Decoy Farm

Decoy Farm is a nursing home providing personal and nursing care to up to 10 people with a learning disability, autistic people, mental and/or physical healthcare support needs. At the time of the inspection, there were nine people living at the service. The service was split into four buildings, two of which were self-contained accommodation.

Decoy Farm is located in the village of Browston. Outside there was nothing to indicate it was a registered care home which helped to promote the concept of community living. The service benefits from a large shared garden, as well as a farm with animals and an area where people can grow their own produce.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Staffing levels had at times fallen short, due to last minute staff sickness. Management had however attempted to find cover which included the use of agency staff. There was a system in place whereby staff could call upon senior managers and on-call for advice. However, a more robust contingency plan is needed for these occasions to ensure people are always supported safely and there is a suitable skill mix of staff.

Staff had received training to support the people they were caring for. Further training was needed for newer staff, so they understood the most effective approach to use when supporting people, and to ensure consistent approaches were used by all staff. Staff were provided with support in the form of continual supervision, appraisal and recognition of good practice. Staff understood the need to promote people's safety from experiencing potential abuse and harm.

People received their oral medicines safely. We could not be assured that people were receiving their topical medicines, such as creams, as there were gaps in records. People were referred to health care professionals to support their wellbeing and help them to live healthy lives. Where people were at risk of weight gain or loss, more robust monitoring of people’s dietary intake was required.

People were mainly 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 support this practice. The provider was affiliated with the Restraint Reduction Network which aims to reduce reliance on restrictive practices.

Care records contained person centred detail and people had been involved in creating their care plans. Some further work was required to ensure all detail was accurate, and that the language used by some staff in written form was appropriate.

Right Care

Risks to people had been identified and detailed support plans were in place. Daily meetings had been implemented so any new risks could be discussed promptly. The core staff team knew people well and had established positive relationships with them. However, some newer staff required further training to ensure that interactions with people were consistent and effective to mitigate potential risk. Additional training was also planned to ensure staff were confident using observation tools and completing incident documentation.

People were taking part in more activities of their choosing, including in the community, and with family or friends.

Right Culture

More robust monitoring and auditing systems were required to ensure all aspects of people's care needs and their quality of life were being measured effectively.

The registered manager had a clear vision for the direction of the service which demonstrated a desire for people to achieve the best outcomes possible. The service worked well in partnership with other health and social care organisations, which helped to improve the wellbeing of people that used the service.

The manager promoted a positive and person-centred culture within the service and led by example. Staff were feeling more supported and valued. The registered manager was working with relatives to improve communication and to gather their feedback about the service provided. The management team and staff shared a commitment to continuously learning and worked in partnership with other professionals to achieve good outcomes for people.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 September 2021) and there were breaches of regulation. We imposed conditions on the provider's registration.

At this inspection we found that improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

The overall rating for the service has remained requires improvement. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report

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

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Decoy Farm is a nursing home providing personal and nursing care to up to 10 people with a learning disability, autistic people, mental and/or physical healthcare support needs. At the time of the inspection, there were ten people living at the service. The service was split into four buildings, two of which were self-contained accommodation.

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

People were not always receiving care and support from staff who were familiar with their individual needs and risks or had the necessary skills and training. This posed a risk to people’s individual wellbeing and safety. The systems in place did not consistently ensure that people received their medicines as prescribed, or when required, for example to support them in the management of their bowel care needs.

Records did not demonstrate that people were consistently supported to maintain a clean and comfortable home environment, particularly in relation to the management of risks associated with COVID-19. Improvements to staff culture and ways of working to best support people was ongoing at the time of the inspection visit. People were being supported to access external activities and opportunities to contribute to their local community.

People were mainly 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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of Safe and Well-led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

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

Rating at last inspection (and update)

The last rating for this service was Requires Improvement with breaches of regulation (published 11 February 2021). Following on from the last inspection, the provider completed an action plan to show what they would do and by when to improve.

At this inspection some improvements had been made, however, the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the standards of safe care and support being provided to people living at the service. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of Safe and Well-led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained Requires Improvement, however, due to the services’ repeat requires improvement rating for well-led, as well as inspection findings, well-led has been rated inadequate.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Decoy Farm on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Decoy Farm is a service providing nursing care for up to 10 people with a learning disability or autistic spectrum disorder. The service was split into four buildings, two of which were self-contained accommodation. There were 10 people living at the service when we inspected.

