Kent Farm Care Home

People's experience of using this service:

People were supported by staff that were caring, compassionate and treated them with dignity and respect. Kent Farm provided a friendly, welcoming and homely environment for people and visitors.

People received person centred care from staff who developed positive, meaningful relationships with them. Staff knew about people's life history and their personal circumstances.

Since we last visited, some aspects of the environment had been improved. Some pictorial symbol/signage had been introduced to help people find their way around and locate toilet/bathroom areas independently. The redecoration took account the importance of colour contrast for people with dementia. Further redecoration and the upgrading of downstairs bathroom facilities were still needed.

People were encouraged to socialise and pursue their interests and hobbies. Care was more personalised and improved care plans were detailed, personalised and up to date about people's needs and preferences.

People and relatives said the service was safe. Staff demonstrated an awareness of each person's safety and how to minimise risks for them. People's concerns were listened and responded to. Accidents, incidents and complaints were used as opportunities to learn and improve the service.

People were supported by staff with the skills and knowledge to meet their needs. Improved training provision meant staff felt confident in their role. The service worked in partnership with local health and social care professionals to keep people healthy.

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 was well led. People, relatives and professionals gave us positive feedback about the impact of the new registered manager and on the quality of care. They said they were approachable, organised, and acted on feedback. Quality monitoring systems included audits, observation of staff practice, and regular provider checks of the environment. Continuous improvements were made in response to findings.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good. (report published June 2017).

Why we inspected: This was a planned inspection based on the rating at the last comprehensive inspection. At this inspection, the service remained Good.

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.

We returned and undertook a focused inspection in December 2016 because of concerns raised with us about the care of a person who had recently left the home. At that inspection we reported that improvements had been made in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberties safeguards (DoLS) but that further improvements were still needed. At this inspection, we found the provider had taken action in all these areas.

Kent Farm residential home is registered to provide accommodation with personal care for up to 21 people, many of whom are living with dementia. At the time of our inspection there were 13 people living at Kent Farm Care Home including two people living in The Old Dairy. The Old Dairy is a four bedroom annexe in the grounds of the main house, which provides accommodation specifically for people living with dementia.

This inspection was to follow up if the required improvements had been made and ensure the provider had maintained standards in other areas. Since the last inspection we received an action plan from the provider which outlined the improvements being made. This included training staff in MCA and DoLS, and upgrading the fire alarm system. The service had updated care records to make them more person centred and comprehensive and had improved quality monitoring. Some improvements in the general décor of the home had been made, such as the hall and stairs carpet had been replaced and some rooms repainted. Further improvements were still needed to make the environment more suited to the specialist needs of people living with dementia.

The service did not currently have a registered manager. The previous manager, had recently cancelled their registration with the Care Quality Commission (CQC) and was still working at the home as a senior care worker. An interim manager had been appointed, which the provider notified us about. A new manager started in post on the first day of the inspection and was planning to register with the CQC. A registered manager is a person who has registered with the CQC 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 offered day to day choices. Staff sought people’s consent for care and treatment and ensured they were supported to make as many decisions as possible. Where people lacked capacity, staff followed the MCA and its code of practice. Relatives, friends and professionals were consulted and involved in best interest decision making.

People said they felt safe living at the home. Staff were aware of signs of abuse and knew how to report concerns; any concerns reported were investigated. People’s risks were assessed and actions taken to reduce them as much as possible. A robust recruitment process was in place to make sure people were cared for by suitable staff. People knew how to raise concerns and were confident any concerns were listened and responded to. The service had a written complaints process. Any concerns or complaints were investigated with actions identified to make improvements.

People who used the service, relatives and health and social care professionals gave us positive feedback about the service. People were treated with dignity and respect, staff knew each person as an individual and what mattered to them. The service was organised around people’s needs and wishes. Staff documented detailed life histories about each person, their life and family before they came to live at the home. People experienced care and support that promoted their health and wellbeing. They received effective care, based on evidence of best practice, from staff that had the knowledge and skills needed to carry out their role. People received their medicines on time and in a safe way. People praised the quality of food and choices available at the home. Staff supported people with poor appetites who needed encouragement to eat and drink, to stay healthy and avoid malnutrition and dehydration.

Care was focused on people’s individual needs, wishes and preferences and people were supported to remain active and independent. They were supported to express their views and were involved in decision making about their care.

People, relatives and staff said the home was organised and well run. Staff worked well as a team and felt supported and valued for their work. Some improvements had been made in the quality monitoring systems and were ongoing. The service were continuing to make improvements in response to the findings of audits, and following complaints, accidents and incidents.

Kent Farm residential home is registered to provide accommodation with personal care for up to 21 people, many of whom are living with dementia. At the time of our inspection there were 16 people living at Kent Farm Care Home, which included three people living in The Old Dairy. The Old Dairy is a four bedroom annexe in the grounds of the main house a short distance away, which provides accommodation specifically for people living with dementia.

The service had a registered manager. 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.

