Archived: Hill Farm

Updated 6 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 18 and 20 April 2018 and was unannounced. The inspection was carried out by two inspectors.

Prior to the inspection, we looked at previous inspection reports and notifications about important events that had taken place at the service.

People were not able to describe their experiences of living at the service so we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also joined some people for lunch and spoke to two relatives and an external activities organiser. We also obtained feedback from a commissioning officer and two care managers from the local authority.

We spoke with the registered manager, administration and finance manager and one senior and three care staff. We looked at a selection of records including three care plans and daily records, two staff files, staff training programme, staff rota, medicines records, environment and health and safety records and quality assurance documents.

At the inspection we asked the provider to send us an updated training matrix and information on the management of epilepsy which we received in a timely manner. We also asked for an action plan to address the Fire Safety Order. We did not receive an action plan so we contacted the provider on 14 May and they sent the relevant information.

Updated 6 September 2018

The inspection took place on 18 and 20 April 2018 and was unannounced.

Hill Farm is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides support for up to nine people with physical and learning disabilities. There were six people living at the service at the time of our inspection including people with sensory impairments, autism and behaviours which can challenge.

The service was run by a registered manager who was present at our visit. They were registered to manage this service and another small service in the local area which is registered with the same provider. 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 was last inspected on 3 August 2017 when the area of ‘Well-led’ was rated as ‘Inadequate’ and the overall rating was ‘Requires Improvement’. At that time we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure that there were sufficient numbers of staff to keep people safe and that they were suitably trained: Regulation 18. There was also a continuous breach of Regulation 17 in that the provider had failed to assess, monitor and improve the quality and safety of the service and to mitigate risks.

The provider sent us a plan of action on 30 October 2017 setting out how they would improve the service to meet the Regulations.

We also made recommendations regarding following guidance in relation to making best interest decisions and reviews staffing deployment to ensure people have access to transportation as required.

At this inspection, on 16 and 20 April 2018, we found continuous breaches of Regulation 17 and 18. Quality assurance systems remained ineffective in highlighting shortfalls in the service or where shortfalls had been identified; they had not been addressed consistently or in a timely manner. Staffing levels had been increased since the last inspection in August 2017, but this had not been maintained. Staffing levels were increased back to safe levels on 20 April, but only as a direct result of our inspection visit. There remained shortfalls in staff training and support. We also found additional breaches of regulation with regards to the management of risks and inconsistency in treating people with dignity and respect.

This is the fourth time the service has been rated Requires Improvement.

The overall rating for this service is ‘Inadequate’ and the service is therefore placed in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Staff had not always received the training or knowledge needed for their roles including how to support people with behaviours that challenged, with an epileptic seizure, to apply first aid and to move people safely. The registered manager booked a training day for staff on challenging behaviour and epilepsy after the inspection visit.

There was inconsistency in the assessment and management of risks which meant that guidance and practices were not always in place to minimise any risks identified to people. There were not effective systems in place to monitor accidents and incidents as some information which informed the provider had not been kept up to date.

Staff knew people well, had built positive relationships, understood their likes and dislikes and preferred methods of communication. One person had a staff team built around them which matched their cultural needs and had had a positive impact on them in the reduction in their behaviours. However, there were inconsistencies in staff practice in treating people with dignity and respect. Some staff spoke about people in their presence as though they were not there and there were occasions when staff did things for people rather than promoting their independence.

There were systems in place for the management, storage, disposal and administration of medicines. However, some people’s pain medicine was out of date so it was not available should it be required. We have made a recommendation about the management of medicines.

It was difficult to assess if people took part in a range of meaningful activities as records had been completed inconsistently. We made a recommendation about the recording of activities. Staffing levels had a direct impact on if people were able to spend time out in the community. On the first day of the inspection people took part in music for health but not everyone was able to go dancing. On the second day of the inspection, when staffing levels had increased, everyone went on a trip and lunch out to the seaside.

Staff were recruited safely and had completed an induction programme. Most staff felt supported but formal planned supervision sessions had not taken place in line with the provider’s policy. Three out of four night staff had not received a supervision or review of their competency for over a year and one of these staff’s probationary period had expired.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been made to ensure that people were only deprived of their liberty, when it had been assessed as lawful to do so. All interested parties were invited to best interest meetings in line with the principles of the e Mental Capacity Act 2005. However, there was inconsistent practice in gaining people’s consent before supporting people with their care. We have made a recommendation about this.

Staff knew about the signs and symptoms of abuse and how to raise a concern inside and outside the organisation.

Staff followed the provider’s guidance to help minimise the spread of any infection.

People’s health, social and physical needs were assessed and guidance was in place to ensure they were monitored and supported to access health care and advice as required. People were supported to have a variety of foods which met their health needs and cultural preferences.

People's care plans detailed people's needs and how they preferred to be supported. They included information about people's life history, likes and dislikes and who was important to them. They contained 'communication passports' and details about how people would let staff know if they were upset or in pain.

There were policies in place that identified that people would be listened to and treated fairly if they complained about the service.

There had been an improvement in staff morale as staff felt that as the service was being sold, a new provider would be more effective in making the necessary improvements.

We found two continued and two additional breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 at this inspection. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.