Farm Cottage

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.

Farm Cottage provided care for five people with very complex learning disabilities, at the time of the inspection four people were living at the service.

At the last inspection, we rated the service ‘Good’. At this inspection, the registered manager and the chief executive officer / provider, demonstrated they had continued to develop the service and the overall rating of the service is ‘Outstanding’.

There was 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.

The service demonstrated an excellent commitment to providing outstanding care that put people at the heart of the service. The registered manager and the provider led by example and inspired the staff to deliver person centred care that consistently achieved outstanding outcomes for all people using the service.

The staff were highly motivated and inspired to offer care that was kind and compassionate. They continuously went the 'extra mile' to ensure that people lived as fulfilled and enriched lives as possible. People's individuality was upheld, which enabled people to grow in confidence and develop as much independence as possible. The staff were proud of the support they provided and the positive outcomes people had achieved. Information was provided to people in an accessible format to enable them to make informed choices and decisions about their care and support.

People and their relatives were very involved in decisions regarding their care and support needs. The care plans were very personalised to reflect people's individual requirements. Staff had an excellent understanding of people’s values and beliefs on how they wanted to receive their care and support to be delivered. The support people received was flexible and responsive to people’s individuality needs and preferences. This gave people an exceptional sense of wellbeing and excellent quality of life. The individual and social activities provided at the service consistently met people’s needs and preferences.

The service played a key role in the local community and was actively involved in building further links. People were encouraged and supported to regularly engage with events outside of the service. People using the service and families were actively encouraged to give their views and raise any concerns or complaints People’s feedback was valued and responses to matters raised were dealt with in an open, transparent and honest way.

Staff continuously demonstrated they upheld and promoted the values and ethos of the service, through providing person centred care that respected the unique qualities of each person using the service. The provider ensured the service kept up to date with the current best practices through membership of relevant organisations and working with various professionals and agencies. The registered manager continuously looked at ways to improve the service and enhance people's lives. The feedback from the people, relatives and professionals was consistently positive.

Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005). The registered manager was aware of how to make referrals to the local authority under the Deprivation of Liberty Safeguards (DoLS). In order to keep people safe the least restrictive practice was always used to ensure people’s human rights were fully promoted.

People continuously received support by the numbers of staff according to their individual assessed needs. People's health was closely monitored by staff and they worked closely with other healthcare professionals involved in their care. People received their prescribed medicines safely; the medicines management system was clear and consistently followed by staff. Healthy eating using some home gown organic produce was integral to promoting people’s good health and overall well-being.

We found that people's needs were assessed and care and support plans were put in place to ensure that people's needs were met. We found that people had activities planned throughout the week that were meaningful and specific to them and their needs. We found that risks were assessed and control measures had been put in place to ensure people were safe.

We found that there were appropriate arrangements in place to ensure that medicines were managed safely and we spoke with two staff members that told us they felt well supported in their roles. We found the provider had a detailed complaints policy in place and we saw the provider had taken action and responded appropriately over any concerns that had been raised.

We spoke with two members of staff who worked at Farm Cottage. They were able to tell us about the needs of the people who used the service and they told us "the care is fantastic" and "I would highly commend the place".

We found that the needs of people who used the service had been assessed and that there were detailed care and support plans in place to ensure that their needs were met. We found that adequate checks and been carried out on staff prior to them starting work. We saw that where staff required a visa to enable them to work in the United Kingdom that it was in place. We saw that the provider assessed and monitored the service provision.