Finn Farm Lodge

Finn Farm Lodge is a residential care home providing personal care to three people with a learning disability at the time of the inspection. The service can support up to six people.

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

People told us they were supported by staff who understood them and were kind. People and their loved ones were encouraged to have a say in planning their care and support. People’s privacy and dignity were respected.

People were supported to understand the need to eat a balanced diet and to exercise. Staff understood people’s needs. When people became anxious staff took the time to listen to their concerns and reassure them. People were supported to develop and maintain relationships with friends, partners and relatives. Staff supported people to visit their families. People took part in a range of activities which they told us they enjoyed. Relatives were happy that people were supported by staff of the same gender and a similar age.

People told us, staff kept them safe. Staff helped people to understand when they were vulnerable and how to get help. Risks to people were assessed and people were involved in planning how to reduce risks. People’s medicines were managed by competent and trained staff.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The manager and staff had a shared vision for the service which focussed on people achieving their potential. The manager was aware of their regulatory responsibilities. Staff worked closely with other professionals to meet people’s needs. People were supported to be a part of their local community.

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 17 May 2017.)

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.

At this inspection there was a new 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.

Although some people we spoke with wanted to move on from the home now they spoke positively about the support they gained form the registered manager and staff and felt there had been improvements since the last inspection. Professionals and relatives said the new registered manager was doing a good job; they had confidence in her knowledge and ability.

People were provided with a clean comfortable environment to live in and could personalise their own space to their requirements. All servicing and checks including the fire alarm and emergency lighting had been updated to help make the environment safe for people. Improvements had been made to fire drill frequencies to ensure all staff attended at least two annually and knew the action to take in a fire.

There were enough staff. There had been continued unsettled staffing since the previous inspection; this looked to be reducing and those staff present showed that they were knowledgeable about people’s individual needs. Appropriate checks were made of new staff who were given induction and training to provide them with the basic knowledge and skills they required for their role. Specialised training was also available in regard to Prader Willi and positive behaviour support of people for when they became anxious and their behaviour could be affected.

Staff said they felt better supported and listened to. They said overall communication had improved within the team and they felt better informed. There were increased opportunities for them to meet together as a team and also to have one to one time with their supervisor to discuss training and development needs.

Staff knew how to keep people safe from harm. Individual and environmental risks that impacted on people were assessed; measures were implemented to reduce risk of harm. Staff understood their reporting responsibilities in regard to accidents and incidents and took appropriate action when these occurred to ensure people were safe, and people’s support needs were reviewed if necessary.

People were very relaxed and involved in the routines of the house and enjoyed the freedoms these gave them within clearly defined boundaries. Staff understood people’s needs and preferences and provided them with individualised support. People were supported to follow a calorie controlled diet designed specifically in relation to their condition. Their health and wellbeing was monitored by staff and they were supported to attend health appointments when needed. Interactions between staff and people were respectful, kind and patient.

Improvements had been made to the robustness of the quality checks undertaken by the organisations’ quality and compliance staff, and those conducted by the registered manager and staff. These provided greater assurance that the service was operating as it should and that the provider and registered manager had a better understanding of the shortfalls in the service and acted upon these to help ensure people received appropriate and safe care.

Staff worked to the principles of the Mental Capacity Act 2005. People’s consent was routinely sought in respect of everyday care and support. Staff understood that when people may not have capacity to make some complex decisions other people might need to be involved in helping them make these their best interest. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made; appropriate steps had been taken to ensure those living at the service who met the requirements for a DoLS authorisation had been appropriately referred. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

We carried out this unannounced inspection on 1 & 4 April 2016. Finn Farm lodge is a Prader Willi Service. It provides accommodation for up to six people. At the time of inspection there were three people living at the service. People had their own bedrooms. Some bedrooms were located downstairs but the service was not accessible for people who needed to use a wheelchair. This service was last inspected on 2 September 2014 when we found the provider was meeting all the requirements of the legislation.

At this inspection there was a new manager in post who was not yet registered with The Care Quality Commission. 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.

