Bannister Farm Cottage

Bannister Farm Cottage is a care home providing personal care to four people at the time of our inspection. The service can support up to five younger adults living with a learning disability or mental health condition. Accommodation consists of self-contained flats with additional communal spaces and a garden for people’s comfort and enjoyment. Bannister Farm Cottage will be referred to as Bannister Farm within this report.

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

The registered manager regularly checked the environment and had multiple control measures to reduce the risk of unsafe care. Relatives described the positive impact the current management team had on people’s welfare. A relative said, “There’s been a real drop in the number of incidents and that’s because they are much more aware of [my relative] and how best to care for him.” Staff followed current guidance to retain effective infection control measures. The registered manager maintained sufficient staffing levels to ensure people’s needs were constantly met in a timely way.

The current management team worked hard at improving the culture and ethos at Bannister Farm. Relatives said the registered manager and staff excelled at maintaining people’s individuality and human rights during the pandemic. One relative commented, “When I wasn’t allowed to visit they suggested I keep that contact going by reading bedtime stories every night. It was lovely.” The registered manager completed a range of audits to maintain everyone’s wellbeing.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Staff supported people to make their own decisions and lead discussions on what they wanted to do. Staff were consistently kind and respectful, ensuring each person maintained their independence and privacy. People confirmed they were happy and settled at Bannister Farm.

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 19 February 2020).

Why we inspected

The inspection was prompted in part due to concerns received about risk management, environmental safety and comfort, staff training, safely supporting people with behaviours that challenge the service and leadership. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained good and the well-led section has changed from requires improvement to good. This is based on the findings at this inspection.

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.

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

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.

Bannister Farm Cottage is a care home providing accommodation and personal care for up to five people who are over 18 years old and require support with learning and physical disabilities. People who used service have associated conditions that may include, autism, sensory and communication difficulties. At the time of the visit there were five people staying in the home.

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.

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

Before and after the inspection we received concerns regarding the management approach and the culture at the home from some staff. Some staff did not always feel valued by the managers and felt their concerns would not be dealt with appropriately. We made a recommendation about the culture and management style.

The provider had a governance system which helped to monitor progress and to drive improvements. The service worked in partnership with a variety of agencies to ensure people received all the support they needed. People were happy with how the service was managed.

People were protected from the risk of abuse and avoidable harm by staff who understood how to recognise, respond and report concerns. Allegations of abuse had been dealt with in a robust manner to assure people about their safety. People’s relatives told us their family members were safe. Risk assessments had been developed to minimise the potential risk of avoidable harm to people during the delivery of their care. People were safely supported to receive their medicines as prescribed. The registered manager had robust and safe recruitment procedures. The provider monitored the safety of the premises.

People received person-centred care, which was responsive to their needs. Care records were well written and contained important details about people’s needs. Staff supported people with meaningful day time activities inside the home and in the local community. People's individual communication needs had been assessed and staff had tools to assist their interactions with people. The registered manager dealt with people's concerns and complaints appropriately.

People's care and support had been planned in partnership with them and their relatives. Staff had received regular training and supervision to support them in their roles. Before the inspection we had received concerns about staff training in the use of restraint. This had been resolved. 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.

People’s relatives were positive about the service and said staff were kind and caring. People were treated with dignity and respect and their right to privacy was upheld. The registered manager worked in partnership with people and their advocates.

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 requires improvement (published 20 February 2019).

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.

Bannister Farm Cottage is care home which provides accommodation for people who require nursing or personal care and living with a learning disability. It is comprised of three en-suite bedrooms within the main house and two self-contained annexes attached to the main building. At the time of our inspection there were four people who lived there permanently and one person who attended each week day and stayed overnight every Monday.

Our last inspection report for this service was published on 01 October 2018 and the rating was 'Inadequate with five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing. We also found one breach of the Care Quality Commission (Registration) Regulations 2009, in relation to notification of other incidents.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve all the five key questions to at least good. The provider also wrote to us to tell what action they would take to comply with these regulations. At this inspection, we found that the provider had made considerable improvements and there were no longer breaches of the regulations. However, we found continuing areas for improvement and the service remains 'Requires Improvement'.

