Archived: Farmhouse Residential Rest Home

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.

As part of the inspection we also looked at the progress the home had made in meeting the concerns we had identified in respect of staff training at our previous inspection. During the inspection we spoke with people who used the service, representatives of people who used the service, members of staff and the acting manager.

We considered our inspection findings to answer the questions we always ask;

Is the service safe?

People who used the service had their needs assessed and risk assessments had been completed to reduce any risks to peoples' health and well-being, but some records were not accurate or had not been reviewed to ensure they were up to date.

There were procedures in place to protect people in an emergency.

Staff had received training and were aware of their responsibilities for safeguarding vulnerable people.

Is the service effective?

People's health and social care needs were assessed and plans were in place to provide the support they required.

People were referred to health care professionals as required and were supported to maintain their physical and mental health care needs.

People were not regularly encouraged to be involved in their care or their representative's care. There was little evidence of participation in reviews of care by people who used the service and/or their representatives. A person said, "I know the care plan is there but I am never asked to participate in it".

Is the service caring?

The staff knew people well and the people who used the service looked relaxed and comfortable in the company of staff. We observed positive interactions between the people who used the service and staff. Staff were patient with people and encouraged them, with support, to take responsibility for their daily living tasks. One person told us: 'It's good here. The girls are very kind".

Is the service responsive?

The home had a complaints procedure. People we spoke with said they would tell the staff if they were worried about anything.

There was no activity programme in place to encourage people to enjoy time together as a community. People did not have their social and therapeutic needs met.

People living in the home and/or their representatives were not regularly enabled to share their opinions with staff, as there had been very few resident's/relative's meetings.

Is the service well led?

The provider had made changes to the care recording to ensure there was clear, comprehensive and detailed information to support staff in caring for people.

There was little evidence of quality monitoring having taken place to monitor and audit the services including the quality of care records.

Staff training had improved but staff had not received regular individual supervision. This meant that staff had not regularly had the opportunity to discuss their own personal development.

In this report the name of registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still Registered Managers on our register at the time of our inspection. Since the last inspection of Farmhouse Residential Rest Home a new manager had been appointed, she understood that she needed to apply to register with us.

During the inspection we spoke with six people who used the service, we also observed how staff and people interacted. People we spoke with told us, "I'm alright. I've lived here a long time and if I didn't like it I wouldn't be here would I?" and "I'm not here for very long, but they have been very good".

New care planning and assessment documentation had been introduced since our last inspection. We saw that people's care needs had been assessed and plans of care were in place, this meant that staff had the information they needed to provide people with the support they required. We observed some positive interactions between people and the staff who supported them; we saw that people were treated with respect, care and compassion.

We saw that any complaints received at the home were looked into and responded to appropriately.

We saw that people were protected from the risks of inadequate nutrition and dehydration and that people were kept free from harm. Staffing levels and the timing of when care staff took their breaks had been reviewed to reflect the needs of the people living at the home.

At our last inspection we found that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. At this inspection we found that there had been no improvement in the accuracy and maintenance of records.