Archived: The Old Farm House Residential Home

The Old Farm House Residential is registered to provide accommodation and personal care for up to 26 people. There were 24 people using the service during our inspection; who were living with a range of health and support needs, including diabetes and dementia. Accommodation is arranged over two floors with the majority of bedrooms having an ensuite facility, the service is fully accessible to those in wheelchairs or with mobility difficulties and the first floor is accessed by a passenger lift. The service had a large communal lounge available with comfortable seating and a TV for people and separate, quieter areas. There was a secure enclosed garden to the rear of the premises.

A registered manager was not in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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. A new manager had been appointed and had started the process for applying with the Commission for their registration; they were not present throughout the inspection. The deputy manager and provider were available throughout the inspection.

The previous inspection on 9 and 10 January 2017 found eight breaches of our regulations. The well led domain was rated inadequate and an overall rating of requires improvement was given at that inspection. The provider and registered manager were issued with a warning notice for a breach of regulation 17 of the Health and Social Care Act. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

At the last inspection the provider had not ensured actions designed to address risk had been followed through into practice. Falls risk assessments were not in place routinely even for those identified as prone to falls. Risk assessments for people’s mobility were not followed in practice; staff did not know how to safely evacuate people in the event of an emergency. People’s health care had not been managed effectively. Medicines had not been managed in a safe way. There was not sufficient numbers of staff deployed to meet people needs. Staff performance was not robustly monitored. Recruitment processes were not robust. People were at risk because there was a failure to ensure that all required servicing of equipment within the premises had been undertaken. Not enough was being done to ensure people's individual preferences around stimulation, activity and engagement were addressed. Staff did not have a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS); Audits had not effectively picked up concerns which we had found during the inspection.

The provider had taken some action to address the concerns raised at the previous inspection. However, further work was required to ensure risk to people’s safety were further reduced specifically in relation to the management of falls, medicines, health and auditing processes.

Some areas of medicine management needed further improvement to ensure people received medicines in a safe way.

People at risk of falls had risk assessments in place. However, the provider had not always taken enough action to analyse incidents so further measures could be implemented to help reduce the number of falls people had.

There were enough staff to meet people’s needs although the deployment of staff needed further improvement to ensure people were always responded to quickly when in need of support.

The provider had taken action to improve how people’s health needs were monitored and responded to. However, further monitoring was required to ensure people’s health was consistently supported and monitored.

The provider had taken action to meet the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, further training for staff was required to ensure they fully understood the requirements of the act.

One person could be verbally and physically challenging towards others. There was no behaviour guidance in the person’s care plan to refer to and staff had not received any training in behaviour management. The majority of staff had received other mandatory training to effectively complete their roles.

The provider had improved their auditing process since the previous inspection which had mainly focused on the environment. There was better oversight of the service as a whole and the new manager had started to take steps to improve service delivery. Staff said they felt morale had improved by means of better communication and understanding about their roles. Staff said they felt more listened to. Further work was required in regards to auditing so improvement could be made in the areas highlighted during this inspection.

Employment checks had been made to ensure staff were of good character and suitable for their roles. Staff were trained in safeguarding and understood the processes for reporting abuse or suspected abuse.

Appropriate checks were made to keep people safe. Safety checks had been made regularly on equipment and the environment. People had individual personal emergency evacuation plans (PEEPs) that staff could follow to ensure people were supported to leave the service in the most appropriate way in the event of a fire.

People had choice around their food and drinks and staff encouraged them to make their own decisions and choices.

People were encouraged to remain as independent as possible. Where possible the consent of people was obtained and their views and preferences were respected. When people were in discomfort or distressed staff responded in a gently and in a caring way. Staff spent time talking to people in a meaningful manner.

Since the last inspection an activities person had been employed. Care plans had been reviewed and updated providing more person specific information about people’s needs.

Complaints were recorded and responded to effectively. The manager had sought the views of people to make improvements to the care and support they received.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

The inspection took place on 9 and 10 January 2017 and was unannounced. The service is a residential service for up to 26 older people. At inspection there were 24 people in residence with one person in hospital. There are two shared rooms but one is currently used for single occupancy only. Accommodation is arranged over two floors with the majority of bedrooms having an ensuite facility, the service is fully accessible to those in wheelchairs or with mobility difficulties and the first floor is accessed by a passenger lift.

There was a registered manager in post. A registered manager is a person who is 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.

This service was last inspected in September 2013 when a shortfall in record keeping was highlighted, a follow up inspection in February 2014 checked that satisfactory improvements had been made and the service was assessed as compliant, these improvements have not however been sustained.

The leadership and management of the service were poor and required significant improvements to ensure people received care which met their needs and kept them safe. The provider and registered manager did not have an effective system in place to assess the quality of the service people received. People did not have robust risk assessments or care plans in place to ensure they received their care appropriately and safety, and in accordance with their wishes. Staff did not have the right guidance or information about people’s needs, or how to recognise when there was deterioration in people’s health. This placed people at risk of harm.

