Manor Farm

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Cambridgeshire and Peterborough. To understand the experience of social care providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

About the service

Manor Farm is a care home providing accommodation, personal care and support to up to 10 people with a learning disability and, or autistic spectrum disorder. One person is accommodated in a bungalow. The other nine people are accommodated in one adapted building. At the time of our inspection there were 10people living at the service.

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

The service did not always fully demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

¿ The home had not been well-maintained. Several areas of the service had been damaged and needed repair and not all people’s bedrooms had been personalised.

¿ People were not always supported to live healthy lifestyles and staff members did not always promote healthy eating choices.

¿ People had limited opportunities to develop life skills, and there was little evidence of planning for long term goals and aspirations.

¿ The service had not always supported people to have the maximum possible choice, control and independence and have control over their own lives.

¿ In the main, staff supported people to take their medicines safely. However, one person had not received their medicine in line with the prescriber’s instruction. The person was not harmed by this and the registered manager took immediate action to address this. The registered manager understood the importance of people not being over medicated particularly when managing people’s increased anxiety.

¿ Staff supported people to take part in activities and pursue their interests in their local area and interact with people who had shared interests. People’s opportunities to pursue their leisure and social interests had improved in recent months.

¿ Staff enabled people to access specialist health and social care support in the community.

¿ Staff worked with people using distraction techniques when they experienced periods of anxiety. People’s freedoms were not restricted by staff unless it had been risk assessed as being a safety concern.

¿ The staff team worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

Right Care

¿ Staff knew the people they supported well. People received kind, compassionate, and patient care. Staff understood and responded to people’s individual needs. However, staff were not always discreet and respectful of people's dignity. The language staff used to describe or refer to people was not always positive or promote people’s dignity.

¿ People were not always supported to respect other people’s space and belongings.

¿ Staff respected and encouraged people to make a choice. However, staff did not always follow through on agreed actions.

¿ People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives.

¿ The service had enough staff to meet people’s individual needs and keep them safe. The service had a high number of vacancies and relied heavily on agency staff. However, these agency staff worked at the home regularly and knew people well.

¿ Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

¿ Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.

¿ The registered manager had started to re-introduce various tools to help aid people’s communication and understanding. These included pictures, symbols, and easy read documents.

¿ People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing.

Right Culture

¿ The registered manager understood the key principles of guidance such as Right support, right care, right culture. However further development was required to help ensure people led inclusive and empowered lives.

¿ Audits were completed to monitor the service people received. They had identified most, but not all, of the shortfalls we identified during this inspection. The provider and registered manager discussed with us their plans to bring about further improvement in the service and people’s quality of life.

¿ Staff turnover under the previous manager was very high and meant people had not received consistent care from staff who knew them well. Staffing was more stable under the current registered manager’s leadership and meant people’s consistency of care had improved. However, this needed to be further improved and embedded.

¿ Staff knew and understood people well and were responsive, supporting their preferences to live a quality life of their choosing. However, people had not always supported people to develop aspirations and longer-term goals.

¿ People and those important to them, including advocates, were involved in planning their care.

¿ The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views.

¿ Staff felt very well supported by the registered manager who led by example and staff found approachable.

¿ The service worked in partnership with advocacy and other health and social care professionals who helped to give people using the service a voice and improve their wellbeing

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 03 April 2020).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right Support Right Care Right Culture.

The inspection was prompted in part due to concerns received about people’s safety, staffing levels, and the quality of care people received. A decision was made for us to inspect and examine those risks.

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

Enforcement and Recommendations

We have identified breaches in relation to the building décor and maintenance, dignity and promoting independence, and governance at this inspection.

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

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good infection prevention and control (IPC) practice.

Visiting was suspended at the time of the inspection, except in exceptional circumstances based on people’s individual wellbeing. Visiting is to commence from the 8 March 2021. There was an effective process and systems in place for any visitor entering the service which is in line with the government guidance.

Enough personal protective equipment (PPE) was available and staff used this effectively.

Good cleaning regimes were in place. The service was clean, odour and clutter free.

Contact with families was undertaken virtually. Health care professionals also undertook virtual meetings to help promote wellbeing and mitigated the risk of cross contamination or introducing infections.

