We carried out an unannounced inspection at Bannister Farm Cottage on 23 and 25 July and 10 August 2018.Bannister Farm Cottage 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.
Bannister Farm Cottage is situated in a semi-rural area of Leyland, Lancashire. Accommodation compromises of three en-suite bedrooms within the main house and two self-contained annexes attached to the main building. At the time of our inspection there were four people who lived there permanently and one person who attended each week day and stayed overnight every Monday.
We inspected the home on this occasion in response to concerns being identified in relation to another service operated by the same provider and under the same registered manager. However, at the time of our inspection the registered manager was no longer working for the organisation. 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.
The care service is aware of 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. However, we found on this inspection that the service was failing to deliver these values.
We found that people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible, in accordance with the policies and procedures of the home.
During this inspection, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing. We also found one breach of the Care Quality Commission (Registration) Regulations 2009, in relation to notification of other incidents.
Our last inspection of Bannister Farm Cottage was carried out on 7, 11 and 12 December 2017. At that inspection we rated the service as overall ‘good.’ There were no breaches of the regulations at the time. At this inspection the rating had deteriorated to overall ‘inadequate’.
We have considered what action we will take in relation to these breaches. Following our inspection, we met with representatives of the provider to discuss our concerns and a way forward. The service submitted a robust action plan and have agreed to update and submit this on a weekly basis, until further notice. We have had management review meetings and followed our guidance in the enforcement decision tree.
We have made the decision, based on the level of risk, and engagement by the registered provider to issue requirements to the provider on this occasion, in relation to all breaches identified. However, the overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
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.
New employees had been recruited safely. However, incidents of misconduct had not been managed appropriately and staff members did not feel supported by the management team. Evidence was available to demonstrate there were insufficient numbers of staff deployed, who were suitably qualified, competent, skilled and experienced to meet the needs of those who lived at the home.
Practices adopted by Bannister Farm Cottage did not protect people from the risk of discrimination. Those who lived at the home were not adequately safeguarded from abuse and their human rights were not being appropriately met.
The staff training matrix showed a high number of employees had not completed learning modules in relation to safeguarding adults. We noted there were no systems in place for staff members to summon help when working in isolation and there was little evidence of lessons learned following safeguarding incidents or accidents.
Family members we spoke with did not feel their loved ones were safe living at the home. Risk assessments were not always accurate and up to date, which compromised people’s safety and well-being. However, the premises were, in general maintained to a satisfactory standard. However, where it was identified work needed to be done, this was addressed at the time of our inspection.
Emergency plans were in place at the home and systems and equipment had been serviced in accordance with manufacturers’ recommendations. However, incidents where injury had occurred had not always been recorded within the accident records.
Simulated fire drills were not always managed effectively and Personal Emergency Evacuation Plans (PEEPS) were not always accurate. This compromised the safety of those who lived at Bannister Farm Cottage.
Records we saw were sometimes vague and confusing. They did not always clearly identify the circumstances to which they referred. The management of complaints could have been better.
The management of medicines was, in general satisfactory. However, the practices in relation to the administration of PRN medication did not help people to reduce the possibility of heightened behaviours.
The provider was working within the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to help ensure people were not being unlawfully restricted.
Records showed people were able to choose their preferred diet. However, healthy eating was not regularly encouraged. We saw that nutritious home cooked meals and healthy snacks, such as fruit were served, but not on a daily basis.
We were concerned that the service was failing to be responsive to peoples’ assessed needs and choices and person-centred care was not being delivered. People who lived at Bannister Farm were not always treated with dignity, kindness and compassion.
The provider had failed to notify the commission of significant events occurring in the home, such as serious injuries and safeguarding incidents. Arrangements for monitoring and assessing quality in the home to ensure people's safety and compliance with regulations were inadequate. Some audits had been completed, but these were ineffective, as they did not cover a wide range of areas and they did not recognise shortfalls, which were identified during the inspection process. The governance and leadership of the home was poor. Managerial oversight of staff and the care that people received was inadequate.