Archived: The Old Farmhouse / The Briars

At the last inspection on 13 March 2015 we found the service was not consistently safe, effective, or well led. Improvements were required in each of these areas. The shortcomings were primarily due to delays in starting the planned major site redevelopment work. At this inspection, the required actions had been taken to address our previous concerns. The redevelopment work was virtually complete and new systems had been introduced to ensure people received their medicines safely.

Relatives said the recent accommodation moves had gone better than they had anticipated. One person’s relative said “They built up their confidence and anticipate things before they happen. They don’t just chuck them in at the deep end”. Another relative said “I’m very happy where [person’s name] is. They’ve improved a lot since moving into their new place”.

The service is registered to provide accommodation and support for up to eight adults with a learning disability or autistic spectrum condition. The redevelopment of the site has reduced the capacity to a maximum of six people, accommodated in five self-contained flats (with two people sharing one of the large flats). On completion of the redevelopment the provider will apply to change their registration accordingly.

People who lived at the location needed one to one staff support at all times. Three of the people with more complex needs also required two to one staff support when going out into the local community. At the time of the inspection there were six people living at the location with complex support and communication needs. People had very limited or no verbal communication skills and required staff support with all of their personal care needs and to go out into the community.

The service had a registered manager. 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 registered manager told us the service philosophy was “To support each person to meet their individual needs and enable them to lead as full a life as possible”. Staff received training tailored to the personal needs of the people living at the location to ensure they were able to deliver the philosophy of care. This was further reinforced through staff meetings, shift handovers and one to one staff supervision sessions. There were sufficient numbers of staff to keep people safe and meet their needs.

All of the interactions we observed between staff and people were caring and supportive. It was clear the registered manager and the staff had people’s best interests in mind and tried to provide as good a lifestyle as possible for them. Relatives told us the staff and management were open and accessible and had a good understanding of people’s complex needs and behaviours. Relatives were always made welcome and were encouraged to visit as often as they wished. One relative said “Staff are really brilliant. I can’t fault them”. Another relative said “Staff come across as very professional and very caring, they have the balance just right”.

People had choice and control over their daily lives to the extent they were able to express their preferences. People were supported by their key workers to express their feelings and preferences. Staff respected and acted on the choices people made. The service knew how to protect people’s rights when they lacked the mental capacity to make certain decisions about their care and welfare. People also had access to external healthcare professionals to help them maintain their physical and mental health.

People were supported to visit relatives, access the community and participate in a range of social and leisure activities on a regular basis.

Staff said everyone pulled together as a team and the senior staff and registered manager were very flexible and supportive.

The provider’s quality assurance systems helped to ensure the service maintained and promoted good safe standards of care.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service caring?

We observed the manager and staff were caring and kind with the people who lived in the home. They did everything they could to ensure people received good quality personalised care and support. One member of staff said 'Everyone cares about the people here, it's not just a job. It's nice to see people happy'.

The people who lived in the home had complex care needs and were unable to fully express their views verbally. We therefore spoke to some of their close relatives to obtain their views about the care provided. Relatives were very complimentary about the support people received. One relative said 'The most important feedback to me is the staff tell me they like Y (their relative who lived in the home) and enjoy caring for Y. I can tell they are genuine and this gives me confidence'. Relatives also said staff were very helpful in supporting people to maintain regular contact with their families.

Staff were very caring but people were let down by the layout and condition of the premises. One relative said 'The home needs to be made more homely. It's all a bit stark'. This reflected our own observations. When we toured the premises we found the condition of most areas was just adequate and some areas were in a poor state of maintenance and repair.

Is the service responsive?

The manager and staff in the home were responsive to people's preferences and support needs. However, the provider had not responded effectively or in a timely manner to people's need for improved individual living space. Interim accommodation changes had been made but the planned reconfiguration of the home had been delayed. It was over a year since our last inspection but there was still no definitive start date for work to begin.

Areas of the home, plant and equipment were in need of repair or replacement. There were delays in responding to these issues which adversely affected the quality of people's care. For example, there was a long standing fault with the boiler in the home which meant the hot water supply was unpredictable. This meant people often had to have a strip wash rather than shower or bath. A member of staff said 'The managers are fighting for the right things but the organisation's bureaucracy means nothing gets done quickly'.

People who lived in the home and their close relatives were invited to contribute to care plan reviews. We saw revisions were made to take account of changes in people's needs or preferences. Staff provided care and support which respected the person's individual needs and preferences. A relative said 'The staff are all wonderful. They are always very helpful and I can talk to any one of them'.

Is the service safe?

