Archived: Heath Farm House Care Centre

Heath Farm House Care Centre is a care home, providing personal and nursing care for up to 10 people living with complex mental health conditions and or learning disabilities. At the time of the inspection, seven people were receiving care. The service has been set up collaboratively with the local authority to reduce the risk of delayed discharge from hospital or for those who require hospital avoidance due to deterioration in their mental health and wellbeing. The service provides short term, residential support.

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

We identified significant concerns in relation to the safe running of the service, which raised questions about the standards of care being provided. There was a lack of managerial and provider level oversight, which had resulted in multiple incidents including safeguarding concerns, which had not been handled in line with their own policies and procedures, to maintain people’s safety and wellbeing.

People told us they sometimes felt unsafe living at the service, and would spend time in their bedrooms, rather than in communal areas to alleviate those feelings. We identified concerns in relation to infection, prevention and control standards at the service, which was of concern as the service was inspected during a national lockdown.

The provider had not implemented enough changes to practice and approach to ensure that people received good standards of care and support and was reinforced by repeated and new breaches of regulation being identified at this inspection.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. At the last inspection, it was identified that the service did not fully meet the requirements to meet the needs of people with autism and learning disabilities in line with best practice guidance.

Following the last inspection, the decision was made to close the service and support people to move to more suitable alternative accommodation. However, in consultation with the local authority, the decision was made to alter the purpose of the service. As an outcome, the service was being refurbished at the time of our inspection visit, but the size, layout and suitability had not changed to be more in line with right support, right care, right culture as set out in the guidance. Whilst most people living at the service had complex mental health support needs, there remained people living at the service with autism and learning disabilities.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

Rating at last inspection

The service was rated requires improvement with breaches at the last inspection, completed 17 October 2019, published 09 January 2020.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to management changes, staffing levels and training, and received anonymous whistleblowing concerns. There had also been a serious incident that had happened a few days prior to our site visit. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

Enforcement

We have identified repeated breaches of regulation in relation to provision of safe care and treatment, trained and skilled staffing and good governance arrangements. We have also identified new breaches in relation to keeping people safe from risk of harm and abuse, and in relation to notifying CQC of incidents that have occurred at the service, during this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

Heath Farm House Care Centre is a residential care home providing personal care to 10 people living with a learning disability and mental health needs. At the time of the inspection there were 10 people living in the home.

The care home provides support to people in one adapted building. The service had not been designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance as was designed prior to the development of the guidance. The principles of the guidance were embedded into the service delivery. 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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 10 people and was full. This is larger than current best practice guidance. We were aware the provider was reviewing the design of the building and the number of people able to reside there, to better incorporate the principles of the best practice guidance. In the interim attempts were made to mitigate any negative impact on people by the availability and access to other daytime accommodation and staff support. The home shared its access with a larger property, a farm shop and a day centre for people living with complex needs. 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 to the service.

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

There was not always enough staff to ensure people had their dedicated one to one staff support. Risks were not effectively managed or reported and risk assessments were not always up to date. The building was safely managed and there were good medicines care plans in place. Staff were safely recruited.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way. The policies and systems in place did not support decisions were made in people’s best interests. The limited communal areas did not always provide people with safe space when emotions were heightened and required de-escalating in quiet areas. Staff had access to training but practical training was mostly out of date. This included moving and handling and medicines administration. Staff supervision and team meetings did not routinely take place in a formal way but staff told us the registered manager was always available and they received a newsletter when team meetings were not held. The chef had a good understanding of people’s dietary requirements and their likes and dislikes.

People were involved in decisions about how they spent their days and we saw positive interactions between staff and people in the home. The home had two cars to enable people to access the community independently or in small groups and daily activities were arranged. The outcomes for people using the service mostly reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support did not always focus on them having as many opportunities as possible to gain new skills but people were supported to become more independent.

There were good personalised care plans in place for people, however, some of this information was disjointed and had not been effectively used to develop risk assessments and risk management plans. Each person had a positive behaviour plan but this was not incorporated into their main care plan. Staff were knowledgeable about people and verbal handovers were completed. We were told no complaints had been received formally and concerns were dealt with as they occurred. Further consideration was being given to people’s end of life needs and wishes.

The provider group had governance structures in place and regular monthly audits were completed. However, these did not always identify issues. The provider was required to ensure they sent notifications to the commission as appropriate. People living in the home had opportunity to influence decisions in the home. Staff were happy in their role and felt supported.

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 (17 January 2017).

Why we inspected - This was a planned inspection based on the previous rating.

Enforcement - We have identified breaches in relation to supporting people under the Mental Capacity Act, risk identification and its management, the availability of staff and the effectiveness of audits 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home had a registered manager in post. 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 principles of the Mental Capacity Act 2005 (MCA) were not always followed. Some people required support from staff when they went outside of the home as they were not able to keep themselves safe. No Deprivation of Liberty Safeguards had been applied for to keep people safe. Where people had one to one staff support, the reasons for this, and the person’s understanding of why they required this level of support was not always documented in their care plans. However, staff demonstrated a lack of understanding of the MCA and how they supported people to make decisions. This was further demonstrated by the lack of MCA assessments.

