Gorse Farm

Gorse Farm is a residential care home providing personal care to 13 people at the time of the inspection. The service can support up to 14 people with a sensory impairment, learning disability or autistic spectrum disorder.

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.

Based on our review of the safe and well-led key questions the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

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. Environmental risk and some aspects of medicine management required improvement. Some action was taken to address this. Staff were recruited in line with the provider’s procedure.

Right care:

The prevention and control of infection was not always managed safely and in line with the provider's guidance and procedures. People received personalised care and their human rights were promoted and protected. People felt safe. Relatives had no concern about their family members safety. Staff understood their responsibilities to keep people safe. Risks associated with people's care were well-managed. There were sufficient staff to provide people’s care and to support people to do things they liked and enjoyed.

Right culture:

Service oversight and audits used to monitor the quality and safety of the service required improvement. The manager promoted a positive and person-centred culture within the home and led by example. Staff felt supported and valued. The manager was working with relatives to improve communication and to gather their feedback about the service provided. The management team and staff shared a commitment to continuously learning and worked in partnership with other professionals to achieve good outcomes for people.

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 good (published 19 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

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.

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

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 infection prevention and control and the management of the service at this inspection.

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 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.

Gorse Farm 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.

The home provides accommodation with personal care for up to 14 people with a learning

disability or autistic spectrum disorder. It does not provide nursing care. At the time of our visit 13 people lived at the home. Accommodation is provided in two single storey bungalows and one supported living flat. The home is located in Solihull.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

We last inspected Gorse Farm in June 2017 and gave the home an overall rating of 'Requires Improvement'. There was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Safe care and treatment. This was because risks associated with people’s care and medicines were not managed consistently and safely.

We asked the provider to send us a report, to tell us how improvements were going to be made to the service.

At this inspection on 16 May 2018 we checked to see if the actions identified by the provider had been taken and if they were effective. We found improvements had been made and action had been taken in response to the breach in the Regulation.

The service had 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.

Improvements had been made to the way people’s medicines were managed and administered. However, further improvement was needed. Action was planned to address this.

The provider’s staff recruitment systems reduced the risk of recruiting unsuitable staff. Relatives were confident their family members were safe living at the home and there were enough staff available to provide the care and support people needed, and to keep them safe.

The management team and staff understood how to protect people from abuse and their responsibilities to raise any concerns. Staff received an induction into the organisation, and a programme of training to support them in meeting people's needs effectively. Staff received regular management support through individual and team meetings.

Risks associated with people’s care and support, the premises and emergencies were regularly assessed. Risk management plans were up to date and provided staff with the information they needed to manage and reduce known risks. Staff followed the guidance provided and understood how to minimise risks to people's safety.

People’s privacy and dignity was respected and their independence promoted. The provider was working within the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

The home offered a varied range of individual and group activities which people enjoyed. Care records were personalised and informed staff how people wanted their care and support to be provided and how they chose to live their lives. People and relatives were involved in developing and reviewing planned care.

People received care that was responsive to their needs which was provided by staff they knew. People were supported to maintain relationships with people who were important to them. People’s families were welcomed to visit the home at any time. Relatives felt staff were caring and dedicated.

Relatives told us positive changes had been made to the service provided and the way the home was managed. Staff enjoyed working at the home and felt supported and valued by the management team. Relatives felt able to raise any concerns with the registered manager and were confident these would be addressed.

The management team completed regular checks to monitor the quality and safety of service provided, and encouraged relatives and staff to share their views about the home to drive forward improvements.

People were encouraged to make choices about their daily lives, including how they would like to spend their day. When needed, people had access to health and social care services and staff worked with other professionals to support people to maintain their mental health, health and well-being. People chose what and when they would like to eat and drink and food provided reflected people’s preferences.

Gorse Farm provides residential care for 14 younger adults with learning disabilities in Solihull. Accommodation is provided in two separate bungalows each for up to 7 people, and an adjoining self-contained flat. At the time of our visit, 13 people used the service.

The service had 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. Since our last inspection a new manager was in post. They had been in post since August 2016 and registered with us in May 2017.

At our previous inspection in June 2016 we rated the service as ‘requires improvement’ in the key questions of ‘responsive’ and ‘well-led’. This was because relatives told us at times communication at the service had been poor and they had not always been informed about their relative’s care or given the opportunity to be involved in this. Relatives were not positive about the management of the service as they felt this had been inconsistent. They told us this had not given them the opportunity to get to know managers and this had impacted on the care people received.

At this inspection, most relatives told us communication was improving and they spoke positively about the new registered manager. However, we found medicines were not always administered and stored safely. Care records required updating. Some audits had been completed to ensure staff were working in line with the provider’s policies and procedures, however these were not always effective in driving improvement, for example in relation to medicines.

Staff were trained to administer medicines, however people did not always receive these as prescribed, and records did not always reflect whether medicines had been given. Medicines were not always stored safely.

Relatives told us people were safe at the service. Staff had a good understanding of what constituted abuse and knew who to contact if safeguarding concerns were raised.

Checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service. Staff received an induction to the organisation, which included working alongside other more experienced staff, and a programme of training to support them in meeting people’s needs effectively.

Staff understood the principles of the Mental Capacity Act (2005), and the registered manager had taken the required action if they felt people were being deprived of their liberty. Capacity assessments were decision specific in line with the principles of the Act.

