Archived: Bawden Manor Farm

Bawden Manor Farm provides care and accommodation for up to seven people who have autistic spectrum disorders. It is part of the Spectrum group who have several similar services in Cornwall. They are providers of specialist care for people with autistic spectrum disorders and learning disabilities. At the time of the inspection six people were living at the service. There was a registered manager in post. 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.

The service was due to close and this was being planned for September/October 2016. Five people were moving to a new Spectrum property and the sixth to a newly developed flat in another Spectrum service.

The service was short staffed with three full time vacancies and another member of staff due to leave in the next two weeks. Attempts to recruit new staff had not been successful. The registered manager told us the HR department were aware of the situation but they did not know if any new staff members had been identified to start the induction process. Some members of staff were working long hours to cover shifts.

We looked at rotas for the previous month and saw there were many occasions when staffing levels had fallen below the commissioned hours. A contingency plan outlined what staffing levels needed to be in ‘extreme’ circumstances. The rotas showed these were met on all but one occasion. However, these were being used routinely rather than as a last resort. Staff told us people were unable to take part in activities in the community as often as they would like due to staff shortages.

Recruitment practices helped ensure staff working in the home were fit and appropriate to work in the care sector. Staff had received training in how to recognise and report abuse. The registered manager reported any safeguarding concerns to the appropriate local authority when necessary.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate. Staff demonstrated a good understanding of the main principles of the Mental Capacity Act (MCA).

Roles and responsibilities were well-defined and understood by the staff team. The registered manager was supported by a deputy manager who had a clear set of responsibilities. There was a key worker system in place. Key workers are members of staff with responsibility for the care planning for a named individual. There were systems in place to help ensure a planned move was carried out in a way which would not cause people unnecessary anxiety. Spectrum had communicated with local residents in the village where people were moving to in order to help alleviate any concerns.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the end of the full version of the report.

We were not able to speak directly to the six people who lived in the home as they had complex communication needs. Instead we saw how the individuals interacted with staff and saw that people approached staff without hesitation.

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us, empathy and understanding towards the people they cared for.

We found people who used the service had a care plan so that they experienced care, treatment and support that met their needs and protected their rights.

We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cleaning and doing their laundry. During the visit we noted that people attended a variety of activities so that they had opportunities to pursue their interests.

Spectrum had reviewed staffing levels at Bawden Manor farm and staff told us they felt there was sufficient staff on duty.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained

We observed staff interacting with people who used the service in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

All people who used the service must have a care plan so that they experienced care, treatment and support that met their needs and protected their rights.

We found that people who used the service were involved in making day to day decisions and participated in domestic tasks at home. We noted people received a varied and nutrious diet.

Staffing levels need to reflect the dependency needs of the people that used the service at all times. Rotas evidenced that the assessed minimum number of staff were not on duty.

Systems for safeguarding people from abuse were robust. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people's rights

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

We saw that people were involved in day to day decisions and asked to participate in tasks at home, such as making meals and drinks. The records showed that people went out frequently. The house was in good order and we were told that the bedrooms had been recently decorated to reflect the preferences of each occupant.

The care plans were comprehensive and contained large amounts of information which made it difficult for staff to find out what a person needed easily. We were told by the registered manager that the current system was being changed to make care plans easier to read and understand. One social worker said that the staff had 'gone the extra mile' to get one person's health care needs met.

We looked at the ways people's different behaviours were managed by staff. We were satisfied that people were being helped appropriately. We found that there were no recorded agreements from health or social care professionals in relation to physical interventions with people or the use of equipment that affected people's right to privacy. However we were told by the registered manager that meetings were being set up to ensure that such management techniques were properly agreed.