This was an unannounced inspection, which took place on 5 December 2016.

We previously carried out a comprehensive inspection at Westward Farm on 23 and 26 October 2015. At this inspection, we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. This was because we identified concerns in respect to the training of staff, notifications of allegations of abuse, people’s privacy and dignity, and quality monitoring. The service received an overall rating of 'requires improvement' from that comprehensive inspection.

After our inspection in October 2015, the provider wrote to us to tell us what action they were taking to meet the legal requirements in relation to the breaches.

We undertook this unannounced comprehensive inspection in December 2016 to look at all aspects of the service and to check that the provider had followed their action plan, and confirm that the service now met legal requirements. At this inspection, we found improvements had been made in the required areas and the provider was no longer in breach of the regulations.

Westward Farm is registered to accommodate up to 19 people with a learning disability. People living at the service have their own flats. At the time of our inspection there were 19 people living in the service.

There were two registered managers in post at the time of our inspection. 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. One of these registered managers had recently registered and was responsible for the day to day running of the service. The other registered manager was in the process of cancelling their registration following changes to the provider’s organisational structure.

Staff were aware of their role in safeguarding people from the risk of abuse and had received appropriate training. Risk assessments had been devised to help minimise and monitor risk, while encouraging people to be as independent as possible. Staff were very aware of the particular risks associated with each person's individual needs and behaviour.

When staff were recruited, their employment history was checked and references obtained to ensure new staff were safe to work within the service. There was enough staff on duty to ensure people were safe.

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People's needs had been identified, and from our observations saw that these were met by. Staff used touch as well as words and tone to communicate with people in a positive way. There was positive interaction between people and the staff supporting them. Staff spoke to people with understanding, warmth and respect and gave people opportunities to make choices. Staff knew each person's needs and preferences in detail, and used this knowledge to provide tailored support to people.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff received specific training in this area and were able to explain to us how they used this in their work.

People were supported to eat and drink sufficiently to maintain a balanced diet and encouraged to be as indepen

Our previous inspection carried out on 07 February 2014 found that improvements were needed to ensure people received the care and support they required. Our follow-up inspection carried out on 18 June 2014 found that satisfactory improvements had been made by the provider to address the shortfalls we had identified.

A single inspector carried out this follow-up inspection. The focus of the inspection was to check that improvements had been made and to answer the 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 people using the service, relatives and staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

People told us that they liked living at Westward Farm. Improvements had been made to ensure that people were consulted and involved in planning their care. The care and support needs of people had been reassessed and reviewed and staffing levels had been increased to ensure people were safe and provided with the care and support they needed.

Staff training had increased to ensure the staff knew how to care and support people living with complex communication, care and behavioural management needs. This meant that the staff members employed had the qualifications and skills needed to support people living at the service.

There was a process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS) to ensure that people who could not make decisions for themselves were protected. Policies and procedures were held. DoLS applications had been submitted for each person living at the service. Staff had been trained and knew when a DoLS application was needed. The service manager and deputy manager knew how to submit a DoLS application.

Is the service effective?

People’s health and care needs were assessed with them or their family member. Specialist dietary, mobility and equipment needs had been identified in care plans when required. Relatives told us their family member received the care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that the staff understood the care and support needs of each person. One person living at the service told us. “It is nice here and my core staff team are lovely.” Staff had received suitable training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that the staff were patient and encouraged people to be as independent as possible. People told us that they had their own core staff team who worked with them. Our observations confirmed this. A relative told us. “I am happy with the care given to my family member. The members of staff are polite and respectful.”

Is the service responsive?

Improvements had been made and care and risk assessments had been rewritten and regularly reviewed. The care and support provided was adjusted to meet the needs of each person. Changes in a person’s care and support had also been recorded in their plans of care. A record was held of people’s preferences, interests and diverse needs so that these could be respected by staff. Relatives told us that staff members consulted their family member and encouraged them to make their own decisions. People received the individual support they needed and had access to a range of planned activities

Is the service well led?

Staff spoken with had an understanding of the ethos of the home. An improved complaints’ system was in place and people were provided with information in a written and pictorial format that met their needs. Relatives and staff told us that improvements had been made. They said that they now felt listened to when they made a suggestion or raised their concerns. They told us that the new manager, service manager, deputy manager and team leaders were approachable and that the service was now better organised. The records we looked at and our observations confirmed this.

A mental health specialist advisor specialising in rehabilitation and two compliance inspectors jointly carried out this inspection visit.

