Manor Farm

Updated 14 July 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

We also asked the registered manager about any staffing pressures the service was experiencing and whether this was having an impact on the service.

Inspection team

The inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Manor Farm is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Manor Farm is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with CQC to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

A manager registered with CQC during this inspection.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 19 April 2022 and ended on 20 May 2022. We visited the service on 19 and 26 April, and on 16 May 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider did not complete the required Provider Information Return (PIR). This is information providers are required to send us annually with key information about the service, what it does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke and communicated with three people who used the service and eight relatives about their experience of the care provided. People who used the service who were unable to talk with us used different ways of communicating such as using their body language. We spent lots of time observing how staff supported people in their day to day lives at the service.

We also spoke with 10 staff. These included two support workers, three agency support workers, three senior support workers, the registered manager, and the regional manager. We also received feedback from five external care professionals who have contact regular contact with the people who used the service.

We reviewed a range of records. These included sampling five people's care records, and two staff files in relation to recruitment checks. We also looked at a variety of records relating to the management of the service, including staff rotas and training records, meeting minutes, audits, quality assurance reports, and action plans.

Updated 14 July 2022

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.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Cambridgeshire and Peterborough. To understand the experience of social care providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

About the service

Manor Farm is a care home providing accommodation, personal care and support to up to 10 people with a learning disability and, or autistic spectrum disorder. One person is accommodated in a bungalow. The other nine people are accommodated in one adapted building. At the time of our inspection there were 10people living at the service.

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

The service did not always fully demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

¿ The home had not been well-maintained. Several areas of the service had been damaged and needed repair and not all people’s bedrooms had been personalised.

¿ People were not always supported to live healthy lifestyles and staff members did not always promote healthy eating choices.

¿ People had limited opportunities to develop life skills, and there was little evidence of planning for long term goals and aspirations.

¿ The service had not always supported people to have the maximum possible choice, control and independence and have control over their own lives.

¿ In the main, staff supported people to take their medicines safely. However, one person had not received their medicine in line with the prescriber’s instruction. The person was not harmed by this and the registered manager took immediate action to address this. The registered manager understood the importance of people not being over medicated particularly when managing people’s increased anxiety.

¿ Staff supported people to take part in activities and pursue their interests in their local area and interact with people who had shared interests. People’s opportunities to pursue their leisure and social interests had improved in recent months.

¿ Staff enabled people to access specialist health and social care support in the community.

¿ Staff worked with people using distraction techniques when they experienced periods of anxiety. People’s freedoms were not restricted by staff unless it had been risk assessed as being a safety concern.

¿ The staff team worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

Right Care

¿ Staff knew the people they supported well. People received kind, compassionate, and patient care. Staff understood and responded to people’s individual needs. However, staff were not always discreet and respectful of people's dignity. The language staff used to describe or refer to people was not always positive or promote people’s dignity.

¿ People were not always supported to respect other people’s space and belongings.

¿ Staff respected and encouraged people to make a choice. However, staff did not always follow through on agreed actions.

¿ People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives.

¿ The service had enough staff to meet people’s individual needs and keep them safe. The service had a high number of vacancies and relied heavily on agency staff. However, these agency staff worked at the home regularly and knew people well.

¿ Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

¿ Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.

¿ The registered manager had started to re-introduce various tools to help aid people’s communication and understanding. These included pictures, symbols, and easy read documents.

¿ People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing.

Right Culture

¿ The registered manager understood the key principles of guidance such as Right support, right care, right culture. However further development was required to help ensure people led inclusive and empowered lives.

¿ Audits were completed to monitor the service people received. They had identified most, but not all, of the shortfalls we identified during this inspection. The provider and registered manager discussed with us their plans to bring about further improvement in the service and people’s quality of life.

¿ Staff turnover under the previous manager was very high and meant people had not received consistent care from staff who knew them well. Staffing was more stable under the current registered manager’s leadership and meant people’s consistency of care had improved. However, this needed to be further improved and embedded.

¿ Staff knew and understood people well and were responsive, supporting their preferences to live a quality life of their choosing. However, people had not always supported people to develop aspirations and longer-term goals.

¿ People and those important to them, including advocates, were involved in planning their care.

¿ The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views.

¿ Staff felt very well supported by the registered manager who led by example and staff found approachable.

¿ The service worked in partnership with advocacy and other health and social care professionals who helped to give people using the service a voice and improve their wellbeing

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 03 April 2020).

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 people’s safety, staffing levels, and the quality of care people received. 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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive, and well-led sections of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to the building décor and maintenance, dignity and promoting independence, and governance at this inspection.

Please see the action we have told the provider to take at the end of this 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 continue to monitor information we receive about the service, which will help inform when we next inspect.