Archived: Foxhills Farm

Foxhills Farm is a residential care home providing personal care to up to 5 people. The service provides support to people who live with learning disabilities and complex needs. At the start of our inspection there were 4 people using the service in 1 adapted building. During the inspection this reduced to 3 people using the service. The home has 2 floors accessed via stairs, communal areas and a large garden.

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

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.

Based on our review of key questions safe, effective and well-led, the provider was not able to demonstrate how they were meeting all of the underpinning principles of Right support, right care, right culture.

Right Support: People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care: The service was close to a busy road, with no pavements, the nearest bus stop was over half a mile away along this road and there was no access to local shops, the closest place being a garden centre. However, since our last inspection the manager had worked on ensuring people were able to get out more often. People were at risk of harm because staff did not always have the information, they needed to support people safely.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff did not fully ensure people using services lead confident, inclusive, and empowered lives.

At the last inspection assessing risk to the health, safety and wellbeing of people, medicines management and infection prevention and control were not managed safely, at this inspection this remained the same.

Recruitment was not managed safely, and people were at risk of being supported by staff who had not had the appropriate checks.

The service was not maximising people's choices, control, or independence. There was a lack of person-centred care.

The provider did not have enough oversight of the service to ensure that it was being managed safely and that quality was maintained. Quality assurance processes had not identified all of the concerns in the service, and where they had, sufficient improvement had not taken place. Records were not always complete. People and stakeholders were not always given the opportunity to feedback about care or the wider service. This meant people did not always receive high-quality care.

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 March 2023) and identified 9 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 the provider remained in breach of 7 regulations.

At our last inspection we recommended the provider sought current guidance on menu planning and updated their practice accordingly. At this inspection we found improvements had been made.

We also recommend the provider sought reputable guidance around the Data Protection Act and updated their practice accordingly. At this inspection improvements had been made.

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.

We carried out an unannounced focussed inspection of this service on 27 June and 4 July 2023. Seven breaches of legal requirements were found. We issued the provider with 4 warning notices in relation to Safe Care and Treatment, Need for Consent, Safeguarding Service Users from Abuse and Good Governance.

We undertook this focused inspection to check they had met the requirements of the warning notices and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to assessing risk, medicines management, safeguarding people, consent to care, staff recruitment, training, person centred care and governance and oversight 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.

The overall rating for this service is ‘Inadequate’. This is the second consecutive inspection with an 'Inadequate rating' and the service remains 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.

Following our inspection the provider notified us that they were closing and de-registering the service. The service was de-registered on 31 August 2023.

Foxhills Farm is a residential care home providing personal care to up to 5 people. The service provides support to people who live with learning disabilities and complex needs. At the time of our inspection there were 4 people using the service in one adapted building. The home has two floors

accessed via stairs, communal areas and large garden.

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

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.

Based on our review of key questions safe, effective and well-led, the provider was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support: People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care: People were at risk of harm because staff did not always have the information, they needed to support people safely. Medicines were not managed safely. People did not receive consistent person-centred care that was empowering, of a high-quality and achieved good outcomes. The service was not located so people could participate in the local community. The service was close to a busy road, with no pavements, the nearest bus stop was over half a mile away along this road and there was no access to local shops, the closest place being a garden centre. The lack of drivers at the service meant people were not supported to access their local community as often as they would like. People had privacy for themselves and their visitors in their bedrooms.

Right Culture: Ethos, values, attitudes and behaviours of leaders and care staff did not fully ensure people using services led confident, inclusive and empowered lives.

Assessing risk to the health, safety and wellbeing of people, medicines management and infection prevention and control were not managed safely.

Recruitment was not always managed safely to support the recruitment of suitable staff. Staff who were employed did not always have the relevant training to enable them to do their job.

The service was not maximising people's choices, control or independence. There was a lack of person-centred care and people's human rights were not always upheld. There was a lack of timely action by leaders to ensure the service was well staffed and safeguarding incidents were responded to. This meant people did not lead inclusive or empowered lives.

People were not being offered a wide variety of food and vegetables. We have made a recommendation about this.

People’s personal identifiable information was not always stored securely, we have made a recommendation about this.

