30 July 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
This inspection was carried out by an inspector, an inspection manager, a specialist adviser with a background in nursing and dementia care and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Lower Farm Care Home with Nursing 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 service did not have a manager registered with the Care Quality Commission however they were in the process of submitting an application. Registered manager/s and the provider of the service are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We looked at the notifications we had received for this service. Notifications are information about important events the service is required to send us by law. We took this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who worked with the service.
We used all of this information to plan our inspection.
During the inspection
During the inspection we spoke with 11 people who used the service and eight people's relatives. We spoke with five care staff as well as a chef, an administrator, the manager and the two providers, one of whom is the nominated individual. A nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with a visiting healthcare professional. We reviewed a number of records including six people's care records, medicines records and records related to the management of the service. Details are in the key questions below.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service.
30 July 2019
About the service
Lower Farm Care Home with Nursing is a 'care home' for up to 49 people. At the time of our inspection the service was providing nursing and/or personal care to 34 people.
People’s experience of using this service and what we found
People did not always have access to their medicines as their prescriber intended. Medicines were not always being managed in line with best practice.
People were still not always fully protected from risk, particularly the risks posed by poor practice when tube feeding and significant weight loss for people. Previously identified risks to the environment had been satisfactorily addressed.
Systems and governance arrangements did not highlight the issues we found in relation to medicines management and risk.
During the inspection visit people were supported by sufficient staff. People and their relatives gave us mixed feedback about the staffing levels and whether these were adequate or not.
We have made a recommendation about the providers continuing to closely monitor staffing levels to ensure there are consistently enough to meet people’s needs.
Despite finding areas of concern the service had been making progress and feedback from a variety of sources was that improved practice was being implemented. This needs to be sustained and fully embedded into the culture of the service.
People were positive about the care staff and told us that their privacy and dignity was promoted.
People were supported and encouraged to participate in activities they enjoyed.
Staff were motivated and enjoyed working at the service. They received training, supervision and were supported in their roles by the manager and provider.
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.
People had to access to healthcare services they needed to maintain good health.
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 inspection for this service was a ‘focussed’ inspection looking at the questions of safe and well led only. Following this inspection, the rating for this service was Inadequate (published 29 April 2019). Prior to that, the most recent comprehensive inspection looking at all questions we ask was in August 2018 where the service was also rated Inadequate (published 19 November 2018).
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
This service has been in Special Measures since August 2018. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
However, we also found that at this inspection not enough improvement had been made or sustained and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvements. Please see all sections of this full report.
At this inspection we have identified continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Regulations 12 around safe management of medicines and risk and Regulation 17 around leadership and governance.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.