There were systems in place to monitor and assess the quality of service being delivered a range of internal audits ensured that areas such as health and safety, medicines and infection control were being managed appropriately and that all risks had been identified and mitigated. However, these had not identified the issues we found in relation to the MCA and absence of DoLS applications.

People and their relatives we spoke with felt that there were enough activities on offer and told us that they went out regularly. However, staff and the manager thought that more people could be supported individually with their own interests if there were more staff and vehicles available.

There was a copy of the complaints procedure in place and there was an easy read format placed on a communal notice board. People and their relatives felt able to raise a complaint if they needed to.

People did not always enjoy the food. Other people felt as though they had a choice of meals and enjoyed the food served. Where it had been identified that people were not eating or drinking enough, we saw that advice had been sought from the Speech and Language Therapy Team. People told us that they were also supported to access other relevant healthcare professionals when there were concerns about

their health or wellbeing.

The manager had an open door policy and was often walking about the home speaking with people. Staff we spoke with felt that the manager was too relaxed in their approach to managing the home. The manager was approachable and would act on their concerns in a timely way. People’s relatives were also complimentary about the manager and told us that they felt able to speak to the manager or call them.

Risks to people’s health and wellbeing had been identified and there were risks assessments in place which detailed to manage and mitigate these risks. People’s care plans were also detailed and accounted for people’s individual support needs. Care plans and risk assessments were reviewed regularly with people and were updated where necessary. Staff knew people’s care and support needs and we saw that staff spent time with people either talking or engaging them in various activities. People felt as though they were cared for and that their views were listened to.

Staff received training relevant to their role and were supported to access any further appropriate training. New staff completed an induction which involved training and shadowing more experienced members of staff before they worked without supervision. Staff told us that they were further supported through supervisions and appraisals.

People told us that they felt safe living in the home. Staff had received training in safeguarding and knew the correct reporting procedures if they suspected that a person was being abused. There was consistently enough staff on duty to support people safely, however, there was not always enough staff to take people out individually to the number of people who required one to one support throughout the day.

Medicines were not always stored and administered safely. Not all staff had received training in the safe administration and management of medicines.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports the summary, please read the full report.

There were nine people living at Heath Farm House at the time of our inspection. On the first day of our visit, many of the people were out in the community so we arranged to go back to the home on a day when more people would be about for us to talk with. As a result of our second visit, we were able to speak in private with six people in total.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve.

We spoke with staff and this showed us that they had the skills and experience to care and support people appropriately. One person told us, "You can talk to staff if you want to and they listen."

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to all care services. While no applications have needed to be submitted, proper policies and procedures were in place so that people who could not make decisions for themselves were protected. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People we spoke with told us they were happy living at Heath Farm House. They told us they received the care and support they needed. One person told us, "This is the best place." They spoke about the activities they engaged in with the help of staff when necessary. One person explained, "I'm cleaning my room today. Staff will help me if I ask, but I want to do it for myself."

People's health and care needs were assessed with them and they were involved in writing their plan of care. People said that they had been involved in writing them and they reflected their current needs. One person told us, "I know about my care plan. We talk about it and they tell me when they make changes to it."

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. The people we spoke with told us that staff treated them with care and consideration. We saw that all staff were warm, friendly and respectful. They offered choice and encouragement to people.

People told us they could spend their time where they pleased. One person told us about the day centre they went to during the week and another described how they worked in the home's garden, keeping it well maintained and attractive.

Is the service responsive?

People knew how to make a complaint and the complaints process was displayed on the noticeboard and in the entrance lobby.

People's needs were assessed on a monthly basis. Where they changed we found that the service responded promptly and sought advice from other health professionals where appropriate. Care records showed that the service worked well with other agencies and services to make sure people received their care in a joined up way.

Is the service well led?

Resident meetings were being held alternate months so that the views of people were known. The provider was developing new satisfaction questionnaires so that they could be sure they were providing a quality service that met people's expectations. Actions were taken where possible, in response to people's comments.

Staff told us they were clear about their roles and responsibilities. They understood the ethos of the home and had access to training and development that enabled them to provide appropriate care and support. This helped to ensure that people received a good quality service.

People told us that they enjoyed living here. We saw staff asking for consent before giving care or support and noted that they always asked permission before entering people's rooms. People told us that they had helped to choose the decor of the home, which had a friendly and welcoming atmosphere.

We looked at the care records for five people. The plans were based on needs and risks identified in the assessments and had been revised to take account of changes to the assessed needs and risks as they occurred. Two people told us about their work in the gardens and about their hobbies and interests which staff supported them in doing. One person was creating his own garden area and said "There's going to be flowers in there." One person told us that he had his own colour television in his room, which was "...one of the bonuses of living here." This showed us that people's individual needs and wishes were taken into account by staff.

The premises were secure and well-decorated. All statutory inspections; for example of the fire alarms and electrical wiring; were up to date as was the record of daily and weekly maintenance checks. There were sufficient staff with relevant knowledge and skills on duty to provide the care and support people required. The provider had a clear complaints policy in place and staff were willing to support people when they wished to make a formal complaint.