Archived: Highfield Farm

Highfield Farm is a residential care home providing personal care to autistic people and/or people with a learning disability. The service can support up to 9 people, at the time of our inspection 7 people were living at the home. The main house was spacious, with ensuite facilities. The grounds contained 3 bungalows annexed to the main building.

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

Staff were not always provided with up-to-date guidance to provide people with the right support. Risks to people were assessed and care plans were in place. However, some records were not reviewed in a timely manner and others contained conflicting information. Environmental risks were not always managed to keep people safe. The provider had systems in place to protect people from the risk of abuse. Medicines were safely managed, and people received their medicines as prescribed. People were supported by enough, suitably qualified staff.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care

The service did not have pictorial signage in place, which may assist people with a learning disability to orientate themselves around the home. Some areas of the home required redecoration, this was identified and formed part of an ongoing maintenance action plan. People and their relatives told us staff were kind and knew them well. People’s rooms were individualised. People told us they were happy and were offered activities of their choice, including evening outings and planned holidays.

Right Culture

The service lacked consistent leadership. We received mixed feedback from people, relatives and staff regarding the leadership and communication of the service. Governance systems in place did not always promote positive outcomes for people and audits did not always improve quality and safety. People and staff were involved in regular meetings, where they could make suggestions, raise concerns and discuss any upcoming events. Accidents and incidents were monitored and overseen by the senior management team. Where people had experienced incidents of distress, debriefs were undertaken with the staff to explore how lessons could be learned from these.

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

Rating at last inspection

The last rating for this service was good (published 17 June 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We received concerns in relation to the management of medicines and restrictive practices. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. However, we have found evidence in other areas that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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.

You can see what action we have asked the provider to take at the end of this full report.

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

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

Enforcement

We have identified breaches in relation to leadership and governance at this inspection.

Follow up

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

Highfield Farm is a residential care home, which at the time of this inspection was providing personal and nursing care to eight younger adults with learning disabilities or autistic spectrum disorder. The service can support up to 10 people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. 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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties, with two bungalows located on the home’s grounds. It was registered for the support of up to 10 people. Eight people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the main building design fitting into the residential area and the two bungalows annexed to the main building.

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

The service had significantly improved since the previous inspection and all feedback had been robustly addressed before we came to inspect. People and staff recognised the service had improved. One staff member said, “Everything is so much more relaxed and happy, everyone is happier, staff, people we support, completely different atmosphere.” The operations manager and service optimisation manager were responsible for the daily running of the service, which was a temporary arrangement until a permanent manager vacancy was filled. The management team were experienced in managing services and supporting them to rapidly improve. The provider had recruited a new manager, who was expected to start after the inspection. People who lived at the service had met the new manager and had an opportunity to ask them questions.

The management team conducted audits and checks to further ensure the quality and safety of services provided to people. The operation of the quality assurance processes had significantly improved and actions arising from audits were being recorded and progressed. As we came to re-inspect the service after a short amount of time, we need to these positive changes sustained at the next inspection to be confident these improvements were embedded.

People received safe and caring support at the service. People received their medicines when they needed them, and there were systems in place to ensure people were protected against the risk of abuse. The premises, including the two bungalows, were clean and there was good infection control practice in place. There was a friendly atmosphere at Highfield Farm, and we saw people looked well cared for.

Staff were recruited safely and there were enough of them to keep people safe and to meet their care needs. Staff were receiving appropriate training which was relevant to their role and people's needs. Staff were supported by the management team and were receiving formal supervisions where they could discuss their on-going development needs.

People’s needs were assessed, and care was planned and delivered in a person-centred way, in line with legislation and guidance. Staff knew people and their needs well, and we saw caring interventions and conversations throughout our inspection. People said they enjoyed their meals and their dietary needs and preferences were met. A range of meaningful activities were on offer to keep people occupied, according to their individual interests. Complaints and concerns were well managed, and the manager took prompt action to address any minor issues we raised during the inspection.

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 identified minor improvements were required to people’s records associated with mental capacity to ensure these were consistently signed and dated.

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.

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 inadequate (published 18 December 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since December 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Highfield Farm is a ‘care home’. 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.

The service had been developed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the time of our inspection the service did not have a manager registered with the Care Quality Commission. Since September 2018 a service improvement manager had been put in place to manage the service. 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 last inspection in May 2017, we rated the home as good. Since then there has been a period of unsettled management and we found there were weaknesses in how the home was being run. We identified six breaches in the regulations, relating to regulation 12 Safe care and treatment, regulation 11 Need for consent, regulation 13 Safeguarding people from abuse and improper treatment, regulation 16 Responding to complaints, regulation 17 Good governance and regulation 18 Staffing.

Staff we spoke with understood what it meant to safeguard people from abuse. However, issues we identified during the day did not support this.

Staff documented accidents and incidents in people’s daily notes, but did not consistently report these incidents to the relevant statutory bodies.

Risk assessments had been completed but staff were not consistently following them.

The provider did not provide supervision and appraisal in line with their own policies and procedures.

