Burridge Farm

Burridge Farm is a 'care home' registered to provide accommodation and personal care support for up to six people living with a learning disability and/or autistic spectrum disorder. At the time of this inspection six people were living there.

At the last inspection, we found a breach of Regulation 11 (Need for consent) of the Health and Social Care Act 2008 (Regulations 2014). At this inspection the service was now meeting the requirements of this regulation.

Services for people with learning disabilities and or autism were supported. The service was in the countryside about two miles from the nearest village, Sandford. This did not impact negatively on people as there were sufficient staff and vehicles to ensure people could access the local community. The farmhouse was two storey and had 5 bedrooms as well as communal areas. There was also a separate annexe where one person had living space including a bedroom. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate Burridge Farm was a care home. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

People were relaxed and happy with staff, who understood and were attentive to their needs. 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.

People were encouraged to be as independent as possible. People were supported to do activities both at the service and in the community. This included attending social events and clubs. People were also supported to develop and maintain life skills including personal care. People had choice and control over decisions where they had capacity to make them. For example, people were encouraged to choose what they had to eat, what they wore and what they did each day.

Feedback from people and their relatives was very positive. Comments included, “I am very happy here.” Professionals were also complimentary about the care and support people received. Comments included, “I have found that the service engages very well with me and feel they pass the ‘mum’s test’.”

People had care plans which described their risks, needs and preferences. Care plans provided information for staff on how to support people. Important details about each person were recorded, for example, details about their family and their background. Staff understood how each person communicated both verbally and non-verbally. People received their medicines from staff who had been trained and knew how to administer medicines correctly. Medicines were stored safely.

Staff were recruited safely. Staff were supported to do training to ensure they knew how to support people well. Risk assessments and care plans described how people should be supported to minimise risks and maximise people’s choices wherever possible. Staff understood the Mental Capacity Act 2005 and worked within this legal framework to support people. This included applying for Deprivation of Liberty Safeguards authorisations when necessary.

The newly appointed manager had applied to be registered with the Care Quality Commission. They had worked at the service as a deputy manager and therefore knew people, their relatives and staff well. Feedback showed they were well thought of. For example, professionals said they thought the service was well run by a manager who knew people well and understood their responsibilities.

There were systems to monitor and assess the quality and safety of the service. Where issues were identified there were improvement plans to address them. The provider was working with the manager to make changes to ensure the service delivered care in line with best practice. They were supported in this by health and social care professionals, including the quality assurance and improvement team at the local authority. The manager understood their responsibility to report significant events when necessary to the correct authorities including the Care Quality Commission. This included acting on their duty of candour where there were concerns about safeguarding vulnerable adults.

Rating at last inspection

The last rating for this service was Requires Improvement (published 20 February 2019)

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.

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

• one person being restricted in terms of their movement around the home,

• restrictions about the times when one person was allowed to eat;

• restrictions about the frequency and times of when one person was allowed to smoke;

• one person not having a choice about whether they wished to shave or not and how they spent their money

• insufficient staff to meet people’s needs and keep them safe and

• a culture at the home which did not support staff being listened to when they raised issues and concerns.

Similar concerns had also been raised by the same complainant about two other homes owned by the same provider. The concerns about the other homes were not addressed during this inspection, but have been considered separately in line with our inspection methodology.

Prior to the inspection, we had raised a safeguarding alert with the local authority about the concerns we had received. The local authority undertook their own investigations into each of the allegations during the same time period as the inspection. Since the inspection, we have received outcome information from the local authority, who have closed all the safeguarding concerns. The outcomes described how either the service had worked with them and where necessary, taken action to address the concerns.

We did not find evidence of unnecessary restrictions being placed upon people, although some formal processes had not always been followed in line with the Mental Capacity Act (2005) and documentation did not fully describe these restrictions. This meant there was a risk that people were being restricted without the legal requirements and authorisations being in place.

