Blamster's Farm

Blamster's Farm is a residential care home providing personal care to people with a learning disability and autistic people. The service can support up to 31 people accommodated across seven individual houses, all within the grounds. The houses are known as Oak, Green, Farmhouse, Lodge and Coach House. The Bungalow and Cottage were currently closed for refurbishment. There were 24 people using the service at the time of the inspection.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support:

The service is made up of a series of houses in a campus style setting on the outskirts of the town of Halstead, which enables people to access the local community and its amenities. People had exclusive possession of their own rooms, in shared accommodation.

The provider had continued to invest in improving the premises, including installing new kitchens, new bathrooms and laundry facilities. These improvements ensured people received care and support in a safe, well equipped, well-furnished and well-maintained environment. Revised cleaning schedules, and improved infection control practices provided a cleaner and safer environment for people.

Work undertaken to reduce restrictive practices in the service enabled people to have choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The use of PRN medicines which affect people’s behaviours, mood, thoughts, or perception had significantly reduced since our last inspection. This ensured people's behaviour was not controlled by excessive and inappropriate use of medicines.

Right Care:

Systems to protect people from poor care had improved. Staff had greater leadership, training and support and understood their role in promoting safe, consistent, and predictable care which met people’s needs, including managing complex needs and feelings of anxiety or distress.

The provider had successfully recruited a significant number of new staff, reducing vacancies and the need to use temporary agency staff. More regular, and consistent staff had led to improved outcomes for people. Recruitment systems were robust ensuring the right staff were recruited to safely work with people using the service.

Improvements in staff training ensured staff had the knowledge and skills to meet the needs of the people using the service. Some new staff felt they needed more shadowing with experienced staff before supporting people with complex needs, on their own. People were supported to live healthier lives, through maintaining a balanced diet and access to healthcare services. Staff worked with health professionals to provide consistent, effective, timely care.

People were treated by staff with kindness, respect and compassion. Staff knew the people they were supporting well, including how they communicated. Staff demonstrated true insight into people’s needs and understood the effectiveness of good communication to achieve positive outcomes. People were supported to access activities, with meaningful interest to them. People’s privacy, dignity and independence was encouraged and respected.

Right Culture:

Since the last inspection, the registered provider had been incorporated into Ivolve Group Limited, an existing adult social care provider with established governance arrangements in place to assess, monitor and improve the quality of the service. Although significant improvements have been made across the service, these systems have not yet been fully embedded. Audits at service level had not been robustly completed. Therefore, these did not always feed into the provider’s overarching quality and risk governance system to identify where quality and safety was compromised and what actions were needed to drive improvement.

Recruitment of the area manager and registered managers had resulted in better leadership and support for people and staff. Where a registered manager had been appointed to the Oak and the Green, these houses were operating better than the Lodge, Coach House and Farmhouse. Leadership and governance arrangements were inconsistent across these houses. A new manager had been recruited to manage the Lodge, Coach House and Farmhouse and is due to start in post on 18 September 2023.

The area manager and registered managers had worked hard to improve the culture in the service. Staff told us staff morale had greatly improved.

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 requires improvement (published 4 February 2022) 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.

At our last inspection we made recommendations about decision making in accordance with the Mental Capacity Act 2005, and about the management of medicines. At this inspection we found improvements had been made. Where people were deemed to lack capacity to make significant decisions about their health and welfare, records now clearly showed who had been involved in making decisions in the persons best interests. Where people were prescribed medicines, as needed (PRN) improved protocols were in place providing guidance for staff to safely administer these medicines.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. It was also prompted by a review of the information we held about this service to assure ourselves people were receiving safe, good quality care. The overall rating for the service has changed from requires improvement to good based on the findings of 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Blamsters Farm 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.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

People, their relatives and staff told us about inconsistency of staff and how this did not provide stable care. Relatives felt the high turnover of staff, use of temporary staff, poor communication and frequent changes in managers had led to a decline in the service. This has led to a poor staff culture, lack of leadership and oversight of the service. As a result, people’s and staff's safety was not always being identified and managed effectively. The provider was taking steps to improve this, and a new management team had been recruited but had only been in place three months. They acknowledged the challenges and recognised the need to change the culture within the service to improve people’s experience of care.

