This unannounced comprehensive inspection took place on 8 February 2018. The last inspection took place on 30 July 2015 when the service was meeting the legal requirements. The service was rated as Good that time. Following this inspection the service remains Good.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Church Farm is a care home which offers care and support for up to 60 predominantly older people. At the time of the inspection there were 44 people living at the service. Some of these people were living with dementia. The service occupies a building over two floors with passenger lift for people to access the upper floors. There was an on-going safeguarding investigation being carried out at the time of the inspection by the local authority. This incident is subject to a separate process and as a result this inspection did not examine the circumstances of that specific concern. However, the information shared with CQC about the incident indicated potential concerns about the management of risk in relation to the availability of equipment. This inspection examined those risks. We found that when people’s health indicated they needed additional equipment action was taken to acquire it.

The records in care plans, relating to the powers of attorney held by some people living at the service, were misleading and inaccurate. Some care plans stated relatives held power of attorney for care decisions when they did not. This meant people who did not hold the appropriate legal powers could be involved in care plan decisions and reviews and were asked to sign consent forms which they were not legally able to do. We have made a recommendation about this in the Effective section of this report.

There were systems in place for the management and administration of medicines. Regular medicines audits were being carried out on specific areas of medicines administration and these were effectively identifying if any issues occurred such as the dating of prescribed creams when opened. We identified an issue with the length of time taken to complete the morning medicine round leaving only a short period of time before the afternoon round began. This could have implications for people on time specific medicines and pain relief. We also observed frequent interruptions of the staff member carrying out the medicine round. We have made a recommendation about this in the Safe section of this report.

The premises were well maintained. The service was not registered for dementia care. However, there were some people, who were living at the service with some early dementia. There was no pictorial signage for people who may require additional support with recognising their surroundings. The deputy manager told us this was constantly under review depending on people’s needs.

The premises were regularly checked and maintained by the provider. Equipment and services used at Church Farm were regularly checked by competent people to ensure they were safe to use.

We walked around the service which was comfortable and appeared clean with no odours. People’s bedrooms were personalised to reflect their individual tastes. People were treated with kindness, compassion and respect.

Risks in relation to people’s daily lives were identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible.

Staff were supported by a system of induction training, supervision and appraisals. Regular staff meetings took place to support each team of staff. Daily heads of service meetings took place to help ensure communication was good across the service. The registered manager was supported by the deputy manager and the provider with regular visits from regional manager, and a team of motivated staff at the service.

Risks in relation to

This inspection was carried out on 23 June 2015 and was unannounced. Church Farm Residential Home is a service which is registered to provide support and accommodation for up to 60 older people. It does not provide nursing care. Accommodation is provided over two floors and there was a lift available to access all floors. There was a total of 39 members of staff employed plus a deputy manager and the registered manager. On the day of our visit 51 people were living at the home.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

People told us they felt safe. Relatives told us they had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of harm.

Care records contained risk assessments to protect people from any identified risks and helped to keep them safe. These gave information for staff on the identified risk and guidance on reduction measures. There were also risk assessments for the building and emergency plans were in place to help keep people safe in the event of an unforeseen emergency such as fire or flood.

Recruitment checks were carried out on newly appointed staff to check they were suitable to work with people. Staffing levels were maintained at a level to meet people’s needs. People told us there were enough staff on duty, however staff told us that due to people’s dependency levels, when senior staff were administering medicines they were at times stretched.

People told us the food at the home was very good. There was a menu displayed in the dining room and information regarding meals and meal times were in each person’s room.

People were supported to take their medicines as directed by their GP. Records showed that medicines were obtained, stored, administered and disposed of safely. The provider’s medicines policy was up to date. There were appropriate arrangements for obtaining, storing and disposing of medicines

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. There were no people living at the home who were currently subject to DoLS. The registered manager understood when an application should be made and how to submit one. The provider was meeting the requirements of DoLS. People were able to make day to day decisions for themselves. There were no restrictions imposed on people. The registered manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity.

Each person had a plan of care which provided the information staff needed to support people and staff received training to help them meet people’s needs. Staff received regular supervision including observations of staff when carrying out their duties. Monitoring of staff performance was undertaken through staff appraisals which were conducted every six months.

Staff were supported to develop their skills and received regular training. The provider supported staff to obtain recognised qualifications such as National Vocational Qualifications (NVQ) or Care Diplomas (These are work based awards that are achieved through assessment and training. To achieve these awards candidates must prove that they have the ability to carry out their job to the required standard). All staff completed an induction before working unsupervised. Staff had completed mandatory training and were encouraged to undertake specialist training from accredited trainers.

People’s privacy and dignity was respected and staff had a caring attitude towards people. Staff were smiling and laughing with people and offering support. There was a good rapport between people and staff. Regular competency checks were carried out on the standard of care provided.

Staff were knowledgeable about people’s health needs and knew how to respond if they observed a change in their well-being. Staff were kept up to date about people in their care by attending regular handover meetings at the beginning of each shift. The home was well supported by a range of health professionals. We contacted a GP practice who provided a service to some of the people at the home. They told us that the registered manager and staff were very approachable and had good communication skills; they said the staff were open and transparent and worked well with them to meet people’s needs

The registered manager operated an ‘open door’ policy and welcomed feedback on any aspect of the service. There was a stable staff team who said that communication between all staff was good and they always felt able to make suggestions and confirmed management were open and approachable.

The registered manager acted in accordance with the registration regulations and sent us notifications to inform the commission of any important events that took place in the home.

The provider had a policy and procedure for quality assurance. The registered manager was visible and an area manager employed by the provider visited the home regularly. Weekly and monthly checks were carried out to help monitor the quality of the service provided. There were regular residents meetings and their feedback was sought on the quality of the service provided. There was a complaints policy and people knew how to make a complaint if necessary.

We spoke with nine people and one relative during our visit. They told us that they were happy living at the home and that staff were caring and supportive. One person said, “I want to be as independent as possible but I know I can ask for help when I need it”. A recent note of thanks from a relative read, ‘We have been really happy with X’s (family member) care. All the staff have been so kind’.

We spoke with four members of staff, the manager and deputy manager. Staff told us that they enjoyed working in the home. One said, “The residents really make the place”. Another told us, “I love it here, it’s a lovely place to work”.

We found that people were supported appropriately. The home had a new manager in place. She was active in seeking the views of people, their relatives and visitors in order to develop the service. At the time of our inspection, the previous manager had not deregistered with CQC and therefore their name remains on any reports until such time as this information is received.

We spoke with 11 of the 45 people who lived at the service. Everyone told us that they were happy with the care and support they received. They also told us that the service arranged healthcare appointments promptly. One person told us, "I'm very satisfied. They help me with my catheter which I'm very grateful for. The staff are very kind. There is a good mix of staff". Of the 11 people we spoke with 10 said that staff treated them with respect and promoted their privacy. All 11 people told us that they felt safe from harm living at the service and that they would be listened to if they raised any concerns. As one person explained, "Old people can be frightened to talk but it's not like that here". Everyone that we spoke with told us that a choice of activities were available and that regular meetings now took place where peoples views were sought.

People expressed satisfaction with the care they receive and the meals provided by the home.