CQC report explained · a residential care home
What the CQC found at Tithe Barn
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risks were not always managed effectively. Inspectors found problems with window restrictors, planning for anxiety during trips and medicine stock recording.
- Effective?
- Good
- This question was not rated in this inspection.
- Caring?
- Good
- This question was not rated in this inspection, although inspectors said care promoted dignity, privacy and human rights.
- Responsive?
- Good
- This question was not rated in this inspection.
- Well-led?
- Requires improvement
- Management systems did not always assess, monitor or reduce risks, or ensure that lessons from incidents led to effective action.
What inspectors found, November 2023
Tithe Barn was rated Requires Improvement; inspectors found risks were not always managed effectively and governance needed strengthening.
The inspection took place on 30 August and 4 September 2023. It followed concerns about a safeguarding incident. Inspectors spoke with people, relatives and staff, observed care, and checked care, medicines, recruitment and management records.
The home was not always safe. Some window restrictors were not fitted correctly after an incident where a person left through a first-floor window. Planning did not always include the possible need for rescue medicine during an anxious person's trip. Medicine stock records were also unclear.
Care was person-centred and people were treated with dignity. Staff were recruited safely, staffing levels were sufficient, safeguarding processes were followed, and the home was clean. However, management systems did not always identify risks or make sure lessons from incidents led to effective action.
The overall rating changed from Good at the previous inspection to Requires Improvement. Safe and Well-led were both rated Requires Improvement. The other three areas were not rated in this inspection.
Person-centred care
Care was shaped around people's needs, choices and independence. Inspectors found that dignity, privacy and human rights were promoted.
“Care was person-centred and promoted people's dignity, privacy and human rights.” from the report
Safeguarding
Safeguarding procedures were in place and concerns were shared with the safeguarding authority and CQC. Staff said they felt able to raise concerns.
“Where concerns were identified the safeguarding authority were notified along with CQC.” from the report
Staffing and recruitment
Inspectors found enough staff to support people. Recruitment checks, including DBS checks, were robust.
“We observed there were sufficient staff to provide people with the support they needed and what was reflected in their care records.” from the report
Clean environment
The home was clean and well maintained. Infection prevention measures were in place.
“The home environment was clean and well maintained.” from the report
Window safety
seriousSome window restrictors were not fitted correctly after an incident in which a person left through a first-floor window. This created a significant risk of injury.
“Some window restrictors had not been fitted correctly leaving their effectiveness compromised.” from the report
Risk planning
seriousPlanning for an organised trip did not fully consider a person's anxiety or the possible need for rescue medicine. Staff could not stop the trip early or use all available ways to reduce the person's distress.
“Measures to reduce the risks and impact associated with a person's anxiety had not always been considered fully.” from the report
Medicines records
needs fixingSome medicine stock records were unclear. Staff did not have clear instructions for booking out medicines, although the provider reviewed the system after the inspection.
“Some of the medicine stock recording was unclear.” from the report
Management oversight
seriousThe provider's governance systems did not consistently identify risks or check that actions taken after incidents were effective. This led to a breach of Regulation 17.
“Systems had failed to effectively assess, monitor and reduce the risks to people using the service.” from the report
- 01How have you checked that every window restrictor is now correctly fitted and maintained?
- 02What changes have you made to plan for people's anxiety and rescue medicines during trips and activities?
- 03How are medicine stocks and medicines booked out now recorded and checked?
- 04How do you review incidents and make sure the actions taken have reduced the risk?
- 05What is in the action plan requested by CQC, and how will you show families that the improvements have been completed?
The inspection rated Safe and Well-led only; the report gives no ratings for Effective, Caring or Responsive. This explanation was written from the published report of 18 November 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, August 2021
Rated Good; inspectors found major improvements from Inadequate and confirmed the home had left Special Measures, with kind and person-centred care.
Inspectors visited unannounced on 30 June and 1 July 2021. They spoke with staff, relatives and a range of professionals, observed how people were supported, and checked care, medicines, staffing and management records.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found staff understood people's needs, supported choice and independence, managed medicines safely and followed infection control procedures.
The home had previously been rated Inadequate and was in breach of regulations. Inspectors found that improvements had been made and that the home was no longer in breach or in Special Measures.
People still did not have access to the swimming pool on site. The manager said this was being addressed.
Choice and independence
People were supported to choose how they spent their time and to be as independent as possible.
“People were now receiving care and support that ensured they had choice and control to meet their needs and preferences.” from the report
Kind relationships
Inspectors saw people relaxed and comfortable with staff, with positive and respectful interactions.
“We observed positive interactions between staff and people which enhanced people's lives.” from the report
Safe medicines
Medicines were received, stored and given safely. Staff were trained and their competence was checked regularly.
“People's medicines were managed safely. Medicines were safely received, stored and administered.” from the report
Improved staff training
Staff had more comprehensive training, including specialist training for people's individual needs and behaviour support.
“Staff were now offered a more comprehensive level of training and had taken opportunities to develop their skills further” from the report
Quality monitoring
The provider had strengthened its audits and checks to monitor safety and the quality of care.
“The provider and senior team had further developed their quality assurance systems so they could be sure people received safe, quality care.” from the report
Swimming pool unavailable
needs fixingPeople still could not use the swimming pool on site at the inspection. The manager said this was being addressed, so families should ask what happened next.
“At this inspection we found people still did not have access to the swimming pool on site.” from the report
Recent management changes
minorThere had been further changes in staff and management. The new manager was still applying to become registered, so families may want to ask about leadership stability.
“A new manager was in post at the time of the inspection. The new manager was in the process of applying to become registered manager at the home.” from the report
Larger-than-recommended setting
minorThe home was larger than recommended by best practice guidance for this type of service. Inspectors said the design and local surroundings helped reduce the possible negative impact.
“The service is larger than recommended by best practice guidance.” from the report
- 01What checks are now used to make sure the improvements that led to the Good rating are being maintained?
- 02What is the current position with access to the swimming pool, and what activities are available instead?
- 03How will you support my relative's individual communication method and involve them in daily choices?
- 04What specialist training has the staff team received to support behaviours that may challenge others?
- 05Has the manager completed the application to become registered, and have there been any further changes in the staff or management team?
This was an unannounced planned inspection covering all five key questions, including infection prevention and control under Safe, following the previous rating. This explanation was written from the published report of 6 August 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Tithe Barn
7 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- November 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2021Goodup from InadequateSafe: GoodWell-led: Good
- October 2020Inadequatestayed InadequateSafe: Requires improvementWell-led: Requires improvement
- January 2020Inadequatestayed InadequateSafe: InadequateWell-led: Inadequate
- November 2019Inadequatedown from GoodSafe: InadequateEffective: InadequateCaring: InadequateResponsive: InadequateWell-led: Inadequate
- January 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2014
Report published without a new overall rating.
- November 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 6 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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11 live-in carers within about an hour of Herefordshire, County of
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £960 to £1,410 a week. 10 can care for a couple. 8 years' experience on average.
“She was very caring, kind and patient to all his needs, she built up a wondetful rapport with him, she was dedicated and was there for him through good times as well as through the tough times”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.