Individual risk assessments were in place for any person or staff member at an increased risk of infections including being able to isolate.

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

Relatives were complimentary and full of praise about staff at the service and the support they gave both them and their family members. One relative told us, “I want to say how amazing the staff are and that they always look at what is best for [name].” People were happy receiving a service from Manor Farm.

Each person had fully detailed personalised support plan, which guided staff on the individual support the person wanted. People took part in a wide range of new activities or were encouraged to do things they had previously enjoyed. Staff worked hard to offer people these opportunities. A relative told us, “Any new ideas that I have for things [name] might like to do are tried where possible.” People led full and meaningful lives with encouragement from staff. Staff supported people in an individual, person-centred way and helped them to maintain or develop relationships that were important to them.

Staff were very knowledgeable about how to keep people safe from avoidable harm and abuse; they gave people their medicines safely and followed good infection prevention and control procedures. Staff had undertaken training and received support from senior staff to ensure they could do their job well.

People enjoyed food that they had chosen. 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.

People had very good relationships with the staff and received kind and compassionate care and support. Staff knew people well and respected people's privacy and dignity. People were involved in all decisions about their care and staff supported them to be as independent as they wanted to be.

Relatives were confident their views would be listened to and complaints would be addressed.

The outcomes for people using the service reflected the principles and values of Registering the Right Support. Thus, ensuring that people who use the service can live as full a life as possible 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 26 August 2017).

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.

This unannounced inspection was undertaken on 21 July 2017 by one inspector. At the last inspection on 13 April 2016. The service was rated as 'Requires Improvement'. At this inspection we found the service was rated as 'Good'.

A registered manager was in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 knew how to respond to possible abuse and how to reduce risks to people. There were enough staff who had been recruited properly to make sure they were safe to work with people.

Medicines were stored and administered safely.

People were cared for by staff who had received the appropriate training and had the skills and support to carry out their roles. Staff members understood and complied with the principles of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received a choice of meals and staff supported them to eat and drink enough. They were referred to health care professionals as needed and staff followed the advice these professionals gave them. People's personal and health care needs were met and care records guided staff in how to do this

Staff were caring and kind and treated people with respect. People's right to privacy was maintained by the actions and care given by staff members.

People were supported with enough social stimulation that they needed throughout the day including hobbies, interests and pastimes.

Complaints were investigated and responded to and people knew who to go to, to do this.

Staff worked well together and were supported by the management team. The monitoring process looked at systems throughout the home, identified issues and staff took the appropriate action to resolve these.

Further information is in the detailed findings below.

This comprehensive inspection took place on 13 April 2016 and was unannounced. There were eight people living at the home when we visited.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 home is run.

People were comfortable with the staff and people’s relatives were happy with the support provided to their family members. Staff liked working at Manor Farm and were well-supported by the registered manager.

Staff had undergone training and were competent to recognise and report any incidents of harm. Potential risks to people had not always been assessed, which meant that people were at risk of not always being kept as safe as possible.

There were sufficient staff on duty to make sure that each person had the support they needed to do whatever they wanted to do. Staff had been recruited in a way that made sure that only staff suitable to work in this care home were employed. Staff had undertaken a range of training in topics relevant to their role so that they were equipped to do their job well. Medicines were managed well so that people received their prescribed medicines safely.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS), which apply to care services. People’s capacity to make decisions for themselves had been assessed. For most people, appropriate applications had been made to the relevant authorities to ensure that people’s rights were protected if they lacked mental capacity to make decisions for themselves. In one instance, a decision had been made by staff, which meant that the person’s rights in this area had not been fully protected.

People’s healthcare needs were monitored and staff involved a range of healthcare professionals to make sure that people were supported to maintain good health and well-being. People were given sufficient amounts of food and drink and the nutritional needs of people who required special diets were met.

Staff showed that they cared about the people they were supporting. Staff treated people with kindness, respect and compassion and made sure that people’s privacy and dignity were upheld at all times. People’s personal information was kept securely so that their confidentiality and privacy were maintained.

