Archived: West Farm House

People’s accommodation was located on the ground and first floor. There was a passenger lift to enable easy access. On the ground floor there was a pleasantly furnished lounge, separate dining room and an adjoining garden room.

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

There were enough staff, but safe recruitment practice was not being followed. This did not ensure people were supported by staff who were suitable. Risks were not always appropriately identified and considered. This impacted on people’s safety. Medicines were safely managed but staff had not always applied people’s topical creams as prescribed. The home was clean and measures to minimise infection were in place.

People had enough to eat and drink and were supported to lead healthy lives. People were supported by staff who felt valued and received training to do their job well. The environment was pleasant, and people were encouraged to personalise their room. People had capacity and were supported to have maximum choice and control of their lives.

People were complimentary about the staff and established relationships had been built. People’s rights to privacy, dignity and independence were promoted. People were able to give their views about their care but were not aware of their care plan.

Care plans did not always reflect people’s needs and the support required. The information was not updated as people’s needs changed. People were encouraged to be as independent as possible and were happy with their care. However, staff shaped some routines, rather than them being chosen by the person. Visitors were welcomed, and people were able to go out when they chose. People were happy with the social activities available to them and knew how to make a complaint.

A range of audits had been introduced to assess the quality and safety of the service. Whilst action plans had been addressed, the shortfalls identified at this inspection had not been identified. This meant risk management and care planning was not effective and safe recruitment practice was not being followed. This is the third time the service had been rated requires improvement and breaches in regulation remained. The provider had a strong presence in the home and there was a caring ethos.

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 09 August 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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.

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

Enforcement

We have identified breaches at this inspection in relation to safe care and treatment and good governance. This was because there were shortfalls in risk management, care planning and quality auditing processes.

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 request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

West Farm House accommodates 10 people in one adapted building. At the time of the inspection there were seven people living at the home.

This inspection took place on 19 and 26 June 2018. The first day of the inspection was unannounced.

At the inspection in June 2016, we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued three warning notices to ensure the provider made improvements. An inspection in November 2016 showed the provider had addressed the shortfalls, as identified in the warning notices. Further improvements were identified at the last inspection, which took place on 22 February and 03 March 2017. However, some areas needed further development and to be embedded over time. We made one recommendation for the provider to consider current guidance on safe recruitment practices and take action to update their practice accordingly.

At this inspection, further improvements had been made but there were remaining shortfalls in some areas.

A registered manager was not required due to the registration of the service. The provider was responsible for the day to day management of the home. They were available throughout the inspection.

At this inspection, safe recruitment practice was not being followed. This did not ensure people’s safety, as the provider could not be assured prospective staff were suitable to work at the service.

The required checks had been undertaken in relation to the fire safety systems. However, the checks had identified some of the internal fire doors did not close properly when the fire alarm was activated. This did not ensure any smoke would be sufficiently contained in the event of a fire. There was no evidence to show any action had been taken to address this. A Fire and Rescue Service inspection had identified external fire doors compromised effective evacuation in the event of a fire. New fire doors were in the process of installed.

People medicines were not always safely managed. There was information about “as required” medicines but it was not specifically related to each person. Staff had not always signed the medicine administration record to show they had applied people’s topical creams. There had been three errors with people’s medicines in the last five months.

Improvements had been to the structure and content of people’s care plans. Some plans were detailed and person centred although there were areas that lacked clarity. Staff had recorded some entries in people’s daily records that were subjective, rather than being factual. All care plans were up to date and regularly reviewed.

Whilst the quality auditing systems had been developed, they were not fully effective. This was because the audits had not identified the shortfalls we found during the inspection.

People and their relatives were encouraged to give their views about the service. This was informally through general conversation or by the completion of surveys. Whilst feedback was positive, it was not co-ordinated to give an overview of people’s views.

People were happy with the care they received. There was a strong focus on promoting independence and encouraging people to have a good quality of life. People were encouraged to follow their own routines and make decisions about their care. People’s privacy and dignity was promoted. New opportunities were being developed to enhance social activity provision. People were encouraged to help out within the home if this is what they wanted to do.

