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Inspection carried out on 25 November 2018

During a routine inspection

We carried out an announced comprehensive inspection on 25 November 2018. The provider was given 48 hours' notice because the location was a small care home for adults who may be out during the day; we therefore needed to be sure that someone would be in.

Little Eastbrook Farm provides care and accommodation for up to three people. On the day of our inspection there was one person living at the service. The home provides residential care for people with a learning disability. The service was run as a ‘family run home’ with people living and sharing all aspects of family life. For example, sharing living space. The PIR (Provider Information Record) states; “We currently provide a one to one service, and (X- the person who lives in the service) are considered as part of the family.”

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post. A registered manager, who was also the registered provider, 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.

We checked the service was working in line with ‘Registering the right support’, which makes sure services for people with a learning disability and/or autism receive services are developed in line with national policy - including the national plan, Building the right support - and best practice. For example, how the service ensured care was personalised, discharge if needed, people’s independence and links with their community.

The service has now improved to Good in Effective.

At the last comprehensive inspection on the 27 May 2016, the service was rated Good overall. However, it was rated Requires improvement in Effective. We followed this inspection up with a focussed inspection to look at the improvements they had made. At the follow up inspection in August 2017 we found the staff had a good understanding of the Mental Capacity Act 2005, but some records needed improving to ensure all decision making was recorded. At this inspection we found the evidence continued to support the overall rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good:

People were not able to fully verbalise all their views therefore they were not able to tell us about all their experience of living there. We spent time with people seeing how they spent their day and observing the interactions between people and the staff supporting them. However, when asked if they were happy living in Little Eastbrook Farm said ‘Yes’ and they ‘didn’t want to move out.’

People remained safe at the service. People were protected from abuse as staff understood what action they needed to take if they suspected anyone was being abused, mistreated or neglected. Staff, who had worked at the service for many years, had been recruited safely and had completed checks with the Disclosure and Barring Service (DBS).

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Staff assessed and understood risks associated with people’s care and current lifestyle. Risks were managed effectively to keep people safe whilst maintaining people’s rights and independence.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff had completed training in medicines and had contact with the local pharmacist to ensure best

Inspection carried out on 2 July 2017

During an inspection to make sure that the improvements required had been made

This inspection took place on 2 July 2017. The inspection was announced and we gave two days notice to the home. This was because this is a small home for two people and we wanted to ensure that they would be in when we inspected.

At the last inspection in April 2016 we asked the provider to take action to ensure they were meeting the requirements of the Mental Capacity Act 20015 ( MCA) and also Deprivation of Liberty Safeguards ( DoLS). This was because the people living at the home had complex needs and may have been at risks of having their liberty deprived unlawfully. The provider had sent us an action plan telling us they would be meeting these requirements by July 2016. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Little Eastbrook Farm on our website at www.cqc.org.uk. At this inspection we found that applications had been made to the local authority for DoLS authorisations.

Little Eastbrook Farm is a small rural care home. The care home offers accommodation and personal care for up to three people with learning disabilities. People living at the home share the accommodation with the providers and their family. At the time of our inspection there were two people living at Little Eastbrook Farm. The providers are Mr and Mrs Gold and as such the service does not require a registered manager. However, Mrs Gold acts as the manager for the service and is supported by her husband, daughter and sister to provide the care at the home.

Staff understood the principles of the MCA and told us healthcare professionals and family members were sometimes involved in decision making when someone lacked capacity to make a specific decision. This was not always recorded. However, the staff discussed where they had consulted with others about what to do in someone's best interest. We have made a recommendation about recording capacity assessments and best interest decisions.

We found that people were happy living at the home. They had a balanced diet and said they enjoyed their meals. Relatives were satisfied with the care being provided.

There was a good relationship with the local GP medical centre and people were referred appropriately for health care needs.

Staff had training to enable them to have updated skills in providing care and support for the people living at the home. They had recognised they needed updates in medicines management and safeguarding adults at risk. This was being organised.

One room on the ground floor had been adapted so that one person could move into this because of an increased level of need. All suitable equipment had been purchased. We advised the provider contact the fire authority about the use of this room, which they did the day after the inspection. The fire authority visited the home on 18 July 2017 and advised on safety issues.

Inspection carried out on 27 April 2016

During a routine inspection

This announced inspection took place on 27 April 2016. The provider was given 48 hours’ notice because the location was a small care home for adults who may be out during the day; we therefore needed to be sure that someone would be in.

At our previous inspection carried out on 28 April 2015 we found breaches of regulation associated with the Health and Social Care Act (2008). Medicines management did not reflect current legislation and guidance; the service was not meeting the requirements of the Mental Capacity Act (2005) (MCA) and did not have systems and processes, such as regular audits and up to date and relevant policies and procedures in place to assess, monitor and improve the quality and safety of the service. We found some improvements had been made when we visited on this occasion, however the service was still not meeting the requirements of the MCA.