People had complex needs and were not all able to let us know their views. One person living at the service indicated that they were happy living at Westward Farm.

No evidence was seen that people were involved in planning their care but relatives told us that staff consulted them and included them in discussions and decisions about their family member.

We found that the plans of care did not all contain complete and up to date information.

Relatives told us that their family member was well cared for. We saw that people received the care, attention and support they needed and that staff used a friendly, calm approach.

We found that people were provided with the food and drink they required.

We found that people were not provided with a way to raise their concerns or report abuse.

We saw that the people’s individual medication was available, administered safely and recorded accurately.

We saw that the environment met the needs of the people living there.

We found that there were times when inadequate staffing levels were provided.

We found that not all staff had completed all of their training and that staff work practise had not been regularly monitored.

Relatives told us that their complaints were listened to and resolved but people living at the service were not assisted to raise their concerns.

We spoke with visitors to the home who told us that staff consulted them and respected and acted on the decisions they made about the care and support they agreed to for their relative.

Our observations showed us that people were consulted and given choice and received the individual support and attention they needed. We saw that people had a positive experience of being included in conversations, decision making and activities.

We found that plans of care were personalised and contained the information staff members needed to ensure that the health and safety of people was promoted.

Relatives told us that people received the care and support they needed and that staff were excellent.

We saw that the people’s individual medication was available and found that it was administered, recorded and stored accurately and safely.

Staffing levels had been increased to ensure people received the personal, one to one or two to one care and support they needed.

Relatives told us their complaints were listened to and resolved. We found that there was a complaints system in place that met the needs of people living in and visiting the home.

We spoke with three people who were living in the home. They told us that their needs were met and that they were consulted about the care and support that they were provided with. People were complimentary about the staff that cared for them and told us that they were always treated with respect and that their privacy was respected. They told us that the activities they chose were planned and arranged and that they were provided with something to do each day. They also told us that the environment was comfortable and clean and that they cooked or were provided with good quality meals.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who did not comment. We observed that people living in the home were given the support and attention they needed, were appropriately supported to manage their behaviour and had a positive experience of being included in conversations and decision making.

We spoke with people who lived in the home and observed their communication with staff members. We observed that their communication needs were met and that they were involved in discussions about the care and support that they were provided with. People were complimentary about the staff that cared for them and told us that they always treated them kindly and with respect. We observed that their privacy was respected. They told us that they always had a staff member to assist them and that they liked living in the home and felt safe. They also told us that the environment was comfortable and that they were provided with enough to eat and daily activities.

We spoke with three people who lived in the service. They told us that their needs were met and that they were consulted about the care and support that they were provided with. People were complimentary about the staff that cared for them and told us that the staff always treated them with respect and listened to them. They told us that there were usually enough staff on duty but they sometimes had to wait for a staff member to take them out to do an activity. They told us that they felt safe living in the home and that the staff encouraged them to be independent and to do their own cleaning.

The inspection took place on 23 and 26 October 2015. It was unannounced.

The service is a care home for up to 19 people with a learning disability. People living in the home have their own flats.

There was a registered manager in post overseeing this and one other care home. 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.

People were protected from the risks of infection as far as practicable, including infections associated with poor food hygiene practices. Proper recruitment processes were in place to contribute to promoting people's safety, with minor gaps in the way they were applied.

People received support from a more consistent and stable staff team and changes were being made to shift patterns to provide more flexibility for people. Staff understood their obligations to report concerns that someone may be being harmed or abused.

Staff training in some areas was improving but the service people received was not always consistently effective. The majority of staff lacked training in the Mental Capacity Act 2005 and associated Deprivation or Liberty Safeguards. They did not demonstrate a clear understanding of how they should support people to make informed decisions and how people’s rights were to be promoted. However, senior staff were better informed and had taken action to seek appropriate authority if restricting a person’s freedom was the only way to keep them safe.

Staff supported people to eat and drink enough and understood the importance of this to people’s well-being. They were alert to changes in people’s health and how they should promote people’s health and welfare. Staff also had a good understanding of each person’s individual needs and preferences and how they should be supported.

Staff responded to people in a warm and respectful manner and took action promptly to offer support if people became anxious. People felt their privacy was respected but the provider’s system for monitoring staff safety significantly intruded upon people’s privacy in their own rooms.

Recent management restructuring provided the service with better leadership and staff morale had improved. However, systems for monitoring and improving the service were not as effective as they could be in identifying where improvements were needed.

You can see what action we told the provider to take at the back of the full version of the report.