Farm Lane

Farm Lane is a residential care home providing personal and nursing care to up to 66 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 55 people using the service.

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

People and their families felt this was a safe service. Relatives told us the provider was good at keeping them updated. The service engaged effectively with people and their relatives to identify how the service could improve and to address any concerns that people may have.

The service operated effective systems for auditing care and ensuring robust governance. However, we identified a serious record system as night staff were completing important records such as welfare checks in advance, which meant that we could not be sure that these had actually taken place. The provider advised us of the steps they were taking to address this issue.

The service had appropriate measures to safeguard people from abuse and ill treatment. Staff understood their responsibilities to report safeguarding concerns and managers took appropriate steps to ensure these were acted on. However, we identified that people sometimes received support from care workers of the opposite gender without robust procedures for ensuring that this was what people wanted. We made a recommendation to the provider to review their procedures to ensure people were consenting to care from male carers.

Staff reported feeling well supported by managers and processes worked effectively to ensure information was shared with staff.

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 COVID-19 and other infection outbreaks effectively.

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 (published 5 October 2022).

Why we inspected

We received concerns in relation to how the provider managed safeguarding concerns. As a result, we undertook a targeted inspection to assess these concerns. As a result of our findings, we decided to widen the inspection to review the key question of well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Farm Lane on our website at www.cqc.org.uk

Enforcement

We have found a breach of regulation in relation to good governance. We served a warning notice to the provider.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Farm Lane is a residential care home providing personal care to up to 66 people. The service provides support to older people and those living with dementia. At the time of our inspection there were 49 people using the service.

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

People and their relatives gave positive feedback about the staff and told us they felt safe with them.

People's care plans and risk assessments included clear risk management guidelines for staff and daily records such as repositioning charts were filled in consistently.

We were assured that this service met good infection prevention and control guidelines. The provider facilitated safe visiting arrangements, had systems in place to ensure the building was clean and had systems in place to prevent the spread of infection.

The provider managed people’s medicines safely. Staff had completed medicines administration training and were clear about their responsibilities.

The provider conducted appropriate pre- employment checks before hiring staff. There were enough staff employed to meet people’s needs.

People were supported to eat and drink enough and their health needs were met. The home was in a good state of decoration.

The provider assessed people’s needs and choices and delivered care in line with these.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Managers and staff were clear about their roles. Staff gave good feedback about their colleagues and the registered manager.

The provider conducted a number of audits and held various staff, residents and relatives meetings to improve the quality of the service.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (Requires Improvement, August 2021).

At our last inspection we found a breach of the regulation in relation to good governance. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was now meeting this regulation.

Why we inspected

We received concerns in relation to infection control and people’s safety. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well- led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Farm Lane on our website at www.cqc.org.uk

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 COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

People had access to health services in the service, including GP and consultant visits and services such as dentistry and chiropody. This promoted good health and reduced the risk of community transmission of COVID-19.

Staff worked as infection control champions to promote best practice and identify areas for development for their colleagues.

Farm Lane is a residential care home providing personal and nursing care to people over the age of 65. The service can accommodate up to 66 people across three separate units. Twenty-one beds on the ground and first floor are allocated to people discharged from hospital requiring further assessment, care and support for a period of up to 28 days. The remaining 45 beds are used to provide nursing care for older people some of whom are living with dementia. At the time of the inspection 29 people were living in the home.

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

We identified shortfalls during our inspection in relation to the accurate and consistent completion of people’s care documentation. People’s turning charts, fluid and elimination records contained gaps and omissions of information. This meant that tasks were either not being completed as directed and/or that outcomes were not being recorded accurately.

Despite the above concerns, people told us they felt safe with the staff supporting them and spoke positively about the service.

People were protected from the transmission of infectious diseases including COVID-19.

Medicines were managed, stored and administered safely.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published July 2019). The service remains rated requires improvement.

At our last inspection we found a breach of the regulations in relation to good governance. 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 made and the provider was still in breach of regulation 17 (good governance). We made a recommendation in relation to monitoring and recording people's health conditions and the care and treatment they receive.

Why we inspected

We received notification of an incident of concern in relation to the care and treatment provided to people with pressure wounds. As a result, we undertook a focused inspection to review the key questions of safe and well-led.

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.

We have judged that the provider needs to make improvements in the key areas of safe and well-led. Based on our findings at this inspection, and in conjunction with the ratings from our previous comprehensive inspection for the key questions of effective, caring and responsive, the overall rating for this service has remained requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Farm Lane on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to governance at this inspection. We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of 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 from the provider to understand what they will do to improve the standards of quality and safety. We will contact the provider in due course to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Farm Lane is a residential care home providing personal and nursing care to people over the age of 65. At the time of the inspection, 57 people were living in the home.

