Easterbrook Farm

About the service

Easterbrook Farm is a residential care home providing accommodation and personal care to up to 12 adults with learning disabilities. Accommodation is centred around a courtyard, with bedrooms located in three separate buildings called the Farmhouse, the Granary and the Shippen. At the time of our inspection there were 12 people using the service.

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

Right support: Model of care and setting maximises people’s choice, control and Independence;

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so. One person commented, “I am happy here. I feel safe.” Other people were not able to comment on their safety. However, their body language while interacting with staff was relaxed and positive, which indicated they felt safe.

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 lived safely and free from unwarranted restrictions because the service assessed, monitored and managed safety well. There were comprehensive risk assessments in place covering all aspects of the service and support provided.

Medicines were managed as necessary. Infection control measures were in place.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. People were supported to maintain a balanced diet. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

There were effective staff recruitment and selection processes in place.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights;

Staff relationships with people were caring and supportive. Staff provided care that was kind and compassionate. People commented, “It is the best here. My keyworker [staff member’s name] helps me with things” and “I love living here.” A relative commented, “The staff are lovely and provide absolutely wonderful care.”

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives;

People’s equality, diversity and human rights were respected. The service’s vision and values centred around the people they supported. The organisation’s statement of purpose documented a philosophy of maximising people’s life choices, encouraging independence and people having a sense of worth and value. Our inspection found that the organisation’s philosophy was embedded in Easterbrook Farm. For example, people were constantly encouraged to lead rich and meaningful lives.

People were supported by staff who had received relevant and good quality training in evidence-based practice. This included training in the wide range of strengths and impairments people with a learning disability and or autistic people may have, mental health needs, communication tools and positive behaviour support.

The service worked hard to instil a culture of care in which staff truly valued and promoted people’s individuality, protected their rights and enabled them to develop and flourish.

Staff felt respected, supported and valued by the registered manager which supported a positive and improvement-driven culture.

A number of methods were used to assess the quality and safety of the service people received. The service made continuous improvements in response to their findings.

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 good (published 12 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Easterbrook Farm on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This comprehensive inspection took place on 18 and 25 July 2017 and was unannounced on the first day.

The home provides accommodation and personal care for up to 12 adults who have a diagnosis of learning disability and/or autism. At the time of our inspection 12 people were living at Easterbrook Farm, all of whom had lived there for a number of years.

The home is situated in a rural setting close to the village of Exbourne. Accommodation is centred around a courtyard, with bedrooms located in three separate buildings called the Farmhouse, the Granary and the Shippen. The Shippen provides accommodation for one person, four people live in the Farmhouse and seven people live in the Granary. Each building has its own lounge, kitchen and dining area, but meals are served in the farmhouse. The main office is located in the granary.

The home had a manager who had registered with the Care Quality Commission (CQC) in January 2017. 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.

The service was previously inspected in May 2015 when the service was rated as good overall. However the safety of the service was rated as requiring improvement. This was because some aspects of medicine administration were not carried out safely and staff had not always been recruited safely. . At this inspection we found that improvements had been made and medicines were now administered safely. Systems had been put in place to ensure staff were recruited safely.

People and their relatives were very positive about the home and said they were safe and very well cared for at Easterbrook Farm. People were happy and laughing with staff, who knew them well. Comments included “…they are brilliant.” and “The most important metric is [person’s] view of how he feels at Easterbrook. Without exception, every time we ask him how he feels and whether he is happy at Easterbrook his reply is very positive.”

The manager had been appointed in the last year and had registered with the CQC in 2017. They spent time working alongside staff. People and staff were very complimentary about the registered manager and how they were improving the service. Resident meetings, staff meetings and surveys were undertaken and provided people and staff with a means to make suggestions. Each person had a personalised complaints procedure using communication methods which were adapted to their needs. Complaints were managed in line with the provider’s complaints policy. There had been no complaints in the last year.

There were sufficient staff to support people safely, although a new member of staff had been scheduled to undertake a night duty when they had not completed their induction. The registered manager assessed the risks associated with this and revised the rota so that this did not occur.