People’s relatives were involved in the planning of their family member’s care and support. Staff gathered as much information as possible about each person so that their support plans were personalised. This meant that people received the support they needed in the way they preferred. Staff did not always utilise identified ways of communicating as fully as possible with each person.

A wide range of activities and outings was organised with each person to make sure they were supported to do whatever they wanted to do. People were supported to complain, if they needed to. People’s relatives knew how to complain and complaints were responded to in a timely manner.

The registered manager was approachable and staff were pleased with the improvements that had taken place since the registered manager had taken up their post. People and their relatives were encouraged to share their views about the quality of the service being provided to them in a number of both formal and informal ways. Staff were also given opportunities to share their views about ways in which the home could continue to improve. Audits of all aspects of the home were carried out by a range of the provider’s staff to make sure that the best possible service was provided. Records were maintained as required.

As part of this inspection we spoke with the senior member of staff on duty and we looked at the records relating to the way medicines were managed.

Below is a summary of what we found.

Is the service safe?

During our inspection of the service on 19 June 2014 we found that although a number of aspects of medicine management were carried out safely, the records showed that staff had made some errors in the recording. This meant that medicines were not managed as safely as they should have been.

During this inspection on 17 September 2014 we found that improvements had been made. This meant that people were given their medicines safely and as they were prescribed.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found.

Is the service safe?

We spoke with people's parents and they told us they were satisfied that their sons were as safe as possible at Manor Farm. One parent said, 'We wouldn't have sent him there if we hadn't felt he'd be safe.'

There were enough staff on duty to meet people's needs while they were at home and to make sure that people could go out into the community, accompanied by the number of staff that were required as a result of the person's risk assessment. Assessments of any possible risks to each person had been carried out, and guidance put in place for staff so that they knew how to minimise any risks.

Although a number of aspects of medicine management were carried out safely, the records showed that staff had made some errors in the recording. This meant that medicines were not managed as safely as they should have been.

Is the service effective?

Parents we spoke with told us how much their sons had developed since moving to or staying at Manor Farm. Staff also gave us a number of examples of the ways in which each person had progressed. It was clear from our observations that people were comfortable with the staff and that staff knew people's needs well. A member of staff told us, 'There are a lot of positive things, this place is lovely and has the potential to be really fantastic. It just needs a bit of tweaking.'

Support plans showed that people were encouraged and supported to make choices about all aspects of their lives. The plans also gave staff detailed guidance about the ways in which each person preferred their support needs to be delivered by the staff. This meant that people were supported consistently.

Is the service caring?

From their body language and their behaviour we saw that people got on well with the staff. Staff treated people with respect and kindness. They spoke to people in a friendly, professional way, which included a lot of fun and laughter.

Is the service responsive?

People's needs were re-assessed each month and any necessary changes made to their support plans. Each year a full review was held for each person, by a multi-disciplinary team made up of a number of health professionals, including psychiatrists and behaviour psychologists.

People were encouraged to participate in a range of activities of their choice, both at home and in the wider community.

Is the service well-led?

There was effective leadership in place, which ensured that people's needs were met, they were kept as safe as possible and the service provided to people by the staff was of a high quality. Staff praised the manager and team leader and told us they were happy to be working at Manor Farm.

A robust quality assurance system was in place, which ensured that all aspects of the service were monitored and improvements made where necessary.

We found that the provider was not compliant with the regulations in all the areas we assessed. If you wish to see the evidence supporting our summary please read the full report.

The service had become active again at the beginning of March 2013 when a person moved in, after several months of being dormant as there were no people who used the service living in.

We saw the initial assessment and the care plan drawn up from it. It was detailed and individualised, promoting the person's independence. Corresponding risk assessments provided a guide for staff to ensure that the person was safe whilst also being encouraged to explore all their abilities, learn new skills and express their wishes and individuality. We saw an example of how the person chose what to eat, what to wear, what activities to undertake and how they learnt new skills regarding personal care.

We spoke with staff who told us that they were well supported through their initial training, further personal development, training, supervisions and appraisals. We saw records that confirmed this.

Staff showed that they were aware of the safeguarding procedure and explained how they would react if there was a concern.

We saw the evidence of the audits carried out to ensure that the provider monitored quality of care.