For a period of time leading up to this inspection the service had had an extended period of unsettled management and this had led to shortfalls in the quality of service people received through an absence of consistent management support. A new experienced manager had been appointed. The inspection found there were strengths within the service and that staff now felt better supported, the manager and senior managers in the organisation understood and had identified many of the shortfalls present within the service and were taking action to address these. The atmosphere of the service was relaxed, people told us they felt safe now that changes had been made to who lived in the house with them. People were comfortable in the presence of staff and actively sought their attention if they wanted something. People received individual support from staff that interacted well with them and showed that they understood their individual needs.

This inspection however, found that people were not always safe because the checks made on new staff were not robust in order to meet the requirements of the legislation. The induction of new staff was poor. Some important details about how people’s health needs or behaviour should be supported were not in place to inform staff. Improvements were needed in the management of medicines to ensure boxed and bottles medicines were dated upon opening and staff competency to administer medicines was updated in accordance with the expectations of the organisation. Informal concerns raised by people in the service although listened to were not routinely recorded to ensure that action was taken to address them.

Fire drills were held but improvements were needed to how these were scheduled to ensure all staff participated in fire drills each year, Improvements were needed to the way in which people were provided with activity and stimulation to meet their needs.

The new manager had taken steps to improve communication between staff and with relatives and other stakeholders. Assessments of risk people might be subject to from their environment, or from activities or risks associated with their assessed support needs had been developed and measures implemented to reduce the likelihood of harm occurring; these were kept updated.

Appropriate systems were in place to ensure staff received training to support the needs of people in the service such as Prader Willi Syndrome, and diabetes. Staffing levels were appropriate to ensure there was enough flexibility to meet people’s demands and needs.

Staff felt supported and listened to and opportunities for more frequent one to one meetings with the manager, and more regular staff meetings was an area both the manager and provider representatives had identified for improvement, and plans were in hand for this. Annual staff appraisals were scheduled.

A range of quality audits were in place to help the manager and provider monitor the service, and these were mostly effective in identifying many but not all shortfalls highlighted from this inspection; the provider was therefore able to assure their selves that a safe standard of care was being maintained. Improvements to the premises had been made to provide a comfortable environment for people to live in, systems were in place for the routine testing and servicing of electrical, gas and fire alarm installations to ensure people were kept safe.

There was a low level of accident and incidents, and staff showed an understanding of safeguarding, they were able to identify abuse and were confident of reporting concerns appropriately. Staff understood the action they needed to take in the event of an emergency that could stop the service.

Staff had received training in Mental Capacity Act 2005, they sought people’s consent on an everyday basis and understood when other people might need to be involved in making more complex decisions on a person’ s behalf. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made; appropriate steps had been taken to ensure those living at the service who met the requirements for a DoLS authorisation had been appropriately referred. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

Staff showed a good understanding of people’s needs and people were relaxed and comfortable in the presence of staff. Relatives thought the arrival of the new manager and recent changes to the people supported in the house were positive steps towards provided a better service to the people now living there. Professionals commented the service was providing good management of the Prader Willi Syndrome needs of people living in the service.

Staff monitored people’s health and wellbeing and mostly supported them to access routine and specialist health when this was needed. People liked the food they ate which was designed specifically in relation to their condition.

We have made one recommendation:

We recommend that the provider and manager review their responsibilities to provide individual staff with fire drill training and the recommended frequencies for this in accordance with the Regulatory Reform (Fire Safety) Order 2005.

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

At a previous inspection in December 2013 it had been found that the home was not meeting the expected standards in two areas. This was in relation to keeping people's care and health records up to date to ensure these areas were appropriately monitored and action was taken where necessary. We also found that systems in place to monitor individual and environmental risks for people were not always used effectively or regularly to ensure risks were managed and people were kept safe. We asked the provider to tell us what action they were taking to ensure improvements were made in these areas, and they had done this. We checked these areas again as part of our inspection.

The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were supported in an environment that was safe, clean and hygienic. There were safe procedures in place for the ordering, receipt, storage, administration, recording and disposal of medicines. There were enough staff on duty to meet the needs of the people living at the home. A member of the management team was available for any evening and weekend emergency support.

Is the service effective?

