Archived: Duckyls Farm Centre

About the service

Duckyls Farm Centre is a residential care home providing personal care and accommodation for up to 10 people with learning disabilities and autism. There were nine people living at the home on the day of our inspection. The home was a large adapted farmhouse building that combined a self- contained flat and main building over two floors.

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

Right Support

Staff supported people to have the maximum possible choice, control and independence be independent and they had control over their own lives. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Each person had their own en-suite rooms, which were personalised to meet their needs and preferences. The home had extensive communal and shared space for which people could undertake individual activities as well group ones. The home was complimented with extensive grounds, that comprised of farm areas and fields that people were supported to use. People took an active role in activities and tasks on the farm. One person recalled excitedly about their work and involvement with the animals on the farm. One relative said, “The management have increased the activities inclusive of mental and physical demands.”

The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced.

Staff enabled people to access specialist health and social care support in the community. Staff supported people to make decisions following best practice in decision-making.

Right care

People received kind and compassionate care. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. One professional said, “I have always found the manager and her team really helpful. They work in a person-centred way supporting the resident I have placed there to make choices and be as independent as possible ensuring their interests, faith and care needs are met holistically with dignity and respect.”

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 9 July 2019) 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.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

This was a planned focused inspection based on the previous rating. We carried out an announced comprehensive inspection of this service on 7 and 9 May 2019. Breaches of legal requirements were found.

Following the last inspection in May 2019, we imposed conditions on the provider's registration. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care by the provider. The conditions meant that the provider was required to send to the CQC information regarding the homes restraint policy and training. The provider was also required to send CQC monthly information about incidents and accidents, safeguarding referrals, Mental Capacity Assessments and information about lessons learnt. We used this information to help us review and monitor the service and actions to improve, and to inform our inspections. We undertook this focused inspection to check they had followed their action plan, to confirm they now met legal requirements and continued to meet the requirements imposed on their Registration.

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.

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 requires improvement to good. 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 Duckyls Farm Centre 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.

Duckyls Farm Centre is a residential care home providing personal care and accommodation for people with learning disabilities and autism. There were eight people living at the home on the day of our inspection.

The home was a large adapted farm house building that combined a self- contained flat and main building over two floors. The building was bigger than most domestic style properties. It was registered for the support of up to 10 people. The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure the people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

People’s experience of using this service:

Since the previous inspection, there had not been sufficient improvements in relation to quality monitoring and governance. The provider did not have effective quality assurance systems to ensure a good level of quality and safety was maintained.

People were potentially at risk due to shortfalls in relation to the management and oversight of; accident reporting, restraint practices, epilepsy care planning, mental capacity assessments, gaps in staff knowledge and/or training and inconsistent record keeping. In addition to this the provider was not always meeting their regulatory responsibility to notify the Commission of significant events.

People were not consistently safe from the risk of abuse. Staff were trained and had an awareness of how people with learning disabilities could be placed at risk. However, incidences of abuse were not always identified and reported in a timely way so that they could be investigated, acted on and learned from.

People were not consistently supported in the least restrictive way possible; the policies and systems in this service did not support this practice. Staff received some training and told us they felt well supported. However, staff had not received accredited training in positive behaviour support and restraint in line with their policies and best practice models. This placed people at potential risk of not having their legal right to liberty respected.

The provider recognised they needed to make further improvements to the oversight of the governance of the service. They were in the process of recruiting a ‘registered manager’ to ensure the day to day running of the service was sufficiently robust.

The outcomes for people living at Duckyls Farm Centre were personalised and reflected the caring values of the staff supporting them. One person told us, “The staff know how to help me, all the staff are nice and like me, they give me help, care, love and kindness.”

There were enough staff to meet people’s needs and they were recruited safely. People were comfortable with staff and were cared for in a safe, friendly and calm environment.

People had access to a range of activities that met their interests and reflected their diverse needs and cultures. A relative told us, “My relative enjoys watching sports, listening to music and going to church is a big part of their life. They go horse riding and really like being on the land with the animals, we come from a family of farmers, the outdoor life is something that they love.”

People were supported to maintain a healthy nutritious diet and had access healthcare services and professionals as and when needed. One relative told us, “They motivate people and ask them to do things and ensure they are active and enjoying themselves. My relative recently joined a gym. They have had a lot of operations and for a long time were less capable. Now they can walk more easily and are getting fitter.”

People were encouraged to express their views and their communication needs were met. A relative told us, “The staff support my relative very well, they understand their facial expressions and demeanour. They are listened to and have a key ring with pictures that they use to make choices.” Staff were asked for their opinions on the home and felt supported within their roles. When needed end of life care could be planned for and people and their relatives’ wish’s respected.

People's privacy, dignity and independence was important to staff and promoted. One person told us, “Staff always ask before they help me.” Another person told us, “I like to cook and help people. I can make an apple crumble and the people love it.”

Medicines were managed in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored and administered appropriately. Risks associated with some people’s care and the environment had been identified and managed. Emergency and infection control procedures were in place and people knew what to do, as did the staff.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement, including breaches of regulation and we serviced a Warning Notice. (Published 24 December 2018). At this inspection the service remained Requires Improvement.

