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Lower Farm Care Home with Nursing Requires improvement

Inspection Summary

Overall summary & rating

Requires improvement

Updated 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

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.

Follow up

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.

Inspection areas


Requires improvement

Updated 30 July 2019

The service was not always safe.

Details are in our safe findings below.


Requires improvement

Updated 30 July 2019

The service was not always effective.

Details are in our effective findings below.


Requires improvement

Updated 30 July 2019

The service was not always caring.

Details are in our caring findings below.



Updated 30 July 2019

The service was responsive.

Details are in our responsive findings below.


Requires improvement

Updated 30 July 2019

The service was not always well-led.

Details are in our well-Led findings below.