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

Staff had not always followed guidance to ensure that risks to people were managed safely. We found there had been three avoidable incidents where staff had not acted to prevent actual and potential harm. There was detailed guidance in place for staff about how to manage or reduce risk, but this was not always followed by individual staff members. People were supported by staff on a 1-1 basis during the day, yet incidents had occurred between people despite this. Staff did not always receive regular supervision, and some did not feel the training offered was effective.

We found improvements in how the service managed people’s medicines. The provider had a system to assess and monitor infection control across the service. This had been updated and amended in response to the COVID-19 pandemic.

The service did not have a registered manager in place. Two managers had been appointed during 2020, but neither remained in post. The operations manager had managed the service at these times, and some improvements had been made as a result. There was a new manager in post who started in December 2020, but they had not registered with CQC at the time of this inspection. There was a lack of consistent leadership and oversight at the service.

Whilst the operations manager had provided leadership to the staff team, staff told us that they needed a manager who would remain in post and provide support to them. Quality assurance auditing systems were in place but had not always identified where improvement was needed. For example, people’s capacity to make decisions around certain aspects of their care were not in place.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People had not always been protected from avoidable harm. The attitudes and behaviours of individual staff members had not always protected people, and staff had not always acted appropriately when providing care to people. The operations manager had however addressed these concerns immediately on becoming aware of them.

People were encouraged to undertake tasks which promoted their independence and well-being. The setting enabled people to care for animals on site, and plant and grow vegetables. Where people had been restricted during the pandemic to use their usual community facilities, the service had brought items in for people. For example, purchasing a trampoline, and creating an art studio which people could use, and a sensory garden. People were still supported to continue to access the community, but this was in line with government guidance during the pandemic.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 23 September 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The service remains rated requires improvement.

At this inspection although we observed some improvements, not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted due to concerns we received about the management and staffing within the service. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Decoy Farm is a service providing personal care and nursing care for up to ten people with a learning disability or autistic spectrum disorder. The service was split into four buildings, two of which were self-contained accommodation. There were nine people living at the service when we inspected.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The service did not consistently apply 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.

The outcomes for people did not always fully reflect the principles and values of Registering the Right Support. People had not consistently been supported to carry out a programme of activity which was meaningful to them. Staff and management told us this was due to recent difficulties in the service which had affected usual routines and activities which took place. Funding authorities were reviewing people’s allocated hours to ensure they were receiving the correct number of hours per week to take part in activity and community outings.

People’s dietary needs were not always documented accurately to ensure people were receiving food groups in line with specialist advice. Changes in people’s weight had not always been referred to dieticians in a timely manner.

The service used systems and processes to safely administer, record and store medicines. However, we found that the records to support the use of medicines were not always available or the information provided was not accurate between different types of documents.

Staff training was not always updated within the recommended time frame and records of staff training were not always up to date. Some staff working directly with people had not received any mandatory training or induction to ensure they were competent to support people effectively. Two new staff had not worked in care previously. Some staff had not received regular supervision.

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; However, the policies and systems in the service did not always support this practice; documentation relating to best interests’ decisions were not always in place for some restrictions such as door sensors and alarms to monitor movement.

People told us that staff were caring, and we observed positive interactions between people and staff.

Auditing processes had not always identified where improvement was needed. Some audits were not completed robustly which would help the service to identify and address on-going issues.

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 24 January 2017).

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive, and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. Some actions have already been taken by the provider to reduce risks, such as additional staff training, and improvements in the management of medicines.

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

Enforcement

We have identified breaches in relation to governance, safe care and treatment, staffing, and person-centred care at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an improvement plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Decoy Farm is a service that provides accommodation and nursing care for up to nine people with a learning disability or autistic spectrum disorder. There were eight people living at the service when we visited.

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.

Staff had been trained to recognise signs of potential abuse and to keep people safe. People felt safe living at the service. Processes were in place to manage identifiable risks within the service and to ensure people did not have their freedom restricted unnecessarily. The provider carried out recruitment checks on new staff to make sure they were suitable to work at the home. There were systems in place to ensure people were supported to take their medicines safely and at the appropriate times.

The staff recruited had the right values and skills to work with people who lived at the home. Staffing levels remained at the levels required to make sure every person's needs were met and helped to keep people safe. The registered manager planned staffing resources flexibly and responsively so that people were able to enjoy a varied but well-structured day.

Staff had received essential training to keep their skills up to date and the registered manager supported them with regular supervision. Staff sought people’s consent to care and support in line with the Mental Capacity Act (MCA) 2005. People were supported to eat and drink and to maintain a balanced diet. People were registered with a GP and were supported by staff to access other healthcare facilities.

