Telford Hall

The Farmstead is a care home providing nursing and personal care to up to a maximum of 66 people. The service provides support to older people, younger adults, people with dementia, physical disabilities and sensory impairments. At the time of our inspection there were 31 people using the service. The Farmstead is a purpose-built care home. Each of its 3 floors has its own communal dining and lounge areas with a kitchenette. A passenger lift gives people access to all floors.

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

People told us they felt safe living at the home and with the staff who supported them. Staff had been trained to recognise and report signs of abuse. There were sufficient staff to meet people’s needs and help keep them safe. The provider’s staff recruitment procedures helped to protect people from harm. Risks to people were assessed and there were plans in place to mitigate risks. People received their medicines when they needed them from staff who were trained and competent, however further improvements were needed in relation to the safe management and administration of medicines. The provider followed best practice in relation to infection control and prevention and management of risks relating to COVID-19.

People were provided with enough food and drink to meet their needs. People were positive about the quality and quantity of the food they received. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the provider's policies and procedures supported this practice. People lived in a home which was well-maintained and adapted to meet their needs. People saw healthcare professionals when they needed. People were supported by staff who were trained and competent to carry out their role.

People told us they were supported by kind and attentive staff who respected their wishes and treated them with respect. People were supported to live their lives as they chose and were regularly consulted about the care they received. People’s privacy was respected, and they could spend time alone in their bedroom when they wanted. People were supported to be as independent as they could be.

People told us staff knew them well and what was important to them. People were supported to maintain contact with those who were important to them and were provided with opportunities for social stimulation. People’s communication needs were assessed and responded to. People did not raise any concerns about the care they received but felt confident action would be taken to address any concerns they may have. There were systems in place to ensure people’s needs and preferences would be understood and met during their final days.

Systems to monitor and improve the quality of the service provided had improved. Staff morale was good and staff told us they felt well supported. Staff received the supervision and support needed to carry out their role effectively. The views of people were sought and valued. The provider worked in partnership with other professionals to ensure good outcomes for people. The provider was aware of their legal requirement and of their responsibility to be open an honest when things go wrong.

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 inadequate (published 7 February 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 7 February 2023. During this inspection the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Farmstead on our website at www.cqc.org.uk.

Follow up

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

The Farmstead is a care home providing nursing and personal care to up to a maximum of 66 people. The service provides support to older people, younger adults, people with dementia, physical disabilities and sensory impairments. At the time of our inspection there were 34 people using the service.

The Farmstead is a purpose built care home. Each of its 3 floors has its own communal dining and lounge areas with a kitchenette. A passenger lift gives people access to all floors.

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

People were placed at risk of harm because the provider failed to ensure people’s medicines were managed and stored safely. People were not protected against the risk of abuse because staff did not always speak up about poor practice and witnessed abuse. Safe infection prevention and control measures were not followed by staff. Lessons had not always been learnt when things had gone wrong.

There was a lack of oversight and direction to ensure staff had the competence and understanding of what they needed to do. Although staff had received training, they did not always put this into practice.

People were at risk of poor health outcomes because staff did not always make timely referrals to health professionals or provide them with sufficient information.

The provider had failed to act in accordance with the Mental Capacity Act (MCA) to gain consent for the use of people's photographs on social media. People were not always supported to have maximum choice and control of their lives and staff did not always support them in their best interests; the policies and systems in the service were not supported by staff practice.

People were not always treated in a compassionate, respectful way. Some people experienced inconsistencies in the caring nature of staff who supported them.

The provider had a complaints procedure in place, but this was not always followed. Improvements were needed to ensure people's end of life wishes were discussed and recorded.

The provider’s audit and governance systems were not operated effectively and known issues continued to occur. The culture at the service did not support people’s safety, choices or the management of risk and there was a lack of accountability from staff when they were aware of poor practice. Feedback from community professionals did not support a well-led service.

People’s preferences were recorded in their care plans along with what was important to them. People were supported to spend their time how they wanted to and to be involved in activities if they wished to.

Despite our findings at this inspection, most people were happy with the care and support they received and gave us positive feedback about the staff and management at the home.

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 the service under the previous provider was good, published on 21 April 2022.

Why we inspected

The inspection was prompted in part due to concerns received about medicines, how the service supported people’s health and care needs and poor engagement with community professionals. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to how people's safety was managed, how people were safeguarded from abuse, consent and how the service was managed at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Farmstead is a nursing home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection.

The Farmstead can support up to 66 people across three floors, in one purpose-built building. Each floor has its own communal dining and living areas with a kitchenette. A passenger lift gives people and staff access to all floors.

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

The provider had systems in place which recorded and monitored the quality of care staff provided at the home. However, improvement was needed to ensure effective management oversight of these and the whole home. There had been a lack of consistent leadership and management since our previous inspection, which had affected staff confidence in managers.

People with dementia would benefit from some improvement to the home’s environment to ensure it fully met their needs and was dementia friendly.

People had a positive experience at the home and praised staff for their support and encouragement. Some people were admitted from hospital for rehabilitation to enable them to go back to their usual place of residence.

People were protected from avoidable harm and abuse because staff understood the support people needed and how to recognise and report safety concerns. People were supported to stay safe because risks were assessed and planned for. People were supported by enough staff. People received their medicines when they needed them.

Infection control practices helped to keep people safe from the risk of cross infection. The provider had updated their policies and practices during the current pandemic to ensure guidance and legislation around COVID-19 was followed.

People’s needs were assessed and their care was planned for. Staff worked in partnership with local health and social care professionals to help keep people healthy and achieve their goals. Staff knew how to meet people’s needs. People were supported to eat and drink enough.

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 supported this practice.

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 requires improvement (published 12 November 2019).

Why we inspected

We received concerns in relation to the culture at the home, leadership and management and concerns around some people’s care. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good. This is based on our findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Farmstead on our website at www.cqc.org.uk.

Follow up

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

The Farmstead is a nursing home providing personal and nursing care to 23 people aged 65 and over at the time of the inspection.

The Farmstead accommodates up to 66 people across three floors, in one purpose-built building. Each floor has its own dining and living areas with a kitchenette.

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

What people drank was not consistently recorded or monitored by staff. People's holistic needs were assessed but care plans were not always clear about the care to be delivered. The provider worked with other healthcare professionals to help ensure people's care and health needs were met. Staff had received training to enable them to provide safe care to people.

Although the provider had already identified some improvements needed at the home, our inspection found further improvement was required. Care records were not always reflective of people’s needs or care which had been delivered. Audit trails of incident reporting and its management were not clear. The provider started improvement work during our inspection and was responsive to all feedback we gave.

Systems and processes were in place to help keep people safe and risks associated with their care needs had been assessed. People were supported by staff who had been recruited safely. Medicines were managed safely. The service was clean and staff practice helped to reduce the risk of cross infection.

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. However, the associated records required more detail to show how decisions had been made.

People were cared for by staff who were kind and thoughtful. People were involved in decisions about their care and support needs. Staff respected people's privacy and dignity.

People told us they received their care the way they wanted it. People's individual needs and wishes were known to staff, who had developed positive relationships with them. There were opportunities for people to participate in various activities of their choice. There were arrangements in place for people to raise concerns about the service.

There was a positive culture throughout the service which focused on providing care that was personalised. Staff were supported in their roles and shared the provider's values of delivering care which was centred around the person.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 15 February 2019 and this is the first inspection.

Why we inspected

This was a planned inspection.