About the service:

Primrose Hill Farm is a residential care service providing personal care and support to 39 people who were all aged under 65 at the time of the inspection. The service is provided in seven self-contained houses and is occupied by people living with mental health problems, learning disabilities or autism.

The care service had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. The home had been registered before such guidance was produced. The guidance focusses on values which include choice, promotion of independence and inclusion so that people with learning disabilities and autism using a service, can live as ordinary a life as any citizen. However, it was clear that people living in Primrose Hill Farm were given such choices and their independence and participation within the local community had been, and continued to be, encouraged and enabled. Although the houses that make up Primrose Hill Farm are near to each other on a shared site, every house is self-contained with a separate staff team and day to day management provided by a deputy manager in each house. Activities and participation in every day events is organised independently by people and staff in each house.

People’s experience of using this service:

People who use the service continued to be supported in a safe way. Staff were attentive, kind and committed to providing safe care and support. People and relatives told us they were positive about the support people received to keep them safe from abuse, known risks and discrimination, whilst having opportunities to lead a full varied life.

People continued to be encouraged and supported to have their physical and mental healthcare needs met. People were encouraged by staff to eat well and maintain good health through everyday activity and participation in activities in the community.

We saw that people were comfortable in the company of staff. We noted that staff were attentive and responsive when people were ill at ease or showing signs of distress.

Staff teams in each of the houses ensured they shared important information about people promptly, and followed up on actions that had been planned by other staff as necessary to provide good continuity of care.

Management oversight of each of the houses and how they supported people was ongoing. People were well supported and the views and opinions of people, staff, relatives, and professionals continued to be sought out and used to help monitor and continue to drive up the quality of the service provided.

Rating at last inspection:

The service was rated Good (report published in June 2016).

Why we inspected:

This was an unannounced scheduled inspection based on the previous rating.

Follow up:

We will continue to monitor the service through the information we receive.

This inspection took place on 5 May 2016 and was unannounced. The home was last inspected in March 2014, and was compliant with all the regulations we looked at. This was the first ratings inspection of this service. The inspection team comprised of one inspector, a specialist advisor and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Primrose Hill Farm is a residential home which provides support to people who have learning disabilities and autism. The home is registered with the Commission to provide care for up to 39 people. The home is set up as seven different houses which are managed by three registered managers. There were two registered managers available on the day of the inspection to speak with us. A third registered manager was in the process of being recruited. 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.

People who used the service and their relatives told us that the home was safe. Staff were aware of the need to keep people safe and the provider conducted checks to ensure people were supported by staff who were suitable. The storage, administration and recording of medication was good and there were robust systems for checking that medication had been administered in the correct way.

Staff were appropriately trained, skilled and supervised and they received opportunities to further develop their skills.

People were supported to express their preferences and decisions about their care, and these were taken into account. When the support people received risked restricting their freedom, the registered manager had supported people in line with the appropriate legislation.

People were supported to have their mental and physical healthcare needs met and were encouraged to maintain a healthy lifestyle. The registered manager sought and took advice from relevant health professionals when needed. People were provided with a good choice of food in sufficient quantities and were supported to eat meals which met their nutritional needs and personal preferences.

We saw that people were happy around staff and with the support they were receiving. People had opportunities to participate in a range of activities staff knew they enjoyed. People were supported to maintain relationships which were important to them.

Staff understood the needs of the people they supported. We saw that staff communicated well with each other and spoke highly of the manager and leadership they received. The manager assessed and monitored the quality of care consistently through regular audits of events and practice.

Our inspection team was made up of two inspectors and a pharmacist inspector who considered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that care was provided in houses on the Primrose Hill Farm site that were safe, accessible clean and well maintained. People had their health and welfare needs safely met as there were sufficient numbers of staff on duty that had the appropriate skills and experience. Recruitment practice is safe and thorough. In addition new staff were told the limitations of their role until they had been trained. We spoke to four people who used the service who confirmed they felt safe and nine relatives and eleven staff agreed. Comments included: "yes feel safe, staff are good" and "Yes its safe. I think it is excellent."

We checked people's care plans and found that these were detailed and up to date. Risks were identified and for the most part plans were detailed enough to ensure that people had the care provided safely and risks to them and / or other people were minimised. Staff we spoke with were aware of the care that people needed to keep them safe. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards applications had been submitted when needed. People who were affected by these safeguards were aware of them and staff worked towards restoring these freedoms to the people concerned.

People received their medicines at the right time and checks were in place to ensure that all medicines were accounted for. Medicines were administered safely.

Is the service effective?

We asked the nine relatives we spoke with whether they had seen any improvements in their relative's well being or behaviour. The majority of relatives told us of improvements they had observed their comments included: "(My relative) is doing far more activities than before," "They work to provide stimulation, (my relative's) behaviour has improved and the service is moving in the right direction" and "Last year (my relative) was institutionalised. Primrose Hill Farm have worked magic since they have been there." All of them told us that they could talk with care staff and some had arrangements for regular up-dates. Amongst relative's comments was praise for the some of the deputy managers of the service who relatives felt ensured that people received a consistent quality of service. All of them told us that there had been improvements in the service in the last 12 months.

Where people who used the service were able, they were asked to comment on the service provided, this included questions about the support they received.

People’s needs were taken into account, where people had restricted mobility they were offered ground floor bedrooms and bedrooms were adapted to reflect their interests or their health conditions.