People had enough to eat and drink. The food was varied, of a good quality and well presented. All food was cooked “from scratch” with an emphasis on fresh produce and people’s preferences.

There were enough staff to support people safely. Staff knew people well and there was a relaxed, homely atmosphere. Staff had time to spend with people and were not rushed. Any requests were undertaken in a timely manner.

Staff felt well supported and received training to help them in their role. Staff knew people well and established relationships had been built.

The environment was homely, comfortable and well furnished. There was a large, well maintained garden which people enjoyed. All areas of the home were clean and there were no unpleasant odours.

We found three breaches of regulation at this inspection and made one recommendation.

You can see what action we told the provider to take at the back of the full version of the report.

West Farm House is registered to provide accommodation and personal care for up to 10 people. During the inspection, there were six people living at the home.

A registered manager was not required due to the registration of the service. 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 provider was responsible for the day to day management of the home. They were not available during the inspection due to being on holiday although we spoke to them on the telephone, on their return.

At this inspection, the improvements previously identified in November 2016 had been sustained. However, there remained some shortfalls regarding staff recruitment. Other areas such as care planning and quality auditing had received focused attention but were being further developed. Both systems required time in order for all developments to be properly embedded. There was a commitment to improve the service. People’s safety had been enhanced through developments to the environment. The laundry room had been fully refurbished, which enabled an effective space, which could be cleaned easily.

People were happy with their care and were encouraged to follow their own interests and preferred routines. There was emphasis on the environment being homely with a relaxed atmosphere. People enjoyed regular visitors and going out with them. Opportunities for additional social activity were being considered, with a newly introduced exercise group, appearing popular.

There were many positive interactions between people and staff. Staff were responsive to people’s needs and relaxed conversations were a regular occurrence. Staff knew people well and consistency of care was assured due to a relatively small staff group. The deployment of waking night staff was continuing to work well and there were sufficient staff available to support people, at all times.

Improvements had been made to the management of people’s medicines. This minimised the risk of error and increased safety. People received good support from various healthcare professionals, to remain healthy. People told us they felt safe at the home and had not seen any practice which concerned them. Staff were aware of their responsibilities to report any suspicion or allegation of abuse or poor practice.

People had no hesitation in talking to staff or the provider if they were not happy with any aspect of the service. They were confident any issue would be quickly and satisfactorily resolved. People were able to post any complaints into a newly introduced box in the hallway, if they wanted to.

Meal provision was based on people’s preferences. People told us they were happy with the food provided and had regular drinks of their choice. The menus were varied and based on fresh produce. If people did not like the main meal, alternatives were offered. Lunch was seen as a social occasion, where people enjoyed conservation with others.

Staff were confident when talking about promoting people’s rights to privacy and dignity. Staff were well supported and worked well as a team. Additional focus had been given to staff training. All staff had completed or were in the process of completing the Care Certificate This was a recognised format, generally aimed at staff, when commencing their employment within a care setting.

The provider continued to be heavily involved in the day to day management of the home. Due to the overall improvements which had been made, the service has been removed from special measures.

We have made a recommendation about safe recruitment practice.

We undertook this focused inspection to check the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for West Farm House on our website at www.cqc.org.uk.

West Farm House is registered to provide accommodation and personal care for up to 10 older people. During the inspection, there were 9 people living at the home.

A registered manager was not required due to the registration of the service. 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 provider was responsible for the day to day management of the home and was available throughout the inspection.

The provider had been working closely with staff and the local authority to make improvements to the service. As part of this work, people’s care plans had been rewritten. The new format was better organised and gave greater information about people’s needs and the support they required. Further work was being undertaken to ensure the plans were more person centred, with added detail. However, the care plans had not been updated as people’s needs changed. Daily records did not always show the follow up action staff had provided, to ensure people’s wellbeing.

