About the service: Barrowhill Hall is a care home that was providing personal and nursing care to 58 people at the time of the inspection.

People’s experience of using this service: Since the last inspection, a large number of improvements had been made at the service. Some improvements needed to be further developed, embedded and sustained. Medicines management had improved but still required some improvement to ensure it was consistently safe.

People felt safe and were happy with the care they were receiving. There were enough staff to meet people’s needs and give people the time and reassurances they needed.

Staff were well trained and supported and knew how to protect people from abuse and avoidable harm and how to reduce people’s risks. Staff knew people well and catered for people’s preferences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had access to activities they enjoyed and were encouraged to maintain their independence and participate in the running of the service when they wanted to. People were involved in developing their own care plans which were regularly reviewed.

There was a new registered manager since the last inspection and people, relatives and staff felt they were approachable and supportive. The provider was also accessible to people and staff, listened to feedback and had plans for further improvements at the service.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The service met the characteristics of Good in three areas but has been rated Requires Improvement overall; more information is in the full report.

Rating at last inspection: At the last inspection the service was rated Inadequate (supplementary report published 1 December 2018)

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor the intelligence we receive about this service and inspect again within 12 months. If we receive information of concern, we may bring planned inspections forward.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 20, 21 and 28 August 2018 and was unannounced.

Barrowhill Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Care and support is provided over two buildings, Barrowhill Hall and Churnet Lodge. Barrowhill Hall is spilt into smaller ‘units’ with Dove House located upstairs. The service is registered to provide care support for up to 74 people. At the start of this inspection 66 people were using the service.

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.

At the last inspection in December 2017, the home was rated as Requires Improvement overall. At this inspection, we found that improvements had not been made and the home was rated ‘Inadequate’ and 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.

There were not enough staff deployed effectively to keep people safe or to meet their needs. We told the provider about our concerns and they increased staffing levels but we still found that staffing impacted on the safety and quality of care people received, including their mealtime experience.

Risks to people's safety, health and wellbeing were not always suitably assessed, monitored and managed. There was a lack of clinical oversight and the systems in place did not support safe risk management.

We found that medicines were not managed safely and people were at risk of not receiving their medicines as directed by the prescriber.

The registered manager and provider had not operated effective governance systems to ensure that the safety and quality of the service were adequately monitored and improvements made when required. Some people did not know who the registered manager was and not all staff felt supported and involved.

Staff knew how to recognise and report abuse but the systems in place meant the provider could not be confident that people were kept safe from potential abuse and avoidable harm. People’s nutritional risks were not managed and mitigated though people

We inspected this service on 18 December 2017. It was an unannounced inspection. Barrowhill Hall is a care home which accommodates 74 people in two buildings, some of whom are living with dementia. In the main hall, 50 people with nursing needs are supported in three separate households, arranged over two floors. Each has a communal lounge and dining area. Churnet Lodge is a separate, purpose built building which supports 24 people with residential needs in accommodation arranged on one level, with an open plan communal lounge and dining area. On the day of our inspection visit, 69 people were living at the home.

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.

At our last unannounced inspection on 3 November 2016, we rated this service as Requires Improvement. This was because the provider was not meeting all the regulations; improvements were needed to ensure that risks associated with people’s care were always safely managed and that there were sufficient staff on duty to meet people’s needs at all times. We asked the provider to complete an action plan to show what they would do and by when. At this inspection we found that the provider had taken action to meet the regulations but some further improvements were

needed.

Improvements were needed to ensure people always received their medicines as prescribed and that the legal requirements and good practice were always followed when people lacked the capacity to make decisions about taking medicines.

Risks to people had been identified and staff understood how to support people to reduce risk and protect them from potential harm whilst maintaining their independence. However, improvements were needed to ensure staff supported people in a consistent manner when they presented with behaviours that challenged.

People had been consulted about how they wanted to be supported and had care plans which reflected their needs and preferences. These were kept under review to ensure they remained relevant. Recruitment checks were made to confirm staff were suitable to work in a caring environment and sufficient staff were available to meet people's needs.

People felt safe living at the home. The staff knew how to protect people if they suspected they were at risk of abuse or harm and how to report concerns. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff knew people well and provided care that met their preferences. Staff promoted people’s independence and maintained their privacy and dignity at all times. People were supported to eat a healthy diet and had regular access to healthcare professionals. People were offered opportunities to take part in activities and follow their interests.

People and their relatives felt there was a positive, inclusive atmosphere at the home. They knew how to raise any concerns or complaints and were confident these would be acted on. People were offered opportunities to take part in activities and follow their interests. The registered manager and provider carried out checks to ensure the quality and safety of the service and encouraged people, relatives and staff to give their feedback to make improvements where needed.

This is the second time the service has been rated Requires Improvement.

This inspection took place on 3 November 2016 and was unannounced. At the last inspection on 5 November 2015, the service was rated as Good overall, but we asked the provider to make improvements to ensure people’s medicines were managed safely. The provider sent us an action plan on10 December 2015 which stated how and when they would make improvements to meet the legal requirements. At this inspection, some improvements had been made but further action was still needed. We also identified that improvements were needed to ensure risks associated with people’s care were managed safely and staff were deployed effectively to meet people’s needs at all times.

Barrowhill Hall has recently been extended and now provides accommodation, personal and nursing care for up to 74 people. The service is provided across two units, the main hall, which accommodates up to 50 people on two floors, and the newly built Churnet unit, which accommodates up to 24 people. At the time of our inspection, 51 people were using the service, some of whom were living with dementia. There was a registered manager at 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 2008 and associated Regulations about how the service is run.