Farm Lane can accommodate up to 66 people on three separate units. 21 beds across the ground and first floor are used as interim beds for people discharged from hospital requiring further assessment, care and support for a period of up to 28 days. The remaining 45 beds are used to provide nursing care for older people some of whom are living with dementia.

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

Care planning documentation and related records were not always complete, accurate and contemporaneous.

Quality monitoring systems were not always providing a sufficient level of detail to evidence that events, incidents, accidents and complaints were analysed in a meaningful way and led to service improvements where required.

Staff completed a range of mandatory training. However, refresher training was behind schedule in key subjects such as fire safety and first aid.

Complaints were investigated but records did not always document the action taken when complaints were related to staff performance.

Some areas of the home were cluttered and being used to store items inappropriately.

People were supported to have choice and control of their lives and staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People's risk assessments provided sufficient guidance to staff as to how to manage risks associated with people's care and support. Staff understood how to recognise and respond to safeguarding concerns to keep people safe

Staff responsible for administering medicines were trained and assessed as competent to do so.

Staff made appropriate referrals to other healthcare professionals when needed.

People were cared for in a way that respected their privacy and dignity and promoted their independence. We saw examples of kind and compassionate care.

People had enough to eat and drink and staff provided appropriate support where this was required.

Lifestyle co-ordinators provided opportunities for people to participate in a range of activities.

We made a recommendation in relation to the safety, adaptation and design of the home.

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 (published 13 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Farm Lane on our website at www.cqc.org.uk.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Farm Lane provides accommodation for up to 66 people on three separate units, which includes 14 rehabilitation beds on the ground floor unit. Central London Community Healthcare NHS Trust are commissioned to provide the therapy for the rehabilitation patients on this unit. The remaining 51 beds are used to provide nursing care for older people with healthcare needs due to frailty and older people living with dementia.

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. At the time of the inspection the registered manager had resigned and was no longer working at the service. Farm Lane was being managed by an operations support manager (interim manager). People and relatives commented on the recent significant changes in management at the service, as the clinical lead (deputy) had also left the service since the last inspection.

People said they felt safe and staff competently discussed with us their understanding of how to protect people from abuse. Risk assessments were carried out and risk management plans were appropriately developed.

Sufficient numbers of staff were deployed in order to meet people’s needs, and they were provided with relevant training, supervision and support. Staff recruitment was thoroughly conducted so that people received their care and support from staff who were suitable for employment at the service.

Satisfactory processes had been implemented to ensure the safe management of people’s prescribed medicines.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on our findings. DoLS are in place to protect people where they do not have the capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. The provider demonstrated that people’s rights were protected and staff had received training to understand their responsibilities. Staff understood how to ask people for their consent before providing personal care and other support.

Systems were in place to support people to access health care, including specialist care and support to meet their end of life care needs. Positive comments were made in relation to the quality of the food and we observed that people were supported in a patient and kind manner.

We saw caring and respectful interactions between staff and people. Staff told us about how they supported people to promote their dignity, which was observed during the inspection.

People’s needs were assessed before they moved into the service and further assessments were conducted once they moved in. This information was used to develop individual care and support plans that evidenced consultation with people and their relatives.

The activities programme provided people with social stimulation and opportunities to meet members of the local community, including young volunteers. There were specific activities offered to people living with dementia, for example music therapy.

People and their relatives were provided with information about how to make a complaint. There were effective systems to investigate and resolve complaints, and where applicable learning took place.

There were quality assurance systems in place to monitor the quality of the service and seek the views of people and their representatives. This monitoring had identified and addressed shortfalls in the quality of the service.

Farm Lane provides accommodation for up to 66 people on three separate units. This includes 21 rehabilitation beds, managed in conjunction with Central London Community Health Care NHS Trust. The nursing and care staff are provided by Care UK Community Partnerships Limited and the specialist team of physiotherapists, occupational therapists and speech and language therapists are employed by the NHS. The remaining 45 beds are used to provide nursing care for older people with healthcare needs due to physical frailty and older people living with dementia.

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.

We found that there were not enough staff deployed at all times to safely meet people’s needs. The recruitment of staff was not consistently thorough in order to robustly ensure that people were cared for by staff with appropriate skills and knowledge for their roles.

Although nursing staff received medicines training and there were systems in place to monitor the management of medicines, we found issues of concern about specific aspects of the medicines service.

People told us they felt safe with staff, who had received safeguarding training and understood how to protect people from abuse.

Risk assessments were conducted as required and people were routinely assessed to identify their potential risk of health care problems associated with the ageing process and frailty, for example risk of skin damage, falls, malnutrition and hydration.

The premises were safely and hygienically maintained in order to provide people with a comfortable environment.

