Bendalls Farm

About the service

Bendalls Farm is a care home providing specialist support for people who may have complex and enduring mental health needs, a learning disability, and times of emotional distress. The home is in the Mendip Hills, and forms part of a wider farm development. There are ten bedrooms all with en-suite bathrooms, a large shared lounge with adjoining games room and a large communal dining room with kitchenette. At the time of this inspection eight people lived in the home.

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

Since the last inspection the registered manager had introduced new auditing processes to prevent or manage infection/COVID-19 outbreaks. In addition, the home had been refurbished to improve safety and people’s quality of life.

All four people we spoke with told us they felt safe living at Bendalls Farm. We observed relaxed and natural interactions between people and staff throughout the inspection.

Although staff knew people well and responded to their needs in a timely way there was mixed feedback from staff about staffing levels. The provider was working hard to recruit and retain staff within a challenging context of national staffing shortages in health and social care.

The service had up to date policies and procedures for safeguarding people from abuse and harm. Staff demonstrated a good understanding of what they should do if they were concerned about a person and how to raise this internally and to external agencies such as CQC and the local safeguarding team.

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

Right support

Although 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 about mental capacity documentation to ensure it is decision specific.

People were supported to live the life they wanted by staff who knew them well and put them at the centre of decision making. Staff enabled people to access specialist health and social care support in the community. People had a choice about their living environment and were able to personalise their rooms.

Right care

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

Right culture

People and those important to them, including advocates, were involved in planning their care. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 requires improvement (published 30 September 2021) and there was a breach in 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 regulation.

Why we inspected

The inspection was prompted in part due to concerns identified during inspection at some of the provider’s other locations. A decision was made for us to inspect and examine those risks. During the inspection we also checked they had followed their action plan and whether they were now meeting legal requirements. This report covers our findings in relation to the Key Questions Safe and Well Led which contain those requirements and also the Effective Key Question.

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.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bendalls Farm 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.

Bendalls Farm is a care home providing specialist support for people who may have complex and enduring mental health needs, a learning disability, and expressions of emotional distress. The home is in the Mendip Hills, and forms part of a wider farm development. There are ten bedrooms all with en-Suite bathrooms, a large shared lounge with adjoining games room and a large communal dining room. At the time of this inspection nine people lived in the home.

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

The management and staff worked together to help ensure people received a good service. However, on our first day of inspection we found issues of concern with the providers infection control policy as it did not address COVID 19 and did not highlight any additional tasks staff should carry out to prevent cross infection during a pandemic. The registered manager did not have full oversight of the home’s infection control processes and issues found during this inspection had not been identified through the registered managers audit processes. We also had concerns regarding the cleanliness of the environment and the general maintenance and condition of the environment.

People told us they were happy with the care they received and people said they felt safe living there. One person said; “Yes, I’m happy here as staff support me.”

The people living at the service were relaxed and comfortable with staff and observations showed they knew people well. Staff were caring and spent time chatting with them and supporting them when they became distressed or anxious.

Following our visit to the service on the first day of the inspection we requested an action plan from the provider to demonstrate how they would address the shortfalls we had identified. This included signposting the provider to resources to develop their approach.

On the second day of the inspection we found the registered manager had addressed some of the concerns identified. The registered manager and locality manager assured us the improvements were ongoing.

Everyone living at the service had capacity to make their own choices and could communicate these to staff, staff knew people well and we observed positive interactions throughout the inspection.

People were supported by staff who completed an induction, training and were supervised. Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction and activities with staff. Staff knew how to keep people safe from harm.

People were protected from abuse because staff understood the correct procedure to follow if they had any concerns. People appeared happy in the company of the staff. Staff received appropriate training and support to enable them to carry out their role safely, including fire safety and mental health training.

People were supported to access healthcare services, staff recognised changes in people's mental health, and sought professional advice appropriately. People received their medicines safely.

Records of people's care were individualised and reflected each person’s needs and preferences. Risks were assessed and identified, and staff had guidance to help them support people to reduce the risk of avoidable harm. People’s communication needs were identified.

Staff told us the registered manager of the service was approachable and listened when any concerns or ideas were raised. One staff member commented that the registered manager was; “Very involved in supporting people and understood their needs.”

