Higher Tunshill Farm

Higher Tunshill Farm is a children’s home providing treatment of disease disorder or injury to up to three children. The service provides support to children and young people aged between 10 and 18 years with their emotional and mental health. At the time of our inspection there were 2 children using the service.

Ofsted are the lead regulator for Higher Tunshill Farm as it is a children’s home. The service is also registered with the Care Quality Commission for the regulated activity of treatment of disease, disorder or injury (TDDI).

People’s experience of the 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 assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Children 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

CQC do not rate services that are defined as being a children’s home and which are also registered with Ofsted.

Why we inspected

The inspection was prompted in part due to concerns CQC received about medicines. A decision was made for us to inspect and examine those risks.

We completed a targeted inspection to examine those risks and looked at parts of the key questions; Safe and Well Led.

We found medicines were stored safely within the home. Medicines were administered in a way that respected young people’s preferences. However, improvements are required regarding the oversight of medicines optimisation and medicines incident reporting,

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

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Higher Tunshill Farm on our website at www.cqc.org.uk.

Enforcement [and Recommendations]

We have identified breaches in relation to:

HSCA 2008 (RA) Regulations 2014. Regulation 17 (2)(a) Good governance.

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

We have made recommendations that the provider should;

• improve the oversight of medicines processes

Follow Up

We will meet with the provider following this report being published to discuss how they will make changes to the services provided. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We last inspected Higher Tunshill Farm in October 2016. We carried out an unannounced inspection on 15 and 16 May 2018.

The published date on this report is the date that the report was republished due to changes that needed to be made. There are no changes to the narrative of the report which still reflects CQCs findings at the time of inspection.

The service used person-centred approaches to assessing and meeting the needs of young people who live there. There is a strong focus on co-production and on developing the skills of the young people living there to enable them to transition to independent adult life.

The provider’s vision of ‘safety, empowerment and independence achieved by opportunity and choice’ was shared and implemented by all staff and evident in all the provider’s processes and policies. Young people’s characteristics, personality and their wishes and feelings were demonstrated strongly throughout all records that related to them and staff knew each young person well.

Young people told us how much they liked living at the service and how their choices were respected. One young person told us, “I’m happy here, I feel like I’ve got a family in the house, feel like they care.” Another young person said, “(Staff member) makes sure I do my exercise every day, but if I want to change it, like do biking instead of swimming, I can do that if I want.”

Risk assessment and management plans were co-produced. Risks were recorded in exceptional detail to ensure staff were able to help the young people experience safe care and support.

Young people who displayed outward and challenging behaviour were helped to manage their anxieties and stressors through positive behaviour support plans. These were also co-produced with young people and provided staff with clear guidance on how to support the young people in the least intrusive way. During our visit we noted one such instance being effectively managed with sensitivity and empathy in accordance with the documented plan.

Staff worked proactively with the young people to promote their life skills to enable them to transition to independent life as an adult. Staff encouraged and supported the young people to make their own safe choices about every aspect of their daily lives such as what to eat and which activities to take part in. Young people were also enabled to make major choices about their personal living space. One young person had designed their own room, using a computer, and had been supported with choosing and budgeting for decorating materials.

Leaders and staff had a strong, shared duty of candour. This was evident in the open and transparent culture of reporting, investigating, learning and improving from incidents.

We last inspected Higher Tunshill Farm in July 2014. At that time we found the provider was in breach of regulations in relation to the management of medication and employment checks required when appointing new staff. The provider sent us an action plan telling us what steps they intended to take to ensure they were compliant. A further inspection was undertaken in September 2014 to check if the provider had addressed the shortfalls. We found the regulations had been met.

This inspection was unannounced and took place on the 31 October 2016. As the service is registered with both the Care Quality Commission and Ofsted, a joint inspection was carried out by an inspector from each of the organisations.

The published date on this report is the date that the report was republished due to changes that needed to be made. There are no changes to the narrative of the report which still reflects CQCs findings at the time of inspection.

The service had a registered manager who was present during the 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.

