Archived: Church Farm Residential Care Home

We found the following examples of good practice.

• The service had bags of personal protective equipment (PPE) in the reception foyer for when visitors arrived. They put on PPE and used hand sanitiser before they entered the building. The bag was then used to put used PPE in when they left and disposed of in bin provided

• Changes had been made to the building including a sink in reception for when visitors and staff arrived to wash their hands; a purpose built, insulated shed for visits near the entrance so visitors did not enter the building

• Relatives had provided photos of their family which were made into cushions and presented to people who lived at the service. Hand prints were taken of people who lived in the service and sent to their relatives with messages from them on.

• Cleaning schedules had been zoned in different colours to signify importance of the task and frequency to lower risk of transmission of Covid-19 from the environment.

• Name badges were being made with staff’s photos to help people who lived in the service recognised staff, due to some confusion with wearing masks.

• Staff were given good support and training which included supervision, wellbeing support, questionnaires, ongoing coronavirus/infection control training and a wellbeing day. Staff force had remained stable during the pandemic with no agency used. Extra uniforms were provided and were washed at the service to manage the risk of cross infection.

• People who lived in the service had risk assessments completed which included vulnerabilities and any extra PPE requirements. Covid-19 care plans for people who lived in the service covered their needs, support required, swab test results, relative visits and any identified risks.

Further information is in the detailed findings below.

Church Farm Residential Home is a residential care home providing personal care to 33 people aged 65 and over at the time of the inspection. The service can support up to 40 people in a period building that has been extended.

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

With the assistance and support of other agencies, the service had made improvements since our last inspection although continued improvements were required. Quality monitoring audits had not been fully effective at identifying issues and rectifying them in a prompt manner. For example, missed signatures on medicine administration records continued and the environmental audit had failed to identify some issues with the premises such as a frayed carpet and a radiator hot to the touch that was a burns risk to people. Care plans for people’s end of life support were still not in place for everyone who used the service and some people told us they would like to do more activities. The service had also failed to report a notifiable incident to CQC as they are required to do by law.

However, sufficient improvement had been made for the conditions imposed on their registration to be removed. The conditions were imposed following our inspection in August 2017 and meant the service had been submitting monthly action plans to CQC since this date. These are no longer relevant and have been removed.

People were very positive about the care and support they received at Church Farm Residential Home and their relatives agreed. They told us they were treated on an individual basis, with warmth and affection, were listened to and respected. One person who used the service told us, “This is a lovely home. The care they give is very good.” Another person said, I am quite happy and think it’s a lovely home. I love the place and would recommend it. I would say to people, come here. My family say they can go to their homes and rest easy.”

There were enough suitably recruited and supported staff to meet people’s needs in a person-centred manner. Staff were trained however we have made a recommendation about this. People benefitted from receiving care provided by a staff team who were dedicated to their roles, worked well together and nurtured a positive and welcoming atmosphere within the home. They were skilled at supporting people and knew people, and their needs and preferences, very well. The management team were approachable, visible and communicative. They took complaints seriously and people told us they felt listened to. They encouraged an open, positive and transparent culture.

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’s nutritional and healthcare needs were met, and they received care tailored to their needs that considered their dignity and independence. Activities were available within the service however some people said they would like more to be provided.

The individual risks to people had been identified and managed and systems were in place to help protect people from harm and abuse. Regular maintenance and servicing of equipment and premises helped to mitigate against associated risks and a business contingency plan mitigated the risks associated with adverse incidents. Accidents and incidents were recorded, investigated and analysed to help prevent reoccurrence. People received their medicines as prescribed and the home was visibly clean with no malodours. Improvements to the environment, such as better lighting, needed to continue.

All the people we spoke with during this inspection were positive about the home and the service it delivered. Those that used it told us they would recommend it as did their relatives. One person who used the service told us the positives were, “The whole atmosphere here, most people are infirm and need different care to me, the care they give me is different and appropriate. Looking at the [staff] team, overall it seems to work excellently.” One relative said, “The home has a good reputation locally, the relatives are all happy. On the whole, I am really pleased as I don’t have to worry.”

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

Rating at last inspection

The last rating for this service was Requires Improvement (last report published 28 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.

The inspection took place on 17 January 2019 and was unannounced.

We previously inspected this service in March and April 2018, where we found repeated breaches of Regulation 17, 9, and 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We had have already taken enforcement action by imposing conditions on the providers registration. These conditions mean the provider has to inform us of actions which have or are being taken to mitigate identified risks on a monthly basis. We also met with the provider and registered manager to discuss our expectations going forward.

This inspection in January 2019, found improvements had been made in relation to people’s safety and care delivery, and the service was no longer in breach of Regulations in relation to consent, person-centred care and governance. We did however find some areas requiring further improvement to ensure people received care that fully met their needs. The overall rating for this service is now ‘Requires Improvement’.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Church Farm 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.

