Dixons Farm

Dixons Farm is a residential care home providing personal care for up to six people living with a Learning disability or autistic spectrum disorder and younger adults in one adapted building. Six people were living at the service at the time of the inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People were safe living in the service, staff had received relevant training and records detailed the actions taken as a result of allegations. Risks were managed safely; relevant servicing and checks had been completed. Incidents and accidents were recorded and actions had been taken as a result, including lessons learned. Medicines were managed safely and no concerns in relation to infection control were noted.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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. Relevant capacity assessments and best interests assessments had been undertaken. Evidence confirmed relevant professionals were involved in people’s care and needs. A range of meals according to people’s choice and needs were provided. The service had been designed to support people’s individual needs. The registered manager told us of their ongoing refurbishment plans.

People received good care. We observed kind and caring interactions between staff and people. People were treated with dignity and respect and their choices were considered.

Care files contained information about how to support people’s individual needs. A range of activities were provided to people according to their likes and choice. Technology was being used to good effect in the service. A system had been developed to ensure complaints were managed.

We received positive feedback about the management, the support they offered and the changes since the last inspection. All members of the staff team were open and transparent during the inspection. Audits and monitoring of the service was ongoing and team meetings were taking place.

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 1 March 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

People’s experience of using this service: Not all people told us the service was safe. Systems to act on allegations of abuse were in place. Risks in general had been managed however actions had not been taken to address shortfalls in the findings of a fire risk assessment. Analysis of incidents had not been completed in a timely manner. Improvements were required in the safe management of medicines. Staff were recruited safely and there was an ongoing recruitment programme to address the staffing levels and provide a consistent staff team.

Deprivation of Liberty applications had been completed however reapplications were not submitted in the required time. Capacity assessments required completing in full. People received a varied diet and had been involved in shopping tasks. Staff training had been completed. Where specialist behaviour support training was required the service was acting on this.

Staff engaged with people and were seen to be kind and caring. However, we noted one occasion where a person’s personal care needs were discussed openly in the communal areas. Not all people were supported with their decisions to access all communal areas of the service.

Good information was available in care files, which ensured staff had access about how to deliver care to people. Activities were taking place. The management discussed that improvements in people accessing activities in the service were required. A system to deal with complaints was seen.

The manager had identified the immediate areas that required action. Audits had recently been recommenced. Senior oversight was ongoing to provide support and drive improvements in the service. Team meetings were taking place.

Rating at last inspection: The last inspection was undertaken on 27 and 28 June 2016. It was rated good in all key questions and good overall. The report for this inspection was published on 1 August 2016.

Why we inspected: This was a scheduled inspection based on the previous ratings.

Enforcement: Information relating to the action the provider needs to take can be found at the end of this report.

Follow up: The service will be reinspected as per our inspection programme. We will continue to monitor any information we receive about the service. We may bring the next inspection forward if we receive any concerning information.

Dixons Farm provides accommodation and personal care for up to six adults with a learning disability. At the time of the inspection there were six people living at the service.

Bedrooms and facilities at the home are located over three floors. All bedrooms are single occupancy. There is a kitchen, dining room, lounge and conservatory. There is a bathroom and appropriate toilet facilities. One person’s living space within the home has a bedroom and a separate lounge and bathroom. There is a garden to the rear of the property.

At the time of our inspection there was a registered manager at the service who had been in post since 2011. 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 on 20 February 2014, the provider was compliant with all of the standards that were reviewed at that time.

Relatives told us they felt people living at the service were kept safe. The staff we spoke with had a good understanding of how to safeguard vulnerable adults from abuse and what action to take if they suspected abuse was taking place.

We saw evidence that staff had been recruited safely. We found that there were enough staff on duty to meet people’s needs and relatives and staff were happy with the staffing levels at the service. Staff felt well supported by the registered manager. They received an appropriate induction, regular supervision and effective training.

There were appropriate policies and procedures in place for managing medicines. The relatives we spoke with were happy with the way people’s medicines were managed. People were supported with their healthcare needs and were referred appropriately to a variety of healthcare services. Local healthcare professionals were happy with the care provided at the service.

The relatives we spoke with were happy with the care provided to people living at the home. One relative told us, “We’re very happy with the care. [Our relative’s] happy there”.

We observed that people’s needs were responded to in a timely manner and saw evidence that their needs were reviewed regularly. We saw staff treating people with patience and kindness. Relatives told us the staff who supported their family members were caring.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The service had taken appropriate action where people lacked the capacity to make decisions about their care. Relatives told us they were involved in decisions about their family member’s care. They told us staff respected people’s privacy and dignity and encouraged them to be independent.

Risks relating to people’s nutrition and hydration were assessed and managed appropriately. Relatives were happy with the food provided at the home and we observed people being supported appropriately with their meals.

People took part in a variety of activities within the home and staff supported them to participate in a variety of activities in the community regularly.

Relatives and staff felt the service was well managed and they felt able to raise any concerns. We observed staff and the registered manager communicating with people and each other in a respectful and friendly manner.

The service had a statement of purpose which focused on maintaining positive changes for people who have a learning disability in a homely environment. We saw evidence that this approach was promoted by the registered manager and staff at the home.

The registered manager completed a variety of audits which were effective in ensuring that appropriate levels of care and safety were achieved and maintained at the home.

We found the provider had completed the improvements included in their action plan. Work had been undertaken to make improvements to the premises to ensure the safety of people who used the service, staff and visitors.

People who lived at the home looked happy in their environment and were evidently very relaxed and content in the presence of staff members. Evidence was available to demonstrate they were supported to experience a way of life suitable to their individual

needs.

We found cleanliness in the home to be of a good standard. Some areas of the home required some maintenance, but otherwise the premises were suitably decorated and furnished.

We found from speaking with a family member of one of the young adults and staff confirmed, there was regular contact between the service and families of the people who they supported. This helped the service to continually monitor the quality of the support they delivered to people. Comments we received from the family member we spoke with were all positive.

People living at the home looked happy in their environment and were evidently very relaxed and content in the presence of staff members. Evidence was available to demonstrate they were supported to experience a way of life suitable to their individual needs. Comments received from the young adult spoken with were all positive.