Hill Farm

Updated 27 April 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors.

Service and service type

Hill Farm is a ‘care home’. People in care homes receive accommodation and nursing or 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 did not have a manager registered with the Care Quality Commission (CQC). The registered manager had left. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided. The provider was in the process of recruiting a new manager and the nominated individual had applied to become the registered manager to provide consistent management support.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who commission the service. We also sought feedback from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. Healthwatch told us they had not visited the service or received any comments or concerns since the last inspection. A local authority commissioner told us they had visited the service and gave us feedback about this visit.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with three people who used the service about their experience of the care provided. Some people were not able to verbally express their experiences of staying at the service. We observed staff interactions with people and observed care and support in communal areas. We spoke with four members of staff including care staff, senior care staff and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included two people’s care records and multiple medicines records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

We are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. In this report, we tried using this communication tool with two people to tell us their experience.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two staff members and a relative.

Updated 27 April 2022

About the service

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.