At the last inspection we asked the provider to take action to ensure people’s medicines were managed safely. At this inspection we found improvements had been made and people received their medicines when needed. However, further action was needed to ensure staff took a consistent approach when administering medicines prescribed on an as and required basis.

The provider had not made the required improvements to the deployment of staff. Staffing levels were not sufficient to meet people’s needs in some areas of the home and people did not always receive timely support. Risks to people were not always well managed and some people’s care and treatment was not consistently planned and delivered in a way that ensured their safety and welfare.

Improvements were needed to ensure the manager’s quality monitoring checks were consistently effective in identifying shortfalls and making improvements where necessary.

The provider followed procedures to ensure staff were suitable to work in a caring environment and staff understood their responsibilities to protect people from the risk of abuse. Staff had received training to know how to support people and maintain their wellbeing but improvements were needed to ensure they received ongoing support to fulfil their role. People were supported to make their own decisions and where they needed help, decisions were made in their best interest and involved people who were important to them. Where people were restricted of their liberty in their best interests, for example to keep them safe, the required legal authorisations had been applied for. However, improvements were needed to ensure staff fully understood the requirements of the legislation.

Staff knew people well and encouraged them to have choice over how they spent their day. Staff had caring relationships with people and promoted people’s privacy and dignity and encouraged them to maintain their independence. People had sufficient to eat and drink and were able to access the support of other health professionals to maintain their day to day health needs. People were offered opportunities to join in social activities and were encouraged to follow their hobbies and interests. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes.

People and their relatives felt able to raise any concerns or complaints and were asked for their views on the quality of the service. Staff felt supported by their colleagues and th

We inspected this service on 5 November 2015. This was an unannounced inspection. Our last inspection took place in August 2013 and at that time we found the home was meeting the regulations we looked at.

The service provides support to 50 older people, some of who may be living with dementia. At the time of the inspection there were 45 who used the service.

There was a registered manager in 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 2008 and associated Regulations about how the service is run.

Medicines were not always managed safely as we saw some medicines were given to family members to administer. The provider had not assessed the risk and staff did not check these had been administered and recorded correctly. Some medicines we saw were touched by staff or broken in half without necessary standards being maintained to ensure the integrity of the tablets were not compromised and risks were minimised in handling medicines. Improvements need to be made in this area.

The provider had reviewed the staffing levels to meet the needs of people who used the service. We saw there were sufficient staff working although at certain times of the day, especially at lunch time the way staff were deployed meant that staff were busy and were not always able to meet people’s needs in a timely manner.

People told us they felt safe and were confident that staff supported them in a manner which protected their welfare. Staff understood what constituted abuse or poor practice and there were systems and processes in place to protect people from the risk of harm.

People’s care needs were planned and reviewed regularly to ensure their care continued to meet their needs. Staff received training to meet identified needs to ensure they could effectively met people’s identified needs.

People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. Staff sought people’s consent before they provided care and support. Where people were not able to make decisions for themselves, they were supported to make decisions that were in their best interests with the help of people who were important to them. Where restrictions were placed upon people these had been assessed and applications made to appropriate authorities to ensure any restriction was lawful.

People were supported to eat and drink and breakfast time was flexible so people could arise at a time that suited them. Specialist diets were catered for and alternative meals could be provided upon request.

Health care professionals visited the service regularly to provide additional healthcare services to people. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

People told us the staff were kind and treated them with dignity and respect. People’s care was tailored to meet their individual needs. Care plans detailed how people wished to be cared for and supported.

People were confident they could raise any concerns with the registered manager or staff and were complimentary about the registered manager and staff. They told us the registered manager was always available and was approachable. They were encouraged and supported to provide feedback on the service. The provider had effective systems in place to review the quality of the service provided.

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

This inspection was unannounced which meant the provider and the staff did not know we were coming. Thirty three people were in residence when we undertook our inspection. We spoke with four people living in the home, three visitors, three visiting professionals, five staff and the registered provider. People spoke well of the home, one person using the service said, “I have settled here, it is very nice, the staff are friendly and kind.”

We found people were safe because the staff were given clear instructions, support and guidance. One relative had recorded on a comment card, ‘My relative is safe in your care because everything is excellent.’

We saw people were treated with care and compassion and the staff responded well to their needs or concerns.

We saw the home could demonstrate how arrangements to seek people’s consent to care or treatment had been agreed in the person’s best interests.

We looked at the cleanliness and suitability of the environment to ensure people lived in a home where the décor and infection control standards were appropriate. We found the home was clean, safe and well maintained.

We saw medicine was managed effectively and was stored, handled and administered safely.

We found the service was well led because the registered manager supported the staff team and managed risks to the service effectively.

At our last inspection on the 23 September 2012 we found the provider was meeting seven of the eight essential standards of quality and safety that we inspected. The provider was non complaint in one outcome. They needed to provide more information in care records and ensure the staff were clear of the needs of the people who used the service.

On this inspection we only looked where non compliance was evident previously. We found improvements had been made, the service was compliant in the outcome area we looked at. The provider could demonstrate they had informative care records in place to ensure the home provided good care, treatment and support for the people who lived there.

We spoke with four people using the service, four staff and the registered manager. No visitors were available to speak with us during our inspection.