Background to this inspection
Updated
28 June 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 17 May 2016 and was unannounced. It was undertaken by two inspectors.
We looked at previous inspection reports and we spoke to the local authority and gained their views on the service. They had concerns over the management and care of people who used the service.
We spoke with four people who used the service and two relatives. We spoke with the new manager, new deputy manager, the manager of a sister home, two care staff and two of the directors of the service.
We observed the care and support people received in the service. This included looking in detail at the care and support three people received, and if it matched the planned care we saw in their records. We looked at the way in which people's medicines were managed. We also looked at people’s daily care records and records of their medication.
We looked at records relating to the management of the service. These included audits, health and safety checks, staff files, staff rotas, incident, accident and complaints records and minutes of meetings. We did this to see if they were effective in monitoring and improving the quality of the service.
Updated
28 June 2016
This inspection took place on 17 May 2016 and was unannounced. We had previously inspected in October 2014 and judged the service as being Inadequate. We had placed the service into special measures and issued a warning notice. We returned to inspect in April 2015 and found that although some improvement had been made the service still overall required further improvements. At this inspection we found that care being delivered was still not safe and people were at risk of harm due to the ineffectiveness of the management. We have judged this service as Inadequate and placed the service into special measures. We have also begun enforcement action against the provider.
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.
Farmhouse Residential Home is registered to provide personal care and accommodation to up to 23 people. At the time of the inspection 14 people were using the service.
There was a new manager in post, they were yet to register with us. 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. People liked the new manager but expressed concerns over the regular change in managers.
The provider was not protecting people from the risk of harm through neglect as they did not ensure that staff delivering care were trained and competent. People were not being safeguarded from the risk of institutional abuse due to a lack of training for the staff supporting people.
People's medicines were not managed safely. People were not always given the correct dose of their prescribed medicine and some people had not been administered their medicine as the provider had not ensured sufficient stock was available at all times. There were insufficient suitably trained staff available to ensure that people could have their prescribed medicine when they needed it.
Risks to people were not always assessed and minimised. When risk assessments were in place, they were not always followed to ensure people were kept safe.
Staff did not receive the training they required to be able to fulfil their role effectively and people had experienced harm as a result of the incorrect use of equipment by untrained staff.
People's nutritional needs were not always met. Assessments of people's dietary requirements did not reflect the person's needs and they were at risk of malnutrition.
When health care advice had been sought for people, it was not always followed by staff to ensure that people's health needs were met effectively.
People right to confidentiality was not always respected by the staff team.
People did not receive care that met their individual needs and preferences and they were not always involved in the planning of their care. People were not engaged or stimulated by activities or their surroundings. Some people sat for long periods of time with no interactions.
Systems the provider had in place to monitor and improve the quality of the service were ineffective. People continued to receive Inadequate care following our previous inspections and input from the local authority.
The provider followed the principles of the MCA 2005 to ensure that people consented to or were supported to consent to their care.
There was a complaints procedure and people knew how to use it. People and relatives we spoke with told us that the provider and staff were kind and approachable.