Farm Cottage

Updated 23 September 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 Health and Social Care Act 2008.

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

The inspection was completed by two inspectors.

Service and service type

Farm Cottage is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Farm Cottage is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post. However, a manager had been appointed and was in the process of registering with CQC.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We used information gathered as part of monitoring activity that took place on 28 June 2022 to help plan the inspection and inform our judgements.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We communicated with three people who used the service and four relatives about their experience of the care provided. People who used the service who were unable to talk with us used different ways of communicating including using Makaton, pictures, photos, symbols, objects and their body language. We observed interactions between staff and people on both inspection visits.

We spoke with seven members of staff including the home manager, health and safety manager, deputy care manager, team leaders and care workers.

We reviewed a range of records. This included four people’s care records and medication records. We looked at three 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.

Updated 23 September 2022

About the service

Farm Cottage is a residential care home providing accommodation and personal care for up to five people. The service provides support to people with a diagnosis of learning disabilities and/or autistic spectrum disorder. At the time of our inspection there were five people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

We have made a recommendation about mental capacity assessments and decisions. Some restrictions regarding food and equipment had been placed on people without the appropriate consideration of people’s choice or clear documentation on the rationale these restrictions were imposed.

People were mostly supported to have 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.

Staff supported people with their medicines in a way that promoted their independence. However, suitable records were not kept regarding the contraindications of one person’s medication, which was provided in a drink.

Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

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

The service made reasonable adjustments for people so they could be fully in discussions about how they received support, including support to travel wherever they needed to go.

Right Care:

Risk assessments and care plans were in place. However, some were insufficiently detailed to ensure staff had all the information required to provide safe care. However, staff knew people well and the service had a consistent staff team.

Staffing levels were not always consistent regarding the number of staff available to support people to have choice and control of outings and activities. However, staff were recruited safely and received an induction and training programme to ensure they had the skills required to support people. The provider was in the process of recruiting suitable candidates with the right values.

Unexplained injuries had not always been investigated to identify any potential causes so that strategies could be implemented to reduce the risk of reoccurrence.

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

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 treatment/care and support because staff had the necessary skills to understand them.

Right Culture:

Systems and processes to ensure the management team had oversight of the service and could make improvements were not always effective. Audits completed on records did not identify the concerns found on inspection.

Feedback from people, relatives and staff was not always service specific. However, the staff updated people and their relatives on significant events and any changes required in the care and support they received.

People and those important to them, including advocates, were involved in planning their care.

Staff felt support and listened to by the management team. Staff felt able to raise concerns and make suggestions.

The provider had a clear vision and ethos that people, relatives and staff understood.

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 outstanding (published 20 February 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Farm Cottage on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risks and oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.