This inspection took place on 26 September 2018 and was announced. At our last inspection in April 2016, we asked the provider to take action to make improvements to their recruitment procedures. The service was rated overall Good. However, a rating of requires improvement had been identified in the 'safe' domain due to the improvements needed in the recruitment of staff. The provider sent an action plan telling us how they would address these concerns. At this inspection we found improvements had been made and there was no longer a breach.

Foxhills Farm 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 service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

Foxhills Farm can accommodate up to 4 younger adults in one adapted building. The home has two floors accessed via stairs, three communal areas and large outside space where people could choose to spend their time. At the time of the inspection 4 younger adults who were living with learning disabilities and complex needs.

A registered manager was 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.

Prior to this inspection we had received concerns about staffing and the environment. We found the service had worked well to make improvements andno concerns were identified on the inspection..

People were protected against abuse because staff had received training and understood their responsibility to safeguard people. Concerns were reported and investigated.

Staff were aware of the need to treat people as individuals and ensure care reflected their individual needs. Risks associated with people’s needs were assessed and action was taken to reduce these risks.

People were supported to ensure they received adequate nutrition and hydration.

Staff worked well as a team and people were supported to maintain good health and had access to appropriate healthcare services.

Staff sought people’s consent and applied the principles of Mental Capacity Act 2005 (MCA) when this was needed, but records of this needed improving.

Observations reflected people were comfortable and relaxed in staff’s company. People were cared for with kindness and compassion. People’s privacy and dignity was respected and they were encouraged to be involved in making decisions about their care. Staff responded to people’s changing needs, supported them to maintain good health, have access to appropriate healthcare services and ensured a person centred service.

The provider’s recruitment process ensured appropriate checks were undertaken to ensure staff suitability to work in the home. People told us that how they felt staff had the skills and knowledge to care for them. Staff received supervisions and training to help them in their role.

There was a process in place to deal with any complaints or concerns if they were raised. Complaints were investigated, outcomes shared with people and staff.

Communication was open and staff felt supported and able to raise concerns at any time. They were confident these would be addressed. People, their families and staff had the opportunity to become involved in developing the service. The service aimed to ensure good quality care was delivered and there were s

This unannounced inspection took place on 27 April 2016. Foxhills Farm provides support and accommodation for up to four people who live with a learning disability. At the time of our inspection there were four people living in the service.

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 2008 and associated Regulations about how the service is run.

Procedures in relation to recruitment of staff had not been followed, which meant people’s safety had not always been considered.

Risks associated with people’s care were identified and plans had been developed to reduce any risks. Incidents and accidents were monitored on an individual basis. Medicines were stored safely and administered as prescribed. Fire safety checks were being carried out by staff, and there were no immediate concerns but as the fire officer has not visited the service we have referred,the service to them

Staffing levels were planned to meet the needs of people. Staff received appropriate training and support to meet people’s needs.. People had developed good relationships with staff who were caring and knowledgeable in their approach. People were treated with dignity and respect. People’s support plans had been updated to reflect people’s current needs. Staff had tried to include people in the development of the care plans. Two people told us they felt safe and people’s relatives told us people were well looked after and safe at the home. There were clear procedures in place for safeguarding people at risk and staff were aware of their responsibilities and the procedures to follow in keeping people safe.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager and staff had a good understanding of DoLS and the action they needed to take. Applications had been made to the local authority and considerations had been given to updating the applications. Staff demonstrated a good understanding of the need for consent and an understanding of the Mental Capacity Act 2005. The registered manager and staff knew how to undertake assessments of capacity and when these may need to be completed.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. People’s physical and emotional health was monitored and appropriate referrals to health professionals had been made.

Details of the complaints procedure were displayed around the home in a pictorial format. The home had a complaints procedure. The registered manager operated an open door policy and encouraged staff to make suggestions or discuss any issues of concerns. A system of audits was in place and used to identify where improvements could be made.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Foxhills Farm provides support and accommodation to a maximum of three people with a learning disability. At the time of our inspection there were three people living at the home.

During our visit we spoke with two of the three people who lived at the home. Due to the nature of people's learning disability we were not always able to ask direct questions to people. We did however, chat with them and were able to obtain their views as much as possible. We also spoke with relatives of two people, two health and social care professionals who had involvement with two people at the home, the homes deputy manager, a senior carer and four members of staff.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

None of the people we spoke with had any concerns about the support they received. People were treated with kindness, dignity and respect by staff. People and their relatives told us about their satisfaction with the home. People told us they felt safe.

We saw care and treatment was planned and delivered in a way that ensured people's safety and welfare. All of the care plans we looked at had risk assessments in place to assist staff in minimising any known risks.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager told us that staff had received training with regard to DoLS and the home had appropriately submitted DoLS applications and were awaiting a response to the application.

