Background to this inspection
Updated
7 January 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by two inspectors, one of whom was a medicines inspector.
Service and service type
This service provides care and support to people living in a supported living setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because the service is small, and people are often out, and we wanted to be sure there would be people at the service to speak with us.
What we did before the inspection
We reviewed information we already had about the service. We sought feedback from healthcare professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.
We had also carried out a direct monitoring call with the registered manager on 9 September 2021. As part of this monitoring approach we spoke with three staff members, four relatives and two people. We also received feedback from a social care professional.
We used all of this information to plan our inspection.
During the inspection
People's communication styles meant that some people relied on staff who knew them well to understand them. It was difficult to obtain people's views regarding the quality of care they received, so we spent time with people and observed their support; this helped us understand the experience of people who used the service. We spoke with the registered manager, two deputy managers and three care workers. We reviewed a range of records. This included four people's care plans, medication administration record (MAR) charts and staff rotas. We also looked at two staff files in relation to recruitment and staff supervision.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training records; policies and procedures, audits and action plans and a range of quality assurance records.
Updated
7 January 2022
About the service
Long Barn is a supported living service for up to six people with a learning disability, autism and, communication needs. At the time of the inspection, there were five people living at the service. The service consisted of a main house where three people shared a kitchen and communal living area and a further two self-contained flats on site which the other two people lived in.
People’s experience of using this service and what we found
The provider’s governance system was not consistently effective and failed to identify shortfalls or recognise how improvements could be made. Best practice guidance such as National Institute for Health and Care Excellence (NICE) was not always followed or adhered too.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right support:
• Model of care and setting maximises people’s choice, control and independence
Staff were focussed on supporting people to be as independent as possible. People had individual goals they were working towards to increase their level of independence with everyday tasks. People were supported to communicate their views and to make choices and have control in their daily lives. Staff utilised a wide range of communication tools to ensure people’s voices and needs were heard, recognised and acted upon.
Right care:
• Care is person-centred and promotes people’s dignity, privacy and human rights
Staff knew people well and understood their needs. Care and support was person centred and reflective of the individual needs of people. Relatives praised the staff team and spoke highly of how staff enabled their loved one to live fulfilling and independent lives. People had developed positive and trusting relationships with staff.
Right culture:
• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives
The culture of the service was open and inclusive. Staff were motivated and positive in their view of the service and described being well supported and having access to relevant training. Relatives told us their views were welcomed and considered. People were supported to have access to the local community and to follow their interests.
Systems were in place to protect people from the risk of abuse. Risk assessments had been carried out to identify the risks people faced. These included information about how to mitigate those risks. There were enough staff working at the service to meet people's needs and the provider had robust staff recruitment practices in place.
Staff understood how to support people in a way that promoted their privacy, independence and dignity. The service sought to meet people's needs in relation to equality and diversity. Staff spoke highly of the support they received from management and relatives praised the service. One relative told us, “The service is brilliant.”
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service under the previous provider was Good (report published 2 December 2016)
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service
We have identified one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to good governance.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.