We carried out an unannounced inspection of Barnfold Cottage Residential Home on 4 and 5 July 2018.

Barnfold Cottage Residential Home is registered to provide accommodation and personal care for up to 14 people. Nursing care is not provided. Accommodation is provided over two floors. At the time of our inspection there were 11 people living at the home.

The service 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 we looked at both during this inspection.

At the last inspection on 18 April 2017, we found five breaches of the regulations. These related to medicines not always being safely managed, a lack of effective infection control processes, a lack of quality audits, a lack of compliance with the Mental Capacity Act 2005 (MCA) and appropriate action not always being taken to manage people’s risks. Following our inspection, the provider sent us an action plan and told us that all actions would be completed by 20 June 2017.

At this inspection we found that improvements had been made and the provider was meeting all regulations reviewed.

People who lived at the home and their relatives were happy with staffing levels. They told us staff provided them with support when they needed it.

Records showed that staff had been recruited safely and the staff we spoke with were aware of how to protect people from abuse or the risk of abuse.

People told us the staff who supported them were kind and caring and respected their right to privacy and dignity. They told us staff encouraged them to be as independent as they could be and we saw evidence of this during the inspection.

Staff received an effective induction and appropriate training. People who lived at the service and their relatives felt that staff had the knowledge and skills to meet their needs.

People received appropriate support with nutrition and hydration and their healthcare needs were met. Referrals were made to community healthcare professionals to ensure that people received appropriate support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice. Where people lacked the capacity to make decisions about their care, the service had taken appropriate action in line with the Mental Capacity Act 2005.

People told us that they received care that reflected their individual needs and preferences and we saw evidence of this. Staff told us they knew people well and gave examples of people’s routines and how people liked to be supported.

People were supported to take part in activities and events. They told us they were happy with the activities that were available at the home.

Staff communicated effectively with people. They supported people sensitively and did not rush them when providing care. People’s communication needs were identified and appropriate support was provided.

The registered manager regularly sought feedback from people living at the home and their relatives about the support they received. We saw evidence that she used the feedback received to develop and improve the service.

People living at the service and staff were happy with how the service was being managed. They found the registered manager approachable and supportive.

A variety of audits and checks were completed regularly by the registered manager. We found that the audits completed were effective in ensuring that appropriate levels of quality and safety were being maintained at the home.

This unannounced inspection of Barnfold Cottage Residential Home took place on 18 April 2017.

Located in a residential area and near to local facilities, Barnfold Cottage is registered to provide accommodation and personal care for up to 14 older people. There were 13 people living in the home at the time of this inspection.

Because the registered person is an individual, under current legislation there is no requirement to have a manager registered with the Care Quality Commission to manage this service. The registered person has responsibility for the day to day operation of the service. They have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. However the registered provider told us they had asked the deputy manager to take over much of the day to day running of the service and therefore intended that this person would apply to register with CQC as manager of the service.

Our previous inspection was undertaken in December 2014 when we identified two breaches of regulations; this was because the registered provider has failed to notify CQC of certain reportable events. Following the inspection the registered provider wrote to us to tell us the action they intended to take to ensure they met the relevant regulations. During this inspection we found the registered provider had fulfilled their legal responsibility to submit required notifications.

During this inspection we identified five breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because medicines were not always safely managed, proper infection control procedures were not followed and action had not always been taken to mitigate identified risks. In addition people’s rights had not always been protected when they were unable to consent to their care in Barnfold Cottage. The lack of formal documented audit processes had led to the shortfalls identified during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

We identified shortfalls in the management of medicines. This was because we found evidence that people had not always been given their medicines as prescribed. Discrepancies were found between the stocks of medicines and the records held for two people who used the service. In addition the system for managing controlled drugs was not sufficiently robust to ensure these medicines were not misused.

Proper infection control procedures were not followed in the home. Laundry facilities did not meet required standards. No system for colour coding cleaning equipment was in place which increased the risk of cross infection. Two large areas of peeling plaster in the main lounge area meant these areas could not be thoroughly cleaned.

Although risk management plans were in place for people, we noted one person had experienced seven falls between February and April 2017. We could not find any evidence that consideration had been given to additional strategies which could be put in place, such as the use of a pressure/sensor mat to alert staff if the person tried to move independently, in order to help minimise the risks of future falls occurring.

The registered provider and deputy manager did not have a thorough understanding of the Deprivation of Liberty Safeguards (DoLS). There was also no system in place to review whether people remained able to consent to their care in Barnfold Cottage. During the inspection the deputy manager identified one person who potentially lacked capacity to consent to live at the home; the lack of any legal safeguards for this person meant there was a risk their rights had not been properly protected.

There was a lack of robust quality assurance processes in the home. Although the registered provider had distributed satisfaction surveys to people who used the service and their relatives, the responses to which had be

This unannounced inspection of Barnfold Cottage Residential Home took place on 9 December 2014. Our previous Inspection was undertaken in June 2013 when we found that the service was meeting all of the outcomes we assessed. This inspection was undertaken by one Adult Social Care Inspector.

