working alongside the interim manager to ensure improvements were being made.
The provider’s action plan had set deadlines for when the improvements would be achieved. We found at this inspection that none of the deadlines had been met.
Although some care plans had been rewritten we still found risk assessments did not always reflect people's identified risks.
Suitable employment checks had not always been made on staff recruited to the service ensuring they were safe to work at Barkby Road. Although staffing levels had improved we continued to have concerns around the deployment of staff. This meant on occasions the most inexperienced staff worked with people with the most complex needs.
Some improvements had been made to the premises and we noted areas had been redecorated and new furniture had been bought. However, the environment in the two bungalows continued to be very poor.
Although people received their medicines as prescribed the temperature of where medicines were stored continued to be of concern as staff were not monitoring it safely and there was still a risk that medicines would exceed the manufactures recommended safe storage limits.
People’s personal finances were not always managed safely
People had a choice of food and drink each day and were given these in sufficient quantities. We did identify concerns over food stocks.
Improvements in people being able to access the community were noted however they were not always meaningful and supporting people’s aspirations and goals.
Not everyone living at Barkby Road had their dignity supported and maintained.
The operations officer and interim manager had plans to start supervision meetings with all staff but these had not begun when we inspected. Staff continued to feel that they did not receive adequate training and support. They continued to feel unsupported and under-valued by the provider.
Improvements were seen in ensuring people had access to information about the provider’s complaints procedure. Information was written in an accessible format suitable for the people using the service.
We continued to find examples of poor management and leadership that impacted on the outcomes for people that used the service. There continued to be a lack of oversight and understanding by the provider about the concerns raised not only by CQC but by the local authorities.
The provider had not ensured there were sufficient processes in place to assess, monitor and improve the quality of the service to maintain the health, safety and welfare of service users. The provider failed to have the systems and processes in place to identify when the service was failing.
At this inspection we found that Barkby Rad were in breach of five regulations relating to safe care and treatment, staffing, governance, premises and equipment. The actions we have taken are reported at the end of the full report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
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.
Further information is in the detailed findings below.