About the service: Barkby Road is a residential care home which provides accommodation and personal care for up to 11 people. At the time of the inspection seven people were living in the main building and two people in the adjacent bungalow.

People’s experience of using this service:

¿ We found improvements had been made following the previous inspection of the service by the Care Quality Commission.

¿ We found that Barkby Road met the characteristics of a ‘Requires Improvement’ service.

¿ Although improvements in recruitment records had been made we still found some records did not contain all the elements they should.

¿ Although incident recording had improved we did find that not all incidents had robust debriefs and lessons learned recorded. However, systems were in place to monitor this and drive improvement.

¿ Improvements were ongoing in the environment and oversight continued to be needed to ensure the timeliness and quality of repairs.

¿ Audits were now in place, the head of adult operations closely monitored the service. Some of the audits were new and still need to fully embed to ensure their effectiveness.

¿ People received safe care. Risks to them were identified and managed.

¿ There were sufficient trained and supported staff to meet people's needs.

¿ Staff understood how to maintain people's safety as they had received regular training and updates.

¿ People's medicines were managed safely, and prescribed medicines were reviewed by a health care professional.

¿ The service was welcoming and provided opportunities for people to socialise, both within the service and the garden.

¿ Staff were kind and caring and promoted person centred care.

¿ People's needs were reviewed with their involvement where possible, or that of a family member. Changes were incorporated in the care plan.

¿ People's health needs were identified and met. Referrals to healthcare professionals were made when needed.

¿ People were happy with the meals provided. People were supported to eat a healthy diet which met their dietary requirements. Food and drinks was readily available.

¿ People were consulted with about their care, and safeguards were in place for people who were unable to make decisions about their care.

¿ Family members commented on the improvements which had taken place over the last few months.

¿ People had opportunities to take part in activities, which were important and meaningful to them.

¿The head of adult operations was aware of the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

Rating at last inspection: Inadequate. The last report for Barkby Road was published on 18 January 2019.

Why we inspected: This was a planned comprehensive inspection based on the rating from the previous inspection and as the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulations.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our 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

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 h

This inspection took place over two days. We arrived unannounced on 30May 2018 and returned announced on 4 June 2018.

At the last inspection on 8 November 2016 we found that the service was meeting the Regulations we looked at.

At this inspection we found the service had deteriorated and rated ‘Requires Improvement’. Therefore improvements were needed.

Barkby Road is an 11 bedded purpose built care home for adults with moderate to severe learning disability, complex needs or challenging behaviour. The service also offers a specialist support to those with Autistic spectrum disorders. The accommodation was provided in the main building and in two additional separate buildings within the grounds. At the time of this inspection the separate buildings accommodated three people who had greater levels of need and very high levels of behaviour that challenged. On the day of our visit there were 11 people living at the home.

The registered manager had gone on maternity leave in May 2018. 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 provider had notified us of the alternative management arrangements during this period, which were the operations officer would oversee the service and support the deputy manager in the day to day running of the service.

We found the high use of agency staff working at the service meant staff often lacked the specialist knowledge and skills to care for and support people safely.

Care plans and risk assessments did not always reflect people's current needs as they were not reviewed and updated regularly.

Medicines were being managed safely when we inspected the service, however the temperature of where medicines were stored was not being monitored safely and there was a risk that medicines would exceed the manufactures recommended safe storage limits.

People had a choice of food and drink each day and were given these in sufficient quantities.

Where people had identified activities they wished to participate in they were not always supported with these. This was due to staffing levels at the service. People were not supported to live fulfilling lives and there was a lack of emphasis on people's goals and aspirations. People spent long periods of time with little or nothing to do.

People’s dignity was not always maintained. People did not receive the right support to maintain their privacy and dignity.

Staff training was not adequate and not designed to meet the needs of people who used the service. Staff did not feel that they received adequate training and their performance was not being effectively monitored by senior management. We were told by support workers they felt unsupported and under-valued at the service. This was as a result of poor communication and a ‘them and us’ attitude within the service.

People did not have access to information about the provider’s complaints procedure as it was not tailored to the communication and cognitive needs of most people living at Barkby Road.

We found examples of poor management and leadership that impacted on the outcomes for people that used the service. Notification regarding arrangements to cover the operation officer leaving who had been covering the registered manager was only sent to us after we raised concerns with the chief operating manager.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

The inspection took place on 8 November 2016 and was unannounced. We returned on 9 November 2016 and this announced.

Barkby Road is a purpose built care home for up to 11 adults with moderate to severe learning disabilities, complex needs or challenging behaviour. The service also offers specialist support to those with autistic spectrum disorders. The accommodation is provided in the main building and in two additional separate buildings within the grounds. At the time of this inspection the separate buildings accommodated three people in total, who had greater levels of need and high levels of behaviour that challenged. On the day of our visit there were 11 people living at the service.

The service 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.

People were safe because staff understood and acted upon the procedures the provider had in place to protect people from abuse and avoidable harm. People were supported to be as independent as they wanted to be. Risks associated with their care and support and activities they participated in were assessed and managed. People also participated in activities at Barkby Road and were supported to maintain their hobbies and interests.

The provider deployed enough suitably skilled and experienced staff to meet the needs of people using the service.

People received their medicines at the right times. Only staff who were trained in medicines management handled medicines. The provider’s arrangements for management of medicines were safe.

People were supported by staff with the necessary skills, experience and training. Staff were supported through effective supervision, appraisal and training.

Staff understood they needed to respect people’s choice and decisions. Assessments had been made and reviewed about people’s individual capacity to make certain care decisions. Where people did not have capacity, decisions were taken in ‘their best interest’ with the involvement of family members where appropriate and relevant health care professionals.