People were assisted to meet their nutritional needs. Staff referred people to other health professionals for further support if they had any concerns.

People received support from staff who they were familiar with and this was provided as outlined in their care records. There were enough staff to care for people and further staff were being recruited.

Care records were in the process of being reviewed by the management team. Care records contained some relevant information for staff to help them provide people’s care including processes to minimise risks to people’s safety. However, these were not always up to date or detailed enough for staff to reduce the risks effectively. People and their relatives had not always been involved in these discussions or reviews of care. Care records were not always produced in a format people living at the service could understand.

Relatives told us staff were kind and caring and supported people with dignity and respect. Staff encouraged people to be independent. People were encouraged to maintain relationships with people important to them.

People and their relatives knew how to complain, however they were no formal opportunities to share their opinions about the service through meetings or surveys.

People, relatives and staff were positive about the registered manager. Staff were confident they could raise any concerns or issues with them knowing they would be listened to and acted on. Relatives and staff told us the management team were available and responsive.

The registered manager gave the staff team formal opportunities to discuss any issues or raise concerns at individual and team meetings. There were some processes to monitor the quality of the service provided and audits were carried out by the provider, registered manager and team leaders. These checks were to ensure staff worked in line with policies and procedures, however were not always effective in driving improvement at the service.

The service was last inspected on 1 April 2015 when we found some improvements were required in relation to how risks were managed. We asked the provider to take the necessary steps to ensure the required improvements were made. At this visit we found improvement had been made in this area, however some further improvements were still required in other areas.

Gorse Farm is a purpose built residential home which provides care for up to 14 adults with learning disabilities in Solihull. Accommodation is provided in two separate bungalows for up to seven people in each. At the time of our inspection there were 13 people living at the home including one person who was living in an adjoining self-contained flat. Three people were away on holiday.

The service did not have 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 registered manager had left in February 2016 and a new manager was in the process of being appointed. Two of the provider’s operations managers were currently managing the service and one intended to apply for registration with us.

Relatives told us at times communication at the service had been poor and they had not always been informed about their relatives’ care or given the opportunity to be involved in this.

Relatives were not positive about the management of the home as they felt this had been inconsistent. They told us this had not given them the opportunity to get to know managers and this had impacted on the care people received.

Relatives and staff told us people who used the service were safe. Staff had a good understanding of what constituted abuse and knew what actions to take if they had any concerns. Staff were effective in identifying risks to people’s safety and how to manage these risks.

There were enough staff to care for the people they supported and new staff were also being recruited. Checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service. Staff received an induction into the organisation, and a programme of training to support them in meeting people’s needs effectively.

People and relatives told us staff were caring and had the right skills and experience to provide the care required. People were supported with dignity and respect and people were given a choice in relation to how they spent their time. Staff encouraged people to be independent, and people had gained increasing skills and confidence in their daily lives. Care plans contained information for staff to help them provide personalised care.

People received medicines from trained staff and medicines were administered safely.

Staff understood the principles of the Mental Capacity Act (2005) and how to support people with decision making, which included arranging further support when this was required.

People had enough to eat and drink during the day, were offered choices, and enjoyed the meals provided. People were assisted to manage their health needs, with referrals to other health professionals where this was required.

People had enough to do to keep them occupied and staff tailored activities to people’s individual interests. The management team had identified that having more staff that drove vehicles would improve activities further, and action was being taken to facilitate this.

People knew how to complain and could share their views and opinions about the service they received. There were no formal opportunities for relatives to feedback any concerns they had at meetings.

Staff told us they could raise any concerns or issues with the managers, who were approachable. There were formal opportunities for staff to do this at group and one to one meetings.

There were processes to monitor the quality of service provided. There were other checks which ensured staff worked in line with the provider’s policies and procedures. Checks of the environment were undertaken and staff knew the correct procedures to take in an emergency.

During our visit, we spoke with two managers and four support workers. We observed interactions and spoke with one person who lived at the home. We also spoke by phone with four relatives of people who lived at the home. At the time of our visit fourteen people lived at Gorse Farm.

On the day of our visit, the registered manager was on long term sick leave. Autism West Midlands, who run Gorse Farm, have appointed another experienced manager to run the home during this time of absence.

One staff member said, 'It's been a difficult few months, but we feel supported and have a sense of belonging again.' Another staff member said, 'Although the new manager has only been here a week, things have vastly improved and there is a clear plan for how that will continue.'

Most people who live at Gorse Farm are unable to express their views about living there. However, four relatives we spoke with were happy with the care they provide. One relative said, 'They have been very, very good. We work together very well. Another relative said, 'They take good care of X. They take him ice skating and swimming. Their activities have been very good.'

People told us, 'They do an excellent job' and 'The facilities are brilliant.' Staff said, 'It's a good, supportive place to work.'

Staff told us that staff cover was good and they plan a wide range of activities for people. We saw that these had recently included horse riding, swimming, movie nights and a range of arts and crafts.

People who lived at the home were not able to tell us what they thought in detail. However, we observed that they interacted positively with staff and appeared very comfortable and relaxed. They were encouraged to make their own choices and decisions. The home was clean, tidy and well maintained.

People told us that staff were pleasant and helpful.