Barnfield provides care and accommodation for up to 63 people, some who are elderly and frail, others who may be living with dementia. At the time of our inspection there were 59 people living in the home.

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 and associated Regulations about how the service is run. The registered manager helped us during our inspection.

We last inspected Barnfield in June 2016 when we identified a breach of regulation relating to acting within the principals of the Mental Capacity Act. We found at this inspection this had improved.

Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). We identified some areas in relation to people’s medicines that staff needed to improve in. The registered manager took immediate action to address this immediately following our inspection.

The registered manager told us that care records were being worked through as he was aware that these needed to accurately reflect people’s needs. Although we found some improvement was required in this area we were satisfied that people received the care they required despite some records not always reflecting this.

Accidents and incidents were recorded and action taken to help prevent reoccurrence. Where people had risks related to them, these had been identified and guidance was in place for staff.

People lived in an environment that the staff checked regularly to help ensure it was safe for them. Staff were knowledgeable in relation to their responsibilities with regard to safeguarding and the registered provider carried out checks to help ensure they only employed suitable staff to work in the home.

Staff supported people to eat a good range of foods and those with a specific dietary requirement were provided with appropriate food. People had access to external health services and professional involvement was sought by staff when appropriate to help maintain good health.

People were encouraged to take part in activities both in the communal lounge and also in individual living areas. People lived in a homely environment. People’s rooms were cosy and personalised and there was programme of redecoration taking place in the home.

We found the registered manager had good management oversight of the home and there was a good culture within the team. Staff told us they felt supported and valued and we found staff had the opportunity to meet with their line manager regularly to discuss their role. Staff received an induction when commencing within the home and their training was updated routinely to ensure staff continued to work to best practice.

There were a sufficient number of staff on duty and we did not see people needing to wait for attention. It was evident staff knew people well and respected people when they wished to have time alone. Staff were caring to people and there was easy going conversation between people and staff.

People, relatives and staff were involved in the running of the home. Regular meetings were held and a questionnaire circulated so people could give their views on the care provided. Where suggestions and ideas were raised these were listened to by the registered manager.

Staff and the registered provider undertook quality assurance audits to ensure the care provided was of a standard people should expect. Any areas identified as needing improvement were actioned. Regular fire checks and fire drills were carried out to help ensure staff would know what to do in the event of an emergency and there was a contingency plan in place should the home have to close.

A complaints procedure was available for any concerns. People and relatives could also leave positive comments and feedback.

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Barnfield is a purpose built residential home that provides care and accommodation for up to 63 people, some who are elderly and frail and some who may be living with dementia. The home is divided into seven separate units, each with their own lounge and dining area. There is a main lounge area for communal use. At the time of our inspection 58 people were living at Barnfield.

This was an unannounced inspection that took place on 13 June 2016.

The home was without a registered manager as they had left the home two weeks prior to our inspection. 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. The new manager was present on the day and she and the deputy manager assisted us with our inspection. The new manager told us they would be starting the process of applying to become the registered manager.

Care records for people were not always accurate and some information around the risks identified for people was missing which meant staff may not know how to respond.

Staff had not always followed the legal requirements in relation to the Mental Capacity Act 2005. Where people had restrictions in place to keep them safe, staff had submitted the appropriate DoLS applications. Staff were heard to obtain people’s consent before they supported them.

Staff followed correct and appropriate procedures in administering medicines and medicines were stored safely and appropriately. People were cared for by a sufficient number of staff which meant they did not have to wait to be attended to. People knew who to speak to if they needed to make a complaint.

Staff knew how to look out for any signs of abuse and who they would report abuse to should they need to. The provider carried out appropriate recruitment checks on staff before they started working at Barnfield.

Were people had falls or accidents, staff took appropriate steps to help ensure the risk of reoccurrence was reduced. Staff worked with external health professionals in this respect. If the home had to be evacuated in the event of an emergency staff knew what action they needed to take.

People had care responsive to their needs. People were provided with a choice of meals each day and those who had dietary requirements received appropriate food. However, we found those people on a soft diet were not offered the same choice of meals. Staff maintained people’s health and ensured good access to healthcare professionals when needed.

There was a good atmosphere in the home where people and staff interacted in an easy-going manner. Staff were kind, caring and respectful to people and there was good relationships between staff and people. People could make their own decisions and have privacy when they wished it. Visitors were welcomed into the home and staff knew relatives well. People told us they did not get bored and they had access to a range of activities which they enjoyed.

Care was provided to people by staff who were trained and received relevant support from their manager. This included regular supervisions and an annual appraisal with their line manager.

Care plans were individualised and contained information to guide staff on how someone wished to be cared for. Information included detail around people’s mobility, food and personal care needs. Some agency staff did not always know relevant information about people, however there was always a permanent member of staff on each unit to assist. People moving into the home may not always have been made to feel welcome. The manager was aware that pre-assessment information needed to be completed in a more comprehensive way.

Quality assurance checks were carried out to help drive improvement within the home. The manager had their own action pla

Barnfield provides care and accommodation for up to 63 people who are elderly and frail and may be living with dementia. The home, which is set over two floors, is divided into seven units, each with their own lounge and dining area. Each unit accommodates approximately eight people. There is also a main dining and lounge area on the ground floor and a level garden to the rear of the building. On the day of our inspection, 59 people were living in the home and four people were receiving respite care.

This inspection took place on 2 October 2014 and was unannounced.

The home is run by a registered manager, who was present on the day of the inspection visit. 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.

