We inspected this service on 11 October 2018 and it was unannounced. This meant that the service did not know we were coming. We last inspected the service on 14 February 2017 where it was rated as requires improvement in safe, effective and well-led and good in caring and responsive. This meant it was requires improvement overall. There were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regulations 12 Safe care and treatment and regulation 11 Need for consent. This was because the provider had failed to ensure infection control practices were not always promoted. They also failed to ensure Mental Capacity Assessments were always conducted and evidence was not always available to demonstrate that decisions had been made in the best interests of those who lived at the home.

Following our last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good. During this inspection, we found improvements had been made and were meeting the requirements of the current regulation.

The Barn 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. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The Barn accommodates up to 12 people who require support with personal care in one adapted building. At the time of our inspection 11 people lived at the service. All of the bedrooms were of single occupancy over two floors, there were two communal lounges, kitchen facilities and outside accessible space. The home was located in a residential area of Leyland close to local shops, amenities and public transport links.

The service had a registered manager in post at the time of our 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 was run.

People we spoke with to us they felt safe living in the home. Staff understood how to deal with any allegations of abuse and records we looked at confirmed investigations had been completed.

Systems were in place that ensured medicines were handled safely in the home. Medicines were stored safely in locked cupboards and records had been completed to confirm their administration safely.

Environmental checks and servicing had been completed as well as completed environmental risk assessments that confirmed that the home was safe for people to live in.

Training records confirmed that the staff had undertaken the relevant training to support their role. Appropriate numbers of staff were in place to deliver good care to people and we saw the staff had been recruited appropriately.

People were asked permission from staff before undertaking any care or activity. Details about consent was recorded in people’s care files. Deprivation of Liberty Safeguards applications had been submitted to the assessing authority. 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.

The home was operating under the principle of registering the right support. People were involved in choice in respect of their care and were encouraged to be independent. Car

The Barn is a care home providing accommodation for up to 12 adults who have learning disabilities and who need assistance with personal care. It is situated in a residential area of Leyland, close to the town centre and all local amenities. It is easily accessible by car or public transport. On road parking is permitted. All bedrooms are of single occupancy. The home is domestic in character providing comfortable accommodation for the people who live there. There is an enclosed garden area to the rear of the building.

The last inspection of this location was conducted on 17 March 2015. The overall rating at that time was ‘requires improvement’, with five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 being identified. Three of the breaches were in relation to safe care and treatment; the other two were around the need for consent and good governance. We asked the provider to tell us what they were going to do in order to address the shortfalls identified. The provider submitted an action plan, as requested.

This inspection was conducted on 14 February 2017 and it was unannounced, which meant that people did not know we were going to visit the home.

The registered manager was on duty at the time of our 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 of the Health and Social Care Act and associated regulations about how the service is run.

At this inspection we found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to the need for consent and safe care and treatment.

At our last inspection on17 March 2015 we found that people who used the service were not protected against the risks associated with the unsafe use and management of medicines, because appropriate arrangements had not been made for the obtaining, recording, using and safe administrations of medicines. Therefore, this area was in need of improvement. We made a requirement about this. The provider sent us their action plan, which showed that actions would be completed by 30 June 2015.

During the course of this inspection we assessed the management of medicines. We found that on this occasion improvements had been made in this area, which helped to protect people from any risks associated with the unsafe use of medicines. Therefore, the previous breach of the Health and Social Care Act regulations had been met. However, we found that hand written entries on the medicine administration records (MAR) had not always been countersigned by another person to reduce the possibility of errors. We have made a recommendation that all hand written entries are signed by two members of staff to ensure accuracy.

At our last inspection on17 March 2015 we found that proper steps had not always been taken to ensure people were protected against the risks of receiving inappropriate or unsafe care or treatment. This was because risks relating to their health, welfare and safety had not always been well managed. Therefore, this area was in need of improvement. We made a requirement about this. The provider sent us their action plan, which showed that actions would be completed by 31 July 2015.

At this inspection we found that robust risk assessments had been implemented in relation to health, welfare and safety. Environmental risk assessments had also been introduced. This helped to keep people safe. Therefore, the previous breach of the Health and Social Care Act regulations had been met.

At our last inspection on17 March 2015 we found that people who used the service and others were not always protected against the risk of acquiring an infection, because infection control protocols were not consistently being followed. Therefore, this area was in need of improvement. We made a

At the time of our inspection there were twelve people living at the home and we were able to speak with five of them, who all gave us positive comments about life at The Barn. When asked if they were happy living at the home, they all said they were. One person, who was on a short term contract for medical reasons told us, "I want to live here." All five people said their needs were being met by a kind and caring staff team and they were able to make decisions about how they spent their time.