Concerns were raised about the care and supervision arrangements for a person who lived at The Old Dairy. This was because people being cared for there go across to Kent farm during the day, and the person was regularly refusing to do so, which meant they were on their own in the Old Dairy with staff checking on them regularly. Whilst not ideal, this was a temporary solution agreed with the person’s relative. The registered manager recognised the home could no longer meet the person’s needs. So, they worked with the person’s relative and their GP in their ‘best interest’ to arrange to find the person a home that could better meet their specialist mental health needs, and the person moved to another home at end of November 2016.

Separate concerns were raised with us about a local advert showing the home had an ‘Excellent 3 star rating with Care Quality Commission’ (CQC), which misrepresented the current ‘Requires improvement’ CQC rating. When we visited we found signage outside the home also referred to an ‘Excellent’ CQC rating. However, in the main entrance of the home and on the home’s website, the home’s current CQC rating was accurately displayed. We followed this up with the registered manager and provider. In response, the provider contacted us the next day to confirm the advertising wording had been amended for the next publication and outlined plans to temporarily amend the signage outside the home with adhesive plastic, until a permanent solution was arranged in January 2017.

We will carry out a further inspection at this home within the next four months to check the requirements of the previous inspection have been met.

Kent Farm residential home is registered to provide accommodation with personal care for up to 21 people, many of whom are living with dementia. At the time of our inspection there were 18 people living at Kent Farm Care Home including four people living in The Old Dairy. The Old Dairy is a four bedroom annexe in the grounds of the main house a short distance away, which provides accommodation specifically for people living with dementia.

The service had a registered manager. 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 said they felt safe and secure at the home and trusted in staff to care for them. Relatives said they felt the home was safe and secure. However, we identified some environmental risks for people, such as a partially blocked fire exit. There were no personal emergency evacuation plans for people in the event of a fire and no fire evacuation equipment upstairs. We asked the fire service to follow up these concerns further with the provider, which they have done. A fire officer visited the service on 3 May 2016 who said they were writing to the provider to require them to risk assess and review aspects of their fire evacuation plan. They were also advising them of further work needed to upgrade their fire doors to meet current fire safety regulations.

Staff sought people’s consent for their day to day care. However, where people appeared to lack capacity, people’s rights were not protected. This was because staff did not complete any mental capacity assessments. There were no records to demonstrate staff involved relatives and other professionals in ‘best interest’ decisions about people’s care and treatment. Some people were subject to restrictions on their liberty for their safety and well-being, without the proper processes in place. This was not in accordance with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DoLS).

Staff knew people well and were friendly and supportive towards people. However, people’s care was task focused, and organised around routines of the home, rather than in response to people’s individual needs and wishes. Care records lacked information about each person, their life before they came to live at the home, or about their hobbies and interests. This meant some care staff did not have all the information they needed to engage in individual conversations of interest to people. At times, there was a lack of stimulation and meaningful activities for people living at the home, which meant people, spent a lot of their time sitting around or sleeping without much to occupy them. An activity programme showed external entertainment was provided at the home, which included, which included musical and reminiscence therapy and regular visits by a massage therapist.

People were not protected because the quality monitoring systems in place were not fully effective, as they had not identified the breaches of regulations found at this inspection.

Most people and relatives were satisfied with the service provided at Kent farm, and said staff knew people really well. One relative said, “No concerns whatsoever, the care is tremendous.” Complaints were investigated and responded to. However, two relatives weren’t entirely happy with how their concerns were responded to.

People received care and support at a pace and time convenient for them because staffing levels were sufficient. A robust recruitment process was in place to ensure people were cared for by suitable staff.

People had access to healthcare services for ongoing healthcare support. Staff recognised when a person’s health deteriorated and sought medical advice promptly when a person was feeling unwell. They worked closely with local healthcare professionals such as the GP, and community nurse, who confirmed staff sought advice appropriately about people’s health needs and followed their advice. People received their prescribed medicines in a safe way.

People were supported to improve their health through good nutrition. Staff encouraged people to eat a well-balanced diet and make healthy eating choices. Staff encouraged people to eat a well-balanced diet and make healthy eating choices and to be active, and maintain their mobility. They involved physiotherapists and occupational therapists and obtained any recommended equipment to promote each person’s independence and safety.

Staff were aware of signs of abuse and had contact details about how to report concerns to an external agency. Staff had no concerns about potential abuse. Most staff said they would report any concerns internally and were confident these would be appropriately investigated, although one said, they would also contact external agencies directly to make sure. Staff were knowledgeable about people’s care needs and received regular training and updating, although we identified some further training needs. For example, in the care of people living with dementia and in understanding Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) safeguards .

We identified five breaches of regulations during the inspection. You can see what action we told the provider to take at the back of the full version of the report.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

At the time of our inspection there were 17 people living at Kent Farm Care Home including three people living in The Old Dairy. The Old Dairy is a five bedroom annexe in the grounds of the main house a short distance away which provides accommodation specifically for people living with dementia.

