27 November 2015
During a routine inspection
Barnfield provides accommodation with personal care for up to 11 people over the age of 18 who have a diagnosis of a learning disability. The home is a farm located on the outskirts of Luppitt; a small village located about six miles from the East Devon town of Honiton. Barnfield Farm is an old thatched and cob house which is home to three people. Eight other people live in two adjacent buildings to the farmhouse, called Shippon and Little Shippon. The home is staffed 24 hours a day. At the time of the inspection, eleven people had lived at the home for a number of years. People had a range of needs and some had communication difficulties associated with their learning disability.
The home had a manager who had been registered in the role with the Care Quality Commission since 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers and nominated individuals, 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 in their role by a team leader as well as senior managers in the organisation. Senior managers visited the home from time to time, offering guidance and advice and undertaking quality assurance checks.
The registered manager had a clear vision for the home and the people who lived there. They described how they and the staff were committed to ensuring people were supported to live as independently as possible. Staff described how they “were visitors” who were there to support people in “their home”. Throughout the inspection we saw staff following these principles, treating people with kindness, friendliness and compassion. Staff made sure people had time to decide what they wanted to do and were then supported to do this.
People were happy and excited about what they were doing throughout the two inspection days. People were involved in lots of activities, including helping a person in the village, Christmas shopping, going to a dance session in the local village hall and going out with family. People chatted to staff about these activities, showing real enthusiasm.
People did activities of their choice and were encouraged to try new things. Staff supported people to achieve their ambitions and potential despite their abilities. They undertook activities on their own and in groups. These included college courses, sports, art, hobbies and social events. One person rang the bells at the local church, while another person had chosen to help clean the church every six weeks. Staff had developed two weekly ‘clubs’ in the local village hall as people had wanted to get more involved in cooking and some people had expressed an interest in dancing. Some people went Christmas shopping during the inspection and were clearly delighted with the success of their trip.
People had worked with staff, local musicians and a choir to stage a variety night in the summer of 2015. Tickets for the variety night were sold to family, friends and villagers. A video of the variety night clearly showed how much everyone, both performers and audience enjoyed the event. People from Barnfield had achieved personal ambitions including singing in a girl band and playing a musical instrument in public. Everyone from the home had sung a number of songs with a local choir. The funds raised were used to support improvements in the home including a multi-media room. The registered manager and staff also worked with people to engage with the local community by hosting an annual open day, visiting and contributing to the local weekly market, hiring the village hall for activities, delivering some of the village newsletters to households and cleaning the village church with other villagers.
People were encouraged to be independent and make decisions wherever possible. One person had been supported to collect and administer their own medicines. The person described how they had had training to enable them to do this safely. Other people had been assessed as requiring their medicines to be administered by staff.
The registered manager and team leader were committed to using innovative systems including new technology to enhance people’s lives. We saw evidence of how this had been achieved in a number of areas including care plan reviews and helping people become independent by the use of training materials. Videos had also been developed to support staff understanding of how to provide people’s care, for example swimming exercises for one person.
People were consulted about how the home was run through regular meetings. Staff had worked with people to make these meetings more inclusive by using a computer presentation each month to make the agenda more visual. Meetings were used to support people to choose the menus for the coming days as well as agree any group activities, for example where to go for the Christmas meal out. People and staff were also involved in the recruitment of new staff. One person had been chosen as the representative of Barnfield at provider meetings, called locality forums, which provided an opportunity to feedback to the provider and share experiences with other provider services. They described how they attended meetings and felt able to talk about what was good about Barnfield Farm.
The home had undertaken a survey of people in the Summer 2015. An ex-member of staff had conducted interviews which were recorded on video. A compilation of the recorded interviews was available for people, their relatives and care managers and staff. An action plan was developed to support improvements based upon the feedback. These included both individual issues such as someone wanting more support with their teeth cleaning as well as general issues about activities people enjoyed doing together. A copy of the compilation video was made available to the inspector.
People living at Barnfield Farm were evidently happy and felt well-supported in a safe, comfortable and well-maintained environment. We saw people being treated with respect and dignity, with staff supporting them to have as much independence as possible doing activities they clearly enjoyed. We observed people laughing and joking with staff who responded in a friendly, caring manner whilst maintaining professionalism. One person said “I like everybody”; another person said “all staff are ok” whilst another described two members of staff in particular who they liked. People had a key worker to support them, one person said their key worker “helps me with everything!”
Relatives were very complimentary about how their family member was supported and cared for. They described the home as “fantastic” and said staff were “always supporting [my relative] to get the most out of life.” People were encouraged to keep in touch with their family by phone and through the use of modern technology such as video links, which enabled even those at a distance to see and speak to each other. People’s privacy when in contact with families was respected by staff. Families were also welcomed into the home at any time. Where relatives were unable to visit, staff took people to visit them.
Health and social care professionals praised the home, the manager and staff for supporting people to meet their physical, health, social and domestic needs. They described how staff asked for and accepted their help and advice when needed. They also commented that staff were proactive in preparing for meetings with them and would feedback and give suggestions for changes to care. People described how they were involved in care reviews. They said they took photos of things they were proud of they showed to people at the meeting.
Staff were recruited safely and were provided a comprehensive induction before they started working with people on their own. Staff were supported, through supervision and appraisal, to reflect on their work with a manager. Staff were trained to deliver the care to each person and received regular updates and opportunities to develop their skills further. All the staff were very positive about working at Barnfield and were able to describe how they worked to the organisation’s objective “to help as many people as possible, throughout the UK, who have learning or similar disabilities to be who they want to be.”
People risks, needs and aspirations were assessed and recorded and care plans were developed to address these. People’s capacity to make decisions about specific aspects of their care, for example their capacity to go out on their own, was assessed. Where they were deemed not to have capacity to make a particular decision the registered manager had recorded this and taken steps to ensure they worked within the Mental Capacity Act 2005. This included applying for Deprivation of Liberty Safeguards Authorisations.