We did not find evidence that there were insufficient staff to meet people’s needs and deliver good quality, safe care.

We found no evidence to support the claim that staff were not listened to when they raised issues and concerns.

At the last inspection in February 2018, we rated the service as requiring improvement overall as we found a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people were not kept completely safe as the service did not have fully robust recruitment procedures. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions “Is the service safe?” and “Is the service well-led?” to at least good. At this inspection, we found there were systems in place to ensure appropriate checks were carried out before a new member of staff started working at the service. We also found that audit processes to monitor these systems were in place. This meant the requirements of Regulation 19 had been met.

Burridge Farm is a residential care home for people who live with a diagnosis of learning disability and/or autism. Some people living at Burridge Farm also have physical disabilities. The service is registered to provide accommodation with personal care (without nursing) for up to six people. 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.

At the service, there is a main building with six bedrooms and communal areas. Across a courtyard from the main building is an annexe which provides living and sleeping accommodation for one person. On the same site, but slightly further away is another registered care home, Kite House, owned by the same provider. Kite House is managed by the same registered manager and most staff work in both care homes. Another building located beside Burridge Farm provides office space for the registered manager, senior staff and administrative staff who work across both the homes.

At the time of the inspection, there were six people living at the service, five of whom had lived at the service for several years. The sixth person had come to live at the home in 2018. In addition to these six people, two other people received regular respite care at the home, though not at the same time. One of these people needed support with personal care, such as washing and dressing. The other person who had respite did not need any support with their personal care but did require support with day to day living activities. This meant that when one of these people was having a respite stay, there was a seventh person living at the home. The registered manager said they had phoned the CQC’s national call centre and been advised by them that the home was still operating within the requirements of their registration. This was because one of the people who lived permanently at the home did not require support with their personal care.

The home had been designed in line with the values that underpin the Registering the Right Support (RRS) and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. During the inspection we observed that staff worked with people promoting their choice and independence. They supported people to do activities of their choice within the home and in the local community.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The registered manager and staff had undertaken training to understand the requirements of the MCA including what was needed to be done if a person was restricted by staff. However, we found that the service was not always ensuring they met all the requirements of the MCA. We found there were some restrictive practices at the home which were put in place after best interest meetings and best interest decisions had been made with health and social care professionals as well with the person (where possible) and their families.

However, some restrictions relating to one person had not been clearly documented. We also found the application for a Deprivation of Liberty Safeguards (DoLS) authorisation did not meet all the requirements of the MCA. The application for a renewal of the DoLS, which had been made to the person’s local authority, did not fully describe all the restrictions that were being made on the person at times when they displayed behaviour that challenged others.

Other restrictions that were in place in relation to when people could eat and smoke had been assessed and documented appropriately.

Staff showed kindness and compassion to people and there was a relaxed and happy atmosphere in the home. People said they liked living at Burridge Farm and were supported to do activities they enjoyed. People were supported to do a range of activities both in the home and in the local community. Care plans were personalised and had been written, as far as possible, with the involvement of the person concerned as well as with their families. Where people did not have good verbal communication, staff used alternative methods to communicate with them.

There was a 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.

Most staff said they were supported by the registered manager and other senior managers, who they said were available when they were needed. However, a few staff commented that they felt it would be beneficial if the registered manager and their deputy spent more time working alongside them. The deputy manager said they did do a shift working in a caring role about once a fortnight. They also explained that a new management structure had been recently implemented to improve day to day support and communications for care staff.

Although staff meetings were scheduled, these were not always well attended. The minutes of one meeting did not provide sufficient detail to enable staff who had not attended to be aware of what actions and decisions had been agreed.

There were sufficient staff to meet people’s needs, including those people who required one to one support. Staffing levels were adjusted according to the activities planned as some people needed two staff to support them when they were in the community. New staff were recruited safely and underwent an induction which helped ensure they were competent before they were allowed to work with people on their own

People said they enjoyed the food and could make choices about what they ate. People were supported to remain healthy and visit health professionals when necessary. This included visits to the GP, the dentist and other health services.

