This unannounced inspection took place on 7, 8 and 9 March 2018.

Barleycroft 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.

Barleycroft is a purpose built 80 bed service providing accommodation and nursing care for older people, including those living with dementia. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. For example, hoists and adapted baths are available. 54 people were using the service when we visited.

The service did not have a registered manager but a new manager had been in post since February 2018 and had started the process to register with CQC. 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 on 22 and 23 February 2017, we found two breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The lack of consistent and specific information about people's needs placed them at risk of not receiving the care they required and wanted. The registered person had not adequately monitored, assessed and improved the quality of the services provided. Following the last inspection, the provider completed an action plan to show what they would do to improve the service and meet the requirements.

At this inspection, we found that action had been taken. Care plans had been reviewed and improved to better reflect the care people needed. Some further development was needed to make them clearer and to support further consistent practice and this formed part of the services future action plan.

Systems to monitor the service provided had been changed and strengthened. However, further work was needed to ensure people received a good quality of service and legal requirements met.

Staffing levels and deployment were not sufficient to meet people’s needs and to enable them to be supported in a way that they wished. Staff training was not always up to date and therefore did not ensure staff the necessary skills and knowledge to meet people’s assessed needs.

The provider’s recruitment process was not always operated effectively to ensure staff were suitable to work with people who need support.

Staff were aware of their responsibilities to ensure people were safe and action was taken if there were any concerns or possible abuse. People told us they felt safe at Barleycroft and were supported by kind and caring staff. Systems were in place to minimise risk and to ensure that people were supported as safely as possible.

People were encouraged to do things for themselves and staff provided care in a way that respected people's privacy and dignity.

Systems in place supported people to receive their prescribed medicines safely and they were supported to receive the healthcare they needed. If there were concerns about their eating, drinking or weight, this was discussed with the GP and support and advice were sought from the relevant healthcare professional.

Staff supported people to make choices about their care and systems were in place to ensure they were not unlawfully deprived of their liberty. Systems were in place to ensure that decisions made in people’s best interest protected their human and legal rights.

Staff and relatives were positive about the changes implemented by the new management team.

We saw that staff supported people patiently, with care and encouraged them to do things for themselves.

People’s nutritional needs were met and they were happy with the food provided. We recommend

This unannounced inspection took place on 22 and 23 February 2017. Barleycroft is a purpose built 80 bed care home providing accommodation and nursing care for older people, including people living with dementia. When we visited, 47 people were using the service.

The service does not have 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 and associated Regulations about how the service is run. A new manager has been in post since 12 December 2016 and has started the registration process.

At our comprehensive inspection on 19 and 20 July 2016, we found that people’s healthcare needs were not consistently met, some care plans contained contradictory instructions or were not sufficiently detailed and management systems had not ensured that required improvements had been made. At this inspection, we found action had been taken and people’s healthcare needs were monitored and addressed. Action had also been taken with regard to care planning and quality improvement. New quality monitoring systems were gradually being embedded, some care plans were more detailed and plans were in place to review and improve the remainder. Further work was needed to fully meet the breaches in regulations identified at the comprehensive inspection and there was an action plan in place to do this.

Staffing levels were sufficient to meet people’s needs.

People told us they felt safe at Barleycroft and that they were supported by kind, caring staff who treated them with respect. One person told us, “Yes, I do feel safe, the staff always come and cheer me up.”

Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in an environment that was suitable for their needs. In one unit, the carpets had been replaced and redecoration was taking place.

Staff received training and support to carry out their duties and felt that this was the right training for the job they did. Not all staff training was up to date but this was being addressed by the manager.

Systems were in place to ensure that people were not being unnecessarily or unlawfully deprived of their liberty. However, evidence was not always in place to support that decisions were made in people’s best interests.

People were supported by kind, caring staff who treated them with respect. Relatives had written positive comments including, “Thank you so much for looking after our [family member] so well. It's a great comfort to know they were in such caring hands.”

People were encouraged to do things for themselves and staff provided care in a way that promoted people’s dignity.

People were happy with the food provided and their nutritional needs were met. If there were concerns about their eating, drinking or weight, this was discussed with the GP and support and advice were sought from the relevant healthcare professional.

The arrangements for administering medicines were safe and people received their medicines as prescribed.

Systems were in place to safeguard people from abuse and staff were aware of how to identify and report any concerns about people’s safety and welfare.

Staff were trained to identify and report any concerns about abuse and neglect and felt able to do this.

The provider’s recruitment process ensured staff were suitable to work with people who need support.

Social and recreational activities and events were available and most people were happy with the activities offered.

A complaints procedure was in place and relatives knew how and who to complain to when needed.

Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.

