The Farmhouse

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People were not always protected from the risk of abuse and harm. Robust risk assessments and safeguarding processes were not in place to ensure people received safe care. Robust systems were not in place to ensure staff were recruited safely and were suitable to support vulnerable people. Lessons were not always being learnt following incidents and accidents to improve the service. Staff were deployed safely. Systems were in place to minimise the risk of infections. Medicines were being managed safely. Safety checks had been carried out to ensure the environment was safe to live in. Staff had completed key training to perform their role effectively, which included training on learning disabilities and autism. Staff were supported through regular supervision.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The home manager told us that lessons were learnt where possible and this was shared with staff in team meetings and supervisions. We saw evidence of this as being discussed in staff meetings. However, systems would need to be made more robust to ensure all learnings were captured following incidents to minimise risks to people.

Robust system was not in place to learn from lessons following incidents. We saw evidence that concerns were not always investigated following incidents and lessons learnt to minimise the risk of reoccurrence such as with unexplained bruising and the support people required when they were anxious.

The home manager told us there had been no new admissions to the home following the last inspection and explained the process in place to ensure people were admitted into the home safely. Staff told us how they supported people to move in between services safely such as with healthcare appointments.

People had been living at the home for a long period and therefore had continuity of care. Records showed people had been referred to hospitals and GP’s when needed and were supported to attend these appointments. Hospital records were in place that included people's support needs and background should they needed to go hospital, which ensured they can receive safe and effective support at hospitals. Meetings were being held with professionals when required to ensure people received safe care at all times. As there had not been new admissions to the home, we will assess this quality statement in full at the next assessment to check if admission processes are robust.

Relatives told us people were protected from abuse and felt safe. A relative commented, " Yes, I think it is safer now. I could talk to staff, there is a safeguarding team and a Social Worker.” However, safeguarding systems would need to be made more robust to ensure peoples experience at the home was safe at all times.

Staff had been trained in safeguarding and the staff we spoke to were aware on how to safeguard people from harm and who to report concerns to. A staff member told us, “We have to ensure that we are keeping the service users safe from danger from any kind of things. I would take it to my line manager (if any concerns), I would escalate further until I had to. Never had to raise any concerns.” The home manager told us that not all staff were aware of safeguarding processes and workshops were held to address this.

From our observation, people knew staff well and they had positive relationships between each other. People were comfortable at the home and felt at ease with staff.

During our last inspection we found robust processes were not in place to safeguard people from abuse. During this inspection, we found shortfalls still remains and the service continued to be in breach of this area. Robust processes were not in place to safeguard people from abuse and harm. A safeguarding policy was in place that detailed the types of abuse and how to escalate concerns if staff suspected or saw abuse to ensure people were protected. However, during our visit we reviewed incidents since January 2024. We noted that for a person there had been 27 incidents, which led to 4 safeguarding referrals. We saw that on one occasion food was removed from a person in an attempt to calm them. We saw no evidence that this was an agreed practice in dealing with this situation. We also found that concerns with unexplained bruising and poor practices were not investigated in full to safeguard people from abuse.

Relative told us staff looked after people well, which included minimising risks to ensure people were safe. However, robust systems would need to be in place to ensure risks associated with people's safety was minimised to ensure they always received safe care and people's experience was positive.

Staff had no concerns about the home and told us people received safe care. However, we were not assured that when staff supported people particularly when they were anxious that this was an agreed practice to ensure people were safe when they were supported.

We observed people were settled and had a positive relationship with staff. However, we observed that food was removed from a person when they were anxious. We saw no evidence that this was an agreed practice in dealing with this situation on the person's care plan.

During our last inspection we found peoples risks were not properly assessed to ensure they were supported in a safe manner particularly with skin integrity, when using a wheelchair and falls. During this inspection, though we found some improvements had been made, there continued to be shortfalls and the service still remains in breach of this area. Robust risk assessments were not in place to ensure people received safe care. Improvements had been made with risk associated with skin conditions and wheelchair. However, robust risk assessments were not in place to ensure people were safe when they were anxious. In addition, we found a person had sustained unexplained bruise following a suspected injury. Records showed the person also had a serious injury at our last inspection and robust risk assessments were not in place to ensure the person was safe and risks was minimised. On another occasion staff wrote in an incident report that ‘staff closed the door of (person), and they asked for it to be opened. The report stated that ‘(person) was told to be nice to another person living in the service.’ We saw no evidence in the person’s care plan that this was an agreed response in dealing with this situation. Failure to have robust risk assessments meant there was a risk people may be at risk of harm.