Church Farm accommodates up to 40 people in one adapted building. At the time of the inspection there were 32 people living in the service, some of whom were living with dementia.

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.

There were various auditing processes in place which helped to identify shortfalls in the quality of care provided. However, these had not been wholly effective in identifying issues that we found during this inspection and therefore some improvements are still needed in this area.

Records showed that overall people living at the service received their medicines as prescribed. However, improvement was needed to ensure that people received their medicines in a timely manner. The service had not considered the risks around self administration of medicines. Medicines were not always stored securely.

People told us that staffing levels were adequate and staff responded to requests for assistance promptly. However, the deployment of staff was not always effective which impacted on people receiving their medicines in a timely manner.

There was improvement in the general recording of people’s food and fluid intake. However, for people requiring fortified food, drinks, and snacks the recording of these was not always consistent.

People told us and we observed, that food was plentiful and there were several choices on offer. The mealtime experience was calm, staff were available to support people with eating, and we saw people socialising together.

Feedback we received from people indicated that the provision of activity was not meeting people’s individual and specialist needs. Whilst events outside of the service had been arranged, day to day stimulation was lacking for some people. The activity co-ordinators role was under review by the registered manager.

We found some environmental risks in the wider building which placed people at risk of harm; the service had not identified this.

Some areas of the service required re-decoration, modernisation or maintenance to ensure it was meeting the needs of people using the service. The provider had plans to address this over time.

People who used the service had access to health care professionals as required, and advice given by health care professionals was followed appropriately.

People's care plans were personalised and reflected their individual needs. Further improvement was needed to ensure people’s wishes were known in relation to their end of life care. People and their relatives had opportunities to contribute to the development of their care plan.

We observed that staff were kind and caring when interacting with people, and there was lots of laughter between people and staff. We saw people’s privacy was respected when receiving support from staff in communal areas. Feedback from people indicated that this had improved.

The provider had applied for Deprivation of Liberty Safeguards when people who lacked capacity to consent, had their liberty restricted. The service worked within the guidelines of the Mental Capacity Act 2005. We found consent to care was sought in line with the law and relevant

guidance.

Staff confirmed they had training to recognise and respond to abuse. All of the people we spoke with told us they felt safe living in the service and being cared for by the staff.

There was a complaints procedure in place and people knew how to voice their concerns if they were unhappy with the care they received. However, the registered manager did not always log verbal concerns which were raised.

During our previous inspection on 30 and 31 August 2017, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to, safe care and treatment, person centred care, consent, and good governance. We also found a breach of Regulation 18 of the Registration Regulations 2009. The overall rating for this service was 'Inadequate' and the service was placed in 'special measures'. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, are to be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Following the inspection, we undertook enforcement action placing positive conditions on the provider's registration. This meant the provider had to submit to CQC a monthly report of the actions taken to improve the quality of the service.

During this inspection in March and April 2018, we found some positive improvements had been made which meant the provider was no longer in breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, or Regulation 18 of the Registration Regulations 2009. We did however find repeated breaches of Regulation 17, 9, and 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have already taken enforcement action in relation to Regulation 17 and 9 following our last inspection, by imposing conditions on the providers registration. These conditions will remain in place, and the provider will continue to send us reports on their progress.

Church Farm 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.

Church Farm accommodates up to 40 people in one adapted building. At the time of the inspection there were 35 people living in the service.

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.

We found that the provider had not made all the improvements required since our last inspection. However, auditing and quality assurance systems had improved and were in place. We found at this inspection that whilst they identified some concerns, they did not pick up all of the shortfalls we found, and therefore are not yet fully effective.

There were improvements in the management of risk, and we saw that assessment of risk in relation to choking, weight loss, and risk of developing pressure sores, was accurate and reviewed regularly. Further improvements were needed with moving and handling risk assessments to ensure staff had clear instructions on how to move people safely.

People who used the service received appropriate support to eat and drink sufficient amounts to maintain a healthy and balanced diet. Meals we observed looked appetising and well presented. However, recording of people’s food and fluid intake was not always consistent or accurate.

Records showed people living at the service received their medicines as prescribed. However, some improvements were still required to ensure documentation was clear, and reflected people’s most up to date medicines.

The registered manager had applied for Deprivation of Liberty Safeguards when people who lacked capacity to consent, had their liberty restricted. However, we did not see that a capacity assessment had been carried out in advance to determine that this was required, or how any restrictions would be managed. Decisions made where people lacked capacity did not always follow best practice and did not evidence decisions were made in a person's best interest. This did not meet the requirements of the Mental Capacity Act 2005.

Staffing levels were now being calculated using a dependency tool, which helped the management team to determine the correct number of staff. We observed that staff were visible and responded to people’s request for assistance in a timely manner. However, some feedback indicated that at particular times of the day staff were more stretched and sometimes people had to wait. We have made a recommendation about this.

