The Farmhouse

About the service

The Farmhouse is a residential care home providing personal care for up to maximum of 7 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 5 people using the service.

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

The provider had recruited new staff, which reduced the numbers of agency staff being used to provide people's care. During our inspection we saw that some people were left unsupervised in communal areas as staff were busy supporting people in their bedrooms, doing domestic work, or other areas within the home. These practices did not ensure people were cared for and supported safely.

People's medicines were not managed in a safe manner. Some staff did not know who needed ‘as required’ medicines as part of their care needs.

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 inadequate (published 14 December 2023).

Why we inspected

The inspection was prompted in part due to concerns received about an incident following which a person using the service sustained a serious injury. We had concerns about staffing level and medicine management. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' links for The Farmhouse on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains 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 5 key questions it will no longer be in special measures.

About the service

The Farmhouse is a residential care home providing personal care for up to maximum of 7 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 6 people using the service.

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

The service could not show how they met some principles of right support, right care, right culture.

The provider was not always assessing, monitoring and improving the quality and safety of the service. We found risks to people were not being mitigated effectively which could lead to people being harmed. For example, windows restrictor were not fitted properly to prevent people climbing out of them and putting themselves at risk.

Pre-admission assessments and care plans were not robust to ensure people's preferences with support and care were captured. Care plans lacked evidence that people were being involved in decisions about their care.

Medicines were not always managed safely and effectively. Staff did not always record temperatures where medicines were stored. The covert administration of medicine was not being managed in line with the provider’s own policy.

Agency staff were not always being given appropriate training to understand people's care needs. People's care plans contained conflicting and confusing information about their wheelchair assessment. Where decisions were made in their best interest by professionals or the person's representatives, such as relatives, there were no records of this for all the care plans we looked at.

We were not assured there were enough staff to meet people's needs. We also looked at four-week staff rota. The staff rota confirmed on average every weekend there were 10 agency staff being deployed at The Farmhouse. This resulted in people not being supported or able to take part in activities and visits how and when they wanted.

Supervisions meetings with staff were inconsistent, staff were not always given opportunities to discuss their progress or discuss issues.

The systems in place to audit the quality of the service were not robust or sufficient to alert the provider of the concerns and issues within the service. Audits had not picked up areas which were identified during the inspection. Accidents and incidents were recorded but not monitored to identify how the risks of reoccurrence could be minimised in future. The provider had failed to notify the Care Quality Commission of all reportable incidents as required. Providers are required to notify the CQC of certain incidents without delay.

Right support

Risk assessments were not always followed to make sure people were safe. Medicines were not always managed safely and people's abilities in managing their own medicines had not been routinely assessed. Environmental risks were not always identified and addressed through audit systems. Staff were not recruited safely and there were not always enough staff to meet people's needs and maintain a clean and safe environment for people. We also found care records were unclear in relation to people's capacity and there were inconsistencies in the 'best interest decision' process.

Right Care

People were not fully supported to meet their social and recreational needs. Staff knew people well but there were missed opportunities to fully involve people in their care and to promote people's independence.

Right Culture:

There was a lack of provider and managerial oversight of the service. There was a failure by the provider to ensure robust governance arrangements were in place to monitor the safety and quality of the service. Shortfalls across the service such as poor risk management, lack of oversight of staffing and supervision and limited oversight of people mental capacity had not been identified prior to our inspection.

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 05 June 2022) and there were four breaches of regulation specifically on Regulations 12 (Safe care and treatment), Regulation 13 (Safeguarding service users from abuse and improper treatment), Regulation 17 (Good governance), and Regulation 18 (Staffing). At this inspection, not enough improvement had been made, the provider continued to be in breach of regulations 12, 13, 17 and 18 for the second time.

Why we inspected

The inspection was prompted in part by notification of a specific incident following which a person using the service sustained a serious harm. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

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.

We undertook this inspection to check if there were improvements regarding the concerns we identified at the last inspection and if the service was compliant with the requirement notices on Regulation 13, and warning notices we served on Regulation 12, 18 and 17.

The overall rating for the service has changed from Requires Improvement to Inadequate based on the findings of this inspection.

You can read the report from our last inspection report, by selecting the 'all reports' link for The Farmhouse on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relations to safe care and treatment, good governance, staffing, need for consent, person-centred care, privacy and dignity, premises and maintenance, Safeguarding service users from abuse and improper treatment, and Fit and proper persons employed.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

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 six 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.

About the service

The Farmhouse is a residential care home providing personal care for up to maximum of seven people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were six people using the service.

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

The service was not able to show how they were meeting some of the underpinning principles of right support, right care, right culture.

Right Support

¿ People were not kept safe from avoidable harm because risk assessments did not identify some potential risks to people and put guidance in place to minimise the risks. Staff did not receive training to enable them to use effectively and safely equipment that was necessary for the health and welfare of people.

¿ Staff supported people to take part in activities and pursue their interests in their local area and to interact online with people who had shared interests.

¿ The service gave people care and support in a clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs.

¿ Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced.

¿ Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

Right care

¿ Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.

¿ People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

¿ People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

¿ People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

¿ People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them.

Right culture

¿ Staff and management were not always clear about how to report serious incidents to the relevant authorities like the police.

¿ Audits were not effective to ensure shortfalls and gaps in the service were identified and improvements made.

¿ Care plans were reviewed regularly, and people and their relatives were involved in the processes. This ensured that people received support that reflected their current needs.

¿ Staff were open and transparent. Staff gave honest information and suitable support, and applied duty of candour where appropriate.

¿ Staff kept people and relatives updated about what was going on in the service. A newsletter was produced and made available every month to people and their relatives. This provided up to date information about activities, festivities, and staffing.

¿ The service sought feedback from relatives and staff to ensure that they had input in the quality of the service. Staff welcomed complaints and compliments and used them as a positive way of driving improvement at the service.

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:

This service was registered with us on 02 March 2021 and this is the first inspection.

The last rating for the service under the previous provider was Good, published on 15 October 2019.

Why we inspected

The inspection was prompted in part by notification of a specific incident Following which a person using the service sustained a serious harm. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of risks to people and staff recruitment. This inspection examined those risks.

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.

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

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

The provider has begun to take steps to mitigate the risks we identified. The provider informed us of the actions they were taking to make improvements to the care and support provided to people. However, we had limited assurance that these measures were effectively reducing the risks faced by people receiving care.

Enforcement and Recommendations

We have identified breaches in relations to safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, and staffing.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider 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.