Cocklebury Farmhouse

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Incidents, accidents and near misses were recorded with clear details of what had happened, including what people were doing in the lead up to the incident. This helped staff identify situations which could escalate people’s anxieties. Staff took a pro-active approach to prevent situations escalating where possible and minimise distress for people. The management team reported they had identified a reduction in the number of incidents since the last inspection that required the use any restraint. The intention was to reduce this further until it was no longer necessary to include restraint in the person’s support plan.

Incidents were reviewed by the registered manager and directors to ensure actions were taken to reduce the risk of a repeated incident. Staff told us learning from incidents was shared with them and gave them clear information on any changes to the way they needed to support people.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Relatives told us systems worked well when people started using the service, with good communication and close work with health services people were using. People’s health conditions were documented, and they were supported to access services from a range of professionals including the psychiatrist and specialist nurses.

People had been supported to develop hospital passports, to ensure key information about their needs and how to meet them was shared with medical professionals if needed.

Health and social care professionals told us the service worked well with them, to ensure continuity of care for people. Comments included, “Cocklebury Farmhouse works closely with individuals and their families to ensure transitions are safe, well-planned, person-centred, and clearly communicated, supporting continuity of care when people move between services.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

At the last inspection we identified shortfalls in the way people were supported following incidents in which they were restrained for their safety. At this inspection we found this had improved. Incidents in which people were restrained were clearly recorded and reviewed by the management team to ensure any learning actions were implemented. Records included a de-brief with everyone involved, including people restrained. The provider had successfully worked to reduce restraint, with only 1 incident in the previous year.

People said they felt safe living at the service and knew who they could talk to if they had any concerns. Staff demonstrated a good understanding of their safeguarding responsibilities and said they completed regular safeguarding training. Staff were confident managers would take appropriate action if they reported safeguarding concerns. Staff were also aware how to raise these concerns outside of the organisation if they needed to.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found the provider had applied to the local authority for (DoLS) authorisations where appropriate. The registered manager had a record of all DoLS applications that had been made, including details of any conditions to the authorisations.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People had been supported to develop clear positive behaviour support (PBS) plans, setting out support they needed to manage periods of anxiety and distress. PBS plans had been developed with input from a clinical psychologist and had been regularly reviewed and updated as people’s needs changed.

Staff demonstrated a good understanding of the risks people faced and how to support them safely. Staff told us risk management plans were regularly reviewed and updated, as people’s needs changed. Staff had immediate access to updated plans through the electronic support planning system and were notified of any changes.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider completed various health and safety checks to make sure the premises, and any equipment was safe. Since the last inspection the provider had reviewed their Legionella risk assessment and water samples were now being regularly tested to ensure they were safe. Equipment was serviced regularly and staff completed regular checks of the environment to identify any shortfalls. However, although windows were fitted with suitable restrictors, the checks staff completed did not include a check of the restrictors to ensure they were operating effectively. The checklist was amended during the inspection to include window restrictors.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

At the last inspection we identified people were not always supported by competent, skilled and experienced staff. At this inspection we found this had improved. Staff told us they received a good induction when they started working in the service and regular training. Staff said the training was a mix of in person and online courses, which gave them the skills and knowledge to meet people’s needs. Records demonstrated staff completed the care certificate when they first started and a detailed induction. Staff were supported to complete training relevant to people’s needs, including autism, epilepsy, communication and mental health. Since the last inspection one of the Directors for the provider had started a higher-level qualification in positive behaviour support (PBS) and all staff had completed level 3 PBS training. Managers had a record of training staff had completed and when any refresher training was due.

Staffing rotas were flexible, to accommodate support for people to attend events they wanted to, including in the evenings and at weekends. People told us staff were available when they needed support.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The service was clean and smelt fresh throughout. All areas of the service were frequently cleaned and well maintained. Staff had appropriate access to personal protective equipment and had received training on infection prevention and control good practice. The service employed housekeeping staff, who told us they had all the equipment they needed and received suitable training. People were supported to take part in household tasks, to keep their home clean.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Medicines were stored safely, in either a medicines cabinet in the office or a locked cabinet in people’s bedroom. The temperature of the medicine fridge was being recorded daily. However, this had not included the minimum and maximum temperature over a 24-hour period, to ensure the temperature had remained in a suitable range. The registered manager took action to address this during the inspection. Medicines administration records had been fully completed, with details of medicines people were supported to take. Staff received training in medicines management and records demonstrated there were regular checks for their competence in administering medicines safely.

The provider was signed up to STOMP (Stopping over medication of people with a learning disability and autistic people). This is a national initiative to stop over prescribing of psychotropic medicines. People had been supported to reduce doses of this type of medicine and ‘as required’ protocols clearly told staff to try other interventions first and use this type of medicine as a last resort. Staff had a good understanding of these protocols.