Suitable arrangements were in place to demonstrate that the young people had enough understanding to make up their own mind about the benefits and risks of their care and treatment (‘Gillick competence’). Where the mental capacity act applied consent had been sought from the young person.

Staff had been appropriately trained in intervention techniques and management plans were in place to guide staff. This helped to minimise the risk to the young person and prevent harm or injury.

The young people had access to an independent advocate who regularly visited the home and helped to ensure their wishes and feelings were heard.

We found that suitable arrangements were in place to help safeguard the young people from abuse and sexual exploitation. Guidance and training was provided for staff on identifying and responding to signs and allegations of abuse. Staff spoken with were clear about their responsibilities and knew what they should do to ensure the young people were protected.

The young people were involved and consulted with about their needs and wishes. Care records provided good information to direct staff in the support needed and explored their individual preferences, likes and dislikes. Information was stored securely ensuring confidentiality was maintained.

Interactions between staff and the young people who used the service were warm, friendly and relaxed. Staff were polite and patient when offering support. The young people were encouraged and supported to following activities of their choosing as well as meet their educational needs. This helped to promote their independence and community presence.

We found the system for managing medicines was safe. A multi-disciplinary team was actively involved in meeting the emotional, social and health care needs of the young people, ensuring their well-being was maintained. We were told there was good communication between the team and external professionals. Professionals we spoke with said they were kept fully informed about the care and welfare of the young people.

We found the young people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for the young people safely. The staff we spoke with had a good understanding of the care and support that people required.

We saw the young people were provided with a choice of suitable and nutritious food. Young people told us they were involved in planning their weekly menus and shopping.

To help ensure the young people received safe and effective care, systems were in place to monitor the quality of the service provided and deal with any emergencies that could affect the provision of care. Relevant checks were made to the premises and servicing of equipment and suitable arrangements were in place with regards to fire safety so that staff and young people were kept safe.

We saw that systems were in place for receiving, handling and responding appropriately to complaints.

During the inspection we spoke with the manager, the nurse and two care workers. We looked at medication records and the recruitment files of two care workers.

We found that the controlled drugs register had been completed correctly. Discussion with one care worker confirmed that correct procedures were followed when the young people were given these strong medicines.

We saw records which demonstrated that recruitment procedures were robust. These records included an application form, two or three written references and a criminal records check from the Disclosure and Barring Service. These checks helped to ensure that people who used the service were protected from the employment of unsuitable staff.

Is the service safe?

We saw that the young people were treated with respect and dignity by the staff. The young people told us they got on well with members of staff, were not bullied and felt safe living at the home.

Systems were in place to make sure that managers and staff were able to learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Although members of staff had received training in the management of medication we found that the correct procedure for the administration of a controlled drug had not been followed.

Recruitment procedures were not thorough. A number of staff had been allowed to start working at the home before two written references or a criminal records check from the Disclosure and Barring Service had been obtained.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medication and recruitment.

Is the service effective?

Young people were referred for admission to Higher Tunshill Farm by mental health professionals. The young person and family members were also involved in this process.

Each young person had a social worker and an independent mental health advocate. This meant that the views of the young people were considered in the planning and delivery of their care and treatment.

Is the service caring?

The young people told us they received the help and support they needed at the home. One young person said, 'It's good.' The other young person said, 'The staff are kind and I talk to them.'

The young people's preference, interests and diverse needs had been recorded and were accommodated within the structured routine of the home.

Meetings for the young people who used the service were held every fortnight. The young people organised these meetings and decided on the items to be discussed.

Is the service responsive?

The young people were accompanied by members of staff to attend educational classes on weekdays. Therapeutic and leisure activities were organised both inside and outside the home.

During the inspection we also saw the young people enjoyed including listening to music and cooking.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

There were systems in place for assessing and monitoring the quality of the service provided. We saw that audits completed regularly by the manager covered all aspects of the service provided.

Discussion with members of staff confirmed that they understood their roles and responsibilities. However, we found that a member of staff who was required to supervise other members of staff had not been trained to safely support young people when their behaviour was challenging.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staff training.