Our inspection team was made up of two inspectors and a pharmacist inspector who considered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
We found that care was provided in houses on the Primrose Hill Farm site that were safe, accessible clean and well maintained. People had their health and welfare needs safely met as there were sufficient numbers of staff on duty that had the appropriate skills and experience. Recruitment practice is safe and thorough. In addition new staff were told the limitations of their role until they had been trained. We spoke to four people who used the service who confirmed they felt safe and nine relatives and eleven staff agreed. Comments included: "yes feel safe, staff are good" and "Yes its safe. I think it is excellent."
We checked people's care plans and found that these were detailed and up to date. Risks were identified and for the most part plans were detailed enough to ensure that people had the care provided safely and risks to them and / or other people were minimised. Staff we spoke with were aware of the care that people needed to keep them safe. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards applications had been submitted when needed. People who were affected by these safeguards were aware of them and staff worked towards restoring these freedoms to the people concerned.
People received their medicines at the right time and checks were in place to ensure that all medicines were accounted for. Medicines were administered safely.
Is the service effective?
We asked the nine relatives we spoke with whether they had seen any improvements in their relative's well being or behaviour. The majority of relatives told us of improvements they had observed their comments included: "(My relative) is doing far more activities than before," "They work to provide stimulation, (my relative's) behaviour has improved and the service is moving in the right direction" and "Last year (my relative) was institutionalised. Primrose Hill Farm have worked magic since they have been there." All of them told us that they could talk with care staff and some had arrangements for regular up-dates. Amongst relative's comments was praise for the some of the deputy managers of the service who relatives felt ensured that people received a consistent quality of service. All of them told us that there had been improvements in the service in the last 12 months.
Where people who used the service were able, they were asked to comment on the service provided, this included questions about the support they received.
People's needs were taken into account, where people had restricted mobility they were offered ground floor bedrooms and bedrooms were adapted to reflect their interests or their health conditions.
Is the service caring?
During our observations we saw that people were supported by kind and attentive staff. We saw that care staff showed patience and acted appropriately when a person showed behaviour that could be perceived as challenging. People we spoke with generally confirmed that staff were caring, one said: "Staff know how to calm me down." Although one person said that there was no staff that they liked. We spoke to eleven staff in four houses on site and they all told us that the staff were caring and they were confident in the care they gave to people.
People's preferences, interests, aspirations and diverse needs had been recorded in people's care plans and people were supported as much as possible with these interests.
Is the service responsive?
People completed a range of activities in and outside the service regularly. People who had capacity to understand knew how to make a complaint if they were unhappy. Relatives told us that they were able to raise their concerns. Amongst relatives comments were: "I am more confident that (an agreed action) will now take place" and "If I have any concerns it soon gets sorted out."
People were supported to attend doctors, dentists and other health appointments when needed.
Is the service well-led?
The service worked well with other agencies and services to make sure people received their care in a joined up way. The provider had arranged for a health professional to be regularly available on site to answer concerns about the care of people who have behaviour that can be perceived as challenging.
The service has a quality assurance system, however some relatives had not been approached to complete a survey for some time. Relatives spoken with felt able to contact the service directly. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. We saw that in each house there were meetings with staff to discuss quality issues and this helped to ensure that people received a good quality service at all times.
We saw that there were safe systems for medicine management in operation. This included undertaking regular checks on medicine records to identify any problems and to ensure staff followed safe medicine procedures. At this inspection, we found arrangements were in place to ensure that medicines were managed safely.