Oxen Barn provides accommodation for up to six males between the ages of 18-65 with learning disabilities and autism. This home comprises of individual self-contained accommodation, with en suite bedrooms, bathroom, lounge, dining room, kitchen and a large garden. There is a separate building adjacent to the main house that contains a small gym, relaxations room, laundry, staff offices and staff training room. The home is situated in the Longmeanygate area of Leyland in Lancashire and is in a quiet semi-rural area. People are placed from various local authorities due to the specialism of the service. At the last comprehensive inspection in October 2016, the service provider had demonstrated improvements to the way services were delivered, and we judged Oxen Barn to be rated Requires Improvement. This inspection took place on 19 and 20 April 2017, and we found that further improvements had been made to the delivery of services.

The home did not have a registered manager at the time of our inspection as the previous manager had recently left the home. The previous deputy manager had been appointed to the position of manager of the home, and at the time of the inspection, he was progressing with his application to be registered with the Commission. 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.

We spoke with staff about their understanding of safeguarding procedures. Staff we spoke with were knowledgeable about how to recognise different types of abuse. They were also aware of how to report potential safeguarding issues both internally and to external agencies such as the local authority and Care Quality Commission (CQC). Records showed that staff had been recruited safely and they received an appropriate induction.

Staff received regular supervision and their practice was observed regularly to ensure that they were providing safe care. Staff told us they felt well supported by management at the service. Staff competence to administer medicines safely was assessed regularly, and medicines were found to be stored and administered safely. Staff had completed training that enabled them to improve their knowledge in order to deliver care and support safely.

People were supported with their healthcare needs and were referred to healthcare professionals when appropriate.

Staff understood the main principles of the Mental Capacity Act 2005 (MCA) and supported people to make everyday decisions about their care. Where people lacked the capacity to make decisions about their care, their relatives were consulted.

We observed staff displayed caring and meaningful interactions with people and people were treated with respect. We observed people’s dignity and privacy were actively promoted by the staff supporting them.

People living in the home were supported to access activities and pass times of their choice. There was a clear management structure in place and staff were happy with the level of support they received.

We saw evidence that regular audits were completed by the registered manager and the service provider. These checks were effective in ensuring that appropriate levels of care and safety were maintained.

We saw there were sufficient numbers of suitably qualified staff deployed within the home, to meet people’s needs and promote people’s safety. However, the home did not have a full complement of permanent care and support staff, and relied on the use of bank staff. Taking into account the nature of the assessed needs of the people who used the service, this high use of bank staff had the potential to lead to inconsistencies of approach occurring in the way care and support was offered, which could have the knock of effect of people

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found –

Is the service safe?

We saw that all permanent members of staff had up to date adults safeguarding training. This was also the case for Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) training.

Because of their needs and associated risks all the people who lived at Oxen Barn were on one to one or two to one staffing. We spoke to the registered manager who had been in close contact with each placing authority to ensure that recent changes to DoLS legislation were being adhered to. We saw evidence of this within peoples care files.

Is the service effective?

There were a number of ‘success stories’ that showed how people had progressed behaviourally and physically since they began living at Oxen Barn. One example included one individual who had lost a significant amount of weight due to a better diet and exercise regime being introduced by the home.

Is the service caring?

We spoke to two families regarding their loved ones care. Both were happy that they were treated with dignity and respect. One relative told us, “I can’t say how please I am with (Name) being at Oxen Barn. I don’t think you can beat this place in terms of the care, staff and activities. I visited tens of places looking for the perfect one, you couldn’t beat it”.

Relatives were involved in helping to plan the care and support needed and this was reviewed at regular intervals, with any changes in circumstances being well recorded. Evidence was available to show a wide range of external professionals were involved in the care and treatment received by those living at the home, including GP’s, social workers, psychologists, speech and language and consultants. Risk assessments were in place across a wide range of areas and were seen to be regularly updated.

Is the service responsive?

Each person’s room was personalised to their own needs and requirements. We saw that one person’s room had been decorated to resemble their own room within their family home whilst they were undergoing a transition period which was aiming to have them stay at Oxen Bar permanently. Another person had a curtain between their living area and en-suite facility as they did not like having doors in their room. There were many other examples of this throughout the home.

Is the service well-led?

We saw evidence that regular team meetings took place and the staff we spoke to confirmed that meetings happened and that they had a chance to raise any issues or ideas they may have. One member of staff told us, “Team meetings happen every other Thursday. In-between there is a management meeting where managers and seniors meet up”.

We visited the home on 7th January 2014 and looked at outcomes 2, 4, 7, 13 and 16. We found the service was compliant with theses outcomes. We spoke with one person at the home and observed the others while being supported by staff. We also spoke with the home manager, deputy manager and other grades of staff at the home who were supporting people. We also observed a staff handover

People did not just use words to communicate their needs; they used some signing as well as their preferred communication styles. The home had introduced people to a pictorial system 'Boardmaker' symbols. We observed staff responding respectfully and sensitively to the nonverbal communication and actions of people as well as using Boardmaker symbols.

Assessment of people's need was thorough and person centred, with focus on their individual circumstances and immediate to longer-term needs. Care and support plans placed an emphasis on people's right to be self-determining in how they lived their lives and took risks.

Peoples' capacity to make their wishes known when they did not use words was recorded and appropriate communication methods were used. Where people posed a risk to themselves staff were trained to respond to people’s distressed behaviours and reactions.

