Grovelands Farmhouse

The provider had implemented measures to reduce the risk of infection. Staff were observed wearing appropriate Personal Protective Equipment (PPE) and they had received ongoing training in its correct use.

The service was clean and hygienic. Additional cleaning schedules had been implemented since the beginning of the pandemic, including the continuous cleaning of high-touch areas such as door handles and switches. Deep cleaning of communal areas, including the use of an antiviral fogging machine had been regularly carried out.

The provider had an infection prevention and control (IPC) policy. Designated staff carried out regular IPC audits to ensure appropriate standards in this area were maintained.

The provider had taken action to minimise risks to people who used the service and staff. Risk assessments had been carried out to identify and mitigate risks, including for people in vulnerable groups.

Staff accessed COVID-19 testing in line with government guidelines. If staff returned positive test results or had COVID-19 symptoms, they did not return to work until they had completed the required period of self-isolation.

If people displayed symptoms or tested positive for COVID-19, staff encouraged them to self-isolate in their bedrooms. Where this was not possible, people were supported to maintain social distance from one another.

During the outbreak, people had been supported to stay in contact with their relatives using the telephone or video calls. At other times, family members had been able to visit people safely in line with the relevant government guidelines.

All visitors to the home were required to wear appropriate PPE and screened before entering the service, which included a Lateral Flow Test and checks on temperature and oxygen levels.

Staff supported people to access the healthcare treatment they required. The registered manager had good links with the local GP service who had provided ongoing clinical advice and support.

Staff had been well supported during the pandemic through the provision of information and guidance, at team meetings and at individual meetings. Staff had been encouraged to speak up about any anxieties or concerns they had.

We found the following examples of good practice:

The home’s staffing model ensured people received consistent support and prevented the outbreak in the main building from reaching the people living in the flats.

Grovelands Farmhouse is a residential care home providing personal care and accommodation for up to nine younger adults living with a learning disability and/or autism.

Services for people with learning disabilities and or autism are supported

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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to nine people. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. At the time of inspection there were nine people living in the service. Seven people lived in the main building and two other people were accommodated in an annexe where they each had their own bedroom, bathroom and sitting room. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People and their families were positive about Grovelands and staff who supported them. People were treated with kindness and compassion. People spent time in the community and at the home, doing activities they enjoyed and had chosen. There were effective systems to manage complaints and resolve them in a timely way.

Risks to people had been assessed and care plans reflected how to support people to keep people safe whilst maximising their independence. 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. Where there were restrictions on people, staff were working within the requirements of the Mental Capacity Act (2005).

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

There were enough staff to support people. Staff had been recruited safely and completed an induction when they first started. Staff updated training to ensure they were able to support people, following best practice guidance. Staff worked in a relaxed manner, ensuring that people had enough time to make decisions for themselves wherever possible.

People were kept safe by a registered manager and staff who were committed to their care and well-being. Safeguarding issues were reported and investigated appropriately. Lessons were learned when things went wrong, and actions was taken to reduce the risks of a reoccurrence. People were supported to access health care when needed as staff worked with health and social care professionals. Medicines were stored, administered and recorded to ensure people received them safely.

The home was well-maintained and looked after. People had the use of both personal spaces and communal areas. Personal spaces, such as bedrooms and bathrooms had been decorated and furnished according to each person’s preferences. The home was clean. There were policies and procedures to ensure the risks of infection was minimised.

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 20 December 2016). At this inspection we found the service continued to be Good

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out a previous inspection of this service on 16 June 2014 where we found the service was meeting the requirements in the areas we looked at.

This inspection took place on 9 November 2016 and was unannounced. At the time of our inspection there were nine people being supported at Grovelands Farmhouse. People had a range of needs, with some people living with learning disabilities, autism, epilepsy and other healthcare needs.

Grovelands Farmhouse and Primrose Bank were located next to a working farm. People who lived in both houses were able to visit the farm at any time and take part in animal care, farming activities as well as arts and crafts and life skills classes. People benefited from a large number of meaningful activities which met their individual needs and interests. These took place at the farm, at the service or out in the community. For example, activities included swimming, cooking, dancing, gardening, shopping and trampoline sessions.

People and their relatives spoke highly of the staff at the service and the quality of care provided. Comments from people included “I do love living here”, “I’ve got a nice home here” and “I love (staff name) and I love all the other staff”. Comments from relatives included “We are impressed with the quality of the carers they have there” and “The staff are genuinely caring. Some of the staff are like having a proxy mum, that’s how caring they are”.

Staff treated people with kindness and respect. People enjoyed pleasant and affectionate interactions with staff which demonstrated people felt comfortable in their presence. Staff knew people’s preferences and communicated with people using their preferred methods of communication. For example, some people who had difficulty communicating verbally used pictures to help them communicate.

People were protected from risks relating to their health, medicines, nutrition and behaviours. Staff had assessed individual risks to people and had taken action to minimise these risks. Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and staff competencies relating to the administration of medicines were regularly checked.

Staff knew how to recognise possible signs of abuse which helped protect people. Staff knew what signs to look out for and the procedures to follow should they need to report concerns. Safeguarding information and contact numbers for the relevant bodies were accessible to staff and people who lived in the service. People and staff told us they felt comfortable raising concerns. Recruitment procedures were in place to ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work in order to ensure they were suitable to work with people who were vulnerable.