We found two breaches of the Health and Social Care Act 2008 (Regulated

We carried out an unannounced comprehensive inspection of this service on 19 and 20 July 2016. Breaches of legal requirements were found and we also issued a warning notice in respect of a serious breach of the regulation relating to medicines. After the inspection, the provider wrote to us to say what they would do to meet the requirements of the warning notice and the other breaches. We carried out this unannounced focused inspection on 8 November to check that the requirements of the warning notice had been met and that they were following their plan to meet legal requirements. This report only covers our findings in relation to this. We inspected the service against four of the five questions we ask about services: Is the service safe, effective, responsive and well-led? This was because the service was not meeting legal some requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Barleycroft Care Home on our website at www.cqc.org.uk.

Barleycroft is a purpose built 80 bed care home providing accommodation and nursing care for older people, including people living with dementia. When we visited 62 people were using the service.

The service does not have 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 and associated Regulations about how the service is run. A new manager has been in post since 26 September 2016 and is not registered.

People were no longer placed at risk of harm from unsafely managed medicines. Unused and unwanted medicines were safely recorded, stored or disposed of. Guidance from the pharmacist had been followed and medicines were safely administered.

The process for obtaining cover for staff absences had been reviewed and strengthened to help facilitate cover being put in place at short notice. People told us that there were still occasions when cover could not be found but the situation had improved.

The system for accessing cleaning and personal care items had been changed and sufficient stocks were available and accessible at all times.

There was an action plan in place to address shortfalls in the service. The provider had increased their visits to the service to monitor the quality of care provided and to ensure that changes were being made.

New care plans were being introduced and about 40% had been changed. The new care plans were more detailed and covered people’s needs. They had been reviewed and updated when necessary. This lessened the risk of them receiving inconsistent or unsafe care that did not meet their needs.

There are two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 identified at the last comprehensive inspection. You can see what action we told the provider to take at the back of the full version of the report.

This unannounced inspection took place on 19 and 20 July 2016. Barleycroft is a purpose built 80 bed care home providing accommodation and nursing care for older people, including people living with dementia. When we visited 65 people were using the service.

The service has 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 and associated Regulations about how the service is run.

At the last inspection on 4 September 2015 we asked the provider to take action to make improvements with regard to medicines, monitoring and improving the quality of the service and care planning. The provider sent us an action plan detailing the action they were taking to meet these requirements. They said that this would be completed by 31 January 2016. However, these actions have not been completed.

The arrangements for administering medicines were not safe. Unused and unwanted medicines were not safely recorded, stored or disposed of. Guidance from the pharmacist had not been followed and medicines were not safely administered. This placed people at risk of harm from unsafely managed medicines.

The provider had systems in place to monitor the service provided and people were asked for their feedback. However, internal audits and monitoring had not identified the issues found during the inspection. In addition the management systems had not supported the necessary improvements to address the shortfalls identified at the last inspection.

People’s individual files contained information about their life history, likes, dislikes, and religious beliefs. However, care plans were not always in place to meet all of their needs. For example, for epilepsy management. Also some care plans contained contradictory instructions or were not sufficiently detailed. This placed people at risk of receiving inconsistent or unsafe care that did not meet their needs.

At the last inspection on 4 September 2015 we also asked the provider to take action to make improvements with regard to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and this had been completed. Systems were in place to ensure that people’s human rights were protected and that they were not unlawfully deprived of their liberty.

Staffing levels were sufficient to meet people’s needs but we have recommended that the process for obtaining cover for staff absences be reviewed and strengthened to enable cover to be put in place at short notice.

During our inspection we noted some cleaning and personal hygiene items were not readily available, and we found that there was not any toilet paper or soap in one toilet, and no hand cleanser in the pump in the clinic room or nurses’ station. This was remedied straightaway and we have recommended that the system for managing cleaning and personal care items be reviewed so that sufficient stocks are available and accessible at all times.

People told us they felt safe at Barleycroft and that they were supported by kind, caring staff who treated them with respect. One person told us, “I’m quite well looked after. I don’t feel threatened, I feel safe.”

The provider’s recruitment process ensured that staff were suitable to work with people who need support.

Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in an environment that was suitable for their needs. In one unit the carpets needed replacing and this had already been identified for action by the registered manager and the provider

People nutritional needs were met and they were very happy with the food provided. They said the chef was very helpful and accommodating.

Staff said they received the training they needed to provide to meet people’s needs and a plan was in place to ensure that train

When we visited this service on 18 and 19 March 2014 we found that the provider was in breach of the regulation that related to medicines. People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. The provider sent us an action plan stating the steps they would take to address the issues identified.

We carried out an unannounced comprehensive inspection of this service on 15 and 16 October 2014 at which we found that this breach of legal requirements had still not been met. This was because the systems in place for the administration of medicines were not safe. Some people had not received all their medicines as prescribed which, was a risk to their health and welfare. Concerns identified in medicines audits were not responded to and there was no guidance for staff for the administration of medicines that were prescribed on an ‘as required’ basis or that should only be given under specific circumstances.

As a result of this we took enforcement action against the provider and a warning notice was served under Section 29 of the Health and Social Care Act 2008. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the warning notice and breach of regulations. We undertook a focused inspection on the 24 April 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Barleycroft Care Home on our website at www.cqc.org.uk.

