Decoy Farm

Updated 27 April 2023

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.

Inspection team

Three inspectors carried out this inspection, one of whom specialised in medicines. An Expert by Experience carried out calls to relatives to gain their feedback about the service. 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

Decoy 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. Decoy Farm is a care home with 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 the Care Quality Commission 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.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

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. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We reviewed care plans and associated records for four people. We reviewed multiple medicines records. We spoke with the registered manager, deputy manager, clinical lead, service director and one support worker. We spoke with one person who used the service, and observed staff delivering care to two people.

After the inspection the expert by experience spoke with four relatives. We spoke to one person who lived at the service, one senior support worker, and two support workers. We also received feedback from a best interest assessor, social worker, quality assurance officer, quality improvement nurse, two learning disability nurses, a consultant psychiatrist, and an adult support co-ordinator in the learning disability team.

Updated 27 April 2023

About the service

Decoy Farm is a nursing home providing personal and nursing care to up to 10 people with a learning disability, autistic people, mental and/or physical healthcare support needs. At the time of the inspection, there were nine people living at the service. The service was split into four buildings, two of which were self-contained accommodation.

Decoy Farm is located in the village of Browston. Outside there was nothing to indicate it was a registered care home which helped to promote the concept of community living. The service benefits from a large shared garden, as well as a farm with animals and an area where people can grow their own produce.

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.

Right Support

Staffing levels had at times fallen short, due to last minute staff sickness. Management had however attempted to find cover which included the use of agency staff. There was a system in place whereby staff could call upon senior managers and on-call for advice. However, a more robust contingency plan is needed for these occasions to ensure people are always supported safely and there is a suitable skill mix of staff.

Staff had received training to support the people they were caring for. Further training was needed for newer staff, so they understood the most effective approach to use when supporting people, and to ensure consistent approaches were used by all staff. Staff were provided with support in the form of continual supervision, appraisal and recognition of good practice. Staff understood the need to promote people's safety from experiencing potential abuse and harm.

People received their oral medicines safely. We could not be assured that people were receiving their topical medicines, such as creams, as there were gaps in records. People were referred to health care professionals to support their wellbeing and help them to live healthy lives. Where people were at risk of weight gain or loss, more robust monitoring of people’s dietary intake was required.

People were mainly 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 support this practice. The provider was affiliated with the Restraint Reduction Network which aims to reduce reliance on restrictive practices.

Care records contained person centred detail and people had been involved in creating their care plans. Some further work was required to ensure all detail was accurate, and that the language used by some staff in written form was appropriate.

Right Care

Risks to people had been identified and detailed support plans were in place. Daily meetings had been implemented so any new risks could be discussed promptly. The core staff team knew people well and had established positive relationships with them. However, some newer staff required further training to ensure that interactions with people were consistent and effective to mitigate potential risk. Additional training was also planned to ensure staff were confident using observation tools and completing incident documentation.

People were taking part in more activities of their choosing, including in the community, and with family or friends.

Right Culture

More robust monitoring and auditing systems were required to ensure all aspects of people's care needs and their quality of life were being measured effectively.

The registered manager had a clear vision for the direction of the service which demonstrated a desire for people to achieve the best outcomes possible. The service worked well in partnership with other health and social care organisations, which helped to improve the wellbeing of people that used the service.

The manager promoted a positive and person-centred culture within the service and led by example. Staff were feeling more supported and valued. The registered manager was working with relatives to improve communication and to gather their feedback about the service provided. The management team and staff shared a commitment to continuously learning and worked in partnership with other professionals to achieve good outcomes for people.

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 15 September 2021) and there were breaches of regulation. We imposed conditions on the provider's registration.

At this inspection we found that improvements had been made and the provider was no longer in breach of regulations.

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

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

Follow up

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.