Little Eastbrook Farm is a small rural care home. The care home offers accommodation and 24 hour care for up to three people with learning disabilities. People living at the home share the accommodation with the providers, and their family. At the time of our inspection there were two people living at Little Eastbrook Farm.

When we visited there was 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 provider was not acting in accordance with the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) codes of practice to ensure people were not deprived of their liberty without lawful authority.

People were safe and staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom. Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. They were supported to maintain a balanced diet, which they enjoyed. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. Through our observations and discussions, we found the staff were motivated and inspired to offer care that was kind and compassionate.

Staffing arrangements, which included recruitment, were flexible to meet people’s individual needs. Staff received training and regular support to keep their skills up to date in order to support people appropriately.

Methods were used to assess the quality and safety of the service people received and make continuous improvements.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 28 April 2015

During a routine inspection

This announced inspection took place on 28 April 2015. The provider was given 24 hours’ notice because the location was a small care home for adults who may be out during the day; we needed to be sure that someone would be in.

At our previous inspection carried out on 18 November 2013 we found there was insufficient detail contained in people’s risk assessments and personal care records to ensure their safety. We found that improvements had been made to these records when we visited on this occasion.

Little Eastbrook Farm is a small rural care home. The care home offers accommodation and 24 hour care for up to three people with learning disabilities. People living at the home share the accommodation with the providers, and a relative of the providers.

When we visited there was 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 home did not have a system in place to ensure accurate stock levels and medicines remained in date and the medicines cupboard did not conform with the Medicines Act 1968. In addition, both staff training and the medicines policy and procedure were last updated in 2004. This posed a risk that medicines management did not reflect current legislation and guidance.

Staff could not demonstrate a comprehensive understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and how they applied it to their practice, despite training completed on both subjects in March 2015. For example, staff did not think the Mental Capacity Act (2005) and DoLS applied to people with learning disabilities. We found the service did not meet the requirements of the Mental Capacity Act (2005).

The provider did not have systems and processes, such as regular audits and up to date and relevant policies and procedures in place to assess, monitor and improve the quality and safety of the service.

Staff received informal supervision on an on-going and informal basis due to the size of the service and team. There was no formal way of recording these sessions which would help recognise personal and professional development for staff.

People felt safe and staff were able to demonstrate an understanding of what constituted abuse and how to report concerns. Risk management was important to ensure people’s safety.

People received personalised care and support specific to their needs and preferences. Health and social care professionals were regularly involved in people’s care to ensure they received the right care and treatment.

Staff relationships with people were caring and supportive. Through our observations and discussions, we found the staff were motivated and inspired to offer care that was kind and compassionate.

Staffing arrangements, which included recruitment, were flexible to meet people’s individual needs.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 18 November 2013

During a routine inspection

We inspected the home at short notice on 18 November 2013. We spoke with and spent time with the two people who lived at the home, the providers and their daughter, who was employed by the home as a carer.

We found the home homely warm and comfortable. Everyone was involved with the inspection around the kitchen table. There were two people living at the home who had lived there for over twelve years. The providers and their family knew the people well and understood the care and support needed. People lived as part of the family and were involved in everything the family did.

The relationships between people, the providers and the family were warm and relaxed. We observed the ways in which everyone spoke to each other which was respectful and inclusive. They told us they were 'very happy'. People told us they liked to go out on trips especially if it involved a ‘cup of tea and a jam doughnut’. We were told that people had a choice of whether to go out or not as there was always someone at home, which meant separate activities could take place.

We examined care files and found that the care plans had been reviewed. We examined risk assessments and found they were not up to date and did not contain sufficient information to prevent further risk to people's safety.

We found that records were organised and accessible, but were not always up to date, which meant that people were not always protected from the risk of unsafe or inappropriate care.

Inspection carried out on 26 September 2012

During a routine inspection

We visited the service and met the two people who lived there. There had been no new people admitted to the home since we last visited in 2009.

The people had learning difficulties and were able to tell us that they were happy at Little Eastbrook Farm. They were supported by the providers and their extended family to maintain their interests and hobbies. One other person was employed by the providers who took them out on day trips.

The people had continued contact with family, friends and the community which provided social enrichment. The home was clean and well-maintained.

The views and concerns of the people using the service were listened to. The people were supported by experienced and competent staff in numbers which meet their needs. Good relationships were maintained between the providers and health and social care professionals to ensure that the people’s needs were met.

Reports under our old system of regulation (including those from before CQC was created)