The inspection took place over one day with two inspectors. During our inspection, we spoke with 11 people who lived at the home, six staff, the visiting masseuse, a community nurse, the cook and the housekeeper and the registered manager. Some people living with dementia were unable to comment directly on their care but we spent time in the communal areas observing their experiences and how staff interacted with them.

Is the service safe?

The service was safe because people were supported by staff who had received appropriate training in the skills required to perform their roles.

There was a stable staff team and enough staff on duty with the appropriate qualifications, skills and experience required at all times. Named staff were allocated to meet people's needs in The Old Dairy and numbers changed depending on need.

The home had suitable arrangements in place to reduce the risks of people receiving inadequate nutrition or becoming dehydrated.

The service was safe because staff told us and we saw there was sufficient equipment to meet people's mobility needs. We saw maintenance schedules for equipment at the home which included the lifts, hoists and general d'cor such as floor coverings and furniture and these ensured maintenance was timely.

Arrangements were in place to manage emergencies, such as power failures, where necessary. We saw a list of emergency contact telephone numbers for staff to ring which included the lifts, hoists, sluices and fire equipment.

The registered manager and staff had undergone training to understand their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. We saw that there had recently been confusion about the practical application of DoLS safeguards, as staff had not had to apply them in the past. However, we saw that the home had learnt from this experience and refresher training had been booked for all staff, which was confirmed by the registered manager, and a meeting had been held to discuss how the health professionals and the home could work together more effectively.

Is the service effective?

We know the service is effective because staff we spoke with knew people very well and understood people's care and support needs. We saw very comprehensive care plans which had identified people's needs and how those needs should be met in a very person centred way involving family/advocates as possible.

The service had undertaken regular audits and produced action plans which were then acted upon so that people could be sure their needs were met.

Is the service caring?

The service was caring because people were treated with respect and their dignity was maintained by staff. Throughout our visit, we saw that people were treated in a caring and compassionate manner and with dignity and respect. We saw staff were engaged in cheerful conversations with people and treated them as individuals, also involving them when undertaking tasks in line with people's wishes.

People told us they were happy with the care they received. Comments included, 'I love it here, people are very nice and we have lovely parties', 'I am certainly looked after very well', and 'everything's good here'. Several people had previously lived in the local area and maintained family contacts and friendships with people in the village.

Is the service responsive?

The service was responsive to people's social needs. There was a regular programme of activities in place and we also saw staff sitting chatting with people in the communal areas and in their rooms.

The home had appropriate systems in place for gathering, recording and evaluating information about the quality and safety of the overall service. Systems were in place to make sure the registered manager and provider learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

The service was responsive because people's needs were risk assessed and their care plans regularly reviewed and based on person centred care.

Is the service well led?

We found the service was well led. The registered manager has been in post for a number of years and is currently registered with CQC. We were told by staff and people who used the service and their visitors they had confidence in the registered manager and were able to approach her if they had any concerns. During our visit we saw the manager teaching a newer staff member about how individual people liked to receive their care. When the manager asked a staff member to show us what they did when they arrived on shift, the staff member was clear about their role and how to be sure they were aware of any care need changes.

The provider lived on site and the registered manager said they were well supported. One staff member said the provider 'is fantastic. Staff told us the provider worked with the registered manager and the staff to ensure the standards people expected at the home were maintained.

The registered manager undertook an annual survey to find out the views of people living at the service and their relatives and staff. This was due to be repeated for 2014. These focussed on topics such as an admissions survey which asked people about whether they felt involved in the assessment of their needs. The manager said they had not received any formal complaints in the past year but dealt with verbal concerns as they arose. These were currently not recorded which the manager said they would do from now on to show they were acted upon in a timely way. People we spoke to all told us they would not hesitate to voice any worries with the manager, staff or the provider who was regularly in the home.

The people we spoke with and their visitors were complimentary about the home and told us they had been consulted about their care, treatment and support. One person told us, 'I'm happy and content here, they look after me so well'. We saw how people's care and welfare was provided with dignity and respect in line with their care needs.

We found there were sufficient staff to support people's needs; the staff we spoke with told us how they met people's social and emotional needs through a range of activities and community involvement.

We saw audits and checks were in place for services such as fire, equipment testing and maintenance and improvements had been identified or completed.

Records were accessible and care plans reflected the current needs of people living in the home; staff demonstrated a good knowledge of people's needs and how to meet them.

The people living in the home told us they liked the home and were happy with the care being provided by the staff. One person who lived in the home told us 'It's a very nice home, I'm happy here' whilst a visitor told us that staff were 'kind and good at giving care'. Another person told us 'I get a sense that people are happy here'.

People appeared very comfortable in the presence of staff, we saw that staff knew people well. Staff were observed being patient and kind towards people when they assisted them with care and support. We saw that staff offered people choices in line with their assessed needs, abilities and preferences and saw evidence that people's nutritional needs were met through a varied and balanced diet.

We saw that people were safe in the home however the provider didn't always have quality assurance processes in place to monitor the quality of their service; for example safe storage of equipment and routinely maintaining documents relating to people and the running of the home.