There were not enough staff in peak times to meet people’s needs. Staff were constantly busy which meant that they did not always have time to support people with their needs. The recruitment checks of new staff did not meet the requirements of legislation.

A pre-admission process was in place but this was not always robust; some people were admitted with needs the service had not indicated they could meet in their statement of purpose; this will now needed urgent review. There were activities from time to time but no regular activity programme. There was a risk that people could become isolated and under stimulated.

The registered manager and staff did not have a good understanding of how to ensure people’s rights were protected. The laws governing this (the Mental Capacity Act) were not followed, and some people had restrictions in place which deprived them of their liberty. When people did not have capacity to make decisions about their care, decisions were made on their behalf without consulting them or other key people to ensure the decision was made in the person’s best interest.

Policies and procedures had not kept pace with changes in legislation; some policies viewed dated back to 1999 this meant staff practice was not being guided and informed by policies and procedures that were aligned to current statutory guidance and good practice. Staff had not received training essential to their roles, including training in how to care for people living with dementia and people with specific health conditions. New staff did not receive a robust induction and they did not receive training in essential areas such as safeguarding. A system for the formal supervision and appraisal of staff was in place but frequencies for providing these had drifted for the majority of staff; the registered manager was therefore unable to adequately monitor staff performance, training and development needs.

People did not always receive their medicines safely. When people required occasional medicines, for example: pain relief, guidance to inform staff when to give this, and how frequent was not sufficiently detailed. Some medicines were stored at very low temperatures which may impact on their effectiveness.

People had access to a range of health professionals, but the registered manager did not always ensure people’s health needs were met in a timely way and there were delays in calling the GP or other health professionals. This placed people at risk of harm.

Although staff demonstrated they had the right attitudes for their role there were shortfalls in the way they had been recruited in that some important checks required by legislation had not been undertaken. The majority of servicing checks and tests of equipment were carried out at appropriate intervals but servicing of the electrical installation was outstanding by some years; a hoist assessed as being in a ‘poor’ state had not been replaced. These omissions could place people at risk of harm.

People told us they were happy and felt safe. Relatives were satisfied with the quality of care and support their relatives received. Meetings were held with people and they were asked to complete surveys about their experience of care but it was unclear how their feedback was used to improve the service; a service development plan was not in place.

Our observations showed many examples of positive interactions between staff and people who they treated with patience and kindness. People respected each other’s privacy on a day to day basis and staff demonstrated they were respectful of people. Staff understood how to report and act on accidents and incidents appropriately.

Systems and processes for the ordering, receipt, storage, and disposal of medicines were in place. Staff understood how to keep people safe from abuse but their knowledge needed updating and the provider had already booked training for January 2017 to address this.

People were provided with a varied diet that was in keeping with their dietary needs and preferences.

People and relatives felt communication was generally good and that they were kept informed. They were confident of raising concerns if they needed to and where they had raised concerns felt they had been listened to and action had been taken.

We have made two recommendations:

We would recommend that existing fire arrangements including the frequency of fire drills for all staff, training in use of fire evacuation equipment and individual evacuation plans are reviewed by a competent person to ensure they comply with fire legislation.

We would recommend that the provider/registered manager seek information from a competent source about establishing end of life wishes for people, the use of end of life care plans and the appropriate training that staff would need to support people appropriately.

We found a number of 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 the report.

During this inspection we found that improvements had been made and the provider was compliant.

We visited the office and spoke with the Registered Manager and three members of staff. We also spoke with five people using the service and one relative.

We found that records including care plans and risk assessments were fit for purpose, and gave staff written guidelines to show that people were receiving the care they needed.

People told us they were satisfied with the service. They said they were happy living at the home. People's comments: 'I am more than satisfied with the service'. 'The manager is a lovely person, full of goodness'. 'The staff are marvellous here'. 'The staff are nice and always help me'. 'The staff are pretty good here, we have a good laugh'.

We saw that people were responsive in the company of staff and staff respond in a caring and positive way. The staff we spoke with had knowledge and understanding of people's needs.

We saw people receiving their medicines in a safe way, and there was an effective system in place for the ordering, storage and disposal of medication.

Staff recruitment records showed that new staff had been thoroughly checked to make sure they were suitable to work with vulnerable people.

We found that in some cases people's records, and other documentation relating to the service lacked detail, were not completed or up to date to reflect the care being provided.

We made an unannounced visit to the service and spoke with people who use the service, relatives, the manager and to staff members. Everyone we spoke with said that they were happy with the service provided.

People told us that they felt safe and well looked after. They said that the staff were polite and respectful. People said: 'The staff are around when I need them". 'They are good and if I want anything, I only have to ask.' "I am very comfortable here, the food is excellent". "The home is always clean, my laundry comes back cleaned and ironed".

A relative said. "I am more than happy with the care my relative is given, the care is really good".

People's health needs were supported and the service worked closely with other health and social care professionals to maintain and improve people's health and well being.

People said they did not have any complaints but would talk about any problems to the manager and to the staff. They felt they would be listened to and action would be taken to sort out any concerns.

People said that the home was clean and that their bedrooms were kept clean. People said that they were happy with their bedrooms.