About the service: Dixons Farm is a residential care home which is registered to provide personal care for up to six people. At the time of our inspection six people were living in the service. The services facilities are over three floors for five people and there is a separate annexe where one person has access to a lounge, bedroom and a bathroom. There is a large secure garden to the rear of the property with car parking available. The service is situated on the outskirts of Preston close to local amenities and public transport links.

People’s experience of using this service: Not all people told us the service was safe. Systems to act on allegations of abuse were in place. Risks in general had been managed however actions had not been taken to address shortfalls in the findings of a fire risk assessment. Analysis of incidents had not been completed in a timely manner. Improvements were required in the safe management of medicines. Staff were recruited safely and there was an ongoing recruitment programme to address the staffing levels and provide a consistent staff team.

Deprivation of Liberty applications had been completed however reapplications were not submitted in the required time. Capacity assessments required completing in full. People received a varied diet and had been involved in shopping tasks. Staff training had been completed. Where specialist behaviour support training was required the service was acting on this.

Staff engaged with people and were seen to be kind and caring. However, we noted one occasion where a person’s personal care needs were discussed openly in the communal areas. Not all people were supported with their decisions to access all communal areas of the service.

Good information was available in care files, which ensured staff had access about how to deliver care to people. Activities were taking place. The management discussed that improvements in people accessing activities in the service were required. A system to deal with complaints was seen.

The manager had identified the immediate areas that required action. Audits had recently been recommenced. Senior oversight was ongoing to provide support and drive improvements in the service. Team meetings were taking place.

Rating at last inspection: The last inspection was undertaken on 27 and 28 June 2016. It was rated good in all key questions and good overall. The report for this inspection was published on 1 August 2016.

Why we inspected: This was a scheduled inspection based on the previous ratings.

Enforcement: Information relating to the action the provider needs to take can be found at the end of this report.

Follow up: The service will be reinspected as per our inspection programme. We will continue to monitor any information we receive about the service. We may bring the next inspection forward if we receive any concerning information.

We carried out an inspection of Dixons Farm on 27 and 28 June 2016. We gave the service 48 hours’ notice of the inspection because it is a small service and we wanted to make sure the people living there and the manager would be in.

Dixons Farm provides accommodation and personal care for up to six adults with a learning disability. At the time of the inspection there were six people living at the service.

Bedrooms and facilities at the home are located over three floors. All bedrooms are single occupancy. There is a kitchen, dining room, lounge and conservatory. There is a bathroom and appropriate toilet facilities. One person’s living space within the home has a bedroom and a separate lounge and bathroom. There is a garden to the rear of the property.

At the time of our inspection there was a registered manager at the service who had been in post since 2011. 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.

At our last inspection on 20 February 2014, the provider was compliant with all of the standards that were reviewed at that time.

Relatives told us they felt people living at the service were kept safe. The staff we spoke with had a good understanding of how to safeguard vulnerable adults from abuse and what action to take if they suspected abuse was taking place.

We saw evidence that staff had been recruited safely. We found that there were enough staff on duty to meet people’s needs and relatives and staff were happy with the staffing levels at the service. Staff felt well supported by the registered manager. They received an appropriate induction, regular supervision and effective training.

There were appropriate policies and procedures in place for managing medicines. The relatives we spoke with were happy with the way people’s medicines were managed. People were supported with their healthcare needs and were referred appropriately to a variety of healthcare services. Local healthcare professionals were happy with the care provided at the service.

The relatives we spoke with were happy with the care provided to people living at the home. One relative told us, “We’re very happy with the care. [Our relative’s] happy there”.

We observed that people’s needs were responded to in a timely manner and saw evidence that their needs were reviewed regularly. We saw staff treating people with patience and kindness. Relatives told us the staff who supported their family members were caring.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The service had taken appropriate action where people lacked the capacity to make decisions about their care. Relatives told us they were involved in decisions about their family member’s care. They told us staff respected people’s privacy and dignity and encouraged them to be independent.

Risks relating to people’s nutrition and hydration were assessed and managed appropriately. Relatives were happy with the food provided at the home and we observed people being supported appropriately with their meals.

People took part in a variety of activities within the home and staff supported them to participate in a variety of activities in the community regularly.

Relatives and staff felt the service was well managed and they felt able to raise any concerns. We observed staff and the registered manager communicating with people and each other in a respectful and friendly manner.

The service had a statement of purpose which focused on maintaining positive changes for people who have a learning disability in a homely environment. We saw evidence that this approach was promoted by the registered manager and staff at the ho

We identified concerns with the premises when we last visited the service, in November 2013. The provider sent us an action plan telling us how they were going to make improvements. We carried out this inspection to check the improvements had been made.

We found the provider had completed the improvements included in their action plan. Work had been undertaken to make improvements to the premises to ensure the safety of people who used the service, staff and visitors.

At the time of our visit to Dixons Farm there were five young adults who lived at the home who were unable to communicate with us verbally.

People who lived at the home looked happy in their environment and were evidently very relaxed and content in the presence of staff members. Evidence was available to demonstrate they were supported to experience a way of life suitable to their individual

needs.

We found cleanliness in the home to be of a good standard. Some areas of the home required some maintenance, but otherwise the premises were suitably decorated and furnished.

We found from speaking with a family member of one of the young adults and staff confirmed, there was regular contact between the service and families of the people who they supported. This helped the service to continually monitor the quality of the support they delivered to people. Comments we received from the family member we spoke with were all positive.

At the time of our visit to Dixons Farm there were six young adults living at the home. Five of these people were unable to communicate with us verbally. One person who could verbalise was at school, but he called home for a short while at lunch time, when we were able to chat with him.

People living at the home looked happy in their environment and were evidently very relaxed and content in the presence of staff members. Evidence was available to demonstrate they were supported to experience a way of life suitable to their individual needs. Comments received from the young adult spoken with were all positive.

People at the home were unable to fully enter into a discussion about many aspects of their care and support, due to the nature of their individual care and and support requirements. However, it was clear from observing the way they, and the staff interacted and worked together that their involvement in their care and support is both valued and promoted.

One person spoke about the choices they have around food and activities, and another person spoke about how they are helped to keep in touch with friends and family. One person spoke about how the staff help them to work out what they like and dislike in relation to food and types of clothing. People said that the staff were great, and that they really enjoyed their company.