Archived: Lady Dane Farmhouse

Updated 25 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 21 August 2018 and was unannounced. The inspection was carried out by one inspector.

Before the inspection, we reviewed the information about the service the provider had sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed previous inspection reports. We looked at notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law. We also reviewed information of concern that we had received.

People were not able to provide verbal feedback about their experiences of living at the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We observed staff interactions with people and observed care and support in communal areas.

We contacted health and social care professionals including the local authority commissioners and safeguarding coordinators and Healthwatch to obtain feedback about their experience of the service. There is a local Healthwatch in every area of England. They are independent organisations who listen to people’s views and share them with those with the power to make local services better.

We spoke with five staff; including the cook, care staff, senior care staff and the manager.

We looked at four people’s personal records, care plans and medicines records, risk assessments, staff rotas, staff schedules, two staff recruitment records, meeting minutes, policies and procedures.

We asked the manager to send us additional information after the inspection. We asked for copies of maintenance records, certificates from approved contractors and training records. These were received in a timely manner.

Updated 25 October 2018

This inspection took place on 21 August 2018, it was unannounced.

At the last inspection on 04 July 2017 we rated the service Requires Improvement overall. The provider had failed to adequately assess and mitigate risks to people and staff and follow the principles of the Mental Capacity Act 2005. We also made a recommendation that the provider followed good practice guidance in relation to managing medicines in care homes. The provider submitted an action plan on 12 September 2017. This showed they planned to meet the Regulations by the end of October 2017.

At this inspection, we found the provider had met some of their actions. However, there continued to be a breach of Regulation 12 and we identified two new breaches. The service has been rated Requires Improvement overall. This is the fourth consecutive time the service has been rated Requires Improvement.

Lady Dane Farmhouse 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. People were not in receipt of nursing care. The provider had applied to remove nursing care from their registration.

Lady Dane Farmhouse accommodates up to 15 people in one adapted building. The service is a two storey building with a passenger lift to rooms on the first floor. There is a separate building in the grounds used as an activities centre and sensory room by the people who live at the service. The service is designed to meet people’s needs who have a learning disability or autistic spectrum disorder, dementia and physical disability. The service had started to provide respite care to people providing short stays. There were eight people living at the service when we inspected, one of whom moved to the service on the day of the inspection. Some people received their care and support in bed. Nobody was staying for respite care when we inspected.

The care service has 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.

The service did not have 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. The previous registered manager had left in March 2018. A manager had been appointed to run the service and they were in the process of registering to become the registered manager.

Fynvola Foundation is the registered provider of Lady Dane Farmhouse. Fynvola Foundation was in the process of merging with another local charity. Some of the staff including the manager were employed by the other charity and were seconded to work at Lady Dane Farmhouse to ensure a smooth transition.

Risks to people’s safety continued to be poorly managed. People who were at high risk of developing pressure areas had pressure relieving equipment such as air flow mattresses in place. The provider did not have an adequate system to check and ensure the equipment was working satisfactorily. There was no guidance and information contained in people’s care records to show which setting the pressure relieving equipment should be set at. When people had been weighed, settings had not been checked to see if they needed to be amended. Fire risks had not been mitigated in a timely manner.

Medicines were not always managed safely. Medicines that had been dispensed from the packaging that had been refused by people had not been disposed of in a safe manner. Stocks of thickening powder for two people had run out and staff were using other people’s thickener to thicken their drinks.

The systems and processes to monitor and improve the service had not been effective in highlighting the issues we found at this inspection.

The complaints procedure required updating. We made a recommendation about this.

Staff had been recruited safely. The provider had obtained a full employment history for new staff. Other pre-employment checks had been carried out. Staff were appropriately supervised. There were sufficient numbers of staff to meet people’s needs and keep people safe.

People’s needs were appropriately assessed. People had care plans which were up to date and accurately reflected their needs.

There continued to be systems in place to keep people safe and to protect people from potential abuse. Staff had undertaken training in safeguarding and understood how to identify and report concerns. Staff were confident that any reported concerns would be dealt with appropriately.

Staff had the skills, training and knowledge they needed to support people safely and effectively. There were opportunities for staff to undertake training and development to enhance their skills.

People were supported to eat, drink healthily and maintain or achieve a balanced diet. People were supported to manage and monitor their health. They had appropriate access to healthcare services when they needed it.

People were treated with respect, kindness and compassion. People were supported by a staff team that knew them well and understood how to meet their needs. Staff knew how to support people to communicate and express their views.

People were supported to maintain their independence. People and their relatives were involved in decisions about their support as appropriate.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The environment was secure and well maintained to meet people’s needs.

The provider had a clear vision and values for the service and staff understood and acted in accordance with this.

When things went wrong lessons were learnt and improvements were made. Lessons learnt were shared with staff. Staff understood their responsibilities to raise concerns and incidents were recorded, investigated and acted upon.

People were kept safe against the risk of infection. Infection control training had been completed by all staff. Staff used protective equipment such as gloves and aprons to minimise cross infection.

Activities took place during the inspection. Activities included arts and crafts, reading and use of the sensory room. Activities staff shared how they had reviewed and developed the activities to meet people's needs and helping people to celebrate their different cultures. People were supported and enabled to access their local community.

Relatives had opportunities to provide feedback about the service their family member received. The manager planned to introduce meetings to enable people to feedback about their experiences.

Staff were positive about the support they received from the management team. They felt they could raise concerns and they would be listened to.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.