This inspection visit took place on 6 and 7 August 2018 and was unannounced.

Farmhouse Care Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Farmhouse Care Home is registered to provide care and accommodation for up to 20 people. The home does not provide nursing care but aims to offer specialist care for older people living with dementia. The accommodation is arranged over two floors with a stair lift available to access the upper floor. Five of the rooms were shared rooms. There is a small secure outdoor patio area but no garden. At the time of our inspection 18 people were living at the home.

There was a registered manager in place. 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.

We last inspected this service on 20 and 23 May 2016 and found the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. The proper and safe use of medicines. We issued requirement notices in respect of those breaches.

Following our inspection, the provider sent us an action plan to tell us about the actions they were going to take to meet these regulations and make the necessary improvements. During this inspection, we found that action had been taken to address these concerns.

People, their relatives and staff told us the registered manager was supportive and approachable.

People were supported by staff who knew them well. Staff we spoke with were enthusiastic about their jobs, and showed care and understanding both for the people they supported and their colleagues.

Staff understood the actions to take to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by the management team.

Medicines were stored safely and securely, and procedures were in place to ensure people received their medicines as prescribed.

The service had robust recruitment procedures to make sure staff had the required skills and were of suitable character and background.

People and their relatives told us they enjoyed the food served which considered peoples individual dietary needs and preferences.

Staff understood the requirements of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The registered provider’s policies and systems supported this practice.

People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way, while promoting their independence. People told us they were treated with dignity and respect.

People’s care records reflected the person’s current health and social care needs. Care records contained up to date risk assessments. There were systems in place for care records to be regularly reviewed.

There was a complaints policy and procedure in place. People’s comments and complaints were taken seriously, investigated, and responded to.

There were effective systems in place to monitor and improve the quality of the service provided.

The service had up to date policies and procedures which reflected current legislation and good practice guidance.

Safety and maintenance checks for the premises and equipment were in place and up to date.

Farmhouse Care Home is owned by Mr and Mrs Kitchen who are throughout this report referred to as the provider. The home is located in a residential area of Totton, on the outskirts of Southampton and can accommodate up to twenty older persons. The accommodation is arranged over two floors with a stair lift available to access the upper floor. Five of the rooms were shared rooms. There is a small secure outdoor patio area but no garden. The home does not provide nursing care but aims to offer specialist care for older people living with dementia. There were 15 people living in the home when we inspected.

The service had a registered manager. 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 and associated Regulations about how the service is run. The registered manager had recently been absent from the service for a period of three months.

Improvements were needed to ensure that medicines were always stored safely. Where people were prescribed ‘as required’ medicines, they did not have individualised protocols in place to guide staff as to when to give these. The provider did not have an up to date medicines policy and staff did not have an annual update of their skills and knowledge to administer medicines safely.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect. Staff were confident the registered manager would act upon any concerns they raised. However the provider’s ‘Safeguarding Vulnerable Adults Policy’ ‘Whistleblowing Policy’ needed to be reviewed and updated to ensure they reflected current legislation.

People had risk assessments and where risks had been identified, measures were in place which helped to ensure that the risk was minimised. However, we did note that body maps could be more effectively used to document and plan for how skin damage was responded to.

Safe recruitment practices were followed and appropriate checks had been undertaken which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff to meet people’s needs.

The registered manager had plans to introduce a mental capacity toolkit developed by the local authority to help ensure that they and staff were able to fully document how mental capacity assessments had been undertaken and what decisions had been reached in the person’s best interests.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations were either in place or had been applied for

Improvements were planned to update aspects of the premises and make the design and layout of the home more suitable for people living with dementia.

New staff received a service based induction which involved learning about the values of the service, people’s needs, key policies and the opportunity to shadow more experienced staff for period of time before they worked independently. Staff felt the training provided was adequate and helped them to provide effective care.

People told us the food was tasty and that they were supported to have enough to eat and drink. Care plans included information about their dietary needs and risks in relation to nutrition and hydration.

People told us they were supported by staff that were kind and caring and that they treated with dignity and respect.

Care plans contained the information needed to support staff to provide people’s care in a manner that was responsive to their individual needs. People were supported to take part in a range of activities and make choices about how they spent their time.

People spoke positively

During this inspection we spoke with three people who used the service, with three staff and with the manager.

People were happy with the service provided and we saw that staff interacted well with people in their care and talked positively about their work.

People's needs were assessed and care was delivered in line with their care plans. There were policies and procedures in place to ensure that the safety and suitability of the premises was maintained, these were understood and followed by staff.

When we spoke with people who used the service they were able to tell us that they felt safe at Farmhouse Care Home and we observed that staff interacted and assisted people in a caring and respectful way.

There was an effective system in place to deal appropriately with comments and complaints made by people, or persons acting on their behalf. A relative had recently commented in a: ‘How well are we doing survey’: ‘Extremely happy with the way it’s run and with staff. What a good choice we made’.

In this report the names of Registered Managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still Registered Managers on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individuals' names from our register.

The purpose of the visit was to follow up on two areas of concern. The way medication was dealt with and numbers of staff with the suitable qualifications. We spoke with the manager and three members of staff on duty. We also spent time observing the interactions between people who use the service and staff. We observed staff providing support to people in a sensitive way that maintained their privacy and dignity. Staff were friendly and respectful in their conversations with people. Staff took the time to respond to requests for assistance and to answer questions.

Staff told us that they felt that there were sufficient staff with the right knowledge, experience, qualifications and skills to support people.

We saw effective processes for the safe and secure handling of medicines and staff were trained and competent in the handling of medicines.

We did not speak with people who lived at the service during this inspection. The purpose of the visit was to follow up on an area of non compliance identified during our visit in August 2012. This related to poor ventilation in one of the bedrooms and the maintenance of some bedroom windows. We spoke with the manager and visited the bedrooms in question. The broken windows had been suitably replaced. We judged therefore that the provider was now meeting the standard relating to safety and suitability of premises.

During the visit we spoke with three people who use the service. People told us they were well treated by staff and that they liked the home. Comments included “staff listen to what I am saying” and “staff treat us well”.

We observed staff supporting people to make decisions, for example, about where to have lunch and what drinks to have. Staff took the time to listen to people’s requests and to respond to them. Staff provided discreet support for people to go to the toilet when necessary and ensured that people’s privacy was maintained when discussing their care needs.

People told us staff provided the care and support that they needed. During the visit we saw examples of good staff interactions with people who used the service, for example, responding to questions and supporting people to go out to the garden when they requested. Staff demonstrated a good understanding of people’s needs and communicated with people in different ways. We saw that staff provided reassurance and calm support to a person who became distressed.

People told us the home was kept clean. One person said the home “always smells fresh” and another person said they had “no concerns about odours” in the home. Although people were happy with the environment, we found that some of the windows did not work and one room had no ventilation. The provider needed to take action to resolve this.

We spoke to the majority of people living in the home. Sometimes this was limited due to their impaired memory. All people were very positive about the home and the staff. People told us they had all their needs met by kind caring staff. People reported they enjoyed their meals in the home.

We spoke with three relatives visiting the home. They all made good comments about the home. They reported they are always made welcome and offered a hot drink. One relative had called in to have lunch with her Mum and reported the meal was very nice. They told us the staff were very caring and they were kept well informed of their relatives care and changing needs. Relatives told us if they had any concerns they would inform the manager who they had confidence in to resolve the situation.

We spoke to the majority of people living in the home. Sometimes this was limited due to their impaired memory. All people were very positive about the home and the staff. People told us they had all their needs met by kind caring staff. People reported they enjoyed their meals in the home.