Archived: Street Farm

Street Farm is a residential care home providing personal care to up to 11 people with a learning disability. The service comprises of the main house which accommodates 6 people and 5 flats at the rear of the property. At the time of our inspection there were 11 people using the service.

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

The service design and model did not fully meet the principles of Right support, right care, right culture. This is because the service is larger than what is usually considered practicable to provide person-centred care and support. The service was registered with us prior to the Right support, right care, right culture guidance was implemented. The service however was able to demonstrate they met these principles, 5 people had their own flats and people received person centred care and support.

People were supported by staff to pursue their interests. Staff supported people to achieve their aspirations and goals. The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced.

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. Staff supported people with their medicines in a way that achieved the best possible health outcomes.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. 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.

Right Culture

There had been a turnover staff, but the service had ensured staff got to know people well. People’s relatives thought communication with the management could be improved. People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

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 good (published 08 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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. 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, which will help inform when we next inspect.

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. The registered manager was also responsible for managing one of the provider’s other homes and visited Street Farm weekly. The provider had appointed a manager oversee the day to day running of the home and report directly to the registered manager.

Street 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 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. Registering the Right Support CQC policy

The service used innovative ways to manage risk and keep people safe. Each person told us they felt “very safe” living at the home and had no concerns at all about their safety. Staff made sure people were safe.

People told us they had choice and control over their lives. They were supported to live a life of their choosing. People talked about the risks they took in their day to day lives. They saw risk as nothing unusual, just part of “everyday life.”

People engaged with services and events outside of the service. People spoke with us about the wide range of social activities, education and work opportunities, trips and holidays they chose.

Staff supported people’s independence. One person said, “I’ve been to work today. They’re very friendly staff I work with and I get on well with the customers. I’ve worked there for 18 years.” One relative had commented their family member’s chosen lifestyle and things they had achieved was, “Simply a testament to the support and guidance (name) receives from the excellent staff.”

People and their relatives felt the staff were extremely caring, compassionate, attentive and dedicated. They commended the quality of the care they received. A relative said about their family member, “It’s quite amazing to see her like this.”

Staffing levels were good and people also received good support from health and social care professionals. Staff had built close, trusting relationships with people over time. One relative said, “The atmosphere at Street Farm is excellent.”

People, and those close to them, were involved in planning and reviewing their care and support. There was a close relationship and good communication with people's relatives. People and their relatives felt their views were “always” listened to and acted on.

Staff were well supported and well trained. Staff spoke highly of the care they were able to provide to people. One staff member said, “It’s their life, their home, their choice, their rights.”

There was a management structure in the home which provided clear lines of responsibility and

accountability. All staff worked hard to provide a high level of care to people. The aims of the service were well defined and adopted by the staff team.

There were effective quality assurance processes in place to monitor care and safety and plan ongoing improvements. There were systems in place to share information and seek people's views about their care and the running of the home. One relative said. “The way (name) has been looked after and cared for has been second to none.”

Street Farm provides support for up to 11 people with learning disabilities. The main house accommodates up to six people and there are flats to the rear of the property for five people. At the time of the inspection there were 11 people living at Street Farm.

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. The registered manager was also responsible for managing one of the providers other homes and visited Street Farm weekly. The provider had appointed a manager oversee the day to day running of the home and report directly to the registered manager.

The provider did not always follow safe recruitment procedures to ensure that staff working with people were suitable for their roles.

Temperature checks on the hot water were not being consistently completed by staff to ensure they remained within a safe range. Risk assessments had been carried out and they contained guidance for staff on protecting people. Individual risks to people were not always fully considered.

There were quality assurance processes in place to monitor care and safety and plan on-going improvements. These processes were not fully effective in identifying the shortfalls we found during our inspection or ensuring action had been taken.

People, their relatives and staff said the home was a safe place for people. Systems were in place to protect people from harm and abuse and staff knew how to follow them. Medicines were stored and administered safely.

People were supported by a sufficient number of staff to keep them safe. Staff had enough training to keep people safe and meet their needs.

There was a stable staff team at the home. They had a good knowledge of people’s needs. People received support from health and social care professionals.

People, and those close to them, were involved in planning and reviewing their care and support. People interacted well with staff. Staff had built trusting relationships with people over time.

People made choices about their own lives, although not all of them felt able to make certain decisions without asking the staff. People were not always referred to as adults by staff.

People were supported to attend a wide range of activities and community facilities to maximise their independence. People and their relatives were aware of the complaints procedure and felt confident to raise any concerns.

Staff felt supported by the registered manager and manager and felt there was an open door policy to raise concerns. People and relatives were complimentary about the registered manager, manager and staff; they said they had a good open relationship with them.

There were systems in place to share information and seek people's and relatives views about the 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.