Archived: Farcroft

This inspection was carried out on 23 October 2018 and was unannounced. On the day of the inspection there were 37 people living at the home. The home had a registered manager who was present throughout the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At our last inspection of the service 3 and 4 August 2017 we rated the service as requires improvement as we found that improvements to safe, effective and well led were necessary. At this inspection the provider demonstrated to us that improvements had been made.

People felt safe at the home and there were enough staff on duty. People received the medicines they needed safely and staff understood their responsibilities about keeping people safe. Staff were using technology effectively to ensure that people's medicine needs were met in a timely and safe way. Risks were identified and managed well and any incidents and accidents were monitored to inform practice and make improvements to the service. We found one incidence of unexplained bruising on a person that had not been thoroughly explored. We have made a recommendation about this.

Staff had received the training and support they needed to carry out their roles effectively. People had confidence in the staff and were content with the care they received. People had enough to eat and drink and they enjoyed the food on offer. People were offered choices and their preferences were respected. Risks associated with nutritional needs were identified and managed and people received the support they needed to have a healthy diet.

People were supported to access health care services when they needed to. Staff described positive working relationships with health care professionals. People's needs had been assessed using formats in line with current good practice. Staff understood their responsibilities about the Mental Capacity Act 2005 (MCA). Staff always asked people for their consent before providing care or support.

People and relatives spoke highly of the caring nature of the staff. Staff treated people kindly. Staff knew people well and treated them with respect. People were included in decisions about their care and support as much as possible. Where appropriate, their family or representatives were also included. Staff supported people to remain independent and promoted their dignity. People's privacy was respected and their personal information was kept securely.

Staff understood how to provide care in a personalised way and people's choices and preferences were considered. Staff had time to spend with people, supporting them to follow their interests and faith and to maintain contact with people who were important to them. People were supported to plan for care at the end of their life.

The home was clean and hygienic. Staff understood their responsibilities regarding prevention of the spread of infection.

People knew how to complain and felt confident that any issues would be addressed. There was a complaint system in place to record any concerns and the actions that were taken. The registered manager used complaints and suggestions to drive improvements at the service.

There was a clear management structure at the home and staff understood their roles and responsibilities. Staff had a firm understanding of the ethos of the home to provide care and support in line with the values of the provider. Staff understood the provider's equality policy and supported people with their diverse needs. Governance arrangements were embedded within practice and regular audits identified any shortfalls in standards of care. Action plans showed how learning from incidents and accidents was also used to drive improvements at the home. People, their relatives and staff were included in planning any developments at the home.

The registered manager had informed the CQC of significant events in a timely way. They were committed to keeping up to date with best practice and updates in health and social care.

At the last inspection on 15 July 2015, the service was rated Good. At this inspection we found that improvements were required and we have changed the rating to requires improvement.

The provider had a range of quality monitoring systems in place to identify areas for improvements. However, these had not identified all the concerns we found during our inspection.

The provider had not ensured people’s medicine was stored safely and securely. This left people at risk of accessing medicines that were not prescribed for them and at risk of cross infection. There was also a risk that the effectiveness of medicines was compromised as they had not been stored at the temperature recommended by the manufacturers.

People received support to take their medicines when they needed them to promote good health. Staff monitored people’s health and made healthcare appointments as necessary.

The provider had not consistently ensured decisions made on people’s behalf were made in their best interests. Staff sought people’s consent before they supported them. Staff provided information in a way people could understand to enable them to make their own decisions wherever possible.

Care plans were not always kept up to date and did not always reflect people’s needs and the support provided by staff.

Food and fluid charts put in place to monitor concerns about certain people’s nutritional intake were not consistently completed and it was unclear how much people had eaten or drunk. People enjoyed the food they received and were given choice. Snacks and drinks were made readily available to people.

People were protected from harm and abuse by staff who were able to recognise the signs of abuse and knew how to report concerns. Staff were aware of the risks to people and how to minimise them without restricting their independence.

People were supported by staff who were kind and caring. Staff treated people with respect and maintained their dignity. Staff had formed positive working relationships with people and their relatives. Staff often gave up their free time to take people out and to complete fund raising events to make improvements to people’s experience of the service.

People received care and support that was personal to them and responsive to their changing needs. People were able to spend their time doing things they enjoyed and had access to a range of activities should they wish to take part.

The provider sought people’s views on the quality of the service to make any required improvements. People and their relatives felt comfortable to raise any concerns or complaints with staff or management. The provider had a clear complaints procedure and the registered manager conducted investigations where necessary.

There was an open and inclusive culture in the home. People and their relatives found the registered manager and management team easy to talk with. Staff felt were supported and listened to. They were able to access to training and support relevant to their roles.

People were supported to maintain optimum health. We saw people's health and wellbeing was closely monitored and reviewed in people's best interests. This meant that the service was responsive to people's changing needs.

Staff experienced a robust recruitment and induction process. This gave them the skills and knowledge they needed to keep people safe and to meet their individual needs.

Systems were in place to gain people's views and to monitor and assess the quality of the service.

Staff used clear procedures to get valid consent from people who used the service. We viewed records that showed people had been involved in and consulted about their care and support. Where a person lacked capacity, 'best interest' meetings were held with people who knew and understood the person.

The service had systems in place to manage and monitor the prevention and control of infection within the home.

People told us that the staff asked them if they were satisfied with the service. They said that they were able to express their wishes and share their views about how they were feeling. People said that if they had any concerns or worries that they would speak with a member of staff or the manager. We saw records that showed the provider had systems in place to monitor and review people's experiences and complaints.