Why we inspected:

This was a scheduled comprehensive inspection based on our methodology. At this inspection we identified areas that required improvement, including breaches of regulation.

Enforcement / Improvement action we have told the provider to take

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

We will be in contact with the provider following this report being published to discuss how they will make changes including; seeking an action plan, requiring positive measures and working with partner agencies to ensure they improve their rating to at least good.

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

Duckyls Farm Centre 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 home can provide accommodation and care for ten people in one detached building that is adapted for the current use providing two-bedroomed self-contained flat and eight individual bedrooms in the main area of the building. The home provides support for people living with a range of learning disabilities some people live with autism and have sensory needs. There were eight people living at the home at the time of our inspection.

The service had a registered provider. A registered provider is a person who has registered with the Care Quality Commission to manage the service. Like registered managers, they are ‘registered persons’. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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. Duckyls Farm Centre has a sole individual provider who has oversight of the service through an employed assistant manager who has responsibility for the day to day running of the home.

Duckyls Farm Centre was designed, built and registered before ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion to enable people with learning disabilities and autism to live as ordinary a life as any citizen. The building did not consistently meet the guidance as it was a large setting that would not, without planning and further adaption, continue to meet the needs of the people living at the home as their physical needs changed.

At the last inspection on 14 March 2017 we found one breach of the regulations. The service was rated as ‘Requires Improvement’. This was because the provider had not fully ensured that staff understood how to work in line with the Mental Capacity Act or that best interest decisions were assessed and evidenced robustly. We wrote to the provider on 23 May 2017 and asked them to tell us what they would do to ensure they met the legal requirements by 14 June 2017. The provider shared further evidence with the Care Quality Commission in relation to best interest decisions that had been made. However, they failed to provide us with an action plan to confirm what they had done or would do to meet the legal requirements. We undertook this inspection on 25 and 27 September to check whether the required actions had been taken to address the breach previously identified.

At this inspection improvements had been made in some areas. Staff could demonstrate that they had received training and understood how to promote choice in line with the MCA. However, there remained shortfalls in how the service evidenced how it supported people in the least restrictive way, and protected their rights to consent to their care and treatment. This was identified as a continued breach of the regulations.

At this inspection we found the overall rating of the service remained Requires Improvement. This is the fourth consecutive time the service has been rated ‘Requires Improvement.’

There was a continued lack if effective quality assurance systems and shortfalls in processes used to maintain and improve standards and quality of care. The provider had not fully ensured that people were protected from the risk of harm or that risks were managed safely. People’s right to have their diverse preferences met in relation to end of life care and potential equalities based choices were also not consistently promoted. This was identified as a breach in regulations.

There was a lack of understanding by the provider in relation to their responsibilities as a registered person with the Care Quality Commission (CQC), to provide timely responses in relation improvements required and to notify us of safeguarding concerns in line with regulations.

Complaints records did not consistently demonstrate that the provider followed their own processes to ensure complaints were analysed and consistently acted on. Staff and relatives told us that the provider was not always open to their feedback and suggestions in relation to how the service could develop.

People told us they felt safe and happy living at Duckyls Farm Centre. One person told us, “I feel safe living here. It’s peaceful and the staff are nice.” Staff could demonstrate a good understanding of their safeguarding responsibilities and were confident that if they raised concerns they would be treated seriously. There were arrangements in place for the safe ordering, administration, storage and disposal of medicines. Environmental risks were identified and managed appropriately including infection control. People were supported to have their medicine safely when they needed it. Staffing levels were consistent and there were enough staff to keep people safe.

People and their relatives felt staff were skilled to meet the needs of people living with a learning disability and provide effective care. People were supported by staff that knew them and their relatives well. Recruitment records demonstrated that staff were safe to work with people. People’s right to maintain important relationships was respected and promoted. Staff understood the importance of protecting people and their colleagues from all types of discrimination. Arrangements were in place that supported the religious expression of both people and staff.

People’s nutritional and dietary needs were met. Mealtimes were relaxed and unrushed and people were actively involved in cooking and planning their meals. One relative told us, “The food is great and always home cooked using fresh ingredients.” People were supported to maintain good health and access health professionals including GPs, and specialist consultants.

People’s relatives told us, and we saw, that the staff were caring and respectful. One person told us, “They are all very kind to me.” A staff member told us, “We are really caring, we help people as much as we can, they are open and free and it feels like a family, we have good relationships with people and their families.” Care and support provided was personalised and met peoples’ emotional and care needs. People and their relatives were included in the assessment of their needs and development of care plans.

People were supported to be as independent as they could be and to have access to meaningful activities by staff that were respectful of their skills. One staff member told us, “We try to treat people as individuals, treat them with respect and encourage them to be independent.” Staff were responsive to people’s communication skills and needs. Information for people and their relatives was provided in a way that met people’s needs including accessible formats such as pictures or signing.