There were positive and caring relationships between people and staff. People were encouraged to maintain their independence and staff promoted their privacy and dignity. Pre-admission assessments were undertaken before people came to live at the service. This ensured their identified needs would be adequately met. There was a strong caring culture in the care and support team.

People were able to contribute to the planning of their care. People participated in a wide and varied range of activities. Regular outings were organised and staff encouraged people to pursue their interests and hobbies. The registered manager and staff planned for these in detail to ensure the maximum amount of enjoyment would be had. People were able to partake in activities and opportunities that were previously thought to be unachievable.

There was a complaints procedure in place to enable people to raise concerns if they needed to. Complaints were responded to an acted upon in a timely way.

There was a positive, open and inclusive culture at the service. There was good leadership and management demonstrated at the service, which inspired staff to provide a quality service. There were systems in place to monitor the quality of the service provided and to drive continuous improvements.

As part of this inspection we spoke with people who used the service. However, most were busy engaged in activities or were unable to comment about their care because of their communication difficulties. We spoke with a visiting health professional, a member of the quality monitoring team for Norfolk County Council, the registered manager and three other members of staff. We also observed how staff engaged with people. We reviewed records relating to the management of the service which included three care plans, daily records, policies and procedures, staff records and quality assurance monitoring records.

Below is a summary of what we found. The summary describes what the staff told us, what relatives said in their surveys, what we observed and the records we looked at.

Is it safe?

Risks to which people were exposed were assessed and guidance was provided about how these were to be managed. Staff knew that they needed to report promptly any concerns about safety or that people may be being abused. The manager had further training planned to improve the knowledge of staff about safeguarding referrals.

Recruitment practices ensured that staff were properly checked before they started work, to ensure they did not present a risk to vulnerable people. Where the conduct of staff may have placed people at risk, disciplinary processes were in place. Staff had regular training in 'safe holding' techniques so that people were not placed at risk of excessive or unlawful restraint.

There were proper procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager was aware that levels of supervision and restrictions for people leaving the home without staff support meant that applications needed to be made and there had been completed.

Is it effective?

People's needs had been assessed with them and there was clear guidance for staff about how people's needs were to be met. Where people were not able to communicate verbally, there was information about how they expressed content or distress and how staff were to respond. Where appropriate, the advice of other health professionals had been incorporated into people's plans of care.

Staff were able to tell us clearly about people's needs and the information they gave us was consistent with what we found in people's plans of care. This showed that staff were aware of how to support people effectively.

Is it caring?

We observed that people approached staff freely during our inspection. One person showed they were comfortable with staff by sitting with them, smiling and making eye contact. Staff spoke respectfully to people during our inspection.

Is it responsive?

We found that people's needs were kept under review so that changes to their care could be made if this was needed. Named members of staff supported people and understood how they would communicate whether they were happy, content or in distress. We observed that staff responded promptly to defuse and distract people who became agitated or anxious.

Is it well led?

The service had a robust quality assurance system. Records seen showed that any shortfalls were identified and followed up. There were regular checks on the quality and safety of the service so that standards could be maintained and address if this was required.

Records seen showed that people and their representatives were asked for their views and these were responded to. Staff told us they felt well supported by the manager and could make suggestions about how to improve the care that people received.

People also told us that their bedrooms and apartments were comfortable and that they had everything they needed. One person told us that the staff, 'Are all good, except this one' while they pointed at a staff member and smiled broadly.

We observed that the staff were attentive to people's needs. Staff interacted with people in a friendly, respectful and professional manner. We saw that staff had a good understanding of the way people communicated their needs.

We found that the service supported the people to eat healthily and to take their medication at the right time and to manage it safely. One person said, 'The food is great, I do the cooking.'

We assessed the staffing levels in the service and found that people's needs were met by sufficient numbers of appropriate staff. We also saw that the provider had systems in place to deal with complaints made about the service and that people who used the service were supported to make a complaint if they wanted to.

One person told us about the small farm attached to the property and the work they did. They were very proud of the farm, and told us, "I really enjoy the animals."

They were aware of the need to respect the dignity of other people who used the service, telling us it, "Isn't right to go into other people's rooms."

The service had a high number of well trained staff working at the time of the inspection This meant that people could undertake individual activities of their choice with the necessary support. While we were carrying out the inspection, people went out individually shopping, out for lunch, bowling and to the bank.

The premises were clean and well maintained, and offered self contained flats as an option for people who wanted more independence.