Archived: Lady Dane Farmhouse

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.

Lady Dane Farmhouse is a purpose built nursing home providing accommodation and nursing care for up to 15 people with a learning disability. The service is provided by the Fynvola Foundation, which is a registered charity. The home 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 by the people who live in the home. There were 11 people living at the home when we inspected.

The service had a registered manager in post who supported us during the inspection. 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 on 03 and 05 January 2017, we found breaches of Regulation 9, Regulation 12, Regulation 17, Regulation 19 and Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of Regulation 18 of The Care Quality Commission (Registration) Regulations 2009. The provider had not properly managed people’s medicines. Risk assessments were not effectively managing risks to people’s safety. Safe recruitment procedures were not in place to make sure staff were suitable to work with people. The provider had failed to effectively meet people’s healthcare needs. The provider had failed to ensure that care plans were in place for all aspects of people’s assessed needs. The provider had failed to establish and operate effective systems and processes to monitor the quality of the service and failed to secure confidential records. The provider had failed to display the rating of the last inspection. The provider had failed to notify CQC about events and incidents. We asked the provider to take action to meet Regulation 9, 12, 19 and 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also asked the provider to take action to meet Regulation 18 of The Care Quality Commission (Registration) Regulations 2009. We served a warning notice on the provider in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and told the provider to meet the regulation by 14 March 2017.

The provider sent us an action plan on 10 March 2017 which showed they planned to make the changes and meet regulations by 30 April 2017. The registered manager provided a follow up action plan received at the end of March 2017 which showed they planned to make the changes and meet regulations 31 May 2017.

Relatives told us their family members received safe, effective, caring and responsive care and the service was well led.

Risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm. Risk assessments did not always detail how to minimise the risk of harm.

Staff had received training in relation to the Mental Capacity Act (MCA) 2005. However, mental capacity assessments did not follow the principles of the MCA 2005.

There were quality assurance systems in place. The registered manager and provider carried out regular checks on the home. Action plans were put in place and completed quickly. The audits hadn’t identified the issues in relation to risk and mental capacity. We made a recommendation about this.

Medicines were well managed; they had been stored and administered appropriately. One person received covert medicine; there was a lack of documentation to evidence who had agreed this. We made a recommendation about this.

Effective recruitment procedures were not in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

The registered manager demonstrated that they had a good understanding of their role and responsibilities in relation to notifying CQC about important events such as injuries, safeguarding concerns and deaths.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner. Feedback from healthcare professionals was positive.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the home was calm and relaxed. Staff treated people with dignity and respect. Information about people was treated confidentially.

People’s care was person centred. Care plans detailed people’s important information such as their life history and personal history and what people can do for themselves.

People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.

People’s views and experiences were sought through surveys and meetings. People were listened to. Relatives knew how to raise concerns and complaints.

People had choices of food at each meal time. People who did not want to eat what had been cooked were offered alternatives. People with specialist diets had been catered for.

There were suitable numbers of staff on shift to meet people’s needs. A nurse was allocated on each shift. Dependency levels were assessed to check the level of support each person needed.

Staff knew and understood how to protect people from abuse and harm and keep them safe.

Nurses and care staff had received appropriate training, supervision and support to carry out their roles.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority and some had been approved. The registered manager had a tracking system in place to enable them to monitor these.

The service had been well maintained, clean and tidy.

Relatives and staff told us that the home was well run. Staff were positive about the support they received from the management team. They felt they could raise concerns and they would be listened to.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour. Handovers between staff going off shift and those coming on shift took place to make sure all staff were kept up to date.

Staff showed us that they understood the vision and values of the organisation; we observed practice to show that staff had embedded this into their work.

We found two 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 this report.

Lady Dane Farmhouse is a purpose built nursing home providing accommodation and nursing care for up to fifteen people with a learning disability. The service is provided by the Fynvola Foundation, which is a registered charity. The home is a two storey building with a passenger lift to rooms on the first floor. One person occupied a room on this floor during the inspection. On the second day of our inspection the lift had broken down. There is a separate building in the grounds used as an activities centre by the people who live in the home. There were 11 people living at the home when we inspected.