Is the service effective?

Each person had a plan of care and support. We saw that support plans explained what support people needed from staff. Staff told us the care and support plans gave them the information they needed to provide the level of support people required.

We observed staff supporting people and care staff were aware of people's needs and preferences in how people wanted care to be delivered. We saw staff offered advice and support and enabled people to make their own choices and decisions as much as possible.

Relatives told us they felt their relatives were well supported by staff. One relative told us “I am happy with the care provided for my relative, In the past I have had some concerns but the home is making progress and I am quite happy”.

Is the service caring?

We observed staff speaking to people appropriately and they used people’s preferred form of address. People we spoke with told us staff were kind and patient in their approach.

We saw care workers taking time to chat with people. They responded promptly to peoples requests for assistance and had a good understanding of people’s needs. Relatives described their satisfaction with the home. One person told us, “My relative comes home every other weekend and when it’s time to go back they are quite happy to go” Heath and social care professionals told us they found that the staff were professional and caring towards people and showed a good understanding of their individual needs, likes and dislikes,

Is the service responsive?

We saw people had regular reviews of the care and support they received. We saw that care plans showed alterations had been made to people’s plans of care as people’s needs changed.

We saw people were able to participate in a range of activities. Staff told us they encouraged and supported people to participate in activities to promote and maintain their well-being.

People who used the service, their relatives and staff were asked for their views about how the home was meeting people’s needs and any concerns or ways to improve the service were acted on.

The two health and social care professional we spoke with told us they had developed a good working relationship with both the manager and senior support staff. This had enabled them to work closely with them to develop good guidelines and risk assessments that have been amended and reviewed as required.

Is the service well led?

A relative we spoke with told us that they had regular contact with the home and said that they could speak to the manager or staff at any time. They told us they were kept informed about any issues which affected their relatives.

All of the staff and people we spoke with said they felt supported. We saw the home had systems to monitor and assess the quality of the service provided by the home. These including a number of audits including health and safety, medicines, cleaning and infection control.

Staff meetings took place every three or four weeks and minutes of these meetings were kept. Staff confirmed this and said the staff meetings enabled them to discuss issues openly with the manager and the rest of the staff team.

We were not able to speak to people during our visit so spoke to three relatives. We observed one person relaxing in their room and another person was getting ready to go out. We spoke to each of the four staff on duty.

We found that each person had a number of documents about their care. These included a daily activities timetable and daily records of key events for each person. There were comprehensive records regarding the management of individual’s behaviour; these included guidance on when ‘as required’ medication should be used. Staff were trained in the use of physical interventions and told us these were used as the least restrictive last resort for preventing injury. Relatives of people living at the service told us they considered the home used physical interventions appropriately and proportionately. Relatives told us they considered the home was a safe place for people to live.

There were four staff on duty and two people at the home at the time of our visit. There were times when the staff rota showed three staff on duty when three people were at the home. The home needs to review these staffing levels as one of the physical interventions used required the input of three staff. Staff told us there were enough staff to meet people’s needs but each of three relatives we spoke to felt a lack of staff plus frequent staff changes had affected people’s welfare.

Relatives gave us mixed views about whether people were looked after well. Two relatives said people were looked after well but one relative said the home did not loook after their relative well, referring to the home not arranging enough outings and frequent changes of staff having an unsettling effect on people.

We noted that incidents regarding people’s health and welfare were not always reported to the Commission.

There were two people present during our inspection visit and we had some observation of people and staff. We spoke to both these people. Due to people’s needs we had only limited communication with them. In order to gather information about people’s experiences at the home we also spoke to a health and social care professional who has involvement with two people at the home. We also spoke to two relatives of people living at the home.

People told us they liked living at the home. They told us they liked to go out and that they went out with staff to community facilities. People showed us the arts and crafts activities they were involved in. We saw that staff communicated well with people and had an awareness of people’s communication needs. Relatives and a health and social care professional told us that people attended a range of activities, which included outings.

Staff told us the home provided a staff to person ratio of one to one as a minimum. We observed these staffing levels being provided.

We saw that each person had comprehensive care records, which included details of how people were supported with personal care and behaviour. A health and social care professional and two relatives told us the home met people’s care needs.

During our visit we spoke with three people who live at the home, three staff and the provider.

People who live at the home are very dependent on the support of the staff, they were not able to comment specifically on their needs and care they are given.

They were able to tell us about recent events such as going out for lunch with family or what was planned for the next day.

We observed how staff interacted with people in a friendly and respectful manner and ensured choice with daily events. The atmosphere seemed calm and relaxed.

Staff told us that they received regular training and were supported by the management of the home. They said that they could speak with senior staff about any concerns they had about the running of the home.