People, relatives and staff understood the value of the service as a homely, family environment. Staff spoke with genuine regard for the people living at the service and had positive relationships with people’s relatives. One staff member, “The most important thing is the wellbeing of the resident and that they are happy.” A relative told us, “Duckyls is homely and friendly.”

There were two breaches of regulations. You can see what actions we asked the provider to take at the end of the full version of the report. 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.  

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. Duckyls Farm Centre had a sole individual provider who had day to day oversight of the service. Therefore a registered manager was not required. The provider employed a deputy manager who assisted with the day to day management of the home. Some members of staff lived on the farm.

The previous inspection of 28 October 2015 had followed up on earlier breaches of the regulations that had been identified. The inspection found that improvements had been made, but there remained areas of practice that needed further improvement. At the inspection on 14 March 2017 we checked if the required actions had been taken. This report covers our findings. We found that whilst some actions had been taken it remained that some areas of practice continued to require improvement.

Staff were inconsistent in their understanding of their responsibilities with regard to the Mental Capacity Act 2005 (MCA). Some restrictive practices were in place however it was not clear if the person was able to consent to this or if a best interest decision had been made. This was identified as a breach of the regulations.

A continued lack of effective auditing systems meant that the provider could not be assured that shortfalls in practice were identified and rectified. This was identified as an area of practice that needed to improve.

People told us they felt safe and happy living at Duckyls Farm Centre. One person said, “It is safe here, we can ask for help if we need to.” People were supported to receive their medicines safely. Risk assessments supported people to take risks and remain as independent as possible. Staff understood their responsibilities with regard to keeping people safe. Staff knew how to recognise signs of abuse and were clear about what to do if they suspected this. Staffing levels were consistent and there were enough staff to keep people safe. Staff told us they felt well supported. They had weekly meetings, regular supervision and access to the training they needed to carry out their roles

People told us that they liked the food and that they had enough to eat and drink. Their comments included, “It is always nice food,” and “My favourite is sausages. I can always ask for more if I’m hungry.” People were able to choose the food they wanted to eat and their dietary needs and preferences were accommodated. There was fresh fruit available for people to help themselves.

Staff supported people to work on the farm and said that this provided them with fresh air and exercise. People told us they enjoyed the work. One person told us, “I am strong and I like work on the farm, it’s my choice and I like it.” People were supported to maintain good health and had access to the health care services they needed.

The staff were kind and caring, one person told us, “All the staff are nice, my boss is nice, I love him.” Another person said, “Yes, I am happy here, everyone is kind. I love living here in the country.” Staff knew people well and supported them to be as independent as possible. People were supported to express their views about their care and felt that staff listened to them. Staff spoke about people warmly and were proud of people’s achievements. One staff member told us, “I will support them to do anything they can, even if it takes longer, with a lot of encouragement. You can see the pride when someone has achieved something.” Visitors were welcomed and we noted that people invited their friends and family to visit regularly.

The range of activities and occupations that people undertook were many and varied. People told us about the work they enjoyed on the farm and in the garden. One person said, “I held a lamb and helped to feed it,” another person said, “I like collecting the eggs.” Some people had volunteering jobs in the local community and staff told us that everyone had their own area of garden where they cultivated flowers, fruit or vegetables. People were supported to lead full and busy lives. Staff had developed links with the local community and supported people to maintain strong connections with neighbours and community groups.

The ethos of the home was to provide people with opportunities to be as independent as possible and to live fulfilling lives. This was reflected by staff and embedded within their practice. Staff were motivated and had a clear understanding of their roles and what was expected of them.

We found one breach of the regulations. You can see what actions we asked the provider to take at the end of the full version of this report.

We found that all the people were actively involved in the day to day tasks at the home and around the farm. People were comfortable in their surroundings and moved freely around the home. We observed that people were treated with respect and as individuals.

People received the care and support which met their needs as individuals. Staff had a good understanding of the needs of each person and encouraged them to be independent and make decisions for themselves. We observed that people enjoyed the activities on the farm.

We found that medication was administered correctly but that people were not fully protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

The environment was maintained to a good standard and there was a homely feel to the layout and decor. However, risks related to windows and hot water meant that people who used the service were not adequately protected.

We found that records were kept securely as required. However, people were not fully protected from the risks of unsafe or inappropriate care because accurate and up to date records were not always maintained.

During this inspection we met and spoke with all six students who were at home that day and spoke with the provider, the deputy manager and two staff. We looked at care plans for three students who required varying degrees of support and spoke with one student in private. We observed students being supported by staff. We found that student's privacy, dignity and independence were respected and that their views, wishes and experiences were taken into account.

Students experienced care and support that met their needs and protected their rights. One student told us 'I really like it here. I like the country and my garden'. Individual needs had been assessed and reviewed. Care plans were personalised.

We looked at safeguarding arrangements including staff training and talked to staff. We found that students were protected because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

We looked at records of supervision and training, spoke with staff and observed practice. We found that staff were well supported and were trained but not all supervision and training sessions were recorded. From observation students' welfare needs were met by competent staff.

The provider had in place systems system to assess and monitor the quality of service which sought people's views.