This comprehensive inspection took place on 25 and 27 September 2018 and was unannounced on 25 September and announced on 27 September.

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 regulati

The inspection took place on 14 March 2017 and was unannounced. Duckyls Farm Centre provides accommodation and personal care for up to 10 people who have a learning disability. One the day of the inspection eight people were living at there. The home is located on a farm in a rural area of West Sussex. The people who live there take part in work on the farm and in the garden.

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,

The inspection took place on 28 October and was unannounced.

Duckyls Farm Centre provides accommodation and personal care for up to ten people who have a learning disability. On the day of our inspection nine people were living there. The home is located on a farm in a rural area and people who live in the community work on the farm and in the garden.

Duckyls Farm Centre had a sole individual provider who had day-to-day oversight of the operations. Therefore a registered manager was not required, so the service did not have one. The provider had a deputy manager who assisted with the day to day management at the home.

We carried out an inspection of Duckyls Farm Centre on 24 February 2015. Breaches of legal requirements were found and we took enforcement action against the provider. We issued warning notices in relation to the management of medicines and the keeping of records. We identified four further breaches of regulations in relation to supporting staff, capacity and consent, safeguarding and governance. After this inspection the provider wrote to us to say what they would do to meet the legal requirements in relation managing medicines, records, safeguarding, capacity and consent, supporting staff and governance.

Following this we undertook a comprehensive inspection on the 28 October to follow up whether the required actions had been taken to address the previous breaches identified and to see if the required improvements as set out in the warning notices had been made. The report covers our findings in relation to those requirements. We found improvements had been made in all areas but that there were some areas that needed ongoing improvement.

Improvements had been made in the management of the service and systems had been introduced to support with this. The registered provider had taken steps to get up to date with current legislation, policy and procedure and developed robust systems for recording care plans and daily records. A system for auditing had been developed, however this was yet to be implemented. This remained an area that needed improvement.

Improvements had been made around the registered provider’s knowledge of Deprivation of Liberty Safeguards (DoLs) and The Mental Capacity Act 2015 (MCA) and the provider demonstrated that they had applied the principles of this legislation to people who lived at the home. This included referral for assessment under DoLs and referral for an Independent Mental Capacity Advocate (IMCA) to ensure people’s rights were respected. However staff were not clear about the principles of this legislation and this remained an area that needs improvement.

Improvements had been made to staff training and staff had received training in areas such as safeguarding and medicine management. Staff told us that they felt supported to carry out their roles. The provider had a training plan in place to address other areas of training such as MCA and infection control. As staff had not received all the training they needed this remained an area that needed improvement.

Improvements had been made in the management of medicines. These were managed and administered safely and the correct policies and procedures were in place to support this. We observed medicines being given and that this was done accurately. Medicines were ordered and disposed of safely and stored appropriately.

People felt safe living at the home. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate the risks. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe from harm and abuse. The registered manager made sure there was enough staff on duty at all times to meet people’s needs. When the provider employed new staff at the home they followed safe recruitment practices. People told us they felt safe living at Duckyls Farm Centre. One person said “Yes, I love it here. I love the countryside too”. A relative told us “My [family member] is safe and looked after”.

Relatives and health and social care professionals spoke positively of the service. They were complimentary about the caring, positive nature of the staff. We were told “Staff are all very nice and caring” and “The care is very good”. Staff respected people’s privacy and dignity and their individual preferences. Our own observations and the records we looked at reflected the positive comments people made.

Accurate care records were kept for each person and there were clear daily records in place that described what medicine they had taken, what they had eaten and what activities they had participated in. These records were person centred and described individual need. People worked on the farm and the garden and had access to and could choose suitable educational, leisure and social activities in line with their individual interests and hobbies. People went swimming, shopping, to the local social club and pub.

People’s relatives, staff and professionals who knew the service spoke positively about the registered provider and deputy manager and the culture of the home. One relative said “”I think [the deputy manager] is well on the ball”. They praised the inclusive nature of the home and how it supported people to be as independent as possible. A representative from commissioning department at the local council commented on the positive improvements that had been made to the home following the last inspection.

The inspection took place on 25 February and was unannounced.

At our previous inspection in July 2014 we identified several breaches of the Regulations. We asked the provider to carry out improvements in the areas of management of medicines, safety and suitability of premises and records. We received an action plan from the provider on 20/01/2014 that stated that actions had been taken to address the issues identified. At this inspection we saw that sufficient action had been taken to address the issues identified around the safety and suitability of premises but that there were continuing concerns in relation to the management of medicines and records.

Duckyls Farm Centre provides accommodation and personal care for up to ten people who have a learning disability. They recently increased their registered beds from eight to ten. On the day of our inspection nine people were living there. The home is located on a farm in a rural area and people who live in the community work on the farm and in the garden.

Duckyls Farm Centre had a sole individual provider who had day-to-day oversight of the operations. Therefore a registered manager was not required, so the service did not have one. The registered provider had a deputy manager who assisted with the day to day management at the service.

Staff had not received up to date safeguarding training. The registered provider was not aware of the current multi-agency arrangements for safeguarding people from abuse. There were no instructions for staff regarding reporting safeguarding concerns and the safeguarding policy was out of date.

Medicines were not managed safely. Practice around the administration of medicines was not safe and there were no plans in place for the storage and administration of controlled drugs and drugs that needed refrigeration. There were gaps in the medication administration records (MAR charts).

Reviews or updates to care plans and risk assessments were not undertaken on a regular basis and there were no daily recordings regarding care delivered by staff. Staff and residents’ meetings and staff supervisions were inconsistently recorded.

Caring interactions took place between staff and people living at the home. Staff knew people well and so could respond to them in a thoughtful and gentle manner. Staff had not received consistent training and staff were not adequately trained in some areas.

People told us they felt happy living at Duckyls Farm Centre and that they thought the staff were kind. Relatives said that staff were kind and caring and that they were happy that their family members were living at the service.

There were a wide range of activities that people could participate in including activities on site, on the farm and garden. People also participated in activities in the local community.

People had access to healthcare professionals including GPs and community nurses.

There were no clear processes or thorough systems in place to manage and monitor the quality of the service being provided at Duckyls Farm Centre. Audits of practice had not been carried out and the views of people and their relatives had not been sought in a formal way.

We found several breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014, including two continued breaches since our previous inspection. You can see what action we have asked the provider to take at the back of the full version of this report.

During our inspection we spoke with the assistant manager, three staff and all the people at the home. People told us they liked living at Duckyl's Farm. Comments included "I like it in the countryside", "I am happy here" and "I like it here very much".

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.

People living at the home were referred to as students by each other and staff and that is how we refer to them in this report.

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.