Hill Farm

Hill Farm is a small residential care home providing personal care to five people with learning disabilities including people living with sensory impairments and autism at the time of the inspection. The service can support up to nine people.

People’s experience of using this service and what we found

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 a larger house which was bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service did not have a negative impact on people as this was mitigated by the building design. One of the bedrooms had been converted into a sensory room. The provider had plans in place to make further changes to the design and layout of the service to further meet best practice. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

Model of care and setting maximises people’s choice, control and independence. People had been supported to gain new skills.

Right care:

Care is person-centred and promotes people’s dignity, privacy and human rights. Most staff demonstrated a person-centred approach and supported people to communicate with others in a way which respected the person.

Right culture:

Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. There was a culture of striving for better quality of care and support enabling people to lead improved lives.

We observed people interacting with each other and staff and being involved in their day according to their wishes. People were smiling and staff knew them well. A relative told us that that communication was good, and they were kept updated and involved. They were happy with the care and support their loved one received.

Staff had been recruited safely to ensure they were suitable to work with people. Staff had completed their training to give them the skills and knowledge they needed to support people with complex needs safely. Staffing levels when we inspected were suitable to meet people’s needs, because extra senior staff were on duty as a meeting had been scheduled. Staffing rotas showed four staff were deployed on shift each day 08:00 to 20:00 to support five people. Two people received one to one support from a member of staff which left the remaining two staff to provide support for the remaining three people.

Medicines had been well managed. Risks to people’s health, safety and welfare had been assessed, managed and reviewed. There was guidance for staff on how to reduce risks to people and support plans mirrored the information to ensure that staff knew how to provide safe care and support. One person's medical needs had changed, and they had a medical device fitted to maintain their health, a risk assessment was in place in relation to the fitting of this device. The provider updated the risk assessment after we inspected to make it clearer for staff what the day to day risks were and how to manage these. Risks to the environment had been considered. The equipment and the environment had been maintained.

We were somewhat assured that the provider was promoting safety through the layout and hygiene practices of the premises. Some areas of the service were not completely clean, the provider had also identified this and was arranging for some deep cleaning to take place and a review of cleaning schedules.

The provider had effective safeguarding systems in place to protect people from the risk of abuse. Staff continued to know how to spot signs of abuse and mistreatment. Training records showed all staff had attended safeguarding training. The provider continued to have monitoring systems in place to review accidents and incidents.

People continued to be supported to eat and drink to maintain a balanced diet and good health. People’s weights were regularly monitored to make sure they remained as healthy as possible. People received medical assistance from healthcare professionals when they needed it. Staff recognised when people were not acting in their usual manner, which could evidence that they were in pain.

The building was suitable for the needs of the people who lived there. People had chosen the decoration for their own room where they were able to. Where people had specific interests and hobbies these were reflected in their room décor. The provider was in the process of making plans to renovate and modernise the service.

The provider had completed regular checks and audits to monitor the quality and safety of the service. The audits had identified concerns in places and action plans had been created. Actions had been completed in a timely manner. The provider had met the previous breaches of regulations identified in November 2019 and was working to continuously improve the service. The provider was working on embedding the changes made and working on further changes and improvements to the service. This included recruiting a new manager for the service.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 06 February 2020). Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing, good governance and notification of other incidents.

The service received a targeted inspection on 8 September 2020 (published 06 October 2020) to check that the actions had been completed. We found they had not and there were still improvements required to improve safe care and treatment, staffing and good governance. The inspection found that that provider was still in breach of three regulations.

At this inspection, we found improvements had been made and the provider was no longer in breach of regulations. There were some areas where improvements were still being made.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This inspection was also prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only. This enabled us to review the previous ratings.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has improved to Good. This is based on the findings at this inspection. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hill Farm on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hill Farm is a residential care home providing personal care to people with learning disabilities or an autistic spectrum disorder. There were six people living at the service at the time of the inspection, including people living with sensory impairments, autism and behaviours which can challenge. The service can support up to nine people.