Staffing numbers at the service were sufficient to meet people’s needs and provide them with two to one or one to one support where required. Staff had the competencies and information they required in order to meet people’s needs. Staff received sufficient training as well as regular supervision and appraisal.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put it into practice. Where people had been unable to make a particular decision at a particular time, their capacity had been assessed and best interests decisions had taken place and had been recorded. Where people were being deprived of their liberty for their own safety the registered manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority.

People were supported to have enough to eat and drink in ways that met their needs and preferences. Mealtimes were a sociable experience with staff eating alongside people. People were supported to help prepare their meals and could choose what they wanted to eat. People’s mealtimes were relaxed and flexible to meet people’s activity commitments and routines.

There was open and effective management at Grovelands Farmhouse. People, relatives, staff and healthcare professionals were asked for their feedback and suggestions in order to improve the service. There were effective systems in place to assess, monitor and improve the quality and safety of the care and support being delivered.

In this report the name of a registered manager appears who was not in post or managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

At the time of our inspection, the service was providing personal care to seven people. As part of our visit to the service we spoke with two people who used the service, the registered manager, five staff and two relatives.We were unable to speak to all of the people who lived at Grovelands Farmhouse as they were out participating in activities during our inspection.

We reviewed records relating to the management of the care agency which included, the support plan, policies and daily records.

Below is a summary of what we found. The summary describes what people who used the service, the relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We saw that risk assessments were in place to provide information to staff to help minimise any identified risks that related to people who used the service.

We saw that the provider had carried out the necessary checks which ensured they employed suitable staff.

We also viewed training records and found that staff had received training in safeguarding vulnerable adults. This meant they would know what to if they had any concerns that people were not been looked after as they should be.

Is the service effective?

We saw that people were involved in developing their care and support plan. The care plan included information that was written in a person-centred way.

We saw that care plans were reviewed and that staff completed daily notes to show what care and support had been provided to each person.

Is the service caring?

We observed staff during our inspection and found them to interact with people who used the service in a kind and caring manner. They provided support when it was required and guidance when a person could do something for themselves.

Is the service responsive?

Records showed us that the people who used the service had been able to indicate their preferences, likes and dislikes and they had access to activities that were important to them. We saw that other health care professionals were involved in the person's care when it was required.

Is the service well-led?

We saw that staff had the opportunity to meet regularly with the manager.

Staff told us they had regular supervisions and access to training. We confirmed this by looking at the files.

The manager showed us that Consensus Care sent out satisfaction questionnaires on an annual basis and we reviewed the responses of the most recent survey. This showed us that on the whole people were happy with the care and support that was provided at Grovelands Farmhouse.

We therefore conducted an unannounced inspection and early in the morning at 6:20am before the day shift to respond to the concerns that were raised by the whistleblowers. We started at this early time because that was one of the key times that the whistleblowers reported denial of choices and rights was occurring and we had previous concerns in this area as highlighted in the last report under outcome 2 consent (regulation 18 ).

As there were also previous compliance actions in related areas we also reviewed these at this inspection. We found some of the whistleblowers concerns were substantiated and are addressed under outcome 2 consent (regulation 18 ) where we already had concerns and a new area, outcome14 (regulation 23 ) staff supervision where we found that people were not always cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. .

The last inspection found shortfalls in 2 out of 4 areas looked at and set compliance actions. The areas were shortfalls were found were, consent to care and treatment and the environment.

At this inspection we also reviewed the actions the provider had taken in response to the compliance actions.

The last inspection report recorded shortfalls under outcome 10 (regulation 15) with the environment and set a compliance action. At this inspection we reviewed the actions the provider had taken in response to the compliance action and we found that the provider had addressed the areas where we had identified shortfalls. This compliance action was therefore met and closed. We therefore found that people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

The last inspection report recorded shortfalls under outcome 2 (regulation 18), consent to care and treatment and set a compliance action. At this inspection we reviewed the actions the provider had taken in response to the compliance action and we found that the provider had not made significant progress. However as the management explained the reason was a lack of understanding of the procedures required and did make some improvements during the inspection, it was seen proportional not to escalate our actions and just leave the compliance action in place on this occasion. This compliance action therefore remained open and we found that before people received any care or treatment they were not always asked for their consent, the provider did not always act in accordance with their wishes and where people did not have the capacity to consent the provider did not always act in accordance with legal requirements.

A suitable manager was put in to the home during the inspection to cover until the new manager starts. We were reassured by the managers knowledge and positive attitudes in the areas we had found shortfalls. The availability of a manager to address the shortfalls in this report therefore reduced the level of impact we assessed those shortfalls would have on people.

It was seen as responsive, that the provider, once they clearly understood what was required, started to take immediate action during the inspection to make improvements. In addition one of the directors took the time to directly feed back to one of the people using the service about the positive changes and improvements they could now expect in their lives, regarding their rights, freedoms and choices and how now they would be more appropriately supported.

We saw that people decided what to eat on the day as opposed to deciding weekly menus. This offered more flexibility and choices.

People said they liked their rooms and they were warm enough in winter.

One of the people who used the service who had an interest in health and safety took us on a building tour and told us how they were supported to do a monthly check for the building.

We found that the provider had not assessed capacity to consent for all of the people who lived at the home and had not taken appropriate steps where people lacked capacity in line with the Mental Capacity act.

We found that the home was not always protecting people against the risks associated with unsafe or unsuitable premises, as they were leaving windows without secure restrictors fitted when these had been risk assessed as needed, not managing sharp objects as risk assessed, and not attending to fire doors with known faults.

We also found that files containing information about staff and those of people who use the service were in good order and kept securely and confidentially.