Leadership was poor, and the service was not always well-led. Governance systems were ineffective and did not identify the risks to the health, safety and well-being of people or actions for continuous improvements. Where improvements had been identified, these had not been fully achieved Records were not always complete. People and stakeholders were not always given the opportunity to feedback about care or the wider service. This meant people did not always receive high-quality care.

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 31 October 2018).

Why we inspected

We received concerns in relation to staffing levels, physical intervention training, waste management, lack of supervision, lack of person-centred care, staff shouting at people, and the lack of the managers presence in the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only, during the inspection we made the decision to look at the effective question as well.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

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

Enforcement and Recommendations

We have identified breaches in relation to risk management, recruitment, safeguarding, the mental capacity act, staff training, person centred care, governance, duty of candour and failure to notify CQC of significant events at this inspection.

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

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.

Foxhills Farm is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

Foxhills Farm can accommodate up to 4 younger adults in one adapted building. The home has two floors accessed via stairs, three communal areas and large outside space where people could choose to spend their time. At the time of the inspection 4 younger adults who were living with learning disabilities and complex needs.

A registered manager was in post. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Prior to this inspection we had received concerns about staffing and the environment. We found the service had worked well to make improvements andno concerns were identified on the inspection..

People were protected against abuse because staff had received training and understood their responsibility to safeguard people. Concerns were reported and investigated.

Staff were aware of the need to treat people as individuals and ensure care reflected their individual needs. Risks associated with people’s needs were assessed and action was taken to reduce these risks.

People were supported to ensure they received adequate nutrition and hydration.

Staff worked well as a team and people were supported to maintain good health and had access to appropriate healthcare services.

Staff sought people’s consent and applied the principles of Mental Capacity Act 2005 (MCA) when this was needed, but records of this needed improving.

Observations reflected people were comfortable and relaxed in staff’s company. People were cared for with kindness and compassion. People’s privacy and dignity was respected and they were encouraged to be involved in making decisions about their care. Staff responded to people’s changing needs, supported them to maintain good health, have access to appropriate healthcare services and ensured a person centred service.

The provider’s recruitment process ensured appropriate checks were undertaken to ensure staff suitability to work in the home. People told us that how they felt staff had the skills and knowledge to care for them. Staff received supervisions and training to help them in their role.

There was a process in place to deal with any complaints or concerns if they were raised. Complaints were investigated, outcomes shared with people and staff.

Communication was open and staff felt supported and able to raise concerns at any time. They were confident these would be addressed. People, their families and staff had the opportunity to become involved in developing the service. The service aimed to ensure good quality care was delivered and there were systems in place to monitor the quality and safety of the service provided.

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

Procedures in relation to recruitment of staff had not been followed, which meant people’s safety had not always been considered.

Risks associated with people’s care were identified and plans had been developed to reduce any risks. Incidents and accidents were monitored on an individual basis. Medicines were stored safely and administered as prescribed. Fire safety checks were being carried out by staff, and there were no immediate concerns but as the fire officer has not visited the service we have referred,the service to them

Staffing levels were planned to meet the needs of people. Staff received appropriate training and support to meet people’s needs.. People had developed good relationships with staff who were caring and knowledgeable in their approach. People were treated with dignity and respect. People’s support plans had been updated to reflect people’s current needs. Staff had tried to include people in the development of the care plans. Two people told us they felt safe and people’s relatives told us people were well looked after and safe at the home. There were clear procedures in place for safeguarding people at risk and staff were aware of their responsibilities and the procedures to follow in keeping people safe.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager and staff had a good understanding of DoLS and the action they needed to take. Applications had been made to the local authority and considerations had been given to updating the applications. Staff demonstrated a good understanding of the need for consent and an understanding of the Mental Capacity Act 2005. The registered manager and staff knew how to undertake assessments of capacity and when these may need to be completed.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. People’s physical and emotional health was monitored and appropriate referrals to health professionals had been made.

Details of the complaints procedure were displayed around the home in a pictorial format. The home had a complaints procedure. The registered manager operated an open door policy and encouraged staff to make suggestions or discuss any issues of concerns. A system of audits was in place and used to identify where improvements could be made.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

During our visit we spoke with two of the three people who lived at the home. Due to the nature of people's learning disability we were not always able to ask direct questions to people. We did however, chat with them and were able to obtain their views as much as possible. We also spoke with relatives of two people, two health and social care professionals who had involvement with two people at the home, the homes deputy manager, a senior carer and four members of staff.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

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

Is the service safe?

