Midtown Farm

At our last inspection in we found the service to be in breach of Regulation 15: Premises and equipment; because some areas of the building were not suitable for purpose or were not properly maintained. At this inspection in April 2018 we saw that structural work had been completed that had dealt with the problems related to water ingress and that broken and obsolete furniture and equipment had been removed or replaced. We judged that the service was no longer in breach.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Effective and Well-led to at least good. This was completed in a timely manner and with suitable levels of detail. We had evidence in this inspection in April 2018 to show that the action plan had been put into effect.

Midtown Farm is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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 consists of a main house for two people, and two separate living areas created for sole occupancy. The home can accommodate up to four people with learning disabilities. Each of the houses provides people with single bedrooms (some with ensuite facilities) suitable toilets and bathrooms, kitchen and dining areas and lounge areas for each person. There were suitable outside areas where people could walk or sit in good weather. The home was situated in the village of Broughton Moor and is near to the amenities of the village and within easy travelling distance of the larger towns of Maryport, Cockermouth and Workington. Each person had their own transport which staff used to take them out.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The home has an experienced and suitably qualified registered manager who had been in post since the home opened. A registered manager is a person who has registered with the Care Quality Commission 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.

The staff team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and spoke to us about how they would identify any issues and report them appropriately. Risk assessments and risk management plans supported people well. Good arrangements were in place to ensure that new members of staff had been suitably vetted and that they were the right kind of people to work with vulnerable adults. There had been no accidents or incidents reported to the Care Quality Commission and the registered manager was aware of her responsibilities if there were any issues in the home.

We judged that there were suitable staffing levels in place by day and night. The registered manager was reviewing the deployment of staff to ensure that people continued to have suitable support as their needs changed.

Staff were suitably inducted, trained and developed to give the best support possible. We met team members who understood people's needs and who had suitable training and experience in their roles. A new method of supervision had been introduced.

Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. People in the home saw their GP and health specialists whenever necessary. The team made sure that strong medicines and any sedation were kept under review by consultants and specialist nurses.

We had evidence to show that people were encouraged to eat a balanced diet. Staff were helping people to reach a healthy weight.

The four separate areas of the home had been redecorated and were now well maintained. The home was warm, clean and comfortable on the day we visited.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005. Deprivation of Liberty authorities were in place and reviewed on a regular basis. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice.

We observed caring interactions and we saw genuine affection and respect between staff and people in the home.

Risk assessments and care plans provided detailed guidance for staff in the home. The management team had ensured the plans reflected the person centred care that was being delivered.

Staff could access specialists if people needed communication tools. Staff communicated well with people, despite their disabilities.

Each person in the home had their own planned activities that met their needs and abilities.

The registered manager ensured that staff understood the vision and values of the registered provider. Staff were able to discuss good practice, issues around equality and diversity and people's rights.

The service had a comprehensive quality monitoring system in place and people or their relatives were consulted, where possible. Quality assurance was used to support future planning.

There had been no concerns or complaints received but the registered manager was aware of the registered provider's policies and procedures.

Records were now well organised, easy to access and stored securely.

Further information is in the detailed findings below.

At this inspection in March 2017 we judged the service was in breach of Regulation 15: Premises and equipment because there were some repairs and improvements needed to the environment. We judged that appropriate improvements had been made to managing risk and reporting safeguarding.

Midtown Farm consists of a main house for two people, and two separate living areas created for sole occupancy. The home can accommodate up to four people with learning disabilities. Each of the houses provides people with single bedrooms (some with ensuite facilities) suitable toilets and bathrooms, kitchen and dining areas and lounge areas for each person. There were suitable outside areas where people could walk or sit in good weather. The home was situated in the village of Broughton Moor and is near to the amenities of the village and within easy travelling distance of the larger towns of Maryport, Cockermouth and Workington. Each person had their own transport which staff used to take them out.

The home has an experienced and suitably qualified registered manager who had been in post since the home opened. A registered manager is a person who has registered with the Care Quality Commission 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.

