We carried out a review of the data available to us about Miller Farm on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Miller Farm, you can give feedback on this service.
Miller Farm is a residential service which provides accommodation and support for up to ten adults who have learning disabilities or additional complex needs. Ten people were living at the service at the time of our visit.
We found the following examples of good practice.
• There were clear measures in place to manage and reduce the spread of infection. This included clear information provided at the entrance to the building, and staff using appropriate personal protective equipment (PPE). During a recent outbreak staff also used disposable gowns, visors and overshoes, and there were good stocks of PPE consistently available. Staff had received training in infection prevention control and knew how to safely put on and take off PPE.
• Some people found communication more difficult when staff wore face masks, however tools such as a white board and using Makaton signs helped. The provider was sourcing PPE which could better meet people’s communication and safety needs. Staff used terminology that people could understand when talking about coronavirus. For example, consistently referring to ‘the bug’.
• People had been supported to keep in touch with their families. Staff provided support where necessary so that people could phone or video call their families. Visits at the service had recently been suspended. When visitors had been able to come to the service, they used a room which was dedicated for the purpose and thoroughly cleaned between each use. The expectations and procedures for visitors to the service were clear.
• Some people had been able to continue accessing facilities in the community. One person had been able to resume local voluntary work and other meaningful activities. This person had been supported to understand social distancing, handwashing and the safe use of PPE. They routinely used a mask, visor and gloves in the community to keep themselves and others safe.
• Another person had been supported to continue visiting the local shop because this was an important part of their daily routine.
• When one person had been unable to visit the local shop because they had to isolate, staff created a daily ‘surprise box’. Staff placed items the person typically bought or liked in a specific box for them to discover and enjoy. This ensured some aspect of their valued daily routine could remain in place.
• Some people found it difficult to comply with social distancing rules, but risk assessments were in place, and actions were taken to keep people and staff safe. Some people had been unable to isolate in their rooms when necessary. Staff had changed the function of other rooms in the service to enable these people to have dedicated spaces for their use.
• The provider was supportive of staff, and risk assessments had been completed with staff who identified as facing higher risks. Managers were positive about the commitment staff had shown throughout the pandemic. Staff were regularly tested for Covid-19 and received full pay if they had to isolate or displayed symptoms.
Miller Farm provides accommodation and personal care for up to 10 people with learning disabilities and autism.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 10 people. 10 people were using the service at the time of the inspection. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.
People’s experience of using this service:
People were supported to have maximum 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.
People received care and support which was person centred. People’s independence was promoted and personal choices respected. People participated in activities that were meaningful to them. New opportunities were regularly offered to enable development and social engagement.
Staff were kind and caring and had developed positive relationships with people. People’s healthcare needs were met and staff supported people to access further healthcare when required.
The environment was accessible. People had personalised their own space to ensure it was homely and to their individual taste.
The provider was committed to staff’s induction, training and supervision to ensure staff were skilled and knowledgeable. Medicines were administered safely. There was a positive open culture. The service was well-led and managed.
For more details, please see the full report which is on CQC website at www.cqc.org.uk
Rating at last inspection:
The last rating for this service was Good (published 30 June 2017).
Why we inspected:
This was a planned inspection based on the previous rating.
Follow up:
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
We carried out this inspection on 4 June 2017. At the last inspection, the service was rated Good. At this inspection we found the service had met all relevant fundamental standards and remained rated as Good.
The service has 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 staff had a clear knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. We have made a recommendation around how the service records people’s best interest decisions and their mental capacity assessments for people.
There were processes in place for the safe storage and management of medicines.
The staff had received training regarding how to keep people safe and they were aware of the service safeguarding and whistle-blowing policy and procedures. Staffing was arranged in a flexible way to respond to people’s individual needs.
People were provided with regular opportunities to express their needs, wishes and preferences regarding how they lived their daily lives. Each person was supported to access and attend a range of social activities. People were supported by the staff to use the local community facilities and had been supported to develop skills which promoted their independence.
People’s needs were regularly assessed and resulting care plans provided guidance to staff on how people were to be supported. Support in planning people’s care and support was personalised to reflect people’s preferences and personalities.
There was a robust staff recruitment process in operation designed to employ staff that would have or be able to develop the skills to keep people safe and support people to meet their needs.
Staff demonstrated a detailed knowledge of people’s needs and had received training to support people to be safe and respond to their support needs. We saw that the service took time to work with and understand people’s individual way of communicating in order that the service staff could respond appropriately to the person. Staff respected people’s privacy and we saw staff working with people in a kind and compassionate way responding to their needs.
There was a complaints procedure for people, families and friends to use and compliments could also be recorded.
The provider had quality monitoring systems in place which were used to bring about improvements to the service.
Further information is in the detailed findings below.
This inspection took place on the 7th May 2015 and was unannounced
Miller Farm is a care home providing personal care and support for people with learning disabilities. The home is registered for up to 10 people. At the time of the inspection they were providing personal care and support to eight people.
There was a registered manager at the service at the time of our inspection. 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.
People and their relatives told us they felt safe and were happy with the care and support provided. Systems were in place to help ensure people were safe. For example, staff had a good understanding of what constituted abuse and the abuse reporting procedures. People’s finances were managed and audited regularly by staff.
People were supported by sufficient numbers of staff. Appropriate recruitment checks were in place which helped to protect people and ensure staff were suitable to work at the service. Staff told us they felt well supported in their role and received regular supervision.
Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed. Care plans were sufficiently detailed and provided an accurate description of people’s care and support needs. The management of medicines within the service was safe.
Appropriate assessments had been carried out where people living at the service were not able to make decisions for themselves and to help ensure their rights were protected. People had good healthcare support and accessed healthcare services when required.
People were supported to be able to eat and drink satisfactory amounts to meet their nutritional needs. The mealtime experience for people was positive. People were treated with kindness and respect by staff. Staff understood people’s needs and provided care and support accordingly. Staff had a good relationship with the people they supported.
An effective system was in place to respond to complaints and concerns. The provider’s quality assurance arrangements ensured that where improvements to the quality of the service was identified, these were addressed
We observed people were free to make their own choices regarding their day to day living. This included personal care routines, clothing, meals and leisure activities. We saw staff respected and acted on people's decisions. Where people did not have the capacity to consent to certain decisions staff acted in accordance with legal requirements.
From our observations and what people said they appeared happy and contented with the care and support provided. One person said 'I'm looked after OK. My key worker is very good'. Another person said 'I'm alright'. Staff spoken with had a clear understanding of each person's support needs and how they should be met.
People who were able to speak with us confirmed they felt safe and were well treated by staff. All the people we observed looked at ease with the staff supporting them. Staff spoken with knew how to recognise signs of abuse and how to report any concerns.
Staff said they felt competent and trained to carry out their roles. Staff told us the provider offered 'excellent training and development'.
The provider maintained accurate and appropriate care records and other records relevant to the management of the service. This helped protect people from the risks of unsafe or inappropriate care.
Staff were competent, knowledgeable and sensitive in their interactions with people, adapting the way they communicated according to people's communication needs. One person told us "I like staff". Another person told us "I talk to my key worker if I have a problem". Information about people's needs was kept up to date in key worker packs and there was consistency in the care provided due to detailed staff handovers.
People were protected from the risk of abuse because safeguarding procedures were in place and staff identified changes in people's behaviours and implemented behaviour management plans to prevent situations from escalating.
There was an effective system in place to monitor the quality of service provision through a range of methods including satisfaction surveys, monthly residents meetings and internal audits. People's concerns or suggestions were acted upon in order to continually improve peoples' experience of the service.