Since our inspection on 29 April 2013 various changes had been implemented to ensure people were safe from physical harm. Additional staffing had been put in place and one of the people had moved to a more appropriate care setting. Interim accommodation changes had taken place to resolve some of the behavioural compatibility issues between people living in the home.

Staff told us there had been a dramatic reduction in the number of incidents of self-harm and incidents between people. One member of staff said 'Everyone is safe and well', another member of staff said 'We have enough staff to keep people safe'.

Relatives told us their family members were always happy to return to the care home after holidays and outings. This showed their relatives were happy living in the home and they did not have concerns about returning. One relative said 'I don't worry about X, I do feel they're safe'. Another relative said 'Since the change in accomodation arrangements I feel Y is safe'.

We saw care plans included a range of individual risk assessments and actions for managing these risks. These had been agreed with appropriate professionals and family members in order to keep people safe. Plans for managing individual risks were recorded in people's care plans and reviewed on a regular basis.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager said no one in the home had been deprived of their liberty. However, they knew when a Deprivation of Liberty Safeguards application should be made and who to go to if an application was required.

Is the service effective?

Staff were effective in meeting people's individual care and support needs. In our conversations with staff they demonstrated a good understanding of each person's needs and preferences. One member of staff said 'We all know what we are doing and the guidelines to follow with each individual'.

Staff received appropriate training and development which gave them the skills and knowledge needed to provide a safe and appropriate standard of care.

Relatives said they were happy with the care and support provided. One relative said 'X gets very good care, I've got no complaints'. Another relative said 'They are working to get the best for Y. In general Y is healthy and happy'.

Records showed people had access to a wide range of health professionals. This included GPs, dentists, speech and language therapists, psychologists, psychiatrists, behavioural specialists, occupational therapists and learning disability nurses.

The layout of the premises did not support people's care and welfare needs. People in the main house were protected from physical harm but sometimes became distressed when other people were in near proximity or were making a lot of noise. One individual who was becoming unsteady on their feet had to use the stairs to access their bedroom.

Is the service well led?

The person who managed the home was registered with the Care Quality Commission as the registered manager for the service. We asked relatives whether they thought the service was well led. One relative said 'I think the manager is wonderful and all the staff are really very good. I can approach the manager to discuss anything'. Another relative said 'The manager is very understanding and approachable'.

There was a clear staffing structure in place with clear lines of reporting and accountability. Staff told us they were well supported by the manager, team leaders and other colleagues. One member of staff said 'This is the best place I've ever worked. Everyone is really supportive'. Another member of staff said 'The managers are good role models and are always prepared to muck in when needed. I think the problem is they have to battle with the layers above them'. One of the agency staff we spoke with said 'The manager and team leaders treat everyone with respect. The team leaders are very informative and direct the staff well'.

Although the day to day management of the home was good, the provider's quality monitoring systems were not effective in managing risks to people's health and welfare. Where management had identified risks, the provider had not taken timely or effective action to address these risks. There had been delays in the planned reconfiguration of the home and maintenance of the building, plant and equipment was not up to standard.

We saw that people were treated respectfully by staff. They were able to make choices about their day to day lives. People used various forms of communication, such as sign language, which enabled them to express their views and make choices. They were well supported by a consistent staff team. Staff were available when people needed them.

People appeared very comfortable and relaxed with the staff who supported them. People were supported by a wide range of health and social care professionals according to their individual needs.

Staff we spoke with understood the various signs of abuse and knew what action they needed to take to ensure people were safe. People who used the service were not adequately protected from the negative effects of other people's behaviour.

People were at risk due to the design and layout of the home. This was not suitable to meet the current or changing needs of people who lived there. Parts of the home had not been adequately maintained.

The home had systems in place to monitor the quality of care provided. Since the last inspection work had been ongoing to address issues identified by the quality monitoring systems.

People who lived at the home were unable to fully express themselves verbally. We observed that staff used a variety of methods to enable people to make choices. Staff spoken with told us about the methods that people used to communicate and we saw that these methods were also recorded in support plans. This made sure that all staff were aware of how people communicated their wishes.

All staff spoken with demonstrated a good knowledge of the needs and abilities of the people who lived at the home. This meant that staff were able to respond appropriately to people's needs and wishes.

There were records of visits and consultations with health and social care professionals. These records showed the reason for the consultation and the outcome, including recommendations for actions. Records demonstrated that people's health and welfare was monitored and action was taken when concerns were highlighted.

A team of senior staff had been put in place and rotas seen showed that there was always a senior member of staff on duty. All staff spoken with said that the appointment of a strong senior team had made a difference to the quality of care provided. One member of staff commented 'the senior team means there is real leadership now."