People were able to choose what foods they had. Staff advised people about healthy eating options and respected people’s choices. People’s health needs were met through heath action plans. People were supported to access health services when they needed them.

People using the service and staff developed caring relationships because staff had a very good understanding of people’s needs. Staff treated people using the service with dignity and respect. People’s views were listened to and acted upon.

People received care and support that was centred on their personal needs and preferences. They spent their time how they wanted and were supported to participate in activities of their choice. Activities developed people’s skills.

The service was well led. People using the service, relatives and staff all felt well supported by the registered manager.

People using the service, their relatives and staff had opportunities to develop the service. Management and staff had a shared understanding of the aims and objectives of the service. The provider had effective arrangements for monitoring and assessing the quality of the service.

We carried out an unannounced comprehensive inspection of this service on 4 and 5 December 2014. Five breaches of legal requirements were found. This was because there was not always sufficient staff available at all times to meet people’s individual needs. The environment was not always safe for people. The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards legislation had not always been correctly adhered to. Staff had not always received an appropriate induction and ongoing training and support. There were systems used to assess and monitor the quality of the service but these were found to be ineffective.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this focused inspection the 20 May 2015 to check that they had followed their plan and to confirm that they had now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Barkby Road on our website at www.cqc.org.uk

Barkby Road is a purpose built care home for up to 11 adults with moderate to severe learning disabilities, complex needs or challenging behaviour. The service also offers specialist support to those with autistic spectrum disorders. The accommodation is provided in the main building and in two additional separate buildings within the grounds. At the time of this inspection the separate

buildings accommodated three people who had greater levels of need and high levels of behaviour that challenged. On the day of our visit there were 10 people living at the service.

Since our last inspection the home’s registered manager had left the service. 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 and associated Regulations about how the service is run. At the time of this inspection a new management team had been appointed. This included an acting manager who started on 26 February 2015; they are currently applying to become the registered manager. A new deputy manager commenced in December 2014 and a new head of operations commenced on 7 April 2015.

At our focused inspection on the 20 May 2015, we found that the provider had followed their plan which they had told us would be completed by the end on April 2015 and legal requirements had been met.

There were sufficient staff available to actively support people to engage in activities of their choice that were important to them, whilst kept them safe. Staff were seen to gain consent and involve people in discussions and decisions about their care and support.

The provider had reassessed people’s dependency needs and staffing levels had been increased to ensure people’s individual needs were met. Staff were seen to be deployed appropriately and were organised, creating a calm and relaxed atmosphere.

Improvements had been made to the safety of the internal and external environment. This included some changes to communal rooms that enhanced people’s lives and were safe. For example a new lounge had been created and the conservatory changed into a dining room.

Staff had received formal and informal opportunities to review their practice, training and development needs. This included completing training in areas such as health and safety, managing risky behaviour and medicines. Some staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and plans were in place to ensure all staff received this required training.

The new management team had taken positive action to improve the service. Staff spoke positively about the changes and that they felt better supported and included in how the service developed.

Improvements had been made to the provider’s quality assurance systems and processes on safety and quality. People were more involved and supported to express their views.

Because many people who live at Barkby Road have cognitive disability or communication difficulties, we were unable to ask all the people we met about their experiences. We spent time with people in the lounge area and conservatory. People appeared relaxed and interacted with staff members in a positive way, some were occupied with, or going out of the home to activities. Of those that did comment one person told us “I am looking forward to going on holiday on Monday”.

We observed staff talking with and assisting people throughout the time of our visit, this was done with the peoples’ privacy and dignity in mind and showed the staffs’ awareness of peoples individual support needs.

We looked at areas of care planning, nutrition, consent, staff support and medicine administration and found the home compliant in all areas.

This inspection took place over two days. We arrived unannounced on 4 December 2014 and returned announced on 5 December 2014.

At the last inspection on 11 September 2013 we found that the service was meeting the Regulations we looked at.

Barkby Road is an 11 bedded purpose built care home for adults with moderate to severe learning disability, complex needs or challenging behaviour. The service also offers a specialist support to those with Autistic spectrum disorders. The accommodation is provided in the main building and in two additional separate buildings within the grounds. At the time of this inspection the separate buildings accommodated three people who had greater levels of need and very high levels of behaviour that challenged. On the day of our visit there were 10 people living at the home.

The service had a registered manager, however following our inspection the registered manager resigned from their position and left the organisation. 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.

Relatives told us that their greatest concern was around the staffing levels. They said that this affected the opportunities for people to participate in activities. They were also concerned about the number and frequency that agency staff were used and how this affected consistency and continuity in care.

Staff were aware of their responsibilities with regard to people’s health and safety. Whilst staff had received relevant training, refresher training in safeguarding legislation and the safe administration of medicines was overdue. The service had begun an improvement plan; this was to improve the environment, including the replacement of furnishings, decoration and to raise standards in cleanliness and hygiene. We found some additional concerns with regard to the safety of the environment in some areas of the service.

The manager was in the process of arranging some training for staff to ensure they were appropriately skilled and competent in meeting people’s needs. We identified that staff had not received sufficient support and opportunities to review their practice and development needs.

We found people’s human rights were not always protected because the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had not always been adhered to.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. The manager made appropriate and timely referrals to health care professionals and recommendations were followed. Support was also provided for people to attend routine health checks.

Staff employed at the service were caring and attentive to people’s needs. However, we found that people were not always involved in decisions about their care and support or their wishes respected and acted upon. Where people had identified activities they wished to participate in they were not always supported with these.

Information was not available that advised people about independent advocacy services. People did have access to information about the provider’s complaints procedure. However, this was not tailored to the communication and cognitive needs of most people living at Barkby Road.

We found examples of poor management and leadership that impacted on the outcomes for people that used the service. After our inspection the provider told us what immediate action they had taken to make improvements and address our concerns.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.