None of the people we spoke with had any concerns about the support they received. People were treated with kindness, dignity and respect by staff. People and their relatives told us about their satisfaction with the home. People told us they felt safe.

We saw care and treatment was planned and delivered in a way that ensured people's safety and welfare. All of the care plans we looked at had risk assessments in place to assist staff in minimising any known risks.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager told us that staff had received training with regard to DoLS and the home had appropriately submitted DoLS applications and were awaiting a response to the application.

Is the service effective?

Each person had a plan of care and support. We saw that support plans explained what support people needed from staff. Staff told us the care and support plans gave them the information they needed to provide the level of support people required.

We observed staff supporting people and care staff were aware of people's needs and preferences in how people wanted care to be delivered. We saw staff offered advice and support and enabled people to make their own choices and decisions as much as possible.

Relatives told us they felt their relatives were well supported by staff. One relative told us 'I am happy with the care provided for my relative, In the past I have had some concerns but the home is making progress and I am quite happy'.

Is the service caring?

We observed staff speaking to people appropriately and they used people's preferred form of address. People we spoke with told us staff were kind and patient in their approach.

We saw care workers taking time to chat with people. They responded promptly to peoples requests for assistance and had a good understanding of people's needs. Relatives described their satisfaction with the home. One person told us, 'My relative comes home every other weekend and when it's time to go back they are quite happy to go' Heath and social care professionals told us they found that the staff were professional and caring towards people and showed a good understanding of their individual needs, likes and dislikes,

Is the service responsive?

We saw people had regular reviews of the care and support they received. We saw that care plans showed alterations had been made to people's plans of care as people's needs changed.

We saw people were able to participate in a range of activities. Staff told us they encouraged and supported people to participate in activities to promote and maintain their well-being.

People who used the service, their relatives and staff were asked for their views about how the home was meeting people's needs and any concerns or ways to improve the service were acted on.

The two health and social care professional we spoke with told us they had developed a good working relationship with both the manager and senior support staff. This had enabled them to work closely with them to develop good guidelines and risk assessments that have been amended and reviewed as required.

Is the service well led?

A relative we spoke with told us that they had regular contact with the home and said that they could speak to the manager or staff at any time. They told us they were kept informed about any issues which affected their relatives.

All of the staff and people we spoke with said they felt supported. We saw the home had systems to monitor and assess the quality of the service provided by the home. These including a number of audits including health and safety, medicines, cleaning and infection control.

Staff meetings took place every three or four weeks and minutes of these meetings were kept. Staff confirmed this and said the staff meetings enabled them to discuss issues openly with the manager and the rest of the staff team.

We found that each person had a number of documents about their care. These included a daily activities timetable and daily records of key events for each person. There were comprehensive records regarding the management of individual's behaviour; these included guidance on when 'as required' medication should be used. Staff were trained in the use of physical interventions and told us these were used as the least restrictive last resort for preventing injury. Relatives of people living at the service told us they considered the home used physical interventions appropriately and proportionately. Relatives told us they considered the home was a safe place for people to live.

There were four staff on duty and two people at the home at the time of our visit. There were times when the staff rota showed three staff on duty when three people were at the home. The home needs to review these staffing levels as one of the physical interventions used required the input of three staff. Staff told us there were enough staff to meet people's needs but each of three relatives we spoke to felt a lack of staff plus frequent staff changes had affected people's welfare.

Relatives gave us mixed views about whether people were looked after well. Two relatives said people were looked after well but one relative said the home did not loook after their relative well, referring to the home not arranging enough outings and frequent changes of staff having an unsettling effect on people.

We noted that incidents regarding people's health and welfare were not always reported to the Commission.

People told us they liked living at the home. They told us they liked to go out and that they went out with staff to community facilities. People showed us the arts and crafts activities they were involved in. We saw that staff communicated well with people and had an awareness of people's communication needs. Relatives and a health and social care professional told us that people attended a range of activities, which included outings.

Staff told us the home provided a staff to person ratio of one to one as a minimum. We observed these staffing levels being provided.

We saw that each person had comprehensive care records, which included details of how people were supported with personal care and behaviour. A health and social care professional and two relatives told us the home met people's care needs.