Barn Rise

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. Based on the findings of this assessment the rating for this key question has changed from good to requires improvement. This meant some aspects of the service were not always safe and there was an increased risk that people could be harmed. This is because the service did not always work well with people and partners to understand and manage risks to keep people safe and medicine administration was not managed safely in line with best practice. These failures had placed people at risk of harm under Regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff we spoke with were able to demonstrate their understanding of safeguarding and their duty to protect people’s rights to live in safety, free from abuse and neglect. However, they were not fully aware of external reporting processes and procedures.

We observed how people using the service interacted with staff and they looked at ease and comfortable in staff’s presence.

The provider had clear safeguarding and staff whistleblowing policies and procedures in place which were kept up to date, these were easy for staff to access. However, the service did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. In 2 safeguarding outcomes we looked at, the service had moved staff members involved to other services within the organisation. This does not effectively resolve the issue, instead relocates it and potentially compromises the safety of people elsewhere within the organisation. Local Authority informed us that the service did not always share concerns quickly and appropriately.

Staff we spoke with knew the people who lived at the service well. Staff were able to provide examples on individual communication needs and talk about indicators of when a person may be in distress, and how they would respond.

We observed staff supporting people in a safe way throughout the onsite visit.

The service did not always work well with people to understand and manage risks. Care records did not always reflect people’s individual needs that kept them safe. Care plans and associated risk assessments we reviewed were generic and not person centred. Choking screening tools for people were not always updated in line with the service’s policy when external health care professionals had reviewed people’s choking risk. We also identified gaps in stool monitoring charts, food intake and sleep records. There was a risk that staff and other healthcare professionals would not have the necessary information due to gaps in records. For example, if a person is at risk of constipation, and stool monitoring charts are not adequately completed, staff may not be aware of people’s emerging needs, potentially leading to delays in medical advice being sought. Additionally, the Local Authority informed us of gaps in fluid monitoring records for a person subjected to a strict fluid intake due to health requirements. Gaps in recordings could pose a potential risk, leading to harm being caused. This impacting on the health and wellbeing of the people they support. Accurate documentation is essential to ensure that all staff members were informed and able to provide timely and appropriate care. Due to the associated risks to the people who reside at the service, this was a breach of regulation 12 safe care and treatment under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Care plans could be simplified as they currently contain a considerable amount of information that could hinder accessibility, leading to vital information being overlooked. The service had a plan to implement Nourish, a digital care planning system.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

A total of 22.2% of the staff members who worked at the service participated in the annual staff survey. The survey indicated a positive perception of the service’s support and workplace wellbeing, expressing that management was approachable and that they looked forward to attending work. However, staff we spoke with felt workload was not evenly shared, this view was also reflected in team meeting minutes. Staff also expressed not having regular supervision to discuss workload and career development opportunities. They spoke about specific examples, which they felt required additional attention and resources, to enable them to effectively manage their workload. Staff told us there were not always enough staff during shifts to cover hospital appointments and to support people to access the community. Some staff expressed the need for night duty to be reviewed, they told us there was insufficient staff during these hours to efficiently meet the needs of the people they supported.

We observed staff were visibly present throughout our inspection visit. For example, we saw people did not have to wait long for support from staff when they requested it. Staff were vigilant when people were moving around the care home to ensure people remained safe.

The service had mandatory training and induction checklist in place for all new starters. The registered manager was accountable for ensuring the pathway was completed by new staff members and signed off. Training records showed that staff received ongoing training that was appropriate for their role. Training records for the service indicated 100% staff training compliance in mandatory areas including Learning Disabilities, Moving and Handling, Health and Safety and Infection Prevention and Control. We saw evidence of improvements in the quality of training being provided to staff

We checked 3 staff recruitment files and saw that all appropriate processes and checks were in place. The service conducted enhanced disclosure and barring service (DBS) checks., which provided information including details about convictions and cautions held on the Police National Computer. However, 1 staff did not have the necessary enhanced disclosure and barring service (DBS) checks in place . We received assurances after the assessment day that appropriate application had been made.

The service was well-maintained, clean and welcoming.

The service assessed and managed the risk of infection. Staff checked, maintained, and cleaned equipment daily, this was reflected in cleaning records and our observations. The service detected and controlled the risk of infection spreading and shared concerns with appropriate agencies promptly.

Staff and leaders knew people they support well and could describe clearly the needs of the people and how they supported them.

The service provided regular training in medicines management. However, records indicated that staff were not always competency assessed for medication medicines administration in line with the service policy. As per policy, new staff required three individual competency assessments to be signed off by the registered manager or designated person. We did not see this in all cases.

We saw 1 instance where a protocol for when required (“PRN”) medicines did not match the prescribed dose. The service recorded the administration of medicines on medicine administration records (MARs), including regular and PRN medicines. However, the records were not always clear. We saw PRN medicines being recorded on MAR charts for regular medicines and regular medicines being recorded on PRN MAR charts. Additionally, staff did not always follow the providers policy when supplying medicines for people on social leave.

The service had a process for recording and learning from medicine related incidents, however the service did not record near misses (errors that did not reach the person). This meant there was reduced opportunities to reduce risk and potential harm.

The service recently had an external audit of medicines management and optimisation. We saw oversight of the issues identified and actions in place to remedy most of them. There was evidence of support from regional leaders when actioning areas for improvement, however not all issues identified by the audits had yet been actioned. Due to the associated risks to the people who reside at the service, this was a breach of regulation 12 safe care and treatment under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.