The right of people to take informed risks had been acknowledged and risk assessments ensured a balance of safety and effectiveness. People were cared for by staff who were well trained and available in appropriate numbers.

Oxen Barn provides accommodation for up to six males between the ages of 18-65 with learning disabilities and autism. This home comprises of individual self-contained accommodation, with en suite bedrooms, bathroom, lounge, dining room, kitchen and a large garden. The home is situated in the Longmeanygate area of Leyland in Lancashire and is in a quiet semi-rural area. People are placed from various local authorities due to the specialism of the service.

This inspection took place over four days, the 6, 7, 9 & 13 October 2015 and was unannounced.

The home had appointed a registered manager since our last 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 last inspection of the service took place on 17, 24 March and 24 April 2015. During that inspection we identified a number of serious concerns and found the service was in breach of regulations in relation to need for consent, staffing, safe care and treatment and good governance. As a result we placed the home in special measures and told the provider significant improvements must be made, to protect the safety and wellbeing of people who used the service.

We found during this comprehensive inspection this provider had demonstrated improvements since our last inspection. We have judged it is no longer rated as inadequate for any of the five key questions. Therefore Oxen Barn will no longer be in special measures.

During this inspection we found the provider and registered manager had taken action to address our serious concerns and significant improvements had been made across the service which meant the home was taken out of special measures. There were no breaches of regulation found during the inspection.

The one person we spoke with told us they felt safe receiving care at the service. Relatives we spoke with also had no concerns with the safety of their loved ones. However there were still some concerns reported to us by families regarding the consistency of staff and the continued use of agency staff at the home. We did see that five new starters were due to begin work at the service shortly after our inspection. We also saw evidence to show that the same agency staff were used whenever possible to keep staffing as consistent and familiar as possible.

We saw staffing levels to be suitable on both the days we spent at the home. On the first day, there was one agency member of staff working at the home, however they had worked at the home previously and were aware of the needs of the person they were working with.

We spoke with staff about their understanding of safeguarding procedures. Staff we spoke with were knowledgeable about how to recognise different types of abuse. They were also aware of how to report potential safeguarding issues both internally and to external agencies such as the local authority and Care Quality Commission (CQC). A record of any safeguarding concerns had been retained within the home, so that a clear audit trail was available to show details of the incident, reporting procedures, action taken following the event and the outcome of the investigation.

We looked at the systems in place for managing people’s medicines. This included talking to staff responsible for administering medicines, looking at training records, recent audits the service had undertaken and by looking at people’s medication administration records (MARS). We found a few minor issues which had been highlighted within the homes own internal audits. These related to open dates for medicines not being recorded and use of prescribed shower creams not recorded when used.

During our inspection we toured the premises, viewing all communal areas of the home and four people’s private accommodation. We found the home was warm, friendly and comfortable. We found parts of the home had been redecorated and some major improvements had been made since our last inspection.

We spoke with five care staff who told us they had an annual appraisal, if they had been at the service long enough, and regular supervision meetings with their manager. We spoke with three care staff who had been at the home during our last inspection and they told us that support for staff had improved greatly since that time.

The registered manager was aware of the requirements of the MCA and associated DoLS procedures. Policies were in place in relation to the DoLS and the MCA. People’s rights were protected, in accordance with the MCA.

We saw good evidence that regular, appropriate training took place. We were sent a training matrix after our inspection which showed that all the key areas of training were covered as well as more bespoke training so staff had the required knowledge to care for people. We also saw evidence of training within staff files and when speaking to staff they confirmed that the training offered by the home was of a good quality and it gave them the tools they needed to do their job effectively.

We saw that advocacy services were available for people to access if they did not have relatives or friends to act as a voice for them or family needed additional support in that area. We saw that one person used advocacy services via an independent mental capacity advocate (IMCA).

We saw that communication with relatives had improved since our last inspection as this had been an area of concern for some families. We saw evidence within care plans that reviews were attended by relatives. We also saw several examples of newsletter that had been set up since our last visit that kept families informed of developments to the service. When talking with relatives they confirmed that communication had improved.

We looked in detail at people’s care plans and associated documents, including risk assessments. As with other areas care planning had been seen as an issue during our previous inspection. We could see that all care plans had been extensively reviewed and updated over the six month period since our last inspection at the home. However there were still a few issues remaining, which the service were aware of as they had highlighted issues via their own quality assurance and auditing processes. The size of the files meant that it was difficult to navigate information quickly. We received a few comments from staff in relation to the amount of information in care plans and that some of the information was no longer needed within them. We also saw that some of the information with care plans was generic across different people’s files which meant that information was not always personal to the individual.

Feedback from external professionals, including the various local authorities who funded people at the service, was positive. They all stated that they had seen big improvements in the service and that communication was much better.

We saw good evidence that social and learning activities took place, both within the home and externally.

There was a registered manager at the service at the time of our inspection who had worked at the service for approximately four months. There was also a newly appointed deputy manager employed at the home. Relatives we spoke with told us they found the management and staff at the home to be approachable and helpful.

We could see that a number of audits and quality assurance systems were in place. These included regular unannounced internal inspections by the groups own compliance inspector. These inspections focused on the areas highlighted at the last CQC inspection and reported on progress made in each area identified. The latest report which had taken place approximately one month prior to our visit showed that improvements had been made in all the areas highlighted.

Staff spoke positively about the new management structure in place; however there were a few issues raised regarding particular members of staff and how some staff were spoken to. Some staff told us that they were still unsure if issues raised were being dealt with effectively however all the staff we spoke with told us there had been big improvements in this area.