Bank Hall Farm is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Bank Hall Farm can support up to seven adults with learning disabilities and autism. The service is in a rural part of Winsford, set back off a main road within its own grounds. All the bedrooms are single and there is a communal lounge, sensory room, dining room and two outside buildings used for activities. Staff are on duty 24 hours a day. On the days of the inspection there were six people living at the service, one was away on holiday.

The inspection took place on 16 and 17 October 2018 and was unannounced. At the last inspection in June 2017 the service was rated Requires Improvement and breaches of the Regulations were found. There was a breach to Regulation 15, Premises and Equipment due to poor maintenance of the property and lack of domestic assistance meaning the home was not always clean. There was a breach to Regulation 17, Good Governance as the registered provider and registered manager had not made improvements to known risks within the building which could have led to an unsafe environment. At this inspection we found improvements had been made and the service was no longer in breach of the Regulations.

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.

There was a registered manager 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.

Since the last inspection the registered manager had made improvements to the environment. The home was now safe and free from potential hazards. They had employed a maintenance person and domestic assistant to carry out the necessary repairs and cleaning. There was now a sensory room and two out-buildings to provide quiet areas for people living there.

People were supported to be safe from the risk of abuse. Staff demonstrated that they understood local safeguarding procedures and were aware of the action they should take if they suspected someone was being abused. There were comprehensive individual risk assessments in place which were reviewed and updated regularly. People received their medicines safely.

There were safe and robust recruitment practices in place. Staff received training and support to meet the specific needs of people living in the home.

There were enough staff to meet people’s needs and keep them safe. Staff knew the people they cared for well and could tell us their likes, dislikes, preferred routines and communication methods. Staff knew the triggers that may cause anxiety and how to respond to reduce this.

The registered manager had quality assurance processes in place. They completed audits and analysis but these were not always documented thoroughly. We discussed that the service would benefit from more support from the registered provider in this area.

People were supported to eat and drink enough and were offered choices. Staff monitored people’s health and well-being and made timely referrals to relevant healthcare professionals.

Staff told us that they were supported by a fair and approachable management team and they were encouraged to make suggestions.

Bank Hall Farm can support up to seven adults with learning disabilities and autism. The service is located in a rural part of Winsford, set back off a main road within its own grounds. All of the bedrooms are single and the service offers communal living space. Staff are on duty twenty-four hours a day. On the days of the inspection there were 7 people living at the service.

The service was last inspected on 26 November 2015. At that time it was rated good in all areas.

There was a registered manager in post. They were present for 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.

People were living in an environment which was not conducive to a stress-free life. This was due to the layout of the building, which was cramped in places and did not offer quiet areas. The provider had failed to make the necessary repairs to the environment, even though they had been aware of them for a long time. As a result, people were not protected from the risk of injury as a result of living in a poorly maintained building and grounds.

People were living in an environment which was not kept clean and hygienic. The provider did not employ cleaning staff to keep the environment clean. Actions agreed by the provider and registered manager 17 months before had still not been implemented.

People were supported to be safe from the risk of abuse. Staff demonstrated that they were aware of the action to take should they suspect that someone was being abused. Risks to people were reassessed when their medical conditions changed. People received their medicines safely and when they needed them.

People were assisted by sufficient numbers of staff who had very good knowledge of each person. Staff knew their likes and dislikes, their important routines and how they demonstrated anxiety. The registered manager checked staff's suitability for their role before they started working at the service.

People had developed strong relationships with staff. Staff had received training and support to meet the specific needs of people living in the home. Staff listened to people and responded in a kind and compassionate manner.

People were supported to eat and drink enough, and their food preferences were known and understood Staff monitored and responded to people's health conditions and worked well with external health and social care professionals to ensure people maintained good health.

Staff told us the registered manager was supportive and led the staff team well.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to premises and equipment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service in August 2014 and the service was rated as good.

After that inspection we received concerns in relation to how people were being supported and cared for at the service. Other concerns had been brought to our attention with regard to health and safety at the service. As a result we carried out an unannounced focused inspection on 26th November 2015. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Bank Hall Farm’ on our website at www.cqc.org.uk.

Bank Hall Farm can support up to seven adults with learning disabilities and autism. The service is located in a rural part of Winsford set back off a main road within its own grounds. All of the bedrooms are single and the service offers communal living space. Staff are on duty twenty-four hours a day.

The service has 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.

Relatives told us that staff were patient, kind, and supported people well. Comments included “The staff are lovely” and “The staff are very friendly.”

Support plans were person centred and gave good information about the person’s individual needs. They were well written and included a range of risk assessments which were tailored to each person’s needs. Most assessments had been reviewed over the last six months, however some had been reviewed significantly longer. This was brought to the attention of the manager and they agreed to address this.

People and relatives said they were safe in the support of the staff. Staff were aware of safeguarding policies and procedures and had undertaken safeguarding awareness training.

