Archived: Blamsters Farm

The service is made up of two larger properties and five smaller houses spread across the grounds. At the time of the inspection there were 30 people living at the service.

The service was a large site and it was registered for the support of up to 31 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design being separated into more domestic style houses across the site. The service followed the principles to reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

At the last inspection we found the service did not have effective systems in place to assess and monitor the environment and ensure people were kept safe from harm. Where problems had been identified it was not always clear to see the action that had been taken to rectify the issue. We were concerned that hot water temperatures posed a potential risk to people that were vulnerable and action to mitigate were not effectively in place. At this inspection effective systems were in place and water temperatures were monitored and action taken when temperatures were outside of the recommended temperatures.

Staff focused on providing person-centred care to enrich people’s lives and support them to promote their wellbeing. They were supported by staff who overcame barriers to people's participation in activities which were socially important to them. Relatives and professionals described people's care in a positive way, telling us people experienced new skills and experiences through the support of staff. Care plans supported staff to provide extremely personalised care to people.

People were protected from abuse. Staff understood how to recognise and report any concerns they had about people's safety and well-being. There was enough staff to keep people safe. Staff were visible throughout the day and they responded to people’s needs in a timely way. Risks to people health and well-being were assessed and mitigated. People's medicines were managed safely.

Staff had access to relevant training and regular supervision to equip them with the knowledge and skills to care and support people effectively. Nutritional needs were met, and people were supported to access healthcare services if they needed them. People's health needs were closely monitored and any changes to their needs were immediately reflected in their care plans and the care they received. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were comfortable and relaxed when interacting with staff and they were happy to ask them for help or support. People's privacy and dignity was protected. When people had specific needs about eating and drinking, these were met. Staff demonstrated a good understanding of the people living there and created opportunities for maximising their independence and life skills. Staff worked in partnership with other social care and health care professionals to ensure people received the support they needed.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support 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.

A range of audits and checks helped ensure service quality was maintained and areas for improvement identified. Learning was shared with staff and used to develop the service.

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

The last rating for this service was good (published 04 April 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.

The service was last inspected on 13 October 2014 and given an overall rating of good, with requires improvement in the domain of caring. This was because it was found that whilst staff had built up good relationships with people they did not always treat them with dignity and respect.

The inspection was unannounced and took place on 11 November 2016.

The service did not have effective systems in place to assess and monitor the environment and ensure that people were kept safe from harm. Where problems had been identified it was not always clear to see the action that had been taken to rectify the issue. We were concerned that hot water temperatures posed a potential risk to people that were vulnerable and action to mitigate were not effectively in place.

There was a registered manager in post and they were present during the inspection. 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 were supported by staff who knew how to identify different types of abuse and who were clear about what action to take if any concerns arose. Staff treated people with kindness and respect. During our inspection we saw positive and caring interactions between people and staff.

Staff had assessed individual risks to people and had taken action to seek guidance and minimise potential risks. The service had a process in place for recording, monitoring and analysing accidents and incidents and action had been taken to mitigate the risk of reoccurrence.

Staff supported people to take their medicines safely and staff competencies relating to the administration of medicines were regularly checked.

People received care from suitably qualified and experienced staff who were supported to access a wide variety of training sessions which ensured that the needs of people using the service were met. Staffing levels were sufficient to keep people safe and meet their needs.

The service had a robust recruitment process in place to ensure that staff had the necessary skills and attributes to support people using the service. New members of staff were introduced to the service through a thorough induction programme.

People were supported in line with the legislation of the Mental Capacity Act and no unnecessarily restrictive practices were in place. There were effective systems in place to ensure that people’s medication, money and personal information were kept safe.

People were supported to maintain a healthy diet and to access drinks throughout the day. Mealtimes were flexible to meet individual’s routines, preferences and commitments. Staff worked alongside health and social care professionals to meet people's needs and sought specialist advice and support when the need arose.

Staff were kind and respectful when providing care and people’s behaviour suggested that they felt comfortable in their presence. Staff demonstrated that they knew people well and delivered care in accordance with their preferences and wishes. Staff were skilled at caring for people who had complex communication needs, offering choice and supporting them to make decisions about the care they received.

The manager was supportive and staff had confidence in their ability to deal with issues raised promptly and effectively. Notifications were sent to us as required, so that we could be aware of how any incidents had been responded to. There were systems in place to monitor the quality of service delivered.

We found that the provider had systems in place to maintain the safety and welfare of people who used the service. The service provided staff with specialised training to ensure the safety of people with specific medical needs. We saw that behaviours were monitored, assessed and managed to ensure that people received safe and responsive care.

The provider had good arrangements to promote effective performance of the service. We spoke with three members of staff and the registered manager and viewed the staff rotas in each of the buildings. We found that there were suitable and sufficient numbers of staff on duty to meet people's needs.

We saw that the registered manager showed clear leadership and that all staff were expected to provide a high quality of care to people. The provider ensured that people's care was regularly reviewed and that additional provisions to support their care were provided where required. We found that the provider had systems in place to ensure that complaints were appropriately managed and responded to.

We saw that Blamsters Farm provided a relaxed and homely environment for people. Staff were friendly and respectful in their approach and interacted with people using the service in a confident and considerate manner. During the course of our visit we saw that people were supported to express their views and choices by whatever means they were able to and staff clearly understood each person's behaviours and their way of communicating their needs. Staff looked after people's healthcare needs in a proactive way.

The staff team were well trained and supported to carry out their role. The provider had effective systems in place to monitor the quality and safety of service that people received.