This was a scheduled inspection based on the service's previous rating.

People’s experience of using this service:

There had been a reduction in the number of incidents involving use of physical restraint, however there were continuing incidents of assaults against staff. There had been improvements to ensure people were protected against abuse, neglect and discrimination. Risk assessments were in place and incidents were analysed and de-briefs. However, we found some of the debriefs were not robust to aid any learning. We were unable to speak to people using the service due to their limited communication however their relatives were positive and acknowledged that improvements had been made.

Oversight on incidents from the manager had improved but needed to be consistent.

Improvements were required to ensure people were adequately supervised while undertaking chores and activities to prevent risks of injuries and ensure their safety.

There had been improvements to people's records. Records had been re-written and were well organised and checked to make sure they included up to date and accurate information about people's needs. Information from audits, incidents and quality checks were used to drive improvements to the service people received.

People were assisted to have choice and control of their lives.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence, inclusion. For example, people's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Improvements had been made to ensure staff were providing effective care for people through person-centred care planning, training and supervision. Consideration had been made for the provision of best practice guidance and support to meet people's individual needs.

There were also good practices within the service and people were treated with compassion and dignity by care staff.

We observed a homely and friendly atmosphere throughout the inspection.

Staff spoke passionately about their roles and wanting to provide quality care.

There was good evidence that equality and diversity had been considered, in particular around those with protected characteristics such as disability, race, culture and religion.

People received personalised care that was responsive to their needs.

Staff knew people well. They had developed good relationships with people. People clearly enjoyed the presence and attention from the staff.

Governance systems had improved, and a new manager had been employed. There was commitment from senior management to improve people’s outcomes.

For more information please see the Detailed Findings below.

Rating at last inspection: The service was previously rated Inadequate.

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Bannister Farm Cottage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Bannister Farm Cottage is situated in a semi-rural area of Leyland, Lancashire. Accommodation compromises of three en-suite bedrooms within the main house and two self-contained annexes attached to the main building. At the time of our inspection there were four people who lived there permanently and one person who attended each week day and stayed overnight every Monday.

We inspected the home on this occasion in response to concerns being identified in relation to another service operated by the same provider and under the same registered manager. However, at the time of our inspection the registered manager was no longer working for the organisation. 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 care service is aware of 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. However, we found on this inspection that the service was failing to deliver these values.

We found that people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible, in accordance with the policies and procedures of the home.

During this inspection, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing. We also found one breach of the Care Quality Commission (Registration) Regulations 2009, in relation to notification of other incidents.

Our last inspection of Bannister Farm Cottage was carried out on 7, 11 and 12 December 2017. At that inspection we rated the service as overall ‘good.’ There were no breaches of the regulations at the time. At this inspection the rating had deteriorated to overall ‘inadequate’.

We have considered what action we will take in relation to these breaches. Following our inspection, we met with representatives of the provider to discuss our concerns and a way forward. The service submitted a robust action plan and have agreed to update and submit this on a weekly basis, until further notice. We have had management review meetings and followed our guidance in the enforcement decision tree.

We have made the decision, based on the level of risk, and engagement by the registered provider to issue requirements to the provider on this occasion, in relation to all breaches identified. However, the overall rating for this service is 'Inadequate' and the service is therefore 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.

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.

New employees had been recruited safely. However, incidents of misconduct had not been managed appropriately and staff members did not feel supported by the management team. Evidence was available to demonstrate there were insufficient numbers of staff deployed, who were suitably qualified, competent, skilled and experienced to meet the needs of those who lived at the home.

Practices adopted by Bannister Farm Cottage did not protect people from the risk of discrimination. Those who lived at the home were not adequately safeguarded from abuse and their human rights were not being appropriately met.

