Camphill Village Trust - Botton Village

Updated 25 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by an inspector, a pharmacist specialist, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service provides care and support to people living in several ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We visited 4 of the supported living settings and spoke with 10 people who used the service. We observed staff interactions with people. We spoke with 6 relatives about their experience of the care provided. We spoke with 10 members of staff including the registered manager, the general manager, the care manager, and 7 support workers.

We reviewed a range of records. This included 8 people’s care records, 2 recruitment files and multiple medication records. A variety of documents relating to the management of the service, including policies, training data and quality assurance documents were reviewed.

Updated 25 August 2023

About the service

Camphill Village Trust – Botton Village is a supported living setting providing personal care to people living in their own homes. The service provides support to people with a learning disability and autistic people. At the time of our inspection there were 55 people using the service. People are supported in a mix of shared houses and single accommodation within Botton Village. The village is located in the North Yorkshire Moors. The village has various amenities for people to use and work in, including a farm, a village store, a café, allotments, and craft workshops. Within the houses there were offices for staff to use and, where needed, a room for staff to sleep overnight.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection, 28 people received personal care.

The service was developed on one site which does not meet best practice guidance. However, the model of care was such that people had lots of opportunities to gain employment, learn new skills and become more independent. The provider also ensured people were involved in the local communities outside Botton Village.

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: People were supported by staff who knew them well and knew how to mitigate risks to people. However, records did not always reflect this. Some parts of people’s support plans were missing or out of date. Other areas were detailed and contained person-centred information. Daily notes were not always robust around the monitoring of risk. Staff knew how to safely support people with their medicines. However, guidance and records were not always in place to support the safe administration of creams, lotions, ‘when required’ medicines and medicines prescribed with a variable dose. Staff supported people to take their medicines safely when away from the service.

People were generally supported to have maximum choice and control of their lives, but the records did not always reflect this. Staff generally supported people in the least restrictive way possible and in their best interests; however the records in this area required improvement. Systems did not always support best practice in record keeping in this area.

Right Care: There were enough staff to safely support people and staff were recruited safely. Staff had access to a wide range of training and received regular supervisions. However, up to date training information and induction records were not available for agency staff. Records and reviews of people’s needs were not always accurate and up to date. People were supported to eat and drink enough to maintain a balanced diet however records were not always robust around particular dietary needs. We have made a recommendation about this. People were supported to attend annual health checks. People received kind and compassionate care. Staff understood and responded to people's individual needs. People told us they felt safe and systems were in place to protect people from harm. The provider safely managed the prevention and control of infection.

Right Culture: Quality assurance procedures and processes were in place but had not always been effective. There was a positive atmosphere in the service. The registered manager was visible in the service and approachable. People and relatives spoke positively about the staff who supported them. The provider had a clear business plan in place which set out a clear commitment to continuous learning and improvement. The provider engaged well with people and sought feedback in a variety of ways. Safeguarding concerns were dealt with appropriately.

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 good (published 24 April 2020).

At our last inspection we recommended the provider reviews and implements best practice guidance regarding positive behaviour support (PBS) to achieve positive outcomes for people and reduce restrictive practices. At this inspection we found improvements had been made and there was clear guidance for staff to follow if people experienced anxiety or distress.

At our last inspection we recommended the provider reviews and implements best practice guidance on the Mental Capacity Act 2005 (MCA). At this inspection we found improvements had not been made in this area, and we identified further shortfalls around compliance with the MCA.

Why we inspected

We received concerns in relation to safeguarding and the culture of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We inspected and found there was a concern with MCA compliance, so we widened the scope of the inspection to include the key question of effective.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. 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 Camphill Village Trust – Botton Village on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to compliance with the MCA, record keeping and governance at this inspection.

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

We have recommended the provider reviews people’s dietary needs to ensure they are accurately reflected within people’s support plans.

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