Archived: The Old Farm House Residential Home

Updated 22 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 7 and 8 September 2017 and was unannounced. The inspection was carried out by one inspector on both days. An expert by experience attended the inspection on the first day. The expert by experience had experience of caring for older people who may have dementia.

Before our inspection, we reviewed the records we held about the service, including the details of any safeguarding events and statutory notifications sent by the provider. Statutory notifications are reports of events that the provider is required by law to inform us about. The provider had not had the opportunity to complete a Provider Information Return (PIR) as they had not received this document before the inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We collected this information throughout the inspection.

We inspected the service, including the bathrooms and some people's bedrooms. We spoke with 16 people who lived at The Old Farmhouse Residential Home. We spoke with three relatives, six of the care workers, the cook, the activities person, the deputy manager and the provider. Before the inspection we received feedback from one healthcare professional.

We 'pathway tracked' seven of the people living at the service. This is when we looked at people's care documentation in depth, obtained their views on how they found living at the service where possible and made observations of the support they were given. This allowed us to capture information about a sample of people receiving care. During the inspection we reviewed other records. These included staff training and supervision records, three staff recruitment records, medicines records, risk assessments, accidents and incident records, quality audits and policies and procedures.

Updated 22 March 2018

This inspection took place on 7 and 8 September 2017 and was unannounced.

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.