Archived: Farm Lane House

Farm Lane is a residential care home providing care and support to people with a learning and physical disability. Most of the people who lived at Farm Lane had complex health and care needs. The service is registered to provide personal care and accommodation for up to nine people. On the day of our inspection, eight people were living at the service.

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

People told us they liked living at Farm Lane House and relatives we spoke with did not raise any concerns about the care their loved ones received.

We found the service was not operating in accordance with the regulation and was not able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture and best practice guidance. This meant people were at risk of not receiving the care and support that promoted their wellbeing and protected them from harm.

Right support:

People were not always supported to have maximum choice and control of their lives and staff were not supporting people in the least restrictive way possible and in their best interests. People were not involved in a meaningful way in the development of their care and support and information was not always provided in a way which met people's individual communication needs

Right care:

Care was not always provided in a person-centred way which promoted people’s dignity, independence or human rights. People’s care and support plans were not always reflective of their range of needs.

Right culture:

The culture of the service did not reflect best practice guidance and we found elements indicative of a closed culture. For example, there was a disabling culture in the service which was embedded in staff practice. There were low expectations for people, a lack of purposefulness to people's day, people’s opinions were not always valued nor were they empowered to speak up.

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

Rating at last inspection

The last rating for this service was good (published 07 February 2018).

Why we inspected

We received concerns in relation to safeguarding, the management of risk, people’s medicines, the culture of service and governance. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe effective and well led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the 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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse, person centred care, the need for consent, notifications and governance at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We will meet with the provider and request an action plan to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

There were effective systems in place to manage the spread of infection. All visitors to the service were required to have their temperature checked on arrival, wear face masks and disinfect their hands. Track and trace information was gathered at the point of people entering the home.

Staff used and disposed of personal protective equipment (PPE) safely. Sufficient stocks of PPE were in place and conveniently positioned around the building.

Enhanced cleaning schedules including regular cleaning of touch areas such as handrails and door handles were in place. This reduced the risk of cross infection.

Tests for COVID-19 were carried out weekly for staff and monthly for people living at the service. This meant action could be taken swiftly in the event anyone developed symptoms of the virus or had a positive test result.

A clear admission and discharge process had been implemented. Staff liaised closely with a multi-disciplinary team to ensure the safe transfer of people between services.

People were supported to keep in contact with friends and relatives through telephone calls, social media and outdoor visits via an appointment system. The provider was looking at how they could accommodate safe visiting outside in the colder weather.

Staff had support from the management team and the wider organisation. Staff were supported to take part in individual discussions, team briefs and offered counselling services if they had any anxieties about working during the COVID-19 pandemic.

The provider had developed policies, procedures and risks assessments for managing the service in relation to COVID-19. Staff understood the measures in place and had received suitable training. Contingency plans were in place to manage any infections or outbreaks.

Infection control audits and checks were carried out and checks were being made to ensure good practice guidance was followed.

Further information is in the detailed findings below.

Farm Lane is a Residential Care Home providing care and support to people with a learning and physical disability. Most of the people who lived at Farm Lane had complex health and care needs. Support for people’s health needs were sought from local primary care services, such as district nursing and specialist learning disability professionals including occupational and speech and language therapists. The service is registered to provide personal care and accommodation for up to nine people. On the days of our inspection nine people were living at the care home.

Mencap is the registered provider for Farm Lane House. Mencap is a National Charity providing a range of care service throughout the country. Farm Lane House is purpose built with all facilities provided on one level.

At the time of the inspection the manager was in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered person’s’. 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. Following the inspection we were informed the manager had successfully registered with CQC as the registered manager for Farm Lane House.

At the last inspection the service was rated as Good. At this inspection we found the service remained Good.

The service continued to provide care, which protected people and kept them safe. This was because staff understood about how to identify and report any incidents of abuse and/or poor practice. Management and staff undertook relevant training and had information about locally agreed safeguarding protocols.

People’s risks in relation to their health and lifestyle were understood by staff and managed appropriately. People lived in an environment, which the provider had assessed to ensure it was safe. People were protected by the provider’s infection control procedures, which helped to maintain a clean and hygienic service.

People received their medicines safely, by staff who had been trained appropriately and had their competency regularly tested. Overall medicines were stored safely. However, some excess medicines required safer storage. This was raised with the registered manager and provider and action was being taken to rectify this.

People continued to receive care that was effective and met their needs. This was because staff received appropriate training and were supported by colleagues and management to undertake their role effectively. People’s human rights were protected because the registered manager and staff had an understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards.

People received an organised and co-ordinated approach to their health and social care needs. People had access to external healthcare professionals to ensure their on-going health and well-being. Healthcare professionals spoke positively about the care people received at Farm Lane particularly in relation to their dietary risks and end of life care. People’s risks and needs in relation to eating and diet were understood and met by staff.

People and their relatives told us staff were caring and kind. Staff demonstrated kindness and compassion for people through their conversations and interactions. People’s privacy and dignity was promoted and respected.

People received personalised and responsive care. People’s individual and diverse needs were understood and met. People were supported in a way they chose and preferred and support plans were reviewed regularly to help ensure they were up to date and appropriate.

People had opportunities to lead as full and active a lifestyle as possible. Relatives were welcomed into the home and were involved in discussions about their loved ones care arrangements. People were supported to access community events and had opportunities to meet with friends and others outside of the place they lived.

The service was well led by the registered manager and provider and supported by a dedicated team. There were quality assurance systems in place to help assess the on-going quality of the service, and to help identify any areas which might require improvement. Complaints and incidents were learned from to ensure improvement. The registered manager and provider promoted the ethos of honesty and admitted when things had gone wrong. The service kept abreast of changes to maintain quality care.

We met and spoke to the seven people who used the service, spoke to staff about the care given and looked at the care records of three people who lived in the home. We looked at other records and observed staff working with people. We also spoke with the manager.

We saw staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. We saw that the staff had a good understanding of people's individual needs and that they respected people's privacy and dignity.

During our visit to the home we saw sufficient staff on duty to meet the needs of people living in the home. We found that staff received the training they required to carry out their roles.

We saw that people's personal support plans described their needs and how those needs were met. We saw records showing that best interest meetings had been arranged to determine whether a new therapy programme was in people's best interest.

We saw that medication was administered by suitably trained staff. People were not always protected against the risks associated with medicines because the records staff completed did not protect people from harm.

We saw that Farm Lane House held all records securely to protect people's confidentiality.

We met all seven people who used services and spoke to three staff members on duty and checked the provider's records. We also spoke via the telephone with one relative. We spoke to staff about the care given, looked at the care records of three people; we met them, looked at other records and observed staff working with them.

We saw that staff treated people with consideration and respect. For example, most people living in Farm Lane House had complex health needs and required a lot of staff input with close monitoring at all times. We observed that the staff responded to each person with patience and understanding at all times.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. They demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have.

One staff member said, 'It is like a family here'.

One person when asked if they liked living at the home said, 'Yes'. A relative said, 'Best one (home) X has been in'.