There were processes in place to monitor the quality of safety of the service. However, these were not effective and there was little evidence of management oversight of the service.

Care plans had identified some needs did not always reflect peoples current or changing needs. We checked the records of three people and two out of the three people did not have current and up to date information in their care records. The service improvement manager was in the process of updating care plans and had completed an action plan identifying the required remedial actions and appropriate timescales for the care plans to be reviewed and updated.”

The provider had identified actions that needed to be taken to address the shortfalls within the service. We saw evidence of appropriate action been taken by the relief management team service action plan.

People were mostly supported to have maximum control and choice over their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice, staff did not always understand legislation around people's mental capacity and documentation for consent and decision making was not robust.

Staff had a kind and caring approach. They showed respect when interacting with people and had good regard for people's privacy and dignity. Staff had discussions with people about their daily routine, although there was limited evidence of people being involved in their own care planning or future goals and people did not always have choice and control.

There was a complaints process but this was not always effective.

We found robust recruitment procedures were followed.

The overall rating for this service is ‘Inadequate’ and the service therefore is in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not, enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

You can see what action we told the provider to take at the back of the full version of the report.

Highfield Farm is a care home for young people with a learning disability and/or autistic spectrum disorder. It can accommodate up to seven people in the main house and another three in individual bungalows on the same site. At the time of our inspection there were 10 people living in the home.

The service did not have a registered manager. 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 and associated Regulations about how the service is run. A new manager had commenced in post the week prior to the inspection. It was their intention to register as manager of the service.

The service had been in breach of regulations since an inspection at the service on 20 October 2015. The service was last inspected on 1 and 9 November 2016. At the last inspection we found the service was not meeting the following regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: regulation 17 Good governance and regulation 19 Fit and proper persons employed. A requirement notice was issued for regulation 19, Fit and proper persons employed and a warning notice for regulation 17 good governance. At this inspection, we checked and found improvements had been made to meet regulations. The registered provider must now maintain those improvements to ensure a consistently good service is offered to people who use the service.

Our observations of the interactions between people and staff identified people were comfortable in the presence of staff and in our discussions with them no-one raised concerns about their safety. People told us and we found the service provided good care and support. People told us and we found staff to be caring, kind and that they respected their choices and decisions.

Staff we spoke with were knowledgeable regarding safeguarding vulnerable adult’s procedures and were able to explain the action required should an allegation of abuse be made.

Care records reflected the care delivered to people and the care and support they described to us. Those records incorporated relevant risk assessments in regard to people’s health, safety and wellbeing. Staff were familiar with the information about how to meet people’s needs, showing they knew people well.

There were sufficient staff to meet people’s needs and provide a regular team of care staff to people who used the service and recruitment information in place showed staff were suitable to work with people who used the service.

Medicines were stored and administered safely. The systems for monitoring medicines ensured medicines were given as prescribed.

There was a programme of training for all staff to enable them to have the qualifications, skills and knowledge to understand the care and support required for people who used the service. Staff received supervision and appraisal.

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

People’s nutritional needs were met and the mealtime experience had been improved with the offering of a choice of desserts with meals.

Staff were aware of the values of the service and knew how to respect people’s privacy and dignity. Reducing the number of beds the service could accommodate had assisted with this, by ensuring private space was available when needed to ensure people’s confidentiality.

We found where concerns were raised these were listened to and acted on.

Systems in place for monitoring quality and compliance with regulations were effective.

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 and associated Regulations about how the service is run.

The service was last inspected on 20 October 2015. At the last inspection we found the service was not meeting the following regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: regulation 13 Safeguarding service users from abuse and improper treatment, regulation 17 Good governance, regulation 18 Staffing and regulation 19 Fit and proper persons employed. The registered provider submitted an action plan telling us the improvements they would make to achieve compliance by 15 February 2016. We found the service had made some improvements, but remained in breach of two regulations. You can see what action we took at the end of the report.

Our observations of the interactions between people and staff identified people were comfortable in the presence of staff and in our discussions with them no-one raised concerns about their safety.

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

Staff we spoke with were knowledgeable regarding safeguarding vulnerable adult’s procedures and were able to explain the action required should an allegation of abuse be made.

Systems in place for monitoring quality and compliance with regulations had not always been effective in practice. This was despite improvements being identified and action plans formulated to ensure improvement, for example, the allocation and expenditure of budgets, staffing levels, recruitment of staff, people’s records and complaints.

People’s nutritional needs were met, but the mealtime experience could be improved by making information about meals available, providing more choice and offering dessert with meals.

Staff were aware of the values of the service and knew how to respect people’s privacy and dignity. However, this was not always met because we heard private conversations conducted in communal areas which could be overheard, and communal areas were used for staff purposes in the management of the regulated activity.

There was a programme of training for all staff to enable them to have the qualifications, skills and knowledge to understand the care and support required for people who used the service. Staff received supervision and appraisal.

Medicines were stored and administered safely. The systems for monitoring medicines ensured medicines were given as prescribed.