People were involved in their assessment and care planning. All care and support was planned with their consent. Where people lacked capacity, mental capacity assessments had taken place; and where any restrictions were in place these had been referred appropriately to the Deprivation of Liberty Safeguards team. People's relatives or representatives were consulted about people's care when important decisions needed to be made. People were asked about day to day choices, such as the things they liked to eat. They were enabled to develop their cooking skills, and were encouraged to eat healthily.

Is the service caring?

People's care was reviewed regularly, and adjustments were made to make sure they remained comfortable, safe and as independent as possible. Everyone we spoke with said they liked living at the home and used words such as 'good', 'friendly', 'nice' when talking about them. People were supported to maintain contacts with their family and friends, some people went home to their relatives to stay on a regular basis.

Is the service responsive?

People's day to day support was kept under close review, and any changes needed were communicated to the team. People told us the manager and team were easy to speak with and were quick to sort out problems. We saw that the team sought help from other health and social care professionals or services without delay, meaning people remained well supported.

Is the service well led?

Records showed us that the management team were up to date on safety matters. There was an effective action plan in case of emergencies. An accessible complaints procedure was available to people and they were supported when making complaints to other agencies or bodies. Comments were responded to quickly and used to improve service provision. People told us that they found the manager and staff approachable and felt able to tell them about things that worried them. They had opportunities to express their views directly to staff through one to one sessions and meetings with other people in the home. A programme of quality audits was in place to ensure service quality was kept under review and that people experienced a safe and improving service.

At our inspection on 29 July 2013 we found that one person's risk assessment did not provide clear information to staff about the risk that was being managed. We found that matters related to two people's diet and weight were not always followed up or monitored effectively. One of these people was unable to access all areas of the service without staff support and had not been given the opportunity to attend regular meetings with a staff member to discuss matters related to their care. The provider wrote to us and told us that they would take action to address these matters by the 30 November 2013. At this inspection we saw that the person's risk assessment had been reviewed and updated. People were provided with the opportunity to provide feedback about the service on a regular basis. However, one person's support plans and risk assessments had not been reviewed, people's weight had not always been monitored regularly and dietary matters had not always been followed up. Following the inspection we were provided with information to show that these matters were being addressed.

At our inspection on 29 July 2013 we found that there were locks fitted to a shared bathroom that could not be overridden in the event of an emergency. We saw that the systems in place to regularly assess and monitor the quality of the service were not always effective because they were not always used regularly. The provider wrote to us and told us that they would take action to address these matters by the 30 November 2013. At this inspection we saw that a new lock had been fitted to the bathroom that could be overridden in an emergency from outside and a window restrictor in a vacant bedroom had been repaired. However, fire safety checks were not always undertaken regularly to ensure people's safety.

We saw that the provider had systems in place to obtain consent from people in relation to people's care and support.

There were four people living at the service at the time of inspection and we looked in detail at the care records of two people. We found that one person had their needs planned for and they were supported by staff to have their needs met. However, a risk assessment for this person did not provide clear information to staff about the risk that was being managed. We found that matters related to both people's diet and weight were not always followed up or monitored effectively. The other person was unable to access all areas of the service without staff support and had not been given the opportunity to attend regular meetings with a staff member to discuss matters related to their care.

Staff were offered appropriate support for their roles and staff knew where to find further information at the service about matters related to their role. We saw there were systems in place to monitor staff training and development.

We saw that one person's bedroom had been redecorated following a recent fire. However, we found that there were locks fitted to a shared bathroom that could not be overridden in the event of an emergency.

We saw that the systems in place to regularly assess and monitor the quality of the service were not always effective because they were not always used regularly.

The people we spoke with who used the service said they liked living at Finn Farm Lodge and spoke positively about the staff and the environment, one person commented 'I am happy living here'.

People said they chose what to do during the day and were encouraged to increase their independence and development of life skills. We found that people had the opportunity to be involved in a wide variety of activities both within the service and in the community, together with direct involvement in making decisions about the service and their care.

People told us that they liked the house, they said their bedrooms were comfortable and they could have their room decorated as they wanted. We saw that one person had drawn a mural on their wall, other people had achievement certificates in their rooms from work placement and training events that they had attended.

We saw positive interactions between staff and the people who lived at the service, they were offered choices and we saw that their dignity and independence was respected. Staff spoke with people in a professional, yet warm manner and explained what they were doing when they supported them.