Church Farm at Rusticus

Church Farm at Rusticus is a nursing home providing personal and nursing care to up to 93 people. The service provides support to adults, some of whom live with dementia and/or physical or mental health conditions. At the time of our inspection there were 86 people using the service.

Church Farm at Rusticus is split into 4 separate units known as Primrose, Hawthorn, Bluebell, and Hickling. The service is split across 2 purpose-built buildings. One of the units, Primrose, specialised in providing care to people following a hospital admission.

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

People were supported and kept safe by staff who understood their duties and responsibilities. Risks were managed well, both those associated with people’s individual health and wellbeing needs and environmental risks. People received their medicines in a safe way.

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.

People’s needs were assessed and staff were provided with relevant information to be able to meet these. Care was delivered inline with nationally recognised guidance. People were supported with their eating and drinking requirements in an effective and safe way. People’s wellbeing and healthcare needs were managed well.

People were very happy with the kind and caring support they received from staff. Staff knew people as individuals and treated them respectfully.

People’s care was planned and delivered in a personalised way. There were opportunities for people to socialise and engage in activities if they so wished.

The provider ensured the home was managed well, with relevant audits in place to check the environment was safe and care was delivered appropriately.

Rating at last inspection

The last rating for this service was requires improvement (published 14 February 2019). The service had made improvements following this inspection in safe and responsive.

Why we inspected

The inspection was prompted in part due to concerns received about risk management and leadership. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

Follow up

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

We found the following examples of good practice.

Staff were following the current government guidance in relation to infection prevention and control. The provider had arrangements in place to help prevent the spread of COVID-19 and other infections. All staff received training on the correct use of PPE and infection control. The management team did regular checks on staff to ensure they were following infection control procedures correctly. The management team regularly audited infection control practices to ensure staff were following them.

The provider was following the current government guidance on visiting. There was a clear system for visitors in place to ensure they followed the current guidance on the use of personal protective equipment (PPE) and social distancing. All visitors were screened for symptoms of respiratory or other infections before being allowed to enter the home.

The provider had ensured that people were able to maintain contact with relatives using technology whilst visiting was limited. The provider had made arrangements for relatives to visit that reduced the risk of any infection coming into the service. The home was clean and well maintained throughout.

The provider had arrangements in place to ensure people and staff were tested for COVID-19 in accordance with current government guidance. Risk assessments were carried out with people and staff to ensure they could safely live and work at the service.

Church Farm at Rusticus accommodates up to 76 people in one building. At the time of our inspection there were 46 people living at the home. This is the service’s first inspection under its current registration since it commenced in September 2017.

A registered manager was in place but not present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was on long-term leave and the home was managed by an interim manager until their return.

People received their medicines safely; however, medicines were not always stored appropriately. Records used to record how medicines were stored were not always fully completed. There were enough staff to support people; however, we did note an occasion when staff were slow to respond to an alarm that was activated in a person’s bedroom. Nursing staff at Hawthorn House required more staff to support them; recruitment for this was in process. Some relatives raised concerns about the variable quality of the agency staff. Risk assessments were in place to reduce the risk people’s safety. Checks of pressure relieving equipment had not always been carried out. The home was clean and tidy and staff understood how to reduce the risk of the spread of infection. Accidents and incidents were regularly reviewed, assessed and investigated by the interim manager and reviewed with the Head of Operations.

People’s physical and mental health and social needs were assessed and met in line with current legislation and best practice guidelines. Staff were well trained and felt supported to carry out their role effectively. People were supported to follow a healthy and balanced diet. Referrals to dieticians had been made when weight loss was identified; however, for one person more action was needed to address these concerns. People had access to external health and social care agencies. The home environment was well maintained and was undergoing extensive renovation work to ensure it offered all people with a physical disability or living with dementia the best possible life. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People found staff to be kind and caring and felt they were treated with respect and dignity. People’s privacy was respected and people were involved with making decisions about their care. People’s cultural and religious needs had been discussed with them and acted on where needed. Advocacy services were made available for people if they required them. Supporting people living with dementia was a key aim of the provider. They had taken steps to provide people, the local community and relatives with information about dementia to enable them to understand the disease. People’s records were handled in line with data protection regulations.

People’s care records were person centred and they received care from staff in line with their personal preferences. There was sometimes a delay in forming detailed care planning and risk assessments at Hawthorn House. Care records were largely up to date but a small number viewed at Hawthorn House did not always reflect people’s current needs. People were treated fairly, without discrimination and systems were in place to support people who had communication needs. Records showed complaints had been dealt with appropriately. People were supported to make decisions about how they wished to be cared for at the end of their life.

However, not all records at Hawthorn House were fully completed.

The interim manager and Head of Operations were aware of the issues raised during this inspection and had already acted to address them. Quality assurances processes were in place to assist the interim manager with identifying any areas for improvement. People, staff and relatives liked the interim manager and found her to be approachable. People told us they would recommend this service to others. Staff felt valued and enjoyed their role. People, relatives and staff were encouraged to give their views about how the home could be improved and developed. The views were then acted on. The provider had extensive plans in place to renovate the home and to provide all people with high quality care.