Work had been undertaken to develop the quality monitoring systems in place. However, the systems were not fully effective and required greater focus. The provider demonstrated a positive attitude to enabling change and ensuring a good service was provided.

A waking member of night staff had been deployed in order to meet people’s night time care needs. People and staff told us this had been a positive development. They told us there were now added safeguards and people were able to safely use the bathroom in the night, rather than relying on continence aids.

Improvements had been made to the safety of the environment. The pipework in the downstairs toilet had been boxed in and covers had been fitted to all radiators. The hand wash basins in people’s en-suite facilities, the bathroom and downstairs toilet had been fitted with regulators. These actions minimised the risk of people burning or scalding themselves from hot surfaces or excessively high water temperatures.

Fire safety had been improved upon. This was because fire doors were being held open appropriately and the fire panel had been properly labelled. Staff had received fire safety training and a fire drill had taken place.

The laundry room was in the process of being fully refurbished. The walls had been painted and new flooring applied. A hand wash basin had been installed and all items such as recycling had been removed. Work was being undertaken to replace the existing right hand side of the room with a window and brick surround. Disposable red bags had been purchased to enable staff to place soiled linen directly into the washing machine. This reduced the need for staff to handle the soiled items, which minimised the risk of infection.

The last inspection to the service was on 16 September 2014. The provider had satisfied the legal requirements in all of the areas we looked at.

West Farm House is registered to provide accommodation and personal care for up to 10 people. During the inspection, there were 9 people living at the home.

A registered manager was not required due to the registration of the service. 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 provider was responsible for the day to day management of the home. They were not available on the first two days of the inspection due to being on holiday but were present during the whole of the third day.

Quality auditing systems were not effective as shortfalls in the service were not being sufficiently identified. A monthly audit was undertaken but this did not cover specific areas, such as infection control, medicine administration or the environment. Not all management systems such as recruitment were being properly managed.

Potential risks to people’s safety were not being identified and properly addressed. The hot water was of an excessively high temperature, which increased the risk of scalding. Radiators in corridors and communal areas were not covered and there was a hot pipe in the downstairs toilet. These issues increased the risk of people burning themselves if they touched or fell against the hot surfaces. Some fire doors were propped open and not all doors closed properly, when the fire alarm was activated. These issues meant fire and smoke would not have been properly contained, in an emergency. The fire panel was not clearly marked and staff were not aware of the different areas of the home, identified as zones. This lack of knowledge increased the risk of delay, when trying to locate and manage a fire.

Whilst there were enough staff on duty to assist people effectively during the day, people were not properly supported at night. A member of staff undertook a “sleeping in” role but there were no waking night staff. This impacted on people’s safety and did not ensure those people with night time care needs, were appropriately supported. The lack of waking night staff compromised some people’s dignity. Staff were not always responsive to people’s changing health care needs particularly in terms of skin integrity and mobility. Each person had a plan of their care but the information was insufficiently detailed and did not identify individual needs or the support required.

People’s medicines were not being safely managed. The medicine administration records were handwritten, which increased the risk of error. Staff had not consistently signed the records to show they had given people their medicines as prescribed. Instructions for topical creams and medicines to be taken “as required” were not clear. This did not ensure staff had sufficient information to administer or apply the medicines as prescribed, for maximum effectiveness.

Good infection control was not being followed. The laundry appliances were located in an outbuilding, which meant the walls and floor could not be wiped hygienically clean. Systems were not in place to reduce the handling of soiled items and such items were inappropriately soaked, before being placed into the washing machine. This increased the risk of contamination.

Staff undertook a range of up to date training to help them do their job more effectively. However, not all topics related to older age or people’s changing needs. Staff had undertaken training in moving people safely but this had not included practicing their learning. Staff were receiving support from health care professionals to address this.

People were supported by a small team of staff who knew them well. Staff felt valued and well supported. They met with the provider on a formal basis to discuss their performance and any concerns they might have. The provider had a “hands on” approach and was involved in all aspects of the home. They undertook shifts, cooked meals and administered people’s medicines on a regular basis. The provider was focused on ensuring people enjoyed their life at West Farm House and were happy with the service they received.

