Cocklebury Farmhouse

Updated 23 July 2022

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 Care Act 2014.

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

Two Inspectors, a member of the CQC medicines team and an internal specialist advisor attended the home. An Expert by Experience carried out phone calls to relatives. 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

Cocklebury Farmhouse 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 service had two managers registered with the Care Quality Commission. 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. One of the registered managers was gradually stepping back and handing over control of the service to two new managers.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We looked at all the information we held on the provider including information from a variety of sources. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. We spoke with health professionals who regularly attend the service. We used all of this information to plan our inspection.

During the inspection

We communicated with people including using a form of signing to support our speech. Seven relatives were called about their experience of the care provided. We also received feedback from six professionals who regularly had contact with the home.

We are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. In this report, we used this communication tool with three people to tell us their experience.

We spoke with seven members of staff including both registered managers, the new managers and support staff. We used the Short Observational Framework for Inspection (SOFI) and spent time observing people. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included five people’s care records and a range of medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 23 July 2022

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.

About the service

Cocklebury Farmhouse is a residential care home providing personal care for up to 10 people. At the time of the inspection 10 people were receiving support. All people had lived at the home for a long period of time. People had communication difficulties at the service. Four people were in two shared bedrooms and the rest had individual personalised bedrooms. Lounges, the garden and dining area were all shared spaces.

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

Right Support

¿ Systems were being developed to ensure staff did everything they could to avoid restraining people. Management and staff made it clear it was considered necessary within their current knowledge and understanding.

¿ Restrictive practices had sometimes not been in line with those being trained which could risk people being harmed. Additionally, reflections post restraints were sometimes limited. The service recorded when staff restrained people however the records contained sometimes derogatory information that demonstrated a lack of knowledge and understanding by staff and management who were analysing the incidents. Work had already started to improve this.

¿ The service had not been working with people to plan for when they experienced periods of distress so that their freedoms were only restricted if there was no alternative.

¿ The service gave people care and support in a safe, clean, well equipped and well-furnished environment. Although certain health and safety checks were not always being completed in line with best practice. People’s sensory and physical needs had not always been considered.

¿ The service supported people to have choice, control and independence although this was restricted by an aversive risk culture leading from the paternalistic view.

¿ Staff had been supporting people to have wishes fulfilled. Although people had no clear long term aspirations and goals. There was a lack of consideration about support which would empower people to live as independent a life as possible.

¿Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways they understood because they knew them well. However, specialist communication approaches had not been explored and records did not always reflect what we were being told.

¿ The service had not always made reasonable adjustments for people so they could be fully involved in discussions about how they received support. The management had plans to improve people’s participation with electronic care plans.

¿ Four people’s choice and dignity had not been considered in relation to sharing bedrooms. People had a choice about their living environment and were able to personalise their rooms.

¿ The management had plans to improve how people played an active role in maintaining their own health and wellbeing. Staff enabled people to access specialist health and social care support in the community.

¿ Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. People’s preferences for administration were known by staff administering medicine.

Right Care

¿ The service had enough staff to meet people’s needs and keep them safe. Caring at the service was paternalistic which was not demonstrating an enabling culture at the home. The staff were not always appropriately skilled due to a lack of training around people’s disabilities and conditions.

¿ People received kind and compassionate care from staff working with the best intentions despite a lack of theoretical knowledge. Staff protected and respected people’s privacy and dignity when delivering care. They understood and responded to their individual needs.

¿ 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 could communicate with staff and understand most information given to them because staff supported them consistently and understood their individual communication needs. The management had plans to further develop interactive and more accessible information.

¿ People’s care and support plans reflected some of their range of needs and this promoted their wellbeing and enjoyment of life. Further information was required related to people’s specific needs relating to their diagnosis and conditions in order to underpin support needs and plans.

¿ Staff and people cooperated to assess risks people might face. Although the service was risk averse and limited the options for people.

¿ People received care that supported their needs and focused on aspects of their quality of life.

¿ People could take part in activities and pursue interests that were at times tailored to them. This included fulfilling wishes and choices they had expressed.

Right culture

¿ The management lacked knowledge of current legislation, guidance and practices which should be underpinning the culture of the support people should be receiving. They were open to improve this and work with other health and social care professionals.

¿ People were not supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have.

¿ Staff felt they placed people’s wishes and likes at the heart of everything they did. At times these were limited by staff knowledge and understanding.

¿ People, relatives and the management saw the service as an extended family which led to a kind and caring environment with positive values. However, the people’s rights as an adult were sometimes not being considered.

¿ People and those important to them, including advocates, were involved in planning their care. Plans were in place to increase opportunities for people to contribute further.

¿ People’s quality of life was enhanced by the current management’s culture of improvement including exploring interactive and digital systems to make things more accessible.

¿ Staff turnover was very low, which supported people to receive consistent care from staff who knew them well.

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

Rating

The last rating for this service was outstanding (published 30 May 2018).

Why we inspected

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

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 received concerns in relation to use of restricted practices at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led. We inspected and found there was further concerns including staff training, culture, management knowledge of guidance, legislation and best practice so we widened the scope of the inspection to become a comprehensive inspection.

The overall rating for the service has changed from outstanding to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement.

Enforcement

We have identified breaches in relation to staff training and use of restrictive practices at this inspection.

We have also made a recommendation in relation to keeping people safe from legionella.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.