People said that they felt safe in the home and staff had written information about risks to people and how to manage these in order to keep people safe.

There were a high number of falls recorded for the service. The registered manager and staff recognised this and were investigating alternative ways to reduce these falls and we heard that more work was needed. Our observations identified a need for additional members of staff to be on duty as there were times when we found no staff available to assist people or keep them safe. During a fire alarm we were told staff remained in each unit, however we did not find this to be the case. One unit had people who required two staff to support and move safely each person, however on the day of our inspection there was only one staff on duty.

While some people were very happy, others were not. One person told us they may have to, “Wait longer in the morning because staff were busy.” One relative said, I often have to go and find staff.” Another told us, “They are very short staffed, especially at the weekend.”

Although people told us they were happy living at Barnfield, we did not observe staff consistently demonstrating kind or empathetic care to people. We saw some people sitting for long periods of time with little interaction from staff and one person told us staff had forgotten to take them to the day centre despite asking them to do so.

Activities were limited to people who had capacity to become involved. We did not see any specific activities or pastimes which would be suitable or appropriate to people living with dementia. Although each unit had an ‘activities’ box, we did not see any staff carry out activities with people. Staff told us, “I try to do something, but I won’t have time today” and, “I feel my role is very task orientated.”

Staff recruitment processes were robust to help ensure the provider only employed suitable people. Staff had been trained in safeguarding adults, and discussions with them confirmed they knew the action to take in the event of any suspicion of abuse.

Medication processes and procedures for the safe administration of medicines were in place. Records were up to date and staff checked they gave the correct medication to the right person.

Staff were provided with a full induction and training programme before they worked unsupervised. Other training was available to staff should they request it and the staff had a ‘train the trainer’ programme which meant staff could carry out training in-house.

The registered manager and staff explained their understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). They current had no one living at the service who was restricted in any way.

People were provided with a choice of meals each day and facilities were available for staff to make or offer people snacks at any time during the day. We heard how relatives could join their family member for lunch if they wished. Staff respected people’s choice in where they ate their meal. Generally People felt the food was good.

We read in people’s care plans staff ensured they were given access to healthcare professionals when needed. For example, the doctor or district nurse. A healthcare professional told us staff referred people to them appropriately when they had concerns.

Care plans were individualised and contained information to guide staff on how someone wished to be cared for. Staff knew people well and were able to describe detailed information about people. Care plans were reviewed regularly although we did find some care plans which needed updating.

People’s views were obtained by holding residents meetings and sending out an annual satisfaction survey. Complaint procedures were up to date and people and relatives told us they would know how to make a complaint, although we heard from one relative they felt their complaints were not always responded to.

The registered manager told us how they were involved in the day to day running of the home. They said they had breakfast in each unit in turn during the week in order to talk to people.

Staff were supported to develop professionally and progress in order to improve their skills and working practice. Staff meetings were held on a regular basis and one care staff told us they were encouraged to, “Suggest new ideas.”

The provider had effective quality assurance systems in place to audit the home. This included regular audits on health and safety, infection control and medication. The registered manager met CQC registration requirements by sending in notifications when appropriate. We found both care and staff records were stored securely and confidentially.

We found the registered manager had undertaken a lot of work since starting at the service and improvements had been made. However, we felt through our observations and by speaking to both people and staff that further work was needed to ensure the service was consistently well-led, cared for people in a way they should expect and provided people with meaningful activities.

During the inspection we found breaches of Regulation 17 and Regulation 22 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 the report in relation to the breaches in regulation.

People's needs were assessed and care and treatment was planned and delivered according to people's individual care plans.

There were fifty four people in the home on the day of our inspection, two people were in hospital and there were seven empty beds. We met and spoke with several people throughout the home during our visit. People told us they liked living in the home and were well cared for. They also said the staff were kind and caring.

We were told that people had the opportunity to visit the home if possible before they moved there to ensure they were happy with the choice. Relatives did this when people were unable to visit for themselves.

We saw the home was clean and hygienic and people were satisfied with the standard of cleanliness.

People told us they liked their rooms and had everything the needed to help them feel comfortable.

We saw a wide range of activities in place which were outlined in the "Barnfield Newsletter". The home also had a day care service located on the ground floor where people from the community came and people who used the service also used for planned activities.

Staff told us they liked working in the home. They said they received the training and supervision necessary to undertake their roles. We saw staff were caring and professional in their manner and had a good understanding of people's care needs.

We saw systems in place that monitored quality assurance.

During the visit, we spoke with four people who use the service. They told us the staff explained what they were doing and asked for permission before they delivered care.

The people we spoke with told us they were happy with the care they received. One person told us there were plenty of activities for people to be involved in. Another person told us she sometimes did not like the food offered but the staff always prepared an alternative meal.

The people we spoke with told us they had no concerns with their medication and felt they were well supported by the staff. They told us they were happy with the staff and told us they were treated well. They also told us that they had no concerns about the care they received.

People told us that they were happy living at Barnfield. They told us that they were given the choice about living in the home and some people were able to visit the home before they came to live there.

People told us that they had their own room and had some of their own furniture with them as it makes them feel like they are at home.

People told us that the staff were very kind and caring. Relatives told us that they kept informed about care and treatment and are made welcome in the home.

People told us that there was always something to do if they wanted to participate in activities but also had the opportunity to spend time alone.

We were given good feedback regarding the food and standard of catering.

People felt that there was sufficient staff employed in the home to meet their needs.