Boars Tye Farm Residential Home

Boars Tye Farm Residential Home is a residential care home providing personal care to up to 27 people in one adapted building, some of whom may be living with dementia. At the time of our inspection there were 23 people using the service.

People’s experience of using this service and what we found

Although there were risk assessments and care plans in place, not all risk to people’s safety and wellbeing had been identified and mitigated. People told us they felt safe; however, the systems in place did not always protect people from avoidable harm. Not all concerns had been reported to the appropriate bodies in a timely way.

People’s medicines were not always safely managed, people did not always receive their medicines as prescribed.

The provider had systems and processes in place to monitor the quality of the service, however some of these had not identified what we found on our inspection.

There was a complaints procedure in place and complaints were being responded to.

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.

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 the service under the previous provider was good (published March 2020).

Why we inspected

We received concerns in relation to safeguarding, keeping people safe from risk of harm and the management of medicines. 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.

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.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Boars Tye Farm Residential Home on our website at www.cqc.org.uk.

Enforcement

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 risk, medicines management and management oversight of the service.

Please see what action we have told the provider to take at the end of this report.

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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The registered manager was following the governments guidance on whole home testing for people and staff. This included using rapid and weekly testing for staff.

Staff had received training on working during the pandemic in relation to COVID-19 and had received training in the correct use of personal protective equipment (PPE), hand hygiene and infection control awareness.

People’s well being was supported by video and telephone calls to relatives and friends.

People were supported to have visitors, and arrangements had been made to facilitate essential care givers and relatives visiting people at the end of their life.

A separate isolation area consisting of four bedrooms enabled people who had tested positive to remain in isolation in the least restrictive way.

Boars Tye Farm Residential Home is a residential care home providing personal and nursing care for up to 27 people in one adapted building, some of whom may be living with dementia. There were 20 people living at the service at the time of our inspection.

People’s experience of using this service and what we found

Risks to people’s health and welfare were in most cases, identified and managed to minimise the risk of them coming to harm. However, individualised emergency evacuation assessments which identified people’s specific needs and the level of assistance they needed to safely evacuate the premises in the event of a fire, had been replaced with a ‘grab sheet.’ This did not contain the same level of detail to guide staff on what to do in the event of an emergency.

We have made recommendation about consulting with the fire service regarding this practice.

People and relatives’ feedback about the quality of the food was good. Catering staff had good knowledge of people’s dietary needs, however the dining experience needed to improve to ensure people received their meals in a timely manner, and ensure mealtimes were a sociable and pleasurable experience.

We recommend the provider reviews the dining arrangements.

Detailed care plans were in place to guide staff on how to meet people’s care and health needs, however these needed more detailed guidance for staff on how to support people when their behaviour became challenging, due to anxiety and distress.

There were enough competent staff on duty with the right skills and mix to support the needs of people using the service. Staff had received training that gave them the skills, knowledge and experience to carry out their roles and provide effective care.

The provider had good systems in place, followed by staff to ensure safe and proper use of medicines. The service recognised where people were able to manage their own medicines and supported them to do this. Staff were aware of safeguarding processes to keep people safe. Staff were aware of their responsibility to raise concerns and report incidents. When things had gone wrong, systems were in place to ensure these were investigated and lessons learned were shared with staff.

The premises have been adapted to meet the needs of people living there. Routine safety checks were in place ensuring the premises were homely, and safe. The service was clean and tidy with no unpleasant odours. Staff had access to and understood policies and procedures for the prevention and control of infection and were observed putting these into practice.

People were supported to access healthcare professionals and specialist teams to ensure they received appropriate healthcare and treatment.

We received positive feedback from people and their relatives about staff. People were treated with kindness, respect and compassion. Staff treated people with dignity and respect

Staff understood obtaining peoples consent before providing care. We saw good evidence to reflect the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met.

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, and their relatives told us they are able to express their views and be involved in making decisions about their care.

We received mixed opinions from people and their relatives about activities in the service to keep people stimulated and occupied. Although the service had engaged with the local community, such as village halls to access coffee mornings and schools to interact with children, further work was needed to ensure people had meaningful engagement, occupation and access to therapeutic activities.

Complaints raised about this service were listened and responded too. The service had an open policy and encouraged people to discuss concerns in an open and transparent way.

The service had two staff who were designated palliative care ambassadors. These staff had done some exemplary work to promote good quality end of life care. They worked well in conjunction with relatives and the local hospice to ensure people had a pain free, comfortable and dignified death.

There was a positive culture in the service. Staff were encouraged to be innovative and share their ideas to help improve the service. Staff received the support they needed for their professional development and so they knew what was expected of them.

The provider had good governance systems in place which were used effectively to assess and monitor the service. The management team worked well together and other professionals to understand where and what improvements were needed to drive improvements and provide high quality care.