Those using the service all looked happy. They said they felt safe when care and support was being provided and they looked comfortable in the presence of staff. We also spoke with several other people who were involved in supporting those living at the home. They were all very complimentary about the manager and staff team.

Comments we received included:

"We do lots of things. It is great."

"We can bake and we all go to the disco on Friday. I like dancing."

"I have just been to the shop for our food."

Prior to our inspection we liaised with the local authority, who currently had no concerns about this service.

During our inspection we assessed areas relating to care and welfare and how medications were being managed. Standards relating to staff recruitment, complaints and monitoring the quality of service provision were also inspected. We did not identify any concerns in any of the outcome areas we assessed.

At the time of our visit to this location there were nine people living at the home and we were able to speak with five of them. When asked if they were happy living at The Barn four of the five replied with a firm, "Yes." The fifth person was in the process of looking for alternative accommodation because she, "Fancied a change." However, all five people told us their privacy and dignity was respected and they were able to make decisions about how they spent their time, whilst living at the home.

We spent some time sitting in the lounge with those living at The Barn. They all looked happy and were laughing and joking with each other and with staff members. They all said they felt safe living at the home and looked comfortable in the presence of staff.

Comments we did receive included:

"I can do what I like."

"I go to the pub down the road sometimes with staff or shopping with Jackie (the manager) in Leyland."

"There's not much going on here, but I have been on holiday to Blackpool with my Mum and Dad and I saw the Illuminations. We had fish and chips too. I love Blackpool."

"Julie, the hairdresser came yesterday. She does all our hair when she comes."

We did not visit the location on this occasion and therefore did not receive any comments from people using the service.

The Barn is a care home providing accommodation for up to 12 adults who have learning disabilities. It is situated in a residential area of Leyland, close to the town centre and all local amenities. Car parking is available on the road and there is an enclosed garden area to the rear of the building. The home is domestic in character and all bedrooms are of single occupancy.

We last inspected this location on 12th September 2013, when we found the service to be compliant with the regulations we assessed at that time.

This unannounced inspection was conducted on 17th March 2015. A Senior Support Worker was in charge when we arrived at the home. She was very co-operative and provided us with the documents we requested. The home did not have a registered manager in post at the time of the inspection. However, a manager had been employed, who was in the process of applying for registration with the Care Quality Commission (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.

Records showed new employees were guided through a detailed induction programme and were supported to gain confidence and the ability to deliver the care people needed. We found the planning of people’s care and support to be adequate, although some areas could have been more person centred.

The provision of activities had improved during the recent months. These were tailored to meet people’s needs and enable those who lived at The Barn to maintain links with the local community.

Medications were not being well managed and our findings demonstrated that proper steps had not been taken to ensure people who used the service were protected against the risks of receiving inappropriate or unsafe care or treatment, in relation to the management of medications. This did not help to ensure people’s health; safety and welfare were consistently promoted.

The staff team were confident in reporting any concerns about a person’s safety and were competent to deliver the care and support needed by those who lived at The Barn. However, areas of risk had not always been managed appropriately and legal requirements had not always been followed in relation to Deprivation of Liberty Safeguards.

Recruitment procedures adopted by the home were robust. This helped to ensure that only suitable people were appointed to work with this vulnerable client group.

The cleanliness of the premises could have been better. Infection control protocols were not being followed in day to day practice. The communal areas were in need of upgrading and modernising. Systems and equipment within the home had been serviced in accordance with the manufacturers’ recommendations, to ensure they were safe for use.

The staff team were provided with a wide range of learning modules. This helped to ensure those who worked at The Barn were trained to meet people’s health and social care needs. However, supervision and appraisals for staff could have been more structured and more regular. We have made a recommendation about staff supervision and appraisal.

People were supported to access advocacy services, should they wish to do so. An advocate is an independent person, who will act on behalf of those needing support to make decisions.

Staff were kind and caring towards those they supported and anticipated people’s needs well. People were helped to maintain their independence with their privacy being respected at all times.

People who lived at the home and the staff team were complimentary about the management of the home and felt that if there were any concerns these would be quickly sorted out.

We found several breaches of the Health and Social Care Act (2008) Regulated Activities Regulations. These breaches also amount to breaches of the Health and Social Care Act (2008) (Regulated Activities) Regulations 2014.

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