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.About the service
The Farmhouse is a residential care home providing personal care for up to maximum of 7 people. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 6 people using the service.
People's experience of using this service and what we found
The service could not show how they met some principles of right support, right care, right culture.
The provider was not always assessing, monitoring and improving the quality and safety of the service. We found risks to people were not being mitigated effectively which could lead to people being harmed. For example, windows restrictor were not fitted properly to prevent people climbing out of them and putting themselves at risk.
Pre-admission assessments and care plans were not robust to ensure people's preferences with support and care were captured. Care plans lacked evidence that people were being involved in decisions about their care.
Medicines were not always managed safely and effectively. Staff did not always record temperatures where medicines were stored. The covert administration of medicine was not being managed in line with the provider’s own policy.
Agency staff were not always being given appropriate training to understand people's care needs. People's care plans contained conflicting and confusing information about their wheelchair assessment. Where decisions were made in their best interest by professionals or the person's representatives, such as relatives, there were no records of this for all the care plans we looked at.
We were not assured there were enough staff to meet people's needs. We also looked at four-week staff rota. The staff rota confirmed on average every weekend there were 10 agency staff being deployed at The Farmhouse. This resulted in people not being supported or able to take part in activities and visits how and when they wanted.
Supervisions meetings with staff were inconsistent, staff were not always given opportunities to discuss their progress or discuss issues.
The systems in place to audit the quality of the service were not robust or sufficient to alert the provider of the concerns and issues within the service. Audits had not picked up areas which were identified during the inspection. Accidents and incidents were recorded but not monitored to identify how the risks of reoccurrence could be minimised in future. The provider had failed to notify the Care Quality Commission of all reportable incidents as required. Providers are required to notify the CQC of certain incidents without delay.
Right support
Risk assessments were not always followed to make sure people were safe. Medicines were not always managed safely and people's abilities in managing their own medicines had not been routinely assessed. Environmental risks were not always identified and addressed through audit systems. Staff were not recruited safely and there were not always enough staff to meet people's needs and maintain a clean and safe environment for people. We also found care records were unclear in relation to people's capacity and there were inconsistencies in the 'best interest decision' process.
Right Care
People were not fully supported to meet their social and recreational needs. Staff knew people well but there were missed opportunities to fully involve people in their care and to promote people's independence.
Right Culture:
There was a lack of provider and managerial oversight of the service. There was a failure by the provider to ensure robust governance arrangements were in place to monitor the safety and quality of the service. Shortfalls across the service such as poor risk management, lack of oversight of staffing and supervision and limited oversight of people mental capacity had not been identified prior to our inspection.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 05 June 2022) and there were four breaches of regulation specifically on Regulations 12 (Safe care and treatment), Regulation 13 (Safeguarding service users from abuse and improper treatment), Regulation 17 (Good governance), and Regulation 18 (Staffing). At this inspection, not enough improvement had been made, the provider continued to be in breach of regulations 12, 13, 17 and 18 for the second time.
Why we inspected
The inspection was prompted in part by notification of a specific incident following which a person using the service sustained a serious harm. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.
We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.
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.
We undertook this inspection to check if there were improvements regarding the concerns we identified at the last inspection and if the service was compliant with the requirement notices on Regulation 13, and warning notices we served on Regulation 12, 18 and 17.
The overall rating for the service has changed from Requires Improvement to Inadequate based on the findings of this inspection.
You can read the report from our last inspection report, by selecting the 'all reports' link for The Farmhouse on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relations to safe care and treatment, good governance, staffing, need for consent, person-centred care, privacy and dignity, premises and maintenance, Safeguarding service users from abuse and improper treatment, and Fit and proper persons employed.
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.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within six months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.