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 the organisation in October 2015. There had been a lengthy delay in submitting an application to register a new manager. The service had a home manager in place who submitted an application to register in December 2016.

At our previous inspection on 03 and 05 November 2015, we found breaches of Regulation 12, Regulation 17 and Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Medicines had not been properly managed. Systems to monitor quality and safety were not always operated effectively and records were not always accurate and complete. The provider had not established and operated effective recruitment procedures. We asked the provider to take action to meet the regulations. We did not receive an action plan from the provider. At this inspection we found that the necessary improvements had not been made.

Relatives told us their family members received safe, effective, caring and responsive care and the service was well led.

Effective recruitment procedures were not in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

Medicines were not always well managed. Medicines had not been stored and administered appropriately.

Risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm. Risk assessments did not always detail how to minimise the risk of harm.

People’s care plans did not always contain information for staff about how to meet a person’s assessed needs.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service.

Information about people was not always treated confidentially. People’s daily observation charts which included observations, repositioning were found outside of people’s bedrooms in communal areas which meant they were accessible to everyone.

The provider had failed to notify CQC of incidents and events such as deaths, serious injuries. The provider had failed to display their rating in the home.

People had not always received medical assistance from healthcare professionals when they needed it.

People had choices of food at each meal time. People that did not want to eat what had been cooked were offered alternatives. People with specialist diets had been catered for.

There were suitable numbers of staff on shift to meet people’s needs. A nurse was allocated on each shift. Dependency levels were assessed to check the level of support each person needed. However, this did not then inform an assessment of whether there were enough staff to provide that level of care.

Staff knew and understood how to protect people from abuse and harm and keep them safe.

Most nurses and care staff had received appropriate training to carry out their roles. The service had not followed good practice guidance to ensure that new staff received a comprehensive induction. We made a recommendation about this.

Staff had received training in relation to the Mental Capacity Act (MCA) 2005. Mental capacity assessments did not always follow the principles of the MCA. We made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority and had been approved. The provider had a system in place to monitor and track these but this was not robust. We made a recommendation about this.

The service had been well maintained, clean and tidy. Some areas of the home, such as people’s bedrooms felt cold.

The complaints procedures were detailed to ensure people and their relatives knew who to contact if they had a complaint.

Staff knew how to ensure that people were respected and treated with dignity. Staff told us they ensured people had choices and were involved in their care.

We observed friendly and compassionate care in the service. The staff were happy and up-beat, they enjoyed their work and this was reflected in the care we observed them providing.

Relatives told us that they were able to visit their family members at any reasonable time, they were always made to feel welcome and there was always a nice atmosphere.

Relatives confirmed that they received regular surveys and were asked to feedback about the service their family members received.

Relatives and staff told us that the home was well run. Staff were positive about the support they received from the manager. They felt they could raise concerns and they would be listened to.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour. Handovers between staff going off shift and those coming on shift took place to make sure all staff were kept up to date.

Staff showed us that they understood the vision and values of the organisation; we observed practice to show that staff had embedded this into their work.

We found 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 this report.

Staff understood the importance of asking people for their consent before any care and treatment was given.

People were provided with appropriate care and support that met their needs and promoted their wellbeing. We found that peoples complex and diverse needs were understood by the staff and were met.

People were provided with meaningful activities which took into account their individual needs and abilities.

We observed that people had positive experiences at mealtimes and there was a range of suitable and nutritional meal options available for people to choose from.

The premises had been designed and equipped with the needs of people who lived in the home in mind. The home was comfortably furnished and decorated to a good standard. This meant that people's quality of life was enhanced by the provision of a pleasant and homely environment.

The recruitment procedures at the service were sufficiently robust to ensure the safety and wellbeing of people living there.

There was an effective system to regularly assess and monitor the quality of service that people received.

People's health, personal and nursing care needs were assessed and monitored to ensure that they were met. Staff were supported to undertake the training that they needed to support the people in their care.

People were supported to take part in activities according to their individual abilities.

People were supported to take their medicines safely.

The service had some systems in place to monitor and evaluate its quality of care. The service had yet to develop a way of recording the views of people who live in the home to ensure that it was run in their best interests.