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.

Based on our review of safe and well-led the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

Staff worked to support the person in line with their preferences providing choice and control.

Right care:

Staff demonstrated a person-centred approach to care and support. People were treated as individuals and staff promoted people’s dignity, privacy and human rights.

Right culture:

Many of the staff working at Bendalls Farm had done so for some time therefore knew people well. They were supporting people to have as good a quality of life as possible.

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.

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 11 August 2018).

Why we Inspected

We carried out an IPC (infection Prevention and Control) inspection on the 19 July 2021 and we found issues of concern.

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 and other infection outbreaks effectively.

We requested an action plan from the provider following the visit 19 July 2021, due to issues identified with infection prevention and control at the service. Due to these and other issues of concern found we visited the service again on the 9 August 2021 to look at the key questions of Safe and Well-led. This report only covers our findings in relation to those key questions. 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. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

On the second day of inspection we found the provider had addressed some of the concerns we identified on 19 July 2021.

The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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 Bendalls Farm on our website at www.cqc.org.uk.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Safe, Effective and Well led to at least good.

The provider wrote to us in June 2017 and told us how they would achieve compliance with the regulations. During this inspection we found the identified improvements had been made.

Bendalls 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.

Bendalls Farm provides support for up to ten people with learning disabilities and/or mental ¿health needs.

The care service worked 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 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.

People were protected from abuse because staff understood the correct procedure to follow if they had any concerns. Staff informed us they were confident concerns would be followed up if they were raised. People appeared happy in the company of the staff.

Risks to people were ¿assessed and managed. People received effective support from staff to help them manage at times when they became anxious. People received their medicines safely.

There were suitable staff levels in the home and staff were recruited safely.

Staff were suitably skilled, and they received on-going training and support to ensure they had the skills and knowledge required to effectively support people.

People were involved in decisions about their lives and their legal rights were upheld in relation to the Mental Capacity Act 2005, people were able to make unwise decisions where they had capacity to do this.

People were involved in planning their menus.

Staff monitored people’s health and well-being and made sure they had access to other healthcare professionals according to their individual needs.

People’s diverse needs were well supported; they chose a range of activities, work ¿placements and trips out.

Staff had built trusting relationships with people over time. Staff interactions with people were positive and caring.

Staff knew people and understood their care and support needs. People were supported by staff to plan and achieve their goals. People were involved in planning and reviewing their care and support.

There were systems in place to ¿share information and seek people's views about their care and the running of the home.¿

Bendalls Farm provides support for up to ten people with learning disabilities and/or mental ¿health needs. ¿

A registered manager was responsible for the service. This 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.¿

People were protected from abuse and avoidable harm; risks to people were not always fully ¿assessed or well managed. People received effective support to help them manage their ¿behaviour. People’s diverse needs were well supported; they chose a range of activities, work ¿placements and trips out. There were mixed views about staffing levels; this sometimes affected ¿people’s choices of trips out.¿

People interacted well with staff. Staff had built trusting relationships with people over time. One ¿person said, “It’s good here. Staff are really nice to you.” Another person told us, “Yeah, it’s ok ¿living here. I get on ok with the staff.” ¿

Staff knew people and understood their care and support needs. Staff encouraged people to try ¿new things and supported them to ‘move on’ if people chose to. People were part of their ¿community and were encouraged to be as independent as they could be.¿

People, and those close to them, were involved in planning and reviewing their care and support. ¿Some care planning needed to be reviewed. People made choices about their own lives, ¿although their legal rights in relation to decision making and restrictions were not always upheld. ¿Improvements were needed to ensure people had a homely place to live.¿

Staff were well supported and well trained, although on line training needed to be completed ¿more effectively. Staff spoke highly of the care they were able to provide to people. One staff ¿member said, “I would say our relationships with the guys here are pretty good really. It does take ¿time to get to know them but once you do we get on well.” ¿

There was a management structure in the home, which provided clear lines of responsibility and ¿accountability. All staff worked hard to provide the best level of care possible to people. The aims ¿of the service were well defined and adopted by the staff team.¿

The quality assurance systems in place were not fully effective. There were systems in place to ¿share information and seek people's views about their care and the running of the home.¿

We found three breaches 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.¿