Located in a residential area and near to local facilities, Barnfold Cottage is registered to provide personal care and accommodation for up to fourteen people. There were fourteen people living at the home at the time of our inspection.

Because the registered person is an individual, under current legislation there is no requirement to have a manager registered with the Care Quality Commission to manage this service. The registered person has responsibility for the day to day operation of the service. They have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People said they felt safe living at the home and were supported in a safe way by staff. Staff understood what abuse was and the action they should take to ensure actual or potential abuse was reported.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. There were enough qualified and skilled staff at the service. Staffing was managed flexibly to suit people's needs so that people received their care when they needed it. Staff had access to information, support and the training they needed to do their jobs well. The provider’s training programme was designed to meet the needs of people using the service so that staff had the specialist knowledge they required to care for people effectively.

People were provided with a range of activities in and outside the service which met their individual needs and interests. The service supported people to be as independent as possible.

Care plans contained information about the health and social care support people needed and records showed they were supported to access other professionals when required. People agreed to the level of support they needed and how they wished to be supported. Where people's needs changed, the provider responded and reviewed the care provided. Our review of a selection of care records informed us that a range of risk assessments had been undertaken depending on people’s individual needs.

People told us they received their medication at a time when they needed it. We observed that medication was administered to people in a safe way.

The building was clean, well-lit and clutter free. Measures were in place to monitor the safety of the environment.

People we spoke with told us the deputy manager and staff communicated well and kept them informed of any changes to their health care needs. People said their individual needs and preferences were respected by staff. They were supported to maintain optimum health and could access a range of external health care professionals when they needed to.

People spoke highly of the meals and the general meal time experience. They told us the food was very good and they got plenty to eat and drink.

People described management and staff as caring, considerate and respectful. Staff had a good understanding of people’s needs and their preferred routines. We observed positive and warm engagement between people living there and staff throughout the inspection.

Staff told us they were well supported through regular supervision and appraisal. They said they were up-to-date with the training they were required to undertake.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). We found the location to be meeting the requirements of DoLS. There had been no applications made in respect of an individuals under the DoLS process but we were informed that an application was being considered with respect to one person living at the home.

The culture within the service was open and transparent. Staff, people living there and a visiting professional said the registered provider was approachable and inclusive. They said they felt listened to and involved in the running of the home.

Staff were aware of the whistle blowing policy and said they would not hesitate to use it. Opportunities were in place to address lessons learnt from the outcome of incidents, complaints and other investigations.

A procedure was established for managing complaints and people living there were aware of what to do should they have a concern or complaint. We found that complaints had been managed in accordance with the complaints procedure.

Audits or checks to monitor the quality of care provided were in place and these were used to identify developments for the service.

Although records of events occurring within the home were well recorded we found that the registered provider has failed to notify CQC of certain reportable events. We found a number of breaches of the Health and Social Care Act 2008 (Registration) Regulations 2009. Youcan see what action we told the registered provider to take at the back of the full version of this report.

We spoke with four people living in the home who told us they were happy with the care and support they received. Comments included, "It's a lovely place; I'm very comfortable", "I can do what I want to do and can get help if I need to" and "I'm very well looked after; they are lovely caring staff".

People told us they enjoyed the food. Comments included, "The food is very good; I've really enjoyed my meals since coming here. I had lost my appetite for food," "We get plenty to drink through the day with cakes and biscuits" and "I like the food; I can choose what I want".

Records we looked at showed people's needs were assessed and care and treatment was planned and delivered in line with the individual care plan. We found that the care plans were accompanied by risk assessments and risk management plans to ensure people were protected from unsafe care practices.

People we spoke with told us they received appropriate support with their medication. We found evidence that there were effective systems in place for the safe administration of medicines.

We saw evidence that there were effective recruitment procedures in place to ensure that people who used the service were protected from inappropriate staff.

People told us they were satisfied with the quality of care and support they received. We were told the staffing levels were sufficient to meet the needs of people living in the home and that the staff were professional, caring and friendly.

People made various positive comments about the staff team. Comments supporting this view included: "They talk to me and ask if anything has changed or do I want things doing differently." "I feel really well looked after here."

People were provided with care plans which were reviewed regularly and updated when required. People said they felt safe living in the home and were able to discuss concerns or issues with the staff if they wished to.

There were comprehensive auditing and reviewing procedures in place to identify any areas where improvements could be made.

People said that staff respected their privacy and dignity. Personal care was provided in the privacy of their bedroom and bathroom. People told us that staff provided them with

choices. They were able to choose what clothes they wished to wear and what time to rise

and retire.

People told us they were happy living in the home and that the staff treated them well and with respect. People said they enjoyed the food.

We were told that there was "Not a lot to do" and that people tended to "Sit around

watching television".

People spoken with told us; "The staff are very kind", "The food is nice, you get a

choice", "I can go to bed when I want" " I've made some friends since moving here".