The service had been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service did not have a negative impact on people as this was mitigated by the building design. One of the bedrooms had been converted into a sensory room. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

Staff had not always been recruited safely to ensure they were suitable to work with people living at the service. The provider had not always carried out checks to explore gaps in staff members' employment history.

Training records evidenced that some staff had not completed the providers mandatory training to give them the skills and knowledge to safely work with people. The provider’s induction process was not robust.

There were systems in place to check the quality of the service. However, these systems were not always effective, as they had not identified the concerns we found during our inspection, such as recruitment practices.

Staff understood the need for good infection control. However, staff were observed not always wearing their masks correctly which increased the risks to people and staff of contracting COVID-19.

There were suitable numbers of staff to provide the care and support people needed. Relatives told us staff knew their loved ones well. We observed that people were happy and relaxed with staff, by wanting to be near them and smiling and laughing.

Since our last inspection, the provider had ensured that medicines were managed safely and in line with best practice. Individual risks to people such as their mobility needs, choking and epilepsy were well managed. The registered manager had checked accidents and incidents had been dealt with appropriately and measures were put in place to prevent a further occurrence. For example, risk assessments had been reviewed and reassessed. Referrals had been made to health and social care professionals when required.

People were supported to have meals to meet their needs. There was a choice of low-fat and normal meals, and the choices were available in an easy to read manner to support people to make informed choices. People also were enabled to make choices through visual aids.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update.

The rating at the last inspection was Requires improvement (published 5 February 2020) and there were breaches of Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. The provider completed an action plan after the last inspection to show what they would do and by when they would improve.

At this inspection we found the provider had improved the service by ensuring that medicines were managed safely. The provider had ensured that there were appropriate risk assessments in place and notifications of incidents and events had been reported to CQC in a timely manner. However, the provider requires further improvement in training and support of staff and effective quality auditing.

Why we inspected

CQC have introduced targeted inspections to follow up on requirement actions, warning notices or to check specific concerns. They do not look at the entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of the key question.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified a new breach of Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe recruitment practice at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hill Farm is a residential care home providing personal care to people with learning disabilities or autistic spectrum disorder. At the time of the inspection, eight people were living at the service, including people with sensory impairments, autism and behaviours which can challenge. The service can support up to nine people.

The service had been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

Medicines were not always well managed. Medicines had not always been administered according to the manufacturer’s guidance. We found medicines that had past their expiry date in stock.

Risks to people’s safety had not always been well managed. Risks to people's individual health and wellbeing had not always been assessed. Risks from storing dried food such as pasta and rice and stock cubes on the same shelf as chemicals had not been appropriately assessed or managed which put people at risk of harm.

Staff had not always been recruited safely to ensure they were suitable to work with people. The provider had not always carried out checks to explore gaps in staff members' employment history. This was an area for improvement. There were suitable numbers of staff to provide the care and support people.

Training records evidenced that some staff had not completed their training to give them the skills and knowledge of safely working with people. Some staff had been administering medicines without having their competency checked. We discussed this with the provider who carried out one competency assessment during the inspection. We found no evidence that people had been harmed.

There were systems in place to check the quality of the service. However, these systems were not always robust, they had not identified the concerns we raised in relation to recruitment practice, training, management of risks including risks relating to cross contamination of foods and chemicals.

People were supported to have meals to meet their needs. There was a choice of low-fat meals and normal meals, the choices were not available in an easy to read manner to support people to make informed choices. People had meals to meet their cultural needs.

Although support plans were in place to describe the basic care and support people needed, they did not always include important information individual to the person. Support plans were not always written in a way to encourage people to make choices. We made a recommendation about this.

People were protected from the risk of abuse. Staff knew where they could go outside of the organisation to raise concerns if necessary.

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.

Staff understood the need for infection control and took appropriate measures such as using gloves and aprons when appropriate. Accidents and incidents had been recorded, including the action taken following the incident. The manager had checked accidents and incidents had been dealt with appropriately and measures were put in place to prevent a further occurrence.

People received medical assistance from healthcare professionals when they needed it. Staff recognised when people were not acting in their usual manner, which could evidence that they were in pain.

