Lucketts Farm

Lucketts Farm is registered to provide personal care to people living in their own homes. At the time of inspection four people were receiving the regulated activity of ‘personal care.’ The service supported adults who have autism, learning disabilities and sometimes displayed behaviour that could be challenging. Each person had a tenancy agreement and rented their accommodation.

This service provides care and support to people living in one ‘supported living’ setting, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Not everyone using Lucketts Farm receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

At the last inspection in September 2017 we identified that staff were not always recruited safely and we issued a notice of breach of regulation. We asked the provider to send us an action plan of how they would address this shortfall which they did. This inspection showed that they had made the improvements they said they would make and more robust checks were now made of new staff which helped to provide assurance that they were suitable to support people using the service.

Previously there had been two registered managers; changes to the management structure had meant there was now only one 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.

The registered manager and staff ensured that people were the central focus of this service. People said they were happy and our observations showed them to be smiling, laughing and engaging well with the staff supporting them. There were enough staff available to meet peoples shared and one to one support needs. People’s medicines were managed safely and people were given opportunities and encouraged to be actively involved in taking more responsibility for their medicines with staff oversight and support. Risks people may experience from their environment and because of their individual needs were assessed and measures put in place to reduce the likelihood of their suffering harm. Staff were trained to understand recognise and response to abuse, they understood the actions to take to escalate concerns they might have and that they needed to notify the Care Quality Commission when alerts were raised. Incidents and accidents were recorded and acted upon appropriately, these were analysed so that steps could be taken to reduce the likelihood of their happening again.

New staff experienced a period of induction suited to their experience. This provided them with the basic knowledge and skills to support people safely and appropriately. All staff received training updates to keep their knowledge and skills updated, specialist training courses were provided to enable staff to understand how to support people with specific needs such as epilepsy or behaviour that could be challenging. Staff said they felt supported and valued. Their practice and competency was assessed through observations and spot checks, supervisions and annual performance meetings.

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 procedures and systems in the service support this. People already living in the service were consulted about new people before they moved in. New people were assessed to be sure their needs could be met and they were compatible with living in shared accommodation. Staff were supportive of people’s differences, any protected characteristics under the Equality Act 2010 were recorded to ensure these could be supported. Staff received training in Equality and Diversity to inform their support of people.

People and relatives were involved in the development and review of care plans which provided detailed guidance for staff about people’s individual needs and their preferences for support. These were updated regularly and in response to any changes in need. Staff were trained to support people who could display challenging behaviour when their anxieties were heightened, clear guidance was available to inform staff how to manage and de-escalate to keep people and others safe.

People planned, purchased and prepared some of their own snacks and meals and were encouraged to eat healthily. Staff supported people with managing their health needs. People were supported to attend appointments. Staff kept records of visits and advice from health care professionals to ensure people’s health care needs were supported appropriately.

An accessible complaints procedure was in place in a format people could understand. People told us if they had any concerns they would make staff and the registered manager aware of these.

People and relatives told us that staff were kind and friendly. People’s privacy and dignity was respected by other tenants in the house and by staff. People retained control of their own records which were kept secure in their rooms, their confidentiality was maintained by staff. Computer records were password protected. People met weekly with staff in tenant house meetings to discuss things of importance to them that included meal planning and activities. People, relatives and staff had been surveyed for their views about the service, these were analysed and acted upon by the registered manager. A service development plan was in place of improvements the provider and registered manager wished to make to the overall service. There were effective systems in place to monitor service quality through audits and observations to improve upon this.

Lucketts Farm is registered to provide personal care to people living in their own homes. Each person had a tenancy agreement and rented their accommodation. The service supported adults who have learning disabilities, autism and sometimes displayed behaviour that could be challenging. At the time of the inspection six people were receiving a personal care service, they were all living together and sharing their support.

The service had two registered managers in post, who shared responsibility for the service between them. A registered manager is a person who is 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.

This was a newly registered service. People received a good level of support from staff, however, there were key areas of the fundamental standards from the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 that the provider and registered managers had overlooked.

Staff were not always recruited safely. Full recruitment procedures had not been followed for all staff, and the provider had not applied for a disclosure and barring check (DBS) for one member of staff. The DBS helps employers make safe recruitment decisions and helps prevent unsuitable people from working with people who use care services.

One of the registered managers had raised a safeguarding alert. Although they had informed the local safeguarding authority and action had been taken to reduce the risk of the situation occurring again, they had not informed CQC, as required by law.

The registered managers completed a range of checks and audits on the service, but had not identified these shortfalls. The provider visited people regularly but did not complete any checks or audits on the service to ensure it was compliant with the regulations. They told us they had ‘overlooked’ this aspect of their role. The provider and registered managers all agreed that they needed to develop their understanding of complying with fundamental standards.

There was a culture of openness and honesty and people were supported to be as independent as possible. People were working towards achievable goals and told us they had learnt new skills since receiving support from the service, such as baking and learning to tie their own shoelaces. People were supported to eat healthily and were involved in planning and preparing meals.

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. Staff had up to date knowledge on the Mental Capacity Act 2005 (MCA) and the registered manager was liaising with people’s care managers regarding applications to the Court of Protection if people’s liberty was restricted.

Risks relating to people’s care and support had been assessed and there was guidance for staff on how to support people safely. Some people displayed behaviours that challenged and there were detailed support plans in place to minimise people’s anxiety. Any accidents and incidents were analysed to reduce the risk of them happening again.

Staff had sought advice and guidance from a variety of healthcare professionals to ensure people received the best care possible. People received support with a variety of health care conditions. People were supported to manage their medicines safely.

There was enough staff to meet people's needs. Staff told us they could always contact a manager out of hours for advice or guidance if necessary. Staff had received induction, training, and supervision to support people effectively. There was an ongoing training programme to ensure that staff had the skills and knowledge to meet people's needs. Staff knew how to recognise and report possible abuse.

There was a complaints policy in place and people told us they knew how to complain if they needed to. Complaints were documented, investigated and responded to. Staff met with people regularly to check how they felt they were being supported and to ensure they were happy with the service. People, their relatives and staff had been surveyed to ask their opinions on the service

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.