Background to this inspection
Updated
14 December 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. This inspection took place on 9 and 10 October 2018 and was unannounced. The inspection team was made up of one inspector and an assistant inspector.
Before the inspection, the provider had already completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This was the first inspection for this service following a new registration of an existing service under a new provider. We looked at any information received about the service since its registration including the details of any safeguarding events and statutory notifications sent by the provider. Statutory notifications are reports of events that the provider is required by law to inform us about.
We met and spoke with 11 people who lived in the service. People could tell us about their experiences and share their views. We made observations of people’s interactions with staff and with other people. We observed staff engagement with people and each other when carrying out their care and support duties.
We spoke with the registered provider, registered manager, area manager, two team leaders, three care staff, and three ancillary staff. We spoke with three relatives at inspection and contacted a further four after the inspection. We received feedback from two social care professionals’ and one community nurse.
We looked at five care plans and this covered associated health information, individual risk assessments, medicine records, and some operational records that included three staff recruitment files, records of staff training, staff rotas and supervision records, menus, accident and incident reports, servicing and maintenance records, complaints information, policies and procedures, survey and quality audit information.
Updated
14 December 2018
This inspection took place on 9 and 10 October 2018 and was unannounced. This was the first rating inspection for this service since its new registration under a new provider in October 2017.
The Old Farmhouse is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This is the first time the service has been rated Requires Improvement.
The service is a residential service for up to 26 older people some of whom had dementia and physical disabilities. At inspection there were 24 people in residence. Accommodation is arranged over two floors with most bedrooms having an ensuite facility, the service is fully accessible to those in wheelchairs or with mobility problems and the first floor is accessed by a passenger lift.
There was a registered manager at the home. 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.
Incident and accident records showed that during a two-week period when the registered manager was on leave two people had experienced falls resulting in admission to hospital for treatment of serious injuries, staff ensured people received the treatment they needed. The registered manager understood that these events should have been notified to the Care Quality Commission, and had done so with other incidents. She agreed to ensure that people covering for her absence were made fully aware of their responsibilities around this. This is an area for improvement.
People, relatives and staff told us that there were enough staff on duty, staff rotas informed us that all shifts were covered. However, the pool of staff available to cover shifts was small and vulnerable to unplanned staff absences, The registered manager agreed to review the overall staff complement to improve flexibility and availability to cover for staff absences. Policies and procedures were in place for staff but those viewed lacked important detail to inform and guide staff practice and ensure this was in line with current best practice guidance and legislation, these were amended at inspection.
A range of audits were in place to enable the registered manager to monitor service quality but there was no mechanism to provide oversight of all shortfalls identified within the audit processes and to monitor their completion or progress, the registered provider and Registered manager agreed to implement a development plan to keep track of progress on meeting shortfalls. The registered provider and area manager had a visible presence at the service, visiting frequently, but did not keep records of what they looked at during these visits. These are areas for improvement.
Medicines were stored and administered safely, individual ‘as and when required’ medicine guidelines would benefit from additional information to aid and inform consistency in administration.
The premises were well maintained and clean. Staff understood how to protect people from abuse and harm. They had been trained to evacuate people safely in the event of a fire. Equipment was tested, checked and serviced at regular intervals to ensure this was in a safe working order. Accidents and incidents were recorded, reported and acted upon, the registered manager analysed these to implement changes and reduce further risk of harm occurring.
Training records showed that staff had completed an induction to their role and essential and specialist training in a range of areas that reflected their job role, this helped them understand how to provide effective care and support for people.
People told us the service was a happy place to live. They said they felt safe and happy living there. Relatives were also satisfied with the level of care their loved ones received and spoke positively about the kindness and attitudes of staff and the leadership of the registered manager.
People and their relatives told us that they knew how to complain and if they had any concerns they were confident these would be quickly addressed by the registered manager.
Risk assessments were in place to identify environmental risks that could affect everyone and individual risks that may be involved when meeting people's needs.
The provider operated safe recruitment procedures.
Staff knew people well and had a good knowledge of their needs. They treated people with kindness. People were encouraged to do what they could for themselves, but support was available when they needed it. People were encouraged to make their own decisions and choices and staff promoted their independence.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
The food menus offered variety and choice. They provided people with a nutritious and well-balanced diet. The cooks prepared meals to meet people's specialist dietary needs.
People and relatives were involved in the development and review of care plans. Staff supported people with health care appointments and visits from health care professionals. Care documentation was updated to reflect any change in health needs. Care plans were routinely reviewed to keep them updated.
People's needs were fully assessed with them before they moved to the home and thereafter to make sure that the home could meet their needs. People were encouraged to take part in activities and hobbies and interests of their choice. People were supported to practice their beliefs, and their end of life wishes were recorded so that staff knew people’s preferences around this.
Staff understood their respective roles and responsibilities. Staff told us that the registered manager was very approachable and understanding.