We found infection prevention and control was poor, specific concerns were identified in cleanliness and hygiene across the service, especially in bathrooms, kitchens and laundry areas. The provider took immediate action taken to address these issues including resourcing an external cleaning company to carry out a deep clean of all the houses, and to provide additional training for staff.

Right Support:

• The service is made up of a series of houses in a campus style setting on the outskirts of the town of Halstead, which enables people to access the local community and its amenities.

• People had exclusive possession of their own rooms, in shared accommodation but did not receive care and support in a safe, well equipped, well-furnished and well-maintained environment that met their sensory needs.

• The service aims to maximise people’s choice, control and independence; however, where people were deemed to lack capacity to make more significant decisions about their health and welfare, records did not always reflect who had been involved to make decisions in their best interests. We have made a recommendation about decision making in accordance with the Mental Capacity Act 2005.

• Staff did not always support people in the least restrictive way possible. People’s behaviour support plans included restrictions to areas of their home and certain types of food and drinks deemed to unhealthy, based on out of date information which had not been reviewed to demonstrate it was still relevant. The new management team had completed an audit of restrictive practices and were working to develop a plan for the safe removal of unnecessary restrictions.

• People were not always actively supported in maintaining their own health and wellbeing. Health plans lacked information about annual health checks; access to screening and primary care services.

• People’s medicines were not always being managed safely. We have made a recommendation about the management of medicines.

Right Care:

• The service did not have enough appropriately skilled staff to meet people’s needs. The provider was working on strategies for the recruitment of new staff.

• People were not always sufficiently protected from the risk of harm. Although staff had completed safeguarding training they had not always recognised or reported poor care.

• Staff did not encourage and enable people to take positive risks. Staff did not always focus on people’s strengths or promote what they could do, to ensure they had a fulfilling and meaningful everyday life.

• People did not always receive good quality care, support and treatment because staff training had not been embedded in practice.

• People were supported by staff to pursue activities and their interests but were not always being supported to achieve their aspirations and goals or try new activities to enhance and enrich their lives.

• People who had individual ways of communicating, using Makaton (a form of sign language), pictures and symbols could not interact comfortably with staff and others involved in their care and support because staff did not have the necessary skills to understand them.

• People were treated people kindness and staff respected their privacy and dignity

Right culture:

• People were not leading inclusive and empowered lives because staff were not aware of the expectations, ethos and values of the provider. Staff had not signed up to a clear, shared vision for delivering person centred care.

• People were not supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability or autistic people may have. This meant people did not always receive empowering care tailored to their needs.

• The management team including the provider’s senior managers were aware of this and were working to promote a more positive culture. They were demonstrating this by working with commissioners of care, safeguarding and other professionals in an open and transparent way. They have recognised and acknowledged the improvements needed.

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

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support Right care Right culture. The inspection was prompted in part due to concerns received about insufficient, poorly trained staff, high use of agency staff, poor communication and a lack of leadership. A decision was made for us to inspect and examine those risks.

Rating at last inspection

This service was registered with us on 23 July 2020 and this is the first inspection. The service was previously registered under TLC Care Homes Limited. The last rating for the service under the previous provider was rated Good published on 08 November 2019.

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.

Enforcement

We have found evidence that the provider needs to make improvements. We have identified breaches in relation to safe care and treatment, staffing, staff training and good governance at this inspection. Please see the safe, effective and well led sections of this full report. We found no evidence during this inspection that people were at risk of harm from these concerns. The provider took immediate action to improve the environment and infection control measures to mitigate the risks to people.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.