We carried out an unannounced comprehensive inspection at Farm Lane on 5 and 6 December 2017.

Farm Lane is a Residential Care Home providing care and support to people with a learning and physical disability. Most of the people who lived at Farm Lane had complex health and care needs. Support for people’s health needs were sought from local primary care services, such as district nursing and specialist learning disability professionals including occupational and speech and language therapists. The service is registered to provide personal care and accommodation for up to nine people. On the days of our inspection nine people were living at the care home.

Mencap is the registered provider for Farm Lane House. Mencap is a National Charity providing a range of care service throughout the country. Farm Lane House is purpose built with all facilities provided on one level.

At the time of the inspection the manager was in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered person’s’. 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. Following the inspection we were informed the manager had successfully registered with CQC as the registered manager for Farm Lane House.

At the last inspection the service was rated as Good. At this inspection we found the service remained Good.

The service continued to provide care, which protected people and kept them safe. This was because staff understood about how to identify and report any incidents of abuse and/or poor practice. Management and staff undertook relevant training and had information about locally agreed safeguarding protocols.

People’s risks in relation to their health and lifestyle were understood by staff and managed appropriately. People lived in an environment, which the provider had assessed to ensure it was safe. People were protected by the provider’s infection control procedures, which helped to maintain a clean and hygienic service.

People received their medicines safely, by staff who had been trained appropriately and had their competency regularly tested. Overall medicines were stored safely. However, some excess medicines required safer storage. This was raised with the registered manager and provider and action was being taken to rectify this.

People continued to receive care that was effective and met their needs. This was because staff received appropriate training and were supported by colleagues and management to undertake their role effectively. People’s human rights were protected because the registered manager and staff had an understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards.

People received an organised and co-ordinated approach to their health and social care needs. People had access to external healthcare professionals to ensure their on-going health and well-being. Healthcare professionals spoke positively about the care people received at Farm Lane particularly in relation to their dietary risks and end of life care. People’s risks and needs in relation to eating and diet were understood and met by staff.

People and their relatives told us staff were caring and kind. Staff demonstrated kindness and compassion for people through their conversations and interactions. People’s privacy and dignity was promoted and respected.

People received personalised and responsive care. People’s individual and diverse needs were understood and met. People were supported in a way they chose and preferred and support plans were reviewed regularly to help ensure they were up to date and appropriate.

People had opportunities to lead as full and active a lifestyle as possible. Relatives were welcomed into the home and were involved i

We used a number of different methods to help us understand the experiences of people using the service because some people had limited communication which meant they were not all able to tell us about all their experiences.

We met and spoke to the seven people who used the service, spoke to staff about the care given and looked at the care records of three people who lived in the home. We looked at other records and observed staff working with people. We also spoke with the manager.

We saw staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. We saw that the staff had a good understanding of people's individual needs and that they respected people’s privacy and dignity.

During our visit to the home we saw sufficient staff on duty to meet the needs of people living in the home. We found that staff received the training they required to carry out their roles.

We saw that people's personal support plans described their needs and how those needs were met. We saw records showing that best interest meetings had been arranged to determine whether a new therapy programme was in people’s best interest.

We saw that medication was administered by suitably trained staff. People were not always protected against the risks associated with medicines because the records staff completed did not protect people from harm.

We saw that Farm Lane House held all records securely to protect people’s confidentiality.

We used a number of different methods to help us understand the experiences of people using the service, because they had complex needs which meant they were not all able to tell us their experiences.

We met all seven people who used services and spoke to three staff members on duty and checked the provider's records. We also spoke via the telephone with one relative. We spoke to staff about the care given, looked at the care records of three people; we met them, looked at other records and observed staff working with them.

We saw that staff treated people with consideration and respect. For example, most people living in Farm Lane House had complex health needs and required a lot of staff input with close monitoring at all times. We observed that the staff responded to each person with patience and understanding at all times.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. They demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have.

One staff member said, “It is like a family here”.

One person when asked if they liked living at the home said, “Yes”. A relative said, “Best one (home) X has been in”.

People living in Farm Lane House have limited communication and were unable to communicate with us, however we did meet with the people living in the home and observed the interaction between them and the staff working in the home. Information about peoples' experiences in the home was given to us by two visiting professionals, staff and management of the home.

During our visit we observed people enjoying there activities, going about there everyday routines and interacting positively with the staff supporting them. One person was in the kitchen assisting the cook in preparing and making cakes.

The inspection took place on 16 and 17 June 2015 and was unannounced. At our last inspection on 15 and 16 December 2014 we found breaches of legal requirements related to the assessing and monitoring the quality of service provision and the management of medicines. The provider produced an action plan which explained how they would address the breaches of regulations. At this inspection we found these actions had been completed and improvements had been made.

Farm Lane House provides care and accommodation for up to 9 people. On the day of the inspection 8 people lived within the home. Farm Lane House provides care for people who have a learning disability and may also have physical disabilities.

The service had a registered manager in post. 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.

During the inspection people and staff were relaxed. There was a calm and pleasant atmosphere. People had the freedom to move around freely as they chose and had an abundance of opportunities to maintain social contact within the community.

People told us they felt safe. Advice was sought to help safeguard people and respect their human rights. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated. The manager had sought and acted on advice where they thought people’s freedom was being restricted.

Care records were focused on giving people control. Staff responded quickly to people’s change in needs. People and those who matter to them were involved in identifying their needs and how they would like to be supported. People’s preferences were sought and respected. People’s life histories, disabilities and abilities were taken into account, communicated and recorded. Staff provided consistent personalised care, treatment and support.

People’s risks were managed well and monitored. There was a culture of learning from mistakes. Accidents and safeguarding concerns were managed promptly. Investigations were thorough and action was taken to address areas where improvements were needed. There were effective quality assurance systems in place. Incidents were appropriately recorded and analysed.

People were promoted to live full and active lives and were supported to go out and use local services and facilities. Activities were meaningful and reflected people’s interests and individual hobbies. One staff member commented, “We give people lots of choice and have different activities to help people in different situations. For example, aromatherapy or use of our sensory bath can be used to help settle people if people feel distressed”. Relative’s told us their loved ones enjoyed the variety of activities the staff enabled them to take part in.

People were supported to maintain a healthy balanced diet. Dietary and nutritional specialists’ advice was sought so that people with complex needs in their eating and drinking were supported effectively.

People had their medicines managed safely. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, social workers and speech and language therapists.

People received consistent co-ordinated care when they moved between services. Staff ensured individual preferences were respected and care needs continued to be met.

Staff were encouraged to be involved and help drive continuous improvements. This helped ensure positive progress was made in the delivery of care and support provided by the service.

People knew how to raise concerns and make complaints. An easy read version of the complaints policy was made available. Relatives who had raised concerns confirmed they had been dealt with promptly and satisfactorily.

Staff received a comprehensive induction programme. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively. The service followed safe recruitment practices to help ensure staff were suitable to carry out their role.

Staff described the management as very open, supportive and approachable. Staff talked positively about their jobs. Comments included: “It’s a really nice place to work”, “I enjoy my job and get a lot of support” and “I think my job is brilliant, there is always somebody to support you when needed”.