Barleycroft is a purpose built 80 bed care home providing accommodation and nursing care for older people, including people living with dementia. There are three separate units. The first provides residential care, the second dementia nursing care and the third general nursing care. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. At the time of the inspection 68 people were using the service.

The service did not have 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 and associated Regulations about how the service is run.

At our focused inspection on the 24 April 2015, we found that the provider had followed their plan and the legal requirement relating to medicines had been met. Systems were in place to ensure that sufficient amounts of people’s prescribed medicines were available for administration when needed. The monitoring and checking of medicines management systems had improved and action was taken when required. Information was in place to ensure that staff knew how and when to administer medicines that were prescribed on an ‘as required’ basis or that should only be given under specific circumstances.

We found that people’s care, health and welfare needs were being met. They were happy with the quality of care that they received. One relative told us “I have no concerns about health and welfare.” Another said “they are good with care and health. My relatives have told me that they are happy there and well looked after.” A person who used the service said “brilliant, they look after people well. I know they would help me if I needed.” Systems had been put in place to ensure that any concerns about people’s health were addressed and followed up. For example staff had observed that one person had started to develop a pressure sore. This was reported immediately and the necessary pressure relieving equipment was put in place. A named nurse was taking the lead with regard to tissue viability and with support from her and the district nurse the wound had healed in a short time.

We also found that people were protected from the risks of unsafe or inappropriate care because accurate and appropriate records were maintained. Records had been reviewed and updated and staff had received training to assist them in completing records appropriately.

We found that people’s care and welfare needs were not being met.

Overall people felt that the quality of care provided at Barleycroft had deteriorated and that their care and welfare needs were not being met. They said that there had been little continuity of care due to a high staff turnover recently and also a reliance on agency staff. One relative said “over the last year the care has gradually deteriorated. Attention to detail has been missing and X has not always been kept comfortable. They lost a lot of good regular staff. We raised this at a meeting with the company and have given them a couple of months to improve things. It has been a little bit better lately.“ Another told us “there are a lot of staff vacancies and a lot of agency staff have been used. They don’t know people and sometimes have not known how to use equipment properly or safely. I feel that staff are not always noticing things and have a lack of understanding. Care has gone downhill.” At a recent relatives meeting people had strongly expressed their concerns about the service. The provider had acknowledged these concerns and agreed that there was a lot of work to be done to identify and address gaps in the service.

People told us what it was like to live at the home and described how they were treated by staff and involved in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. Through the use of SOFI we were able to observe that people's experience of the service was a positive one. Staff support was provided in a way that protected the people’s dignity and the service was meeting people’s nutritional needs.

Overall people made positive comments about the staff team and told us that they were satisfied with the way they were looked after. They told us that they were asked how they would like their care to be provided and that they were treated with dignity and respect. One relative said, “They know how to meet her needs.” People who use the service said, “They are polite and put you at ease. It’s one of the better homes” and “I am happy here, nice staff and nice food.”

This inspection took place on 27 and 28 August and 4 September 2015 and was unannounced on 27 August 2015.

Barleycroft is a purpose built 80 bed care home providing accommodation and nursing care for older people, including people living with dementia. There are three separate units. The first provides residential care, the second dementia nursing care and the third general nursing care. The service is accessible throughout for people with mobility difficulties and has specialist equipment to support those who need it. For example, hoists and adapted baths are available. When we visited 57 people were using the service.

A new manager had started work at the service on the day before the inspection and was therefore not registered. 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 had started the process to cancel their registration at the service they previously managed and to apply to be the registered manager at Barleycroft.

We found that the arrangements for administering medicines were not safe. People were not always protected from the risks associated with taking expired medicine. Medicines records were not always accurate and we could not be confident that people received all of their prescribed medicines safely.

People told us they felt safe at Barleycroft and that they were supported by kind, caring staff who supported them with respect. One relative said, “I have peace of mind when I leave that [my relative] is in a safe place. I know they are well looked after.”

The provider’s recruitment process ensured that staff were suitable to work with people who need support.

Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in a clean, safe environment that was suitable for their needs.

Robust systems were not in place to ensure that people received care and support in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People told us that the food was good and that they had a choice of food and drinks. We saw that people’s nutritional needs were met. If there were concerns about their eating, drinking or weight this was discussed with the GP and support and advice were sought from the relevant healthcare professional. For example, a dietitian.

Staff received the training they needed to provide a safe appropriate service that met people’s needs.

Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.

Arrangements were in place to meet people's social and recreational needs. There were mixed views about these. Some people said that they were satisfied with the activities and others told us they would prefer more activities or in some cases more appropriate activities.

Although people’s individual files contained information about their life history, likes, dislikes, and religious beliefs, we found that care plans were not always reviewed each month. They did not give sufficient detail to ensure that people received care and support that fully met their current needs.

The provider had systems in place to monitor the service provided and people were asked for their feedback about the quality of service provided. However internal audits had not been carried out consistently and timely action had not always been taken to address shortfalls.

There had been a number of concerns about the service and the registered provider had taken action to address the issues and improvements were happening.