The inspection took place on 26 June 2018 and was announced. The last inspection took place on 1 September 2016 and the service was rated good overall. We found one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because systems to ensure the safe handling of medicines were not sufficiently robust. At this inspection we found that the medicines policy and procedure had been reviewed and a number of changes made. Improvements had also been made to the systems used with regard to medicines and all staff had received further training in this area. This meant that the medicines systems were now safe.

Newbarn Limited is based in Rochdale, Greater Manchester. This service is a domiciliary care agency and provides 24-hour support, and personal care where required, to people living in their own houses and flats in the community. It provides a service to people with a range of physical and mental health needs. At the time of the inspection there were fifty people using the service.

There was a registered manager in place. 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.

Safeguarding policies and procedures for adults and children were in place. Staff undertook annual refresher training.

Recruitment procedures were robust. The service employed their own bank of experienced support staff whom they could call upon to supplement the regular staff to cover sickness or annual leave.

The medicines policy and procedure had been reviewed and updated. Some additions had been made around error reporting and staff training following the last inspection.

There was a general risk assessment and management plan and appropriate health and safety measures were in place. Accidents and incidents were recorded appropriately.

There was a thorough induction process and training was on-going at Newbarn. There were opportunities for staff to access supplementary training relevant to their roles.

Support action plans included relevant health and personal information. There was evidence that the service worked alongside other agencies to help ensure the best outcome for each individual.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA).

The service provided exceptional training for staff on equality and diversity. People’s dignity and privacy was respected by staff, who demonstrated real empathy and compassion for people they supported. Throughout our inspection we witnessed a strong person led culture; staff were highly motivated and offered kind and compassionate care.

Staff were aware of confidentiality issues and were meticulous in ensuring the confidentiality procedures were followed. Documents were suitably stored in locked cabinets and computer systems were password protected.

People who used the service were fully involved with the support planning and review processes. The service was exceptional at helping people to express their views. Opportunities for people to put forward suggestions and discuss their support included one to one conversations, questionnaires and regular tenants’ meetings.

The service encouraged a high level of independence. Positive risk taking encouraged people to take control of their own lives.

Support plans outlined people’s likes and dislikes, background, hobbies and family dynamics. People who used the service were supported to follow their own spiritual and religious beliefs and cultural practices.

Individual risk assessments clearly identified the particular risks and triggers for each person. These risk assessments were reviewed and updated on a six-monthly basis or when changes occurred.

People were encouraged to partic

This was an announced inspection which took place on 1 and 2 September 2016. The service was previously inspected in September 2014 when it was found to be meeting all the regulations we reviewed at that time.

Newbarn Limited is based in Rochdale and is registered to provide personal care and support services to people who live in their own homes. The service specialises in providing support to people with complex mental health needs or a learning disability. At the time of our inspection there were 40 people using the service.

There was a registered manager in place at the time of the 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 2008 and associated Regulations about how the service is run. The registered manager was supported by three project leads.

During this inspection we found one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because systems to ensure the safe handling of medicines were not sufficiently robust. You can see what action we have told the provider to take at the back of the full version of the report.

Our review of five people’s Medication Administration Record (MAR) charts showed these did not contain full administration details of each person’s prescribed medicines. All the charts were handwritten and had not been checked or countersigned to ensure their accuracy; as a result a person had not received their medicines as prescribed. Staff had received training in the safe handling of medicines. However, there was no system in place to regularly assess their competence in this task; particularly should a medication error occur. Although medication audits were in place, these had not been sufficiently robust to identify the shortfalls we found during the inspection.

People told us they felt safe with the staff that supported them and considered staff had the right skills and experience to meet their needs. Staff had received training in safeguarding adults. They were able to tell us of the action they would take to protect people who used the service from the risk of abuse. They told us they were regularly reminded by the registered manager regarding the whistleblowing (reporting poor practice) policy and that they would be fully supported should they report any concerns.

We were told that as far as possible people who used the service were matched with staff who shared their interests or culture; this helped to ensure they had the best chance of getting on well together in order for staff to provide the support individuals required. People who used the service told us staff were always available to provide the support they needed. During the inspection we observed staff were kind, caring and respectful in all their interactions with people who used the service.

Care records contained sufficient information to guide staff on the support people required. The care records showed that risks to people's health and well-being had been identified, such as the risk of a person using alcohol or drugs. Risks were also assessed in relation to general health and safety issues within people’s homes. We saw that plans were in place to help reduce or eliminate any identified risks. Arrangements were also in place to help ensure the prevention and control of infection.

We found that staff received the essential training and support necessary to enable them to carry out their role effectively. New staff received an induction when they started work at the service which included reading policies and procedures as well as care records. All new staff completed a period of shadowing more experienced staff; this period was used to introduce new staff to the people they would be expected to support.

Staff demonstrated a good under

During our inspection visit we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on speaking with three people who used the service, two care workers, two support mangers and the manager.

Is the service safe?

We saw that members of staff were friendly and treated people with dignity and respect. One person said, “The staff are nice they treat me well.”

The members of staff spoken with understood their role in safeguarding the people they supported.

Members of staff had received training about the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards and knew the procedure to follow if a person was unable to make decisions for themselves.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations.

We saw that detailed risk assessments were also in place in order to identify and effectively manage any risks to people using the service and care workers.

Care workers had been trained so that they knew how to safely give medicines to people who used the service.

Is the service effective?

People’s personal and social care needs and abilities were assessed with them and their relatives before any support was provided by agency staff. People were also asked about their individual preferences so that care workers knew how best to meet people’s needs.

People were registered with a GP and had access to specialists and other healthcare professionals when necessary. People were usually accompanied by members of staff to attend healthcare appointments.

People new to the service were given a service user guide which provided information about the agency and the support people could expect to receive from members of staff.

Discussion with a support manager and examination of records confirmed that induction training was in place for new employees. In addition to this a rolling programme of training was in place so that all members of staff were kept up to date with current practice.

Is the service caring?

People who used the service told us they received the help and support they needed from members of staff.

People were involved in planning and reviewing the care and support provided by the agency. People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. We saw that people had signed their individual care plan to indicate their agreement with the care provided.

People who used the service were encouraged to express their views by completing a ‘listen up’ document which provided feedback about the support provided by the agency. The completed ones we saw all contained positive comments and indicated that people were satisfied with the care they received.

Is the service responsive?

People were supported by staff to lead full and active lives. This included helping with everyday household tasks and pursuing their individual interests and hobbies both in the houses and the local community. One person said, “We do something different every day.”

People knew they could raise any concerns with the manager or members of staff at any time. They could also discuss any issues at the regular tenants meetings.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care and support in a joined up way.

There were systems in place for assessing and monitoring the quality of the service provided. We saw that audits completed regularly by the manager covered all aspects of the service provided.

Discussion with members of staff confirmed that they had received appropriate training and understood their roles and responsibilities. This helped to ensure that people who used the service received the care and support they needed. Members of staff told us the management team were approachable and supportive.

As part of the inspection, we spoke with three people who were using the services.

The people we spoke with told us they were happy with the care they received. They told us the staff discussed and reviewed their care needs with them on a regular basis.

The people we spoke with told us they were satisfied with the care staff. They told us the staff were helpful and carried out their duties appropriately.

One person said “It’s amazing; I get all the support I need, especially at appointments”.

Another person told us “The staff make me feel better”.

The people we spoke with had no complaints about the service and felt safe with the staff.