Is the service caring?

During our observations we saw that people were supported by kind and attentive staff. We saw that care staff showed patience and acted appropriately when a person showed behaviour that could be perceived as challenging. People we spoke with generally confirmed that staff were caring, one said: "Staff know how to calm me down." Although one person said that there was no staff that they liked. We spoke to eleven staff in four houses on site and they all told us that the staff were caring and they were confident in the care they gave to people.

People’s preferences, interests, aspirations and diverse needs had been recorded in people's care plans and people were supported as much as possible with these interests.

Is the service responsive?

People completed a range of activities in and outside the service regularly. People who had capacity to understand knew how to make a complaint if they were unhappy. Relatives told us that they were able to raise their concerns. Amongst relatives comments were: "I am more confident that (an agreed action) will now take place" and "If I have any concerns it soon gets sorted out."

People were supported to attend doctors, dentists and other health appointments when needed.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. The provider had arranged for a health professional to be regularly available on site to answer concerns about the care of people who have behaviour that can be perceived as challenging.

The service has a quality assurance system, however some relatives had not been approached to complete a survey for some time. Relatives spoken with felt able to contact the service directly. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. We saw that in each house there were meetings with staff to discuss quality issues and this helped to ensure that people received a good quality service at all times.

We saw that there were safe systems for medicine management in operation. This included undertaking regular checks on medicine records to identify any problems and to ensure staff followed safe medicine procedures. At this inspection, we found arrangements were in place to ensure that medicines were managed safely.

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 named as registered managers on our register at the time of our visit.

During this inspection we spoke with ten people and 14 staff. Several people were not able to give us their views because of their complex needs and conditions and others did not want to talk with us. People made positive comments about the service and these included: "Staff are respectful,” "I am happy here, I want to live here for ever," " I am very happy with the support I have" and "I know how to make a complaint I have done this before." We spoke with one person that was not happy living in the home and arrangements were in place for this person to move to another placement.

We observed that care staff were attentive and polite and that people were comfortable and relaxed with care staff. Care staff spoken with were knowledgeable about people in their care. However we found that there had been a large turnover of staff in the last year and this presented a risk of unsettling some people with the health conditions they had. There also had been some management changes since our last visit.

We found whilst the houses on the campus generally provided a good environment for people, the heating system was not always responsive enough to ensure that each person had a comfortable temperature for them.

There had been improvements in record keeping and this helped to ensure that communications about people's care could be passed effectively between staff groups.

On the day of our inspection, 39 people were using the service. We spoke to two of these people. Several people were not able to give us their views because of their complex needs and conditions. People made positive comments about the service and these included, “I like it here” and “The staff are good.”

We observed that care staff were attentive and polite and that people were comfortable and relaxed with care staff. It was clear that the staff had a good knowledge of all of the people who used the service and were familiar with their preferences and health conditions. People’s diversity, values and human rights were respected.

We found that since our last inspection of this home that improvements had been made in relation to safeguarding and that people who use the service were protected from the risk of abuse, because the provider had now taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found that the provider did not always have an effective record keeping system regarding people’s care and health needs. This meant that people were not always protected from the risks of unsafe and inappropriate care because decisions and communications about care and support were not always documented within personal records effectively and promptly.

We spoke with seven people living in Primrose Hill Farm. They told us that they were happy with the care they received and with how staff treated them. They told us about the activities they enjoyed and how their rooms had been decorated and furnished to match their interests. Comments included “I can have food whenever I want," " I like my room very much, I can see cars and buses from my window,” "I like it here," "I go out with the staff I can see (my relative)," "(Staff name) is my best friend."

We observed the care people received and spoke to eight staff at different levels of responsibility in the home. We found that staff spoke to people appropriately and were interested in what people had to say. They had a good knowledge of people's abilities, disabilities and interests.

We visited the home after concerns had been raised with us about how people were managed when their behaviour became challenging. We found that recording of these incidents needed to be improved, it was not detailed enough on incidents of self harming behaviour and this meant it was not always clear how injuries were sustained.

The home had begun to collect together records of these incidents but detailed analysis of these events had yet to be completed. This was needed to ensure that the least level of physical intervention was used when people were challenging.

We looked at some records and found checks were in place to ensure for example that the environment and medication administration were safe.

A person we spoke with during the visit said, “I go out shopping, go out bowling, going to C’s grave next week, she was my best friend”. We asked him about whether he goes on holiday, “Cornwall to visit my brother”. We were advised that the person visits his brother regularly for one week at a time when his brother can take time off work.

We observed that staff appeared to have good relationships with people who use the service and took time out to listen and communicate. A senior member of staff asked a person if he would like a drink and was told, “Yes please, tea”.

A person who used the service told us, “I like it here”.

During the visit we spoke with a trainee social worker who had bee seconded to the home. She told us that the secondment was full time and would end April 2011. We asked her about the standards of care that people received, she said, “It’s an eye opener about how it should be done”. She also said, “It’s great here, people receive a good lifestyle because of the assistance they receive”.

A person who uses the service was spoken with. We asked him about the standard of the meals, he said, “Smashing, I don’t like cheese”. We asked him if staff made him eat cheese, he said, “No”.

During the visit we spoke with a person who uses the service. We were told that his key worker had been on annual leave. The person commented, “I missed her”.