People’s risks, needs and preferences were assessed when they first came to Burridge Farm. Risk assessments and care plans were developed with the person, and where appropriate, their families. When there was a change in a person’s presentation, their risk assessments and care plan were reviewed to ensure they still met the person’s requirements. Staff were knowledgeable about each person, their history and family background. Staff worked to ensure that people’s rights in relation to the Equality Act (2010).

The administration, storage, record keeping and auditing of medicines was safe. People’s personal information including care records were kept secure.

We made two recommendations one about communication systems

At the time of the inspection there were six people living at the service, all of whom had lived at the service for a number of years. The home was made up of a main building with a separate annexe where one person received support. On the same site, but slightly further away was another registered care home, Kite House, owned by the same provider. This was managed by the same registered manager and most staff worked in both care homes.

At the last inspection in November 2015 the service was rated overall Good. The Safe domain was rated as requiring improvement as some aspects of recruitment were not fully safe. At this inspection we rated the service as requiring improvement. Although we found there had been some improvements in recruitment processes, the processes were still not fully robust.

The home had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People were relaxed and happy with staff, communicating with them about the activities they wanted to do. Staff were knowledgeable about each person and their needs. This included how people communicated, using both verbal and non-verbal methods. Staff were able to describe how each person should be supported to keep them safe and enjoy life at Burridge Farm. A professional commented “I observed [staff member] supporting this [person]. [Staff member] provided person with time and sufficient space to work at their own pace.”

Care records contained risk assessments and care plans which described people’s risks, needs and preferences as well as how these should be met. Each person’s care plan provided information about their family background and history as well as the care and support they required. People had been involved in developing the care plans. Staff were able to describe how they worked with people to deliver the care in the care plans. A professional said staff “engage and work with the risk plan.”

People were supported to have choice and control of their lives; staff worked with them in the least restrictive way possible; policies and systems in the service support this practice.

People were encouraged to take part in a range of activities both in the home and in the community. Staff worked with people so they could choose what they wanted to do and who they wanted to do it with. People were treated with dignity and people’s right to privacy was respected by staff. Staff supported people with diverse needs, for example, helping people fulfil their religious preferences. Staff understood their responsibilities in terms of safeguarding vulnerable adults and how to report issues if they were identified.

People experienced effective care that promoted their health and wellbeing. People were encouraged to eat a healthy diet of their choice. Staff prepared meals to meet people’s preferences and dietary needs. People were offered drinks throughout the day to ensure they remained well hydrated. People’s health needs were monitored and health professionals were involved where necessary. Medicines were stored and administered in a safe way. Staff recorded accurately when medicines were given.

People, their families, staff, health and social care professionals were asked their opinions about the care and support provided at Burridge Farm and how this could be improved. Records showed that their opinions were taken into account when planning improvements to the service. One professional commented “Would I be happy to have a relative of mine living at the home? The answer would be yes, I would be happy if they received the standard of care [person] I support receives.”

There was a registered manager in post and a provider who visited the home frequently supporting them. 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. There was a quality assurance and governance framework which checked that the home was safe, well maintained and clean and free of infection. However these checks and audits had not identified some recruitment processes and some environmental safety issues. There were quality assurance systems which monitored the care provided to people, including their medicines.

The home had a complaints policy and process. No complaints had been received for over a year. Independent advocate services were used to support people voice their opinions.

There were sufficient staff with the knowledge, skills and experience to support people with their care. Staff were supported to undertake training when they first joined the home and to refresh their knowledge from time to time. Staff were also supported to do nationally recognised qualifications. Staff had regular one to one supervisions with a senior worker which gave them an opportunity to reflect on what was going well, what was not going so well and what support they needed to improve their work.

We found one breach of regulations in relation to recruitment of staff. You can see what action we told the provider to take at the back of the full version of the report.

Further information is in the detailed findings below.