People lived in a safe environment where they were able to move around the home safely and the home was well looked after. Relatives no concerns about the safety of the home. A relative told us, “Yes, I do (premises is safe). I do feel it is well looked after.”

Staff told us the premises was safe to live in. The home manager told us that checks were made to ensure the premises was safe to live in such as fire safety checks and that an ice cream van would be hired during summer in the garden for people to enjoy.

The home was clean and tidy, which ensured people were able to move around the home safely. Sluice and storage rooms were locked, and hand towels were available in bathrooms. Information such as food menus were also made accessible to people.

During our last inspection, we made a recommendation for the provider to consider current best practices guidance to ensure the premises were adapted with people's needs in mind. During this inspection, we found improvements had been made. The premises and environment met the needs of people who used the service and were accessible. People were involved on the decisions about the home where possible. Premises and fire safety checks had been carried out to ensure the premises was safe to live in. Checks on equipment were made to ensure it was safe to use such as on wheelchairs. There was a communal and sensory area. There was a garden if people wanted to go outside.

There was enough staff to support people safely. Relatives had no concerns about staff that supported people and with staffing. A relative told us, “Whenever we go there seems to be enough (staff). They are not overrun with staff but there seems to be enough to make sure everyone is OK.” Another relative commented, “Generally, very good (staffing), in the past they were using agency staff, but this has got better.” However, we found robust recruitment checks were not being made to ensure staff were suitable to support people safely to ensure people’s experience was positive.

Staff were trained to support people safely and felt supported in their role. A staff member told us, " I have supervisions once a month. Last month was my supervision carried out by deputy manager. I find it useful because it’s my opportunity to tell them about my job and what I think is working well and not working well. All my trainings have been completed.” Robust systems would need to be in place to ensure staff were of good character. The home manager informed that a new member of staff had been employed to concentrate on pre-employment checks, which would address the shortfalls with staff recruitment.

We observed that there were appropriate number of staffing to meet people’s needs and staff supported people safely and knew them well. Staff were available when people wanted them and they responded to people’s requests quickly.

During our last inspection we found systems were not in place to deploy, support and train staff to meet people’s needs. During this inspection, we found improvements had been made. Staff rotas confirmed there were enough staff to support people safely. Over reliance on agency staff had reduced since our last inspection, which ensured continuity of care for people. Staff had completed mandatory training such as on learning disabilities or autism awareness to help perform their roles effectively. Staff had also completed training in other mandatory areas such as moving and handling, first aid and safeguarding. Regular supervisions and appraisals had been carried out. During our last inspection we found robust systems were not in place to recruit staff safely. During this inspection, we found the shortfalls remain and the service still remains in breach in this area. Robust systems continued not to be in place to ensure staff were recruited safely. We saw gaps in recruitment files, such as not all staff had completed interview notes, gaps in employment and references had not always been received or verified. Staff told us they were supported with an induction when they first started working. However, limited information was available on staff files to demonstrate a robust induction had been completed to enable staff to carry out their role and responsibilities effectively.

People lived in a home that was clean and systems were in place to minimise the spread of infections.

The home manager and staff told us the home was always clean and tidy and they had access to infection control products such as handwash to ensure risk of infection was minimised.

We observed the home to be clean and tidy. Food were stored and sealed safely to avoid contamination. Labels were in place on the date the food was opened and should be used by.

An infection control policy was in place and staff had been trained on infection control. Personal Protective Equipment (PPE) was readily available, and staff confirmed they had access to PPE when needed. Infection audits were being carried out to ensure the risks of infection was minimised. A cleaning rota was in place that evidenced regular cleaning of the home took place.

People received their medicines safely and as prescribed.

Staff told us how they administered medicines safely. Staff was able to give example of how they worked with healthcare professionals to ensure that the principles of STOMP (stopping over-medication of people with a learning disability, autism, or both) were reviewed and stopped. We saw an example where a medicine prescribed to control behaviour was reviewed and stopped for a person who used the service.

During our last inspection we found medicines were not being managed safely. During this inspection, we found improvements had been made. The provider had a medicines policy. Staff completed medicines training and competency assessments before they were able to complete medicines tasks. The GP visited people as and when needed to review their health and medicines. Staff signed medicines administration record (MAR) charts to show that medicines were given as prescribed. There were protocols available to guide staff on how to manage ‘when required’ medicines. The service had a policy on the use of covert medicines administration and had recently had a best interest decision meeting to propose administration of covert medicine for a person.