People and their relatives predominantly told us they thought staff had the appropriate expertise to provide the care they needed. However, this did not match information we had received from people and relatives prior to the inspection, who expressed concerns about the skills and approach of the staff team. Records demonstrated that staff received training, supervision and appraisals in order to improve on and monitor their knowledge and performance.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on our findings. DoLS are in place to protect people where they do not have the capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. Although staff had received applicable training, some did not understand the principles of the Act.

A varied and balanced diet was provided, although some people indicated areas of the food service that could be improved upon. We observed people being supported with meals and drinks in a patient and respectful manner.

People were able to access health care support from doctors and other health care professionals, including dietitians and community specialist nurses. However, the registered manager and people who used the service told us there were delays in accessing NHS podiatrists, so people sought private services instead.

There were some conflicting views expressed about whether staff were kind and caring, and our own observations indicated that some staff did demonstrate their fondness for people during interactions but were often task orientated due to the busy level of work.

Records relating to how people were supported with their personal care were often confusing due to the provider using a combination of hard copy and electronic records. This meant that sometimes important documents such as moving and positioning charts were not properly completed but other information to demonstrate that people were provided with this care was recorded on the electronic care plans.

There was a programme of activities and entertainment provided by the activities team. However, some people reported that they were bored at times and needed more stimulation. We observed that people sat in their bedrooms and in lounges for lengthy periods watching television.

People and their relatives were provided with information about how to make a complaint. All complaints were investigated; however, the quality of some of the investigations was not satisfactory and within given timescales. The provider did not demonstrate how they used complaints as a learning tool for service improvement.

There were quality assurance systems in place to monitor the quality of the service and seek the views of people who used the service, relatives and staff. However, we found that the systems used by the provider had not identified and addressed the range of problems that we found during the inspection.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe staffing levels, rigorous recruitment, safe management of medicines, record keeping for person centred care that reflected people’s accurate needs and wishes, complaints investigations and quality monitoring.

You can see what action we told the provider to take at the end of the main report.

At this inspection we found that the service had made improvements. The relatives of people with dementia told us they felt consulted and involved in care planning, and they had been asked to provide information about people's life histories and interests. One relative told us, "It's good here, it's really nice. All of the staff are very approachable and helpful. They come and talk with me and update me with what they are doing." Another relative said, "There are meetings and I can give my views at any time. They look after [my relative] beautifully, right down to making sure they get their favourite pudding."

We saw that staff had received training about how to meet the social needs of people with dementia and new therapeutic and recreational equipment had been provided. Records showed that an additional person was being recruited in order to expand upon the existing activities programme.

We saw that the service had addressed required actions within it's own dementia care audits. Records showed that actions had been taken to identify ways of improving the quality of care for people with dementia, such as workshops with specialist practitioners, observations by the manager and staff meetings.

We also spoke with the home manager and members of the care team. We found that the home ensured that people were assessed and that their care plans were up to date and reflected their current needs. We saw that staff had been trained in dementia care.

Some relatives told us that they did not always feel involved in discussions and decisions made about their family members and we saw that there was a lack of emphasis on people's social histories and preferences when their care was planned. Some of the comments we received from family members explained that there were not enough person-centred simulating activities which took place. We saw that the activities scheduled did not take place and not everyone people was engaged in the activities on offer.

The home worked with other health and social care providers to ensure that people received necessary medical care and we saw that the home worked with other agencies to meet the needs of people who used the service.

The provider had systems in place to ensure that the quality of the home was monitored however these were not always consistently applied to ensure that there was an improvement in the quality of dementia care in the service.

As well as the dementia themed inspection, we also looked at the records to follow up on previous non-compliance in the last inspection in this area. We found that there had been some improvement in this area.

We saw that staff sought consent on day to day issues, and people gave their views about what they would like to eat, wear and do each day.

Care records were kept securely. The manager had a good understanding of the Mental Capacity Act 2005 which meant decisions were taken in the best interests of people who lacked capacity; however the process that led to these decisions was not always clearly recorded on the electronic records. Records were not always complete.

Two people we spoke with said they felt safe and that staff always came if they needed help. Staff had received training in safeguarding vulnerable adults and understood what was meant by safeguarding. We saw staff attending promptly to people seeking assistance.

Staff and people we spoke with said they felt there were sufficient staff to meet the needs of people living at Farm Lane.

Systems were in place to monitor the quality and risks to the health, safety and welfare of people who use the service and others. Audits were centrally planned and coordinated by Care UK and included annual feedback from people and families.

People who use the service told us that they were 'satisfied' with the quality and amount of food available and were able to request snacks outside meal times. There was a variety and choice of meals available according to people's dietary requirements.

People who use the service told us that they felt safe on the unit and had no complaints 'whatsoever'. Most staff felt that there was adequate staffing to carry out care activities with the people who use the service.