People were complimentary about the staff, the provider and the home in general. They liked the homely, relaxed approach, being able make decisions and follow their preferred routines. People told us they enjoyed the meals provided and had enough to eat and drink. All meals were cooked “from scratch” and based on fresh produce but there was no choice of main meal. People were given alternatives if they did not like the meal provided. People told us staff responded to them quickly during the day and had sufficient time to chat. They were able to give their views about the service they received and knew how to make a complaint. People and their relatives were confident any issues would be quickly and satisfactorily resolved.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and of the Care Quality Commission (Registration) Regulations 2009. The overall rating for this service is ‘Inadequate’ and the service is therefore 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 this 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.

West Farm House provides support for up to ten people. At the time of our inspection seven people lived in the care home.

The registered manager was also the registered provider. They gave us a tour of the home.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service, the staff and management supporting them and from looking at the records.

Is the service safe?

We spoke with people who told us they felt comfortable with the staff who supported them. One person said, "I feel safe here". We observed staff interacted well with the people they supported. We spoke with staff who were able to tell us how they would recognise abuse, and confirmed the actions they would take if they suspected a person was being abused. Policies, procedures and local guidelines, including contact telephone numbers were available for staff to follow.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider had policies in place with regard to the Mental Capacity Act (2005) and the staff we spoke with had received training.

People who use the service told us that staff administered their medicines. We spoke with one person who received medication every three hours during the day. They said staff were "Excellent", and made sure they received what they needed at the correct time.

Is the service effective?

Staff told us they received appropriate training for their roles. They told us they received regular support from the registered manager who worked alongside them on a regular basis.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Risk assessments and care plans had been completed and were up to date for most people. This meant most people could be confident that care and treatment was planned and delivered in a way that was intended to ensure their welfare and safety.

Is the service caring?

We spoke with staff and observed the interactions they had with people. We found they demonstrated a good understanding of people's needs. We found, without exception, that they spoke kindly and respectfully to the people they were providing care for.

People we spoke with were complimentary about the staff. One person told us, "Nothing is too much trouble [for the staff] and we are well supported".

Is the service responsive?

People generally had their needs assessed on a regular basis. Records confirmed people's likes and dislikes. People who told us their individual preferences were acknowledged and acted upon.

Is the service well-led?

We saw that people were asked for feedback and we found this was acted upon.

We found that quality monitoring processes were in place, but some of the processes were not recorded. We saw some quality checks were not detailed or specific. This meant that inadequacies in systems were not always identified. For example, people were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

The manager told us, "we have reviewed all the care files to make sure everyone has complete information. We accept there were some gaps."

The manager had recently reviewed the systems in the home to identify, monitor and manage risks to people who used the service. We saw the records of system audits to monitor the quality of service delivery and maintenance of the building. The manager told us, " the last inspection was very much a wake-up call for us. We know what we have to do and we are really getting on with it.'

We saw the home had a policy on safeguarding adults and preventing abuse. This policy was known to staff and they were able to describe what they should do if they suspected abuse was taking place in the home.

The manager told us staff had also received training in the Mental Capacity Act 2005 and safeguarding vulnerable adults. We looked at four staff files and saw they contained certificates of attendance on these courses.

One person said of the staff 'Just ask and they'll do anything.' All of the people we spoke with were complimentary about the care they received.

Care records were not always up to date and some potential risks to people using services had not been adequately identified and followed up. The staff team had not always been given opportunities to attend training that would assist them to understand safeguarding issues. However, people benefited from a well-established staff team who knew them very well. The staff team felt well supported by their manager. This strong team spirit coupled with a low turnover of staff offered stability and consistency of care to people living in the home.

Visiting relatives told us that they held the staff in high regard and felt that the staff were professional and the manager was approachable. They felt listened to.

We found that the provider did not have an effective system for monitoring and assessing the quality of the service which regularly took into account the views of people and their representatives.