The staff training matrix showed a high number of employees had not completed learning modules in relation to safeguarding adults. We noted there were no systems in place for staff members to summon help when working in isolation and there was little evidence of lessons learned following safeguarding incidents or accidents.

Family members we spoke with did not feel their loved ones were safe living at the home. Risk assessments were not always accurate and up to date, which compromised people’s safety and well-being. However, the premises were, in general maintained to a satisfactory standard. However, where it was identified work needed to be done, this was addressed at the time of our inspection.

Emergency plans were in place at the home and systems and equipment had been serviced in accordance with manufacturers’ recommendations. However, incidents where injury had occurred had not always been recorded within the accident records.

Simulated fire drills were not always managed effectively and Personal Emergency Evacuation Plans (PEEPS) were not always accurate. This compromised the safety of those who lived at Bannister Farm Cottage.

Records we saw were sometimes vague and confusing. They did not always clearly identify the circumstances to which they referred. The management of complaints could have been better.

The management of medicines was, in general satisfactory. However, the practices in relation to the administration of PRN medication did not help people to reduce the possibility of heightened behaviours.

The provider was working within the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to help ensure people were not being unlawfully restricted.

Records showed people were able to choose their preferred diet. However, healthy eating was not regularly encouraged. We saw that nutritious home cooked meals and healthy snacks, such as fruit were served, but not on a daily basis.

We were concerned that the service was failing to be responsive to peoples’ assessed needs and choices and person-centred care was not being delivered. People who lived at Bannister Farm were not always treated with dignity, kindness and compassion.

The provider had failed to notify the commission of significant events occurring in the home, such as serious injuries and safeguarding incidents. Arrangements for monitoring and assessing quality in the home to ensure people's safety and compliance with regulations were inadequate. Some audits had been completed, but these were ineffective, as they did not cover a wide range of areas and they did not recognise shortfalls, which were identified during the inspection process. The governance and leadership of the home was poor. Managerial oversight of staff and the care that people received was inadequate.

Our last inspection of the home was carried out in July 2015. At that inspection we rated the service as good. At this inspection in December 2017 we found the service remained good.

Bannister Farm Cottage provides accommodation for up to five people between the ages of 18-65 with learning disabilities and autism. The home was fully occupied at the time of our inspection with one person coming to the service daily, Monday to Friday, and staying overnight on one of those days. Bannister Farm Cottage is situated in the Longmeanygate area of Leyland, Lancashire and is in a quiet semi-rural area. Accommodation compromises of three en-suite bedrooms within the main house with two self-contained annexes attached to the house.

Bannister Farm Cottage 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. People were supported to have maximum 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.

The care service has been developed and designed 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.

There was a registered manager in place at the time of our 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.

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs.

Medication procedures observed protected people from unsafe management of their medicines. People received their medicines as prescribed and when needed and appropriate records had been completed.

Staffing levels were seen to be sufficient to meet the assessed needs of the people at the home. Staffing had been highlighted by relatives and staff as an issue prior to our inspection but we saw evidence to show that these issues had been resolved. The reasons for the staffing difficulties experienced were discussed with the registered manager and area manager and were out of the control of the service.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live.

The design of the building and facilities provided were appropriate for the care and support provided and were being further adapted and improved.

Staff we spoke with had a good understanding of protecting and respecting people’s human rights.

The service had information with regards to support from an external advocate should this be required by them.

Various methods of communication were used with people according to their needs and preferences. Some staff we spoke with were not as aware of some people’s needs as we would expect. However via the new care planning process we saw that this was being addressed and all staff would be briefed accordingly.

We saw a large range of activities were undertaken both within the home setting and externally and that they were appropriately risk assessed.

The management of the service had dealt with the staffing issues experienced earlier in the year. This had led to staffing levels becoming more stable and areas for improvement had been identified and were already in the process of being completed, for example the care and support planning process.

A number of audits were undertaken to ensure the ongoing quality of the service was monitored appropriately and lessons were learned from issues that occurred.