Archived: Fenners Farm House

At our last inspection on 15 December 2016, we rated the service overall Good. The key questions Effective, Caring and Responsive were rated good. The key questions Safe and Well-Led were rated Requires Improvement with a repeated breach of Regulation 12 of the HSCA Regulated Activities 2014. People’s medicines were not always managed safely.

We asked the provider to complete an action plan to show what they would do and by when to make improvements. The provider submitted an action plan to us about the measures they were taking to address the concerns found at the previous inspection.

At this inspection, we found that the improvements had been fully embedded into practice and all key questions are now rated as Good.

Fenners Farm House 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.

Fenners Farm House accommodates people in one building, which has been extended and adapted in some areas.

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.

There was a registered manager in post. 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.

Staff worked with people to identify goals and manage risks in a way that enabled people to develop confidence and skills whilst ensuring that they were safe. The provider took a proactive approach to incidents and which meant that they were deescalated quickly and systems were in place to respond to concerns. Staff understood their roles in safeguarding people from abuse.

There were sufficient numbers of staff to meet people’s needs and the provider had carried out checks to ensure that staff were suitable for their roles. People received their medicines safely. Trained staff administered medicines and the provider managed medicines in line with best practice and regularly audited them. The provider had systems in place to ensure the risk of the spread of infection was reduced and people lived in a clean home environment.

People were supported to access healthcare professionals when required with support from staff.

Staff had received appropriate training for their roles. Staff received one to one supervisions and there was an appraisal process in place. Regular meetings took place that involved staff, people and relatives in decisions about the service. People were asked for consent and care was provided in line with the Mental Capacity Act (2005).

Staff knew people well and interacted with them with kindness and compassion. Staff were respectful of people’s privacy and dignity when providing care to them. People were supported to maintain relationships that were important to them.

Care was planned in a person-centred way. People had their own records to document their care and activities using pictures and photographs. Care planning had achieved positive goals for people and helped them to develop skills and try new things. Care plans were regularly reviewed and any changes to people’s needs were actioned by staff. People were supported by allocated staff that oversaw their care and helped to identify choices and preferences. People and relatives were routinely involved in care planning.

People had access to a range of activities that suited their needs and interests. The provider had a clear complaints policy in place and had a proactive approach to feedback to identify improvements.

The provider carried out regular checks on the quality of the care that people received, this included visits from stakeholders independent of them. There was a variety of audits in place to monitor quality and the provider had sent surveys to relatives to gather feedback from them. The provider maintained accurate an up to date records and had notified CQC of important incidents and events. Staff felt supported by the registered manager, team spirit and morale was very positive.

Fenners Farm House provides accommodation and support to a maximum of nine people with a learning disability. The home is an old, former farm house with accommodation ranged over two floors, with changes of level on both floors. Access between the ground and first floor is via a stair lift. At the time of our inspection, there were nine people living in the home.

There was a registered manager in place. 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.

At our last inspection in July 2015, improvements were needed to the safety of the service and to the management processes for identifying and driving improvements and we found breaches in three regulations. At this inspection, we found some action had been taken to improve and reduce the risk of an adverse impact on people's safety and welfare. However, there were still shortfalls, which the registered persons had not proactively identified and addressed.

The registered manager had not made all the improvements that were needed to the safety of systems for managing medicines. Processes for checking and auditing them were not robust and made it difficult to monitor medicines management properly. This led to some people not receiving their medicines as prescribed. This was a further breach of regulations and you can see the action we have asked the provider to take at the back of this report.

Improvements had been made to the way health and safety issues in the environment were monitored and assessed. However, the systems in operation for assessing and monitoring service quality and checking compliance with regulations were not robust. They did not identify the concerns we found for medicines management. The information the provider sent to us before our inspection contained information about supervision and appraisal for staff that, when we checked, was not fully reliable. The registered manager had not recognised shortfalls in this area and developed a 'recovery plan' to ensure they made improvements to their own expected standards.

People received a service which met their needs effectively. Staff were competent to fulfil their roles and had access to a range of training to develop their skills. They recognised the importance of seeking consent from people to deliver their care and of acting in people's best interests where there were specific decisions people may not be able to make for themselves. Where there were restrictions on people's freedom due to the level of supervision they needed to ensure their safety, the registered manager took action to promote people's rights.

People were able to make choices about what they ate and drank and mealtimes were a social occasion shared with staff. Staff ensured that people had enough food and drink to meet their needs and promote their health. Staff supported people to access advice about other aspects of their health and wellbeing, for example from their doctor or dentist, and from professionals in the local learning disability team. They acted on the advice they were given about people's health and understood how people's conditions affected them.

Staff had developed warm and compassionate relationships with people and people living in the home got on well with the staff team. There was a friendly and comfortable atmosphere in the home with people seeking out the company of staff to chat about their day and what they wanted to do. People's privacy and dignity was promoted and they were able to choose how and where they spent their time within the home. Staff understood the importance of encouraging people to do what they could for themselves, to maintain or develop their independence.

Staff had a sound knowledge of the needs and preferences of each person so that they could offer support focused on the needs of each individual. Staff were committed, motivated and worked well together to deliver support and consistent care for people. They recognised that sometimes things went wrong and offered people support to make a complaint if they needed this.

The registered manager had improved their understanding of which events taking place within the service they must tell us about. There were arrangements for asking people about their views and experiences of the care and support they received.

We saw that staff asked the people who used the service if they wished to participate in activities and receive support to meet their personal needs. We observed that staff gave people choices. People had good choices of meals offered and received good nutritional support.

The service had good infection control procedures in place and complaints had been dealt with appropriately.