7 September 2017
During a routine inspection
The Old Farm House Residential is registered to provide accommodation and personal care for up to 26 people. There were 24 people using the service during our inspection; who were living with a range of health and support needs, including diabetes and dementia. Accommodation is arranged over two floors with the majority of bedrooms having an ensuite facility, the service is fully accessible to those in wheelchairs or with mobility difficulties and the first floor is accessed by a passenger lift. The service had a large communal lounge available with comfortable seating and a TV for people and separate, quieter areas. There was a secure enclosed garden to the rear of the premises.
A registered manager was not in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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. A new manager had been appointed and had started the process for applying with the Commission for their registration; they were not present throughout the inspection. The deputy manager and provider were available throughout the inspection.
The previous inspection on 9 and 10 January 2017 found eight breaches of our regulations. The well led domain was rated inadequate and an overall rating of requires improvement was given at that inspection. The provider and registered manager were issued with a warning notice for a breach of regulation 17 of the Health and Social Care Act. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.
At the last inspection the provider had not ensured actions designed to address risk had been followed through into practice. Falls risk assessments were not in place routinely even for those identified as prone to falls. Risk assessments for people’s mobility were not followed in practice; staff did not know how to safely evacuate people in the event of an emergency. People’s health care had not been managed effectively. Medicines had not been managed in a safe way. There was not sufficient numbers of staff deployed to meet people needs. Staff performance was not robustly monitored. Recruitment processes were not robust. People were at risk because there was a failure to ensure that all required servicing of equipment within the premises had been undertaken. Not enough was being done to ensure people's individual preferences around stimulation, activity and engagement were addressed. Staff did not have a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS); Audits had not effectively picked up concerns which we had found during the inspection.
The provider had taken some action to address the concerns raised at the previous inspection. However, further work was required to ensure risk to people’s safety were further reduced specifically in relation to the management of falls, medicines, health and auditing processes.
Some areas of medicine management needed further improvement to ensure people received medicines in a safe way.
People at risk of falls had risk assessments in place. However, the provider had not always taken enough action to analyse incidents so further measures could be implemented to help reduce the number of falls people had.
There were enough staff to meet people’s needs although the deployment of staff needed further improvement to ensure people were always responded to quickly when in need of support.
The provider had taken action to improve how people’s health needs were monitored and responded to. However, further monitoring was required to ensure people’s health was consistently supported and monitored.
The provider had taken action to meet the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, further training for staff was required to ensure they fully understood the requirements of the act.
One person could be verbally and physically challenging towards others. There was no behaviour guidance in the person’s care plan to refer to and staff had not received any training in behaviour management. The majority of staff had received other mandatory training to effectively complete their roles.
The provider had improved their auditing process since the previous inspection which had mainly focused on the environment. There was better oversight of the service as a whole and the new manager had started to take steps to improve service delivery. Staff said they felt morale had improved by means of better communication and understanding about their roles. Staff said they felt more listened to. Further work was required in regards to auditing so improvement could be made in the areas highlighted during this inspection.
Employment checks had been made to ensure staff were of good character and suitable for their roles. Staff were trained in safeguarding and understood the processes for reporting abuse or suspected abuse.
Appropriate checks were made to keep people safe. Safety checks had been made regularly on equipment and the environment. People had individual personal emergency evacuation plans (PEEPs) that staff could follow to ensure people were supported to leave the service in the most appropriate way in the event of a fire.
People had choice around their food and drinks and staff encouraged them to make their own decisions and choices.
People were encouraged to remain as independent as possible. Where possible the consent of people was obtained and their views and preferences were respected. When people were in discomfort or distressed staff responded in a gently and in a caring way. Staff spent time talking to people in a meaningful manner.
Since the last inspection an activities person had been employed. Care plans had been reviewed and updated providing more person specific information about people’s needs.
Complaints were recorded and responded to effectively. The manager had sought the views of people to make improvements to the care and support they received.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.