Barclay Street is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulated both the premises and the care provided, and both were looked at during this inspection.

Barclay Street accommodates up to seven people in one adapted building. At the time of the inspection there were five people in residence. Barclay Streets supports people with a learning disability and whose behaviour can be challenging. Some people also have Autism

This inspection took place on 28 January 2019 and was unannounced. We returned, announced on 30 January 2019.

Barclay Street had a registered manager 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.

Barclay Street was previously inspected by the Care Quality Commission on 27 March 2017 and was rated good. This inspection found the key questions of is the service safe; effective; caring and well-led had not retained the rating of good. Therefore, the overall rating following this inspection has been reviewed and found to be requires improvement.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

The provider had recently appointed a head of operations for adult services who had taken over the role of registered person. The registered person had undertaken a range of audits in key areas for the purposes of monitoring the quality of the service. The audits undertaken had identified key areas of improvement were required.

The provider had failed to maintain the environment and keep it clean. We found shortfalls in both communal areas and people’s bedrooms. The lack of maintenance impacted on people’s privacy and dignity. Work was being undertaken to bring about improvement within a given timescale set by the registered person. However, the resources had not been identified to achieve the improvements required. The provider had failed to plan the improvements to minimise the impact on people using the service.

Opportunities to learn from accidents and incidents to improve the support people received were not fully utilised.

Many staff had not completed or renewed their training in key areas to promote people’s safety and welfare.

People were not fully supported to have maximum choice and control of their lives. Staff did not always support people in the least restrictive way possible. The policies and systems in the services had not fully recognised the need to assess people’s capacity to make informed decision. Referrals had been made to relevant organisations to deprive people of their liberty which complied with the Mental Capacity Act (MCA).

Staff had very recently began to speak with people about their goals and aspirations, which has the potential to provide support to develop living skills, gain confidence and explore new ideas. People’s support plans provided clear information about the support they required in all aspects of their daily lives, which included accessing activities and events within the community. Information as to the number of staff required to support each person was included within their support plan, with a majority of people receiving one to one or two to one support.

Potential risks to people were assessed. Plans to reduce risk including risks to people and staff where people displayed behaviour that challenges were in place. These were understood and implemented by staff. Staff had received training in supporting people when their behaviour became challenging. This had had a positive impact on people and had reduced the frequency for

This inspection took place on 27 March 2017 and was unannounced.

Barclay Street provides residential care for up to 7 people with a learning disability and/or autistic spectrum disorder. At the time of our inspection there was 1 person in residence.

Barclay Street 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.

Staff had the appropriate knowledge and skills to provide the person with the support and care and they required and were aware of their responsibilities in the provision of safe and effective care. The person’s safety was promoted by staff that had a good understanding of how to keep the person safe. Staff followed the guidance and information as detailed within the person’s risk assessments and care plans.

Systems to monitor the person’s medicine and health were in place, which included access to relevant health care professionals. Staff had consulted with family representatives of the person along with a range of health and social care professionals to ensure the care and support being provided was in the person’s best interests, to ensure their rights were promoted and upheld.

Staff encouraged the person to continue with activities they were familiar with, which included on-going contact with family members. Staff were developing a positive supportive relationship with the person, which had had a positive impact on the person’s well-being. Staff used the knowledge they gained from supporting the person to continually review and update the person’s care plan so that they could respond to the person’s changing needs.

Staff worked collaboratively with each other in the best interests of the person. The registered manager provided on-going support, through day to day contact and supervision of staff.

A quality assurance system had been purchased and was to be implemented in full, once more people started to use the service. Members of the management team undertook a range of audits to ensure the environment was well-maintained and that people’s safety and welfare was assured.

The CQC will continue to monitor information received about this service to ensure it continues to provide a good service as the service accepts more people into the home.

This inspection took place on the 20 January 2015 and was unannounced.