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 August 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.

The service had 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.

During our previous inspection on 10 February 2016, we found several breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. We found that the service was not consistently working within the principles of the Mental Capacity Act (MCA) 2005 and improvements were required in the management’s oversight of the service. We also identified improvements were required with regard to the monitoring of the safety of the environment and ensuring that people had their medicines administered safely. We gave the home an overall rating of requires improvement. The provider sent us an action plan, setting out the actions they planned to take to improve the quality of the service. At this inspection, we looked to see whether they had implemented the action plan. We found that since our previous inspection the provider had made the required improvements to improve the standard of care and they were no longer in breach of the regulations.

Records showed that there had been an improvement in the frequency and effectiveness of quality assurance checks. This meant that the management team had a clear oversight of the service and were able to effectively monitor and manage the service and drive improvement.

Improvements had also been made to the storage and management of medication. Effective systems were in place to safely manage and administer people's medicines. Some people had been prescribed 'as required' medicines, information relating to why and when these should be given was clearly documented in people's care plans.

The service was consistently working within the principles of the MCA. The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The management team understood their responsibility to comply with the requirements to comply with the MCA and this was reflected within people’s care plans. People were supported to make choices and no unnecessarily restrictive practices were in place.

The service kept people safe from harm. Staff had completed safeguarding training. They understood their responsibilities to protect people from harm and were confident about how to raise concerns in line with the provider's safeguarding and whistleblowing policies.

Risks to people’s daily lives had been assessed and measures were taken to prevent avoidable harm and to help ensure that people’s freedom was supported and respected.

The service had a process in place for recording, monitoring and analysing accidents and incidents and action had been taken to mitigate the risk of reoccurrence.

Robust recruitment and selection procedures were in place and the management ensured that appropriate checks had been undertaken before staff began work. New members of staff were introduced to the service through an induction programme and were required to complete a probation period to ensure that they had acquired the necessary skills to care for people.

Staff were well-trained and worked together as an effective team. Records confirmed that staff had access to regular supervision sessions and received annual appraisals.

There were sufficient staff available to effectively care for people in a meaningful way. People received individualised care and support from staff who were kind and patient. They knew people well and understood their choices, likes and dislikes and were committed to ensuring people received good quality care.

Staff supported people to maintain a healthy diet and to access drinks throughout the day. People were encouraged to be as independent as possible and where appropriate staff assisted people in a patient and kind manner.

Staff worked alongside health and social care professionals to meet people's needs and sought specialist advice and support when the need arose.

The service was managed by an established team who were supportive and visible and staff had confidence in their ability to promptly deal with issues raised. The management team were aware of their responsibility to send notifications as required, so that we could be made aware of how incidents had been responded to.

We previously inspected the service on the 24th June 2013.

The service had 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. The service also had two care managers who were responsible for managing the service in the absence of the registered manager.

People, including family members, told us that they felt safe living at Boars Tye Farm Residential Home. Staff who were responsible for administering medicines had been trained to do so. However, there were not effective procedures in place to monitor the safety of the environment and to ensure that people had their medicines safely. This meant that people were not kept safe from potential harm.

The staff described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training.

The service was not consistently working within the principles of the Mental Capacity Act (MCA) 2005. The MCA and Deprivation of Liberty Safeguard (DoLS) ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements.

We found staffing levels were sufficient to meet people’s needs and that staff were recruited safely and trained appropriately. There was a thorough induction process for new members of staff.

A caring environment was evident. Staff knew about people’s life history and their likes and dislikes. We saw that staff were kind and caring in their approach and there was a warm and friendly atmosphere in the home. The people that we spoke with said they were happy living there and both they and their relatives spoke about the care staff positively.

People's dignity and privacy were respected. The registered manager held regular meetings with staff, people who lived at the home and their relatives and felt that their views and opinions were taken into consideration and acted upon.

People were supported to eat and drink at meal times. During lunchtime people received the help they needed to eat their lunch.

Relatives told us that staff were caring towards their relative and treated them with respect. Care plans and risk assessments were in place and reviewed. We saw that staff supported people to maintain regular contact with health professionals such as doctors and community health teams.

Relatives knew how to raise concerns or make a complaint and were confident that they would be responded to appropriately.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found that care was provided according to people's assessed needs and people were asked for their views about the service. People were provided with support when needed to help with eating and drinking. People's care was provided in accordance with their care plan. People who use the service and their families were included in the development of their care plans.

We saw there were good arrangements to protect people from abuse. People told us they felt safe living at Boars Tye, one person said, 'The staff are lovely."

We found that the provider had an effective quality assurance and monitoring system in place to ensure the safety of people who use the service. The provider had effective systems to deal with complaints.