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Inspection carried out on 23 January 2018

During a routine inspection

The inspection took place on 23 January 2018 and was unannounced. We also returned on the 31 January 2018. The registered manager was given notice of the other date, as we needed to spend specific time with them to discuss aspects of the inspection and to gather further information. Fenners Farm House is a residential care home providing support to up to nine people. At the time of our inspection there were eight people living at the service. People living at the service had learning disabilities, physical disabilities and some people were living with dementia.

At our last inspection on 15 December 2016, we rated the service overall Good. The key questions Effective, Caring and Responsive were rated good. The key questions Safe and Well-Led were rated Requires Improvement with a repeated breach of Regulation 12 of the HSCA Regulated Activities 2014. People’s medicines were not always managed safely.

We asked the provider to complete an action plan to show what they would do and by when to make improvements. The provider submitted an action plan to us about the measures they were taking to address the concerns found at the previous inspection.

At this inspection, we found that the improvements had been fully embedded into practice and all key questions are now rated as Good.

Fenners Farm House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Fenners Farm House accommodates people in one building, which has been extended and adapted in some areas.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.

There was 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.

Staff worked with people to identify goals and manage risks in a way that enabled people to develop confidence and skills whilst ensuring that they were safe. The provider took a proactive approach to incidents and which meant that they were deescalated quickly and systems were in place to respond to concerns. Staff understood their roles in safeguarding people from abuse.

There were sufficient numbers of staff to meet people’s needs and the provider had carried out checks to ensure that staff were suitable for their roles. People received their medicines safely. Trained staff administered medicines and the provider managed medicines in line with best practice and regularly audited them. The provider had systems in place to ensure the risk of the spread of infection was reduced and people lived in a clean home environment.

People were supported to access healthcare professionals when required with support from staff.

Staff had received appropriate training for their roles. Staff received one to one supervisions and there was an appraisal process in place. Regular meetings took place that involved staff, people and relatives in decisions about the service. People were asked for consent and care was provided in line with the Mental Capacity Act (2005).

Staff knew people well and interacted with them with kindness and compassion. Staff were respectful of people’s privacy and dignity when providing care to them. People were supported to maintain relationships that were important to them.

Care was planned in a person-centred way. People had their own records to document their care and activities using pictures and photographs. Care planning had achieved positive goals for people and help

Inspection carried out on 15 December 2016

During a routine inspection

The inspection took place on 15 December 2016 and was unannounced.

Fenners Farm House provides accommodation and support to a maximum of nine people with a learning disability. The home is an old, former farm house with accommodation ranged over two floors, with changes of level on both floors. Access between the ground and first floor is via a stair lift. At the time of our inspection, there were nine people living in the home.

There was 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.

At our last inspection in July 2015, improvements were needed to the safety of the service and to the management processes for identifying and driving improvements and we found breaches in three regulations. At this inspection, we found some action had been taken to improve and reduce the risk of an adverse impact on people's safety and welfare. However, there were still shortfalls, which the registered persons had not proactively identified and addressed.

The registered manager had not made all the improvements that were needed to the safety of systems for managing medicines. Processes for checking and auditing them were not robust and made it difficult to monitor medicines management properly. This led to some people not receiving their medicines as prescribed. This was a further breach of regulations and you can see the action we have asked the provider to take at the back of this report.

Improvements had been made to the way health and safety issues in the environment were monitored and assessed. However, the systems in operation for assessing and monitoring service quality and checking compliance with regulations were not robust. They did not identify the concerns we found for medicines management. The information the provider sent to us before our inspection contained information about supervision and appraisal for staff that, when we checked, was not fully reliable. The registered manager had not recognised shortfalls in this area and developed a 'recovery plan' to ensure they made improvements to their own expected standards.

People received a service which met their needs effectively. Staff were competent to fulfil their roles and had access to a range of training to develop their skills. They recognised the importance of seeking consent from people to deliver their care and of acting in people's best interests where there were specific decisions people may not be able to make for themselves. Where there were restrictions on people's freedom due to the level of supervision they needed to ensure their safety, the registered manager took action to promote people's rights.

People were able to make choices about what they ate and drank and mealtimes were a social occasion shared with staff. Staff ensured that people had enough food and drink to meet their needs and promote their health. Staff supported people to access advice about other aspects of their health and wellbeing, for example from their doctor or dentist, and from professionals in the local learning disability team. They acted on the advice they were given about people's health and understood how people's conditions affected them.

Staff had developed warm and compassionate relationships with people and people living in the home got on well with the staff team. There was a friendly and comfortable atmosphere in the home with people seeking out the company of staff to chat about their day and what they wanted to do. People's privacy and dignity was promoted and they were able to choose how and where they spent their time within the home. Staff understood the importance of encouraging people to do what they could for themselves, to maintain or develop their in

Inspection carried out on 22 July 2015

During a routine inspection

This inspection took place on 22 July 2015.

Fenners Farm House provides accommodation and support for up to nine people. People using the service have learning disabilities.

There was 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.

There were some shortfalls in the way the safety of the service people received was assessed and managed. This included a concern for the way medicines were managed. Systems for monitoring service quality and addressing risks had not properly identified where improvements were needed to ensure the service continued to comply with expected standards and regulations. This included the failure to identify when documents, including the fire safety risk assessment were overdue for review.

There were enough staff and they had a good understanding of the needs of each person. They were skilled and competent in meeting individual needs. Staff were flexible in the amount of support they offered people when their needs changed. They acted to promote people’s health and welfare and to encourage people to be as independent as they could be. Staff supported people in a kind and caring manner and promoted people’s privacy and dignity and were clear about their roles.

Staff had training in the Mental Capacity Act (MCA) 2005 and, where people were not able to make decisions about their care, staff understood the importance of acting in their best interests. The manager understood when an application to deprive someone of their liberty under the MCA and associated Deprivation of Liberty Safeguards should be made to promote people’s rights, but had not attended to this promptly.

Staff supported people to raise any concerns or complaints and people were confident that their views would be listened to and addressed. People had the opportunity to discuss the running of the service and their views at regular meetings within the home. Relatives were regularly asked for their views and expressed a high level of satisfaction with the quality of care people received.

We found that the service was in breach of three regulations. Systems for managing medicines were not as safe as they should be. Action had not been taken promptly to ensure best practice in this area was maintained, to assess and manage other risks within the service and to ensure that records were kept up to date. The provider had also failed to notify us of events happening within the home that affected people’s care and welfare.

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

Inspection carried out on 19 June 2013

During a routine inspection

During our inspection we spoke with four people who used the service. They told us that they were happy and that they felt safe.

We saw that staff asked the people who used the service if they wished to participate in activities and receive support to meet their personal needs. We observed that staff gave people choices. People had good choices of meals offered and received good nutritional support.

The service had good infection control procedures in place and complaints had been dealt with appropriately.

Inspection carried out on 13 July 2012

During a routine inspection

During the review we spoke with two of the nine people who used the service, and observed two other people and their interactions with staff.

One person told us they liked living at Fenners farm as "They liked the country." They also told us that they "Enjoyed helping with the cooking."

The two people we observed during our visit were able to make their choices known to staff who were aware of their communication needs at all times.