Barclay Street provides residential care for 7 people with a learning disability and/or autistic spectrum disorder. At the time of our inspection there were 7 people in residence.

There was a registered manager 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 confident that if they had any concerns about people’s safety, health or welfare then they would know what action to take, which would include reporting their concerns to the registered manager or to external agencies.

Staff had received training which reflected the needs of people who used the service and enabled them to provide care in a safe manner. This included supporting people when their behaviour became challenging and also through the appropriate use of equipment and techniques to move people safely. We found people received their medication in a timely and safe manner by staff who had been trained in the administration of medication.

We saw people accessing a range of community activities independently or with the support of staff. People’s needs had been risk assessed to promote their safety and independence. We saw there were sufficient staff to support people’s individual needs.

Our discussions with staff told us that they received on going support and development through supervision, appraisal and training. The training staff accessed reflected the needs of people who used the service which meant people received effective care and support.

People were protected under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that appropriate referrals had been made where people were thought to not have capacity to make decisions and had restrictions placed upon them. Staff spoke about their role in supporting people to maintain control and make decisions which affected their day to day lives. They told us how this was a key part of their role when supporting people.

People at risk of poor nutrition and hydration had assessments and plans of care in place for the promotion of their health and well-being. Some people were involved in menu planning and the preparation and cooking of meals. We saw people being offered a choice of options to eat at breakfast and lunch time and drinks and snacks were served regularly throughout the day.

People’s health and welfare was promoted and they were referred to relevant health care professionals in a timely manner to meet their health needs. Information gathered from a visiting professional and our observations showed there to be a positive working relationship between professionals and the service, which positively impacted on the quality of care people received.

We observed positive and supportive relationships between people who used the service and staff. People were comfortable and relaxed in the company of staff and shared laughter and conversation with them. We noted staff supported people in a timely manner, which included supporting them when they became anxious. We observed people being encouraged to make decisions about their day and records showed people’s comments and views were documented in daily records and within the minutes of meetings.

Visiting professionals who provided us with information told us that they found the staff of the service to be caring and supportive and receptive to the needs of people in their care.

People were supported by staff who were responsive to their needs and requests for support including accessing the community, shopping and attending college. People who remained at the service were supported to take part in their interests with the support of staff. Relationships between people using the service and their relatives and friends were promoted by staff who supported them in visiting people and by encouraging visitors to the service.

People we spoke with were confident that any concerns they had would be responded to appropriately. Records showed that the service within the last twelve months had not received any complaints, however they had received compliments about the service they provided.

People who used the service, their relatives, staff working at the service and visiting professionals were complimentary about the registered manager saying they were confident to speak with them and found them to be approachable.

There were effective systems in place for the maintenance of the building and equipment which ensured people lived in an environment that was well maintained and safe. Audits and checks were effectively used to ensure people’s safety and needs were being met, as well as improvements being made as required

People using the service and staff had the opportunity to influence the service by attending meetings and sharing their views, which enabled the provider to review and develop the service. Although the provider sought the views of relatives they had identified that seeking the views of people who use the service was an area for further development and improvement.

All the three outcome areas inspected we found compliant. We observed people using services and saw positive warm interactions between staff and each person who used services. We saw people had a freshly cooked evening meal in the conservatory. One person was using a lap top with the assistance of a staff member. We spoke with all three people who use services and they told us: " There is lots of space here, and good takeaways to go to. I like going swimming" " It's alright here, I like the fish pie." We saw people who use services had regular meetings together where they discussed trips and planned their holidays. We found people who used services were regularly consulted and able to take part in a range of daytime activities that interested them. We looked around the communal areas and people's bedrooms and the garden area. One person liked birds and a bird table had been purchased to enable them to watch the birds more closely in the garden. We saw bedrooms were personalised and the environment was homely and comfortable. One person who used services told us they felt safe at Barclay Street and would speak to staff if they saw anything that worried them. They felt staff were kind to them.