We carried out an inspection of Higher Cockham Farm on 20 and 21 April 2017. The first day of the inspection was unannounced.

Higher Cockham Farm is registered to provide accommodation and nursing care for up to six people with mental ill health. The home is set in its own grounds in a rural position off a main road. Accommodation is provided in six single rooms. Shared space including a dining kitchen and living room is available on the ground floor.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers ('the provider'), 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 10 and 11 May 2016, we asked the provider to make improvements to the management of medicines and ensure people were fully involved in the care planning process. The home was awarded an overall rating of requires improvement. Following the inspection, the provider sent us an action plan which set out what action they intended to take to improve the service. During this inspection, we found improvements had been made in order to meet the regulations.

Safeguarding adults’ procedures were in place and staff understood how to protect people from abuse. Risks associated with people’s care were identified, assessed and recorded. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Safe staff recruitment procedures were in place which ensured only those staff suitable for the role were in post. People's medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

Staff had completed an induction programme when they started work and they were up to date with the provider's mandatory training. The registered manager and staff understood the main principles of the Mental Capacity Act 2005 (MCA). There were appropriate arrangements in place to support people to have a varied and healthy diet. People had access to a GP and other health care professionals when they needed them.

Staff treated people in a respectful and dignified manner and people's privacy was respected. People were involved in the development and review of their care plans. This meant people were able to influence the delivery of their care and staff had up to date information about people’s needs and wishes. We observed people were happy, comfortable and relaxed with staff. Care plans and risk assessments provided guidance for staff on how to meet people’s needs and were reviewed regularly. People were encouraged to build their independence skills and were supported to participate in a variety of daily activities.

The complaints procedure provided information on the action to take if a person wished to raise any concerns. People were aware of the complaints procedure and processes and were confident they would be listened to.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. The registered manager took into account people’s views about the quality of care provided through discussion and meetings. The registered manager used the feedback to make on-going improvements to the service.

We carried out an inspection of Higher Cockham Farm on 10 and 11 May 2016. The first day was unannounced.

Higher Cockham Farm is registered to provide accommodation and nursing care for up to five people with mental ill health. The home is set in its own grounds in a rural position. Accommodation is provided in five single rooms. Shared space including a dining kitchen and living room is available on the ground floor. From May 2015, the function of the service had changed from providing care for young people aged 18 and under to providing care and treatment for adults. At the time of the inspection there were four people using the service.

The service was managed by 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.

We last inspected this inspected this service on 3 October 2013 and found it was meeting the regulations applicable at the time.

During this inspection, we found there were two breaches of the current regulations. These related to the management of medicines and people’s lack of involvement in the care planning processes. You can see what action we told the provider to take at the back of the full version of the report.

People were treated with respect and staff engaged with people in a friendly and courteous manner. Throughout our visit we observed caring and supportive relationships between staff and people living in the home. People told us they were satisfied with the service they received. They told us staff were kind and respected their privacy and dignity.

There were procedures for safeguarding people. Staff had a good knowledge of how to identify abuse and the action to take if abuse was suspected. Arrangements were in place to make sure sufficient numbers of skilled staff were deployed at all times.

People were satisfied with the arrangements in place to manage and administer their medicines. However, we identified shortfalls in the medicines records, for instance there were no clear instructions for staff on when to administer medicines prescribed “as necessary”. There were also gaps in the medicines administration records where staff had not signed to indicate the medicine had been given and there were not always directions for the application of prescribed creams.

We found staff recruitment to be thorough and all relevant checks had been completed before a member of staff started to work in the home. Staff had completed relevant training for their role and they were well supported by the registered manager.

Staff understood the relevant requirements of the Mental Capacity Act 2005 and how it applied to people in their care. People's consent was sought before care was given and they made choices and decisions about how this was carried out.

People's individual needs and risks were identified and managed as part of their plan of care and support to minimise the likelihood of harm. However, we found people had not been involved in the care planning process. This was important so that staff were fully aware of their views and preferences.

People were supported with their nutritional needs and staff promoted healthy dietary options. Staff liaised closely with healthcare professionals and ensured people had good access to healthcare services.

People were encouraged and supported to make decisions for themselves and their independence was maintained and promoted. People were provided with the support to maintain links with their family.

People were aware of how to make a complaint or raise a concern and had opportunities to provide feedback on the service at the residents’ meetings.

There were systems in place to regularly assess, monitor and improve the quality of the service

Our inspection on 25 April 2013 found that care plans had not been reviewed on a regular basis and staff had not been supported with on-going supervision and training. Following the inspection, the provider sent us an action plan stating these issues would be addressed by the end of June 2013. We visited the home again to check the actions taken and found the necessary improvements had been made.

Young people’s care plans had been reviewed on a monthly basis and the young people had been involved in the care planning process. A young person spoken with was satisfied with the care and support provided in the home.

Staff training had been updated and staff had received a monthly supervision. They had also been given the opportunity to attend team meetings once a month. This meant staff were able to discuss their views about the operation of the home.

At the time of our inspection there were two young people living in the home. Both young people told us they were happy and comfortable and they liked the staff team.

The young people had been involved in their initial assessment of needs, however, we found one young person’s care plan had not been reviewed and updated since their admission several months ago and the other young person’s plan had been reviewed but not updated. This meant staff were not provided with clear information about the young people’s current needs and preferences.

Suitable arrangements were in place to manage, administer and record medication in the home.

The recruitment and selection of new staff included an interview and appropriate checks to ensure suitable people were employed in the home.

Whilst staff told us they were provided with training, the staff training records had not been kept up to date. We also found two senior staff had not been provided with supervision or an appraisal of their work performance. This meant staff were not always provided with appropriate support to carry out their role.

At the time of our inspection there was one person living in the home. The young person told us they were happy with the service and confirmed they were involved in decisions about their care. We noted the young person had detailed support plans which were underpinned with a series of risk assessments. The service used a variety of therapeutic techniques to help young people work towards their desired outcomes. A teen star approach was used to enable young people to plot their progress throughout their therapy programme. This enabled the young person to play an active part in their therapy.

The young person told us they felt comfortable and safe in the home. Staff spoken with confirmed they had received appropriate training on safeguarding children and knew what to do in the event of an alert.

Staff were provided in suitable numbers to meet the needs of the young person. Staff told us they were provided with a range of training which was relevant and useful to their role.

We found there were established systems to monitor the quality and operation of the service and the views of the young person using the service were obtained on an ongoing basis.

A number of records were maintained including comprehensive individual support plans. However, we found some financial records were contradictory and the medication records lacked sufficient detail. This meant young people were not fully protected against the risks arising from the lack of proper information.