Staff received training in areas relevant to their role, however, we found two staff were overdue training in moving and handling. Not all staff had received training in end of life care, but the registered manager had booked training sessions for this. The software system in place for monitoring staff training did not support the management team to have effective oversight of when refresher training was due.

People who used the service had access to health care professionals as required, and advice given by health care professionals was followed appropriately.

The activity co-ordinator had increased their working hours which helped to ensure people had the opportunity to take part in activities of their choosing. However, this was still not meeting the individual and specialist needs of all the people using the service.

Staff interacted well with people who used the service and were caring in nature. The service had a calm and relaxed atmosphere and staff and people had a good relationship. Staff respected people's privacy and dignity, however, we found some practices needed to be improved to ensure people’s dignity was always respected.

Infection prevention and control systems were much improved. We found the service to be clean and staff followed procedures to reduce the risk of infection.

The service had developed their practice to ensure that lessons were learned and improvements made when things had gone wrong. Accidents and incidents were now being monitored closely and analysed for trends.

The provider had given some thought to maximising the suitability of the premises for the benefit of people living with dementia. However, we felt this could be improved further, and we have made a recommendation about this.

People we spoke with knew how to raise a complaint and said they felt comfortable speaking with the registered manager or any of the staff.

We found staff were recruited safely. Suitable checks were made to ensure people recruited were of good character. Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

The overall rating for this service is 'Requires Improvement'. The rating for 'well-led' in this service is 'Inadequate' and the service therefore remains in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Church Farm residential care home provides accommodation and personal care for up to 40 people. At the time of this inspection, there were 37 people using the service, some of whom were living with dementia.

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.

At our previous inspection in 2015, we rated the service as ‘good’ overall. During this inspection in 2017 we found the registered provider to be in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

We took enforcement action to impose conditions on the providers registration. We asked them to advise us what action is being taken to improve the quality of the service in relation to the assessment and monitoring of risk and staff competency. This will include the implementation of quality and monitoring audits, how the quality assurance system is identifying issues, and what action has or is being taken to mitigate any shortfalls. This condition continues on a monthly basis, whereby the provider informs us of actions which have or are being taken to mitigate identified risks. We decided to impose these conditions on the providers registration because people may be exposed to the risk of harm.

The registered provider did not have sufficient oversight of the service's operations. Quality assurance systems and audits were not in place to monitor the service provided to people, and as a result shortfalls in the safety and quality of the service were missed. The provider had not undertaken regular checks to ensure the quality of care or to drive improvement. Additionally, the registered manager had not notified us of serious injuries which had occurred in the service, which is required by law.

Records relating to MCA and DoLS were not clear. Mental capacity assessments were not completed without delay where a person was regularly refusing medicines.

Two people living in the service did not have a care plan which meant that staff did not have clear and accurate guidance on how to care for and their needs. This put people and the staff delivering their care at risk. Some information was not documented fully in care plans.

Risk assessments were not in place for two people who had complex health needs. Risk assessments in relation to nutrition and moving and handling were not always completed accurately, and there were no risk assessments for people who were at risk of choking.

Clear and accurate records were not being kept of medicines administered by staff. This meant we could not be sure people were always given their prescribed medicines.

Infection prevention and control procedures were ineffective and we found that hygiene in the service was poor.

A risk assessment for legionella was in place. However, cold water temperatures had not been taken, despite the service having been advised to do this in November 2016.

We could not be assured that suitably competent and skilled staff were deployed to ensure that people's care and treatment needs were met. Staff’s competence in risk assessing and administration of medicines was not being checked by the management team.

People's food and fluid intake was not always monitored effectively.

There was an activity co-ordinator in the service. However, the provision of activity was not meeting the individual and specialist needs of all people using the service.

Staff were observed to be kind and caring, but the staffing level arrangements in the service meant that staff did not always have time to spend with people in a meaningful way to meet their social and emotional needs.

People had access to a range of healthcare professionals. However, we found that one person was not referred for specialist advice in a timely manner. Risks were not accurately assessed, which meant there was a risk that people may not be referred to other professionals when needed.

Staff were aware of their responsibilities in relation to safeguarding people, were aware of the types of abuse they may come across, and had received training in this area. Appropriate recruitment checks had been carried out on new staff, to ensure they were of good character and suitable to work with people in the service.

There was a complaints procedure available in the service for people and relatives to raise concerns.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

One person told us: "It's not like your own home of course, but the staff keep me going, some like to sing while they work and it can be quite uplifting." Another person said: "I am quite content here, they look after me well now that I can't do things for myself. The food is very tasty, I have put on weight."

One of the visitors told us: "They look after them very well here, the activities lady is very good at organising events and individual things." "My relative is very well looked after and the staff keep me up to date about their assessments."

We observed lunch time and saw people were offered their choice of meal, were given appropriate utensils, and assisted when required so people could enjoy their meal at their own pace.

We looked at records of people living at the home, how staff were recruited, checked the premises and how equipment was maintained to ensure that people living and working at Church Farm was safe.