Staff worked with people in a calm and unrushed manner and knew people well. People were supported to do a range of activities both inside and outside the home, which included working on the farm. People were supported to be as independent as possible and undertake meaningful activities which they clearly enjoyed. Staff understood people’s individual communication skills, abilities and preferences and ensured they took these into account when providing care.

People’s health was monitored and, where necessary, staff ensured that health professionals were contacted for advice and support. People were supported to attend appointments with the GP, their dentist and other health professionals.

People were provided with a healthy balanced diet with food of their choice. People were involved in growing vegetables and salads which were incorporated into meals. A relative commented “The food at Easterbrook is of a very high standard.”

Staff were recruited safely as checks were carried out before they started working at the home. Staff completed an induction to ensure they were competent to work with people. Staff also received refresher training and were supported to undertake nationally recognised qualifications in care. Staff administered, stored and managed people’s medicines safely. Staff had regular meetings with the registered manager and senior staff to discuss their work and ways to improve and develop.

Staff were aware of how to protect people from the risk of abuse and knew how to report concerns to the relevant authorities. The registered manager understood their responsibilities to ensure vulnerable adults were protected. Where issues had arisen, the registered manager had taken action to keep people safe.

The registered manager and staff worked within the requirements of the Mental Capacity Act 2005. Applications for Deprivation of Liberty Safeguard authorisations had been made. The registered manager had also applied for and had renewed authorisations in a timely way.

There were quality assurance and governance systems in place to monitor the quality and safety of the home. Checks and audits were carried out by the registered manager and staff. As the provider had stepped down from the day to day management of the home, they had developed a new quality assurance system which they planned to use to monitor the quality and safety of the home on a monthly basis.

Easterbrook Farm was well maintained, clean and had comfortable communal areas. People had personalised their rooms by decorating them in a colour of their choice. People had also chosen what furniture, ornaments and pictures to have in their room. Relatives and friends were welcomed to the home and could visit when they wanted. An annual party to which family and friends were invited occurred during the inspection and had been a great success.

Checks were carried out to ensure that the home and the equipment used were safe. Contingency plans for staff to follow in the event of a catastrophic event, such as fire or flood affecting the home were in place.

After the inspection, we received some concerns about the care and treatment of people at Easterbrook Farm. We asked the provider to respond to the concerns and take action about some issues. We also shared the information with the local authority safeguarding team, who undertook an investigation. Following their investigation, they asked the provider to review their hand-over arrangements between shifts. The provider took appropriate actions including increasing staffing levels at hand-over periods.

Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at the home.

People did not comment or raise concerns about how the home managed medicines. Ten of the eleven people living at Easterbrook Farm were away for Christmas staying with relatives.

Before people living in the home received any care or treatment they were asked for their consent and staff acted in accordance with their wishes. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people's choices and preferences.

We saw that people's care records described their needs and how those needs were met. We saw that people's rights were promoted and they were protected through legal safeguards, such as 'best interests' meetings to determine if they were able to make particular decisions.

We saw that medication was administered by suitably qualified staff. People were not always protected against the risks associated with medicines because the provider had not made appropriate arrangements for the recordings of medication.

During our visit to the home we saw sufficient staff on duty to meet the needs of people living in the home. We spoke with most of the staff working during our visit and all agreed that they were supported by the registered manager.

We saw that Easterbrook Farm held all records securely to protect people's confidentiality.

Care professionals told us that they had no concerns about the home, their clients were "very happy" and the registered manager and staff had people's best interests at heart. People's rights were promoted and they were protected through legal safeguards, such as 'best interests' meetings. People's health care needs were fully met.

People told us that they felt safe at the home and would take concerns to the staff or manager. One said, 'I get on with (the manager). She likes me very much'. There were good arrangements to safeguard people from abuse.

Staff were liked, skilled and knowledgeable. One person said 'It's nice that staff come and have dinner with us'.

The accommodation was in a good state of repair, warm, clean, well maintained and appeared comfortable. People liked their rooms. One was excited that they had chosen a new colour for the walls. Other buildings provided activities, such as a gym and woodworking.

Records were complete, fit for purpose and secure.