There were good staff recruitment processes in place which meant that people were protected from staff that were unsuitable to work with people who may be deemed vulnerable. Staff had undertaken an induction process and had access to supervision sessions, staff meetings and training relevant to their job role.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This inspection was unannounced. At our last inspection on 27 February 2014, we found breaches of regulation 9 (care and welfare of people who use services) and regulation 22 (staffing). We found that care was not planned and delivered to ensure people’s safety and welfare. Staff did not have the skills and support people needed in order for people to receive care that was safe and appropriate to their needs. During this inspection we found significant improvements had been made.

Bank Hall Farm supports six younger adults with autism. The service is located in a rural part of Winsford set back off a main road within its own grounds. All of the bedrooms are single and the service offers communal living space.

The service does not have a registered manager. However, the regional manager for the service told us that they had recruited a new manager and they would be taking up their role within the month following our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were supported by staff who had the required skills to promote their safety and welfare. The provider had a rolling training programme and had addressed any training shortfalls. The provider had robust and effective recruitment processes in place so that people were supported by staff of a suitable character.

People's nutritional needs had been assessed and staff were knowledgeable of people’s nutritional needs.

People told us that staff were caring and we saw good interactions between people who used the service and the staff team. People were involved in the planning of their care and had an opportunity to say what was important to them.

We found that people had an opportunity to take part in the activities they enjoyed inside the home and out in the community. Relatives told us they had no complaints about the service. They told us they knew how to make a complaint and felt the acting manager was approachable. No complaints had been made to the service since our previous inspection in February 2014.

The provider had learnt from previous concerns and incidents at the home and had regard for reports prepared by the Commission and the local authority. Systems were in place for checking on the quality of service provided and processes were in place to deal with any areas identified for improvement.

We spoke to four relatives. Comments from them included; “The care is exceptionally good”, “X is really happy there”, “I’m really pleased, they seem on top of things there” and "I have turned up recently and noticed X wandering alone by the gates that lead to the main road".

We found that care was not planned and delivered to ensure people’s safety and welfare. We found that four of the six people who lived at the home had epilepsy. Only two of them had care plans in place to offer guidance to staff on how to manage this. We saw that people had also had seizures recently. This meant there was a risk that people may receive care that was inappropriate or unsafe.

Examination of accidents and incident records described events that required peoples care files to be updated. Two of the care files we looked at showed that risk assessments had not been evaluated, particularly after a significant incident had occurred. We examined the staff rota and following a roll call, we found that the staff on duty matched what was on the rota. All of the staff spoken with said had not received training that was specific to epilepsy and how to manage seizures if they occurred.

Three staff members, who were new to their roles, told us that they had not received training about autism and no training for this was planned ahead. This was important as Bank Hall Farm was an autism specific service.

We found that training was current for all staff in relation to the Mental Capacity Act 2005. This meant they had the information required for their roles so the act was complied with. The service had a consent policy in place which reflected this legislation.

We spoke with two relatives of people who used the service. They told us they had no concerns with the care provided at Bank Hall Farm. Comments from them included: "The care is exceptional. I have literally got no fault to find" and "(My relative) is really settled here. He looks forward to going back after he's been to visit us at home."

We found that the service carried out daily audits of its medication management system with processes in place to address any shortfalls identified. There was evidence that the pharmacy supplier visited to check the service had an effective system in place.

We found that before any member of staff began employment with the company they required two references to ensure that the people who used the service were supported by people of a good character.

We found that surveys were sent to the relative's of people who used the service. The manager was currently in the process of analysing them so an action plan and a summary could be devised. We saw this had been done in previous years.

Since our last inspection on 18 February 2013 we had not received any concerns about the care that was provided at Bank Hall Farm.

We met people living at the service during our visit and we spoke to four relatives. Most people living at Bank Hall Farm were unable to communicate verbally and used non verbal signs to communicate. People living at the service looked content, happy and comfortable with the staff supporting them.

Relatives gave various suggestions to help improve Bank Hall Farm. Overall they were happy with the standard of support provided. They all told us they could raise issues about the service and previous concerns had been addressed. However they advised another bus would help improve more access to activities outside the service for everyone. One relative felt there should be a lot more support and structure for activities within the house.

Staff had developed a file called ‘Your Voice.’ They used lots of pictures to help everyone living at Bank Hall Farm to raise what was important to them. Staff were able to keep everyone up to date with plans for their home. They had recently discussed plans to decorate their home and install new floorings in bedrooms.

Support plans had clear and up to date information about each person's needs and requests. The plans covered various topics such as; healthcare needs; communication; personal care and lifestyles. We noted that support plans had been developed in an easy read format using lots of pictures which can help some people to better understand information developed about them.

The people who live in Bank Hall Farm were unable to communicate verbally due to their illness but looked well cared for and content. The relatives we spoke with were very happy with the care and support provided and were confident that the service was meeting their needs. One relative said that “ I feel my relative is safe here” Another said “ I would know if my relative was unhappy”

Staff working at the home felt that the staff morale was low due to all the changes that had taken place but felt the manager was addressing issues and the home was improving slowly.