Staff supported people in a friendly, upbeat manner and in a way which met each person’s needs. People were relaxed in the company of the staff, smiling and communicated happily using either verbal communication or expressions and gestures.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement at a comprehensive inspection which was carried out on 3 and 5 October 2018 (published 19 November 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection, enough improvement had not been made and the provider was still in breach of Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had a new breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. The service remains rated Requires Improvement. This service has been rated Requires Improvement for two consecutive inspections under the new ownership of Optimal Living (Kent) Limited.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

In July 2018 the new providers took over Hill Farm and another small service in the area called Sunnyfields. This is the first time the service has been rated since the change in ownership in July 2018. At the previous inspection in April 2018, under the previous provider, the service was rated ‘inadequate’. We found at this inspection that improvements had and were being made however, further improvements were needed.

Hill Farm is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides support for up to nine people with physical and learning disabilities. There were six people living at the service at the time of our inspection including people with sensory impairments, autism and behaviours which can challenge.

The registered manager had worked at the service for many years, was present at our visit and working with the new providers to improve the service. They were registered to manage this service and another small service in the local area which is registered with the same provider. 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.

There was inconsistency in the assessment and management of risks which meant that guidance and practices were not always in place to minimise any risks identified to people. The registered manager had not completed all appropriate risk assessments to minimise any risks identified to people. There were no effective systems in place to monitor accidents and incidents.

Staff did not have the training or knowledge needed for their roles including how to support people with blindness, with an epileptic seizure, to apply first aid and to move people safely. The providers had worked hard to update staff training in the short time they have managed the service. However further improvement was needed especially in providing additional specialist training for staff, so that staff were trained to meet people’s needs.

Quality assurance systems had been implemented, but did not highlight all areas of improvement needed.

We found inconsistencies in staff practice in treating people with dignity and respect and providing people with choices.

There were systems in place for the management, storage, disposal and administration of medicines. However, two records were not accurately completed and for one person their medicine has not been given on one occasion. We have made a recommendation about the management of medicines.

It was difficult to judge if people took part in a range of meaningful activities as records had been completed inconsistently and no record being made for some days. We have made a recommendation about the recording of activities.

There was a shortfall in the recruitment procedure. Recruitment procedures were in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles. However, the registered manager had not obtained a full employment history for the three newest members of staff. We have made a recommendation about following robust recruitment procedures.

There were enough staff deployed on shift to keep people safe.

Staff knew people well, had built positive relationships, understood their likes and dislikes and preferred methods of communication.

Staff said they felt more supported since the providers had taken over the service and that formal supervision was now taking place on a more regular basis.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been made to ensure that people were only deprived of their liberty, when it had been assessed as lawful to do so. All interested parties were invited to best interest meetings in line with the principles of the Mental Capacity Act 2005. However, there was inconsistent practice in gaining people’s consent before supporting people with their care. We have made a recommendation about this.

Staff knew about the signs and symptoms of abuse and how to raise a concern inside and outside the organisation.

People’s health, social and physical needs were assessed and guidance was in place to ensure they were monitored and supported to access health care and advice as required. People were supported to have a variety of foods which met their health needs and cultural preferences.

People's care plans were being changed by the provider. The changes had not been completed by the registered manager and the care plans we saw although containing information about people's needs and how they preferred to be supported were not easy to follow. The care plans included information about people's life history, likes and dislikes and who was important to them. They contained 'communication passports' and details about how people would let staff know if they were upset or in pain.

There were policies in place that identified that people would be listened to and treated fairly if they complained about the service.

There had been an improvement in staff morale since the providers has taken over the service in July 2018, and staff told us they could see improvements taking place.

Staff followed the provider’s guidance to help minimise the spread of any infection.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider and registered manager failed to ensure people were treated with dignity and respect; assess risks to people’s health and safety and do all that was reasonably practical to mitigate them; assess, monitor and improve the quality and safety of the service and to mitigate risks and failed to effectively support staff to update their training, and to ensure staff received regular supervision.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.