Camphill Village Trust - Botton Village

Camphill Village Trust – Botton Village is a supported living setting providing personal care to people living in their own homes. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 55 people using the service. People are supported in a mix of shared houses and single accommodation within Botton Village. The village is located in the North Yorkshire Moors. The village has various amenities for people to use and work in, including a farm, a village store, a café, allotments, and craft workshops. Within the houses there were offices for staff to use and, where needed, a room for staff to sleep overnight.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection, 28 people received personal care.

The service was developed on one site which does not meet best practice guidance. However, the model of care was such that people had lots of opportunities to gain employment, learn new skills and become more independent. The provider also ensured people were involved in the local communities outside Botton Village.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: People were supported by staff who knew them well and knew how to mitigate risks to people. However, records did not always reflect this. Some parts of people’s support plans were missing or out of date. Other areas were detailed and contained person-centred information. Daily notes were not always robust around the monitoring of risk. Staff knew how to safely support people with their medicines. However, guidance and records were not always in place to support the safe administration of creams, lotions, ‘when required’ medicines and medicines prescribed with a variable dose. Staff supported people to take their medicines safely when away from the service.

People were generally supported to have maximum choice and control of their lives, but the records did not always reflect this. Staff generally supported people in the least restrictive way possible and in their best interests; however the records in this area required improvement. Systems did not always support best practice in record keeping in this area.

Right Care: There were enough staff to safely support people and staff were recruited safely. Staff had access to a wide range of training and received regular supervisions. However, up to date training information and induction records were not available for agency staff. Records and reviews of people’s needs were not always accurate and up to date. People were supported to eat and drink enough to maintain a balanced diet however records were not always robust around particular dietary needs. We have made a recommendation about this. People were supported to attend annual health checks. People received kind and compassionate care. Staff understood and responded to people's individual needs. People told us they felt safe and systems were in place to protect people from harm. The provider safely managed the prevention and control of infection.

Right Culture: Quality assurance procedures and processes were in place but had not always been effective. There was a positive atmosphere in the service. The registered manager was visible in the service and approachable. People and relatives spoke positively about the staff who supported them. The provider had a clear business plan in place which set out a clear commitment to continuous learning and improvement. The provider engaged well with people and sought feedback in a variety of ways. Safeguarding concerns were dealt with appropriately.

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 good (published 24 April 2020).

At our last inspection we recommended the provider reviews and implements best practice guidance regarding positive behaviour support (PBS) to achieve positive outcomes for people and reduce restrictive practices. At this inspection we found improvements had been made and there was clear guidance for staff to follow if people experienced anxiety or distress.

At our last inspection we recommended the provider reviews and implements best practice guidance on the Mental Capacity Act 2005 (MCA). At this inspection we found improvements had not been made in this area, and we identified further shortfalls around compliance with the MCA.

Why we inspected

We received concerns in relation to safeguarding and the culture of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We inspected and found there was a concern with MCA compliance, so we widened the scope of the inspection to include the key question of effective.

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 based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Camphill Village Trust – Botton Village on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to compliance with the MCA, record keeping and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

We have recommended the provider reviews people’s dietary needs to ensure they are accurately reflected within people’s support plans.

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.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection the service offered a regulated personal care service to 35 people.

The service was developed on one site, which does not meet best practice guidance. However, we have rated this service good because the provider had arranged the service in a way that ensured people received person-centred care and were supported to maximise their independence, choice, control and involvement in the community.

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

The service applied the principles and values of registering the Right Support and other best practice guidance. These ensure 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 through choice and control, independence and inclusion. People were offered as many opportunities as possible to gain new skills and become more independent.

Systems were in place to safeguard people and promote their health and wellbeing. We have made a recommendation regarding positive behaviour support to assist people who may need help when they are anxious or distressed.

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. We have made a recommendation regarding best interest decisions.

Warm, professional relationships existed between people who used the service and staff. People told us staff were kind and caring, and they treated them with dignity and respect.

Care plans were generally well maintained and these were person-centred. People and their relatives were involved in the care planning and review process. People said staff looked after them well and supported them to follow their chosen lifestyle, interests and pursuits. They could maintain and develop links with friends and family and access social activities in the wider community.

Some relatives reported they had limited contact with the provider’s senior management team. However, they felt local managers were approachable and supportive and the service was well led. Staff spoke highly of the support they received from managers and were positive about their roles.

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

Rating at last inspection

The last rating for this service was good (published 15 July 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.

Some people lived as part of a shared lives model of support which meant that staff and their families lived together with people who used the service and supported them on behalf of Botton Village Domiciliary Care Group. Other people had a domiciliary care model of support where staff employed by Botton Domiciliary Care Group went into their house to give care and support over a 24 hour period but did not live there. All of the staff were employed by Botton Village Domiciliary Care Group.

At the last inspection on 19 March 2015, the service was rated Good. At this inspection we found the service remained Good.

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.

Recruitment was robust and there were sufficient staff on duty to meet people’s needs. Staff received training to support their roles although some training updates were due. They received supervision and support from senior staff.

Staff were aware of how to safeguard people and report concerns.

Risks to people’s health and safety were identified with clear management plans in place. Medicines were managed appropriately and staff received training in administering medicines.

People had access to healthcare services when necessary. People were supported to choose what foods they wished to eat and they received a nutritious diet.

Staff were described by people and their relatives as caring and kind.

People were encouraged to have control of their lives. They were involved in all aspects of the service and contributed to decisions. They knew how to complain and there were clear policies and procedures in place in written and easy read format. Care plans were personalised and reflected people's needs. They were reviewed regularly.

People took part in a variety of activities both within and outside the village.

There was a registered manager employed at the service. They used a quality monitoring system to identify where improvements to the service could be made using audits.

Surveys of people who used the service were sought through a ‘My Life’ survey. People who used the service helped to devise this survey.

People who lived at Botton told us they would speak with their house co-ordinator, one of the care and support managers or the manager if they did not feel safe. One person said 'Yes I feel safe living here' and 'I like learning how to do different weaving and I am getting good support' and 'I don't want to change anything'.

People also told us "I have a support plan -we talked about the future and what I wanted to do. I was very much involved in that." Another person told us "I was involved in my support plan and risk assessments and I can see my support plan at any time", and "I have two support plans one for when I am working on the farm and one for my social life".

We saw that tenants had a care plan and were involved in the development of their plan. We saw that the plan was reviewed regularly to ensure it stayed up to date.

Proper recruitment processes were followed for people who worked at Botton Village. They also received training and support to ensure they had the skills needed to do their job.

We saw that a system was in place for checking the quality of the service provided. This helped the service develop and to ensure it was meeting the needs of the tenants.

We saw that people were encouraged to make their own decisions about what to wear, how they spent their time and when they weren't working they could follow their own interests. One person said they enjoyed reading and they could watch football on their TV. Another person was involved with the drama group and was looking forward to their next production.

We saw that people's care files contained detailed information about the individual and the help and support they need. The care files looked at the person as a whole and not just as the support they need.

Staff were properly checked to ensure they were suitable to work with vulnerable people prior to the commencement of their employment. People who used the service were involved in the selection process and recorded their opinion for those on the interview panel. The staff were friendly and respectful, one person said they appeared gentle by nature.

The manager had identified some areas that required improvement and had a clear plan to ensure this work was implemented.