People in the home were now protected from potential harm and abuse because staff understood their responsibilities and had received suitable training in understanding and reporting safeguarding. The properties were safe and secure and there was a suitable emergency plan in place.

All four people in the home had a risk assessment that covered their care needs and risks around activities. There were suitable risk assessments in place regarding the building and the grounds. Accidents and incidents were rare and suitable risk management was in place to lessen or prevent any accidents.

Staffing levels met the assessed needs of people in the service. The registered manager had ensured that the staffing arrangements were constantly under review to ensure staffing ratios met people's needs.

Staff were suitably recruited and West House had human resources policies and procedures in place. The organisation had grievance procedures and less formal ways of staff being able to 'whistle blow' if necessary. We had evidence to show that matters of a disciplinary nature were dealt with appropriately.

Medicines were suitably managed with staff receiving training and checks on competence. People were only given sedative medicines on the recommendation of specialist consultants and were kept under constant review.

Suitable arrangements were in place to minimise cross infection and staff had ready access to personal protective equipment.

Staff received good levels of support through supervision, appraisal and checks on competence. Staff had been given a thorough induction and then received both formal and informal supervision. Staff had support that helped with their overall personal development. Records showed that the staff team discussed best practice issues in supervision and in team meetings as well as informally during their shifts.

The registered manager and her team had a good understanding of the Mental Capacity Act 2005 and staff had received training on making decisions in people's best interests, Deprivation of Liberty authorities and on consent.

People in the home sometimes had difficulties managing their emotions and behaviours but careful delivery of care and management of these had resulted in very low reporting of incidents. Restraint had not been used and staff had received suitable training on behaviours that challenge and how to manage them.

People in the home were given good quality food and meals and snacks were as nutritious and as healthy as possible. Some people needed some extra support to maintain a healthy weight and we recommended that the staff team gain support from professionals and formalise nutritional planning for some people.

People saw their GP, specialist and community nurses, opticians, dentists and other specialised health care practitioners where appropriate. People had been under the care of specialist psychiatrists for people with learning disabilities and had the support of psychologists where necessary.

The care staff team were respectful and patient when working with people and they supported people as much as possible to retain their dignity and privacy. We judged the team to have a person centred approach to care. We spoke with relatives who confirmed this.

We saw evidence of on-going assessment of need and we saw that the registered manager contacted health and social care practitioners to support her in this. Each person had a good, detailed health action plan, a care plan and a person centred plan. These covered people's social, emotional, personal and practical needs. Staff understood the content and could deal with emergencies as people had contingency plans to cover every eventuality.

People were encouraged and supported to attend events and activities. They went for walks and to swimming and games. They attended West House entertainments and some people had the support of the organisation's day services. People went out for meals and coffees and did their own shopping where possible.

Staff used the registered provider's quality monitoring systems and were audited by senior people in the organisation. These had ensured that the delivery of care was of an adequate quality but we noted that the quality monitoring systems had failed to deal with some of the environmental issues and nutritional planning issues we discovered. We recommended that the outcomes of quality monitoring be reviewed and suitable action taken to prevent a repeat of these problems.

Staff were good at recording details of care and activities and the records were accessed for us. We judged that the team now needed to archive some records and deal with the back log of filing for some records. We recommended that records management be reviewed in the service.

Midtown Farm is located in the village of Broughton Moor near the town of Maryport. The service provides support for up to four people with a learning disability who have complex needs some of whom have limited verbal communication.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.

We recommended that some people's care required a review following an incident.

We recommended that the registered manager ensure that staff were familiar with a specific risk management plan.

We recommended that the provider review and improve the environment.

We recommended that the registered manager and the provider ensured their quality assurance systems were sufficiently robust.

The service had sufficient staff meet people’s needs in a timely manner.

Medicines were ordered, stored, administered and disposed of correctly.

Staff had been trained to an appropriate standard and had undertaken additional training in order to meet the changing needs of people who used the service.

People were supported to take a good diet that was based on an assessment of their nutritional needs.

Staff had developed caring relationships with people who used the service.

People received appropriate support to enable them to access and the local community.

Support plans were based on thorough assessments and were written using a person centred approach.