Blamsters Farm is a residential care home that provides accommodation and support for up to 34 people who have a learning disability and or autistic spectrum disorder. The service is made up of two larger properties and five smaller houses spread across the grounds. At the time of the inspection there were 31 people living at the service. Many of the people living at the service had highly complex needs and people had a range of communication abilities and requirements. Some were able to express themselves verbally whilst others used body language and gestures to communicate their needs.

The service was last inspected on 13 October 2014 and given an overall rating of good, with requires improvement in the domain of caring. This was because it was found that whilst staff had built up good relationships with people they did not always treat them with dignity and respect.

The inspection was unannounced and took place on 11 November 2016.

The service did not have effective systems in place to assess and monitor the environment and ensure that people were kept safe from harm. Where problems had been identified it was not always clear to see the action that had been taken to rectify the issue. We were concerned that hot water temperatures posed a potential risk to people that were vulnerable and action to mitigate were not effectively in place.

There was a registered manager in post and they were present during the 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 supported by staff who knew how to identify different types of abuse and who were clear about what action to take if any concerns arose. Staff treated people with kindness and respect. During our inspection we saw positive and caring interactions between people and staff.

Staff had assessed individual risks to people and had taken action to seek guidance and minimise potential risks. The service had a process in place for recording, monitoring and analysing accidents and incidents and action had been taken to mitigate the risk of reoccurrence.

Staff supported people to take their medicines safely and staff competencies relating to the administration of medicines were regularly checked.

People received care from suitably qualified and experienced staff who were supported to access a wide variety of training sessions which ensured that the needs of people using the service were met. Staffing levels were sufficient to keep people safe and meet their needs.

The service had a robust recruitment process in place to ensure that staff had the necessary skills and attributes to support people using the service. New members of staff were introduced to the service through a thorough induction programme.

People were supported in line with the legislation of the Mental Capacity Act and no unnecessarily restrictive practices were in place. There were effective systems in place to ensure that people’s medication, money and personal information were kept safe.

People were supported to maintain a healthy diet and to access drinks throughout the day. Mealtimes were flexible to meet individual’s routines, preferences and commitments. Staff worked alongside health and social care professionals to meet people's needs and sought specialist advice and support when the need arose.

Staff were kind and respectful when providing care and people’s behaviour suggested that they felt comfortable in their presence. Staff demonstrated that they knew people well and delivered care in accordance with their preferences and wishes. Staff were skilled at caring for people who had complex communication needs, offering choice and supporting them to make decisions about the care they received.

Th

This inspection took place over three visits on 13, 15 and 17 October 2014 and was unannounced.

The service consists of five group homes, set within four acres of well-kept grounds and nine people are supported off site in their own flats. It supports up to 34 people who have a moderate to severe Learning Disability with complex challenging needs and/or a Mental Health diagnosis.

Blamsters Farm has 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.

People felt safe, not many of the people living in in Blamsters Farm were able to talk with us, but we were able to see from people’s demeanour, gestures and facial expressions that they got on well with staff and felt safe when they were with them. The people we did speak with told us that it is a good place to live, they like the environment and that staff are kind and caring. The provider trained staff in how to recognise abuse and how to report it. Staff told us that if they ever see or suspect that people are being hurt or abused in any way, they will always report it to the registered manager.

People are able to take risks in their day to day life, but assessments are made of how dangerous the activity is and plans are put in place to minimise the risk to people so that they can keep their independence wherever possible.

Medicine is stored and administered effectively. It is locked away safely and is never left unattended when a medicine round is underway. Senior staff check the medicine to make sure it is being managed properly and that no mistakes have been made.

People receive care that is planned to keep them healthy and are supported to live in a way they want to. People are supported to keep their independence and to continue activities which interest them. Staff have time to spend with people to chat with them and get to know them. Sometimes, but not always, they show disrespect by talking amongst themselves and excluding the people they are supporting from the conversation. They also disrespected people while we were talking with them, staff repeatedly came in and out of the room we were trying to talk privately in.

There are enough staff to support people and they are caring and support people in a way that is compassionate and normally protects people’s privacy and dignity. They take time to listen to people and do what they can to make their life comfortable. Baby monitors are used to listen to people while they are on their own in case they need help. Although people consented to having the baby monitors in place, the way they are used takes away people’s privacy and dignity.

Staff received a good level of training to make sure that they are qualified to care for the people they support. Staff feel that they have enough training and support from the registered manager to be able to do their job properly.

People told us that they enjoy their meals and have enough to eat. People are able to make choices about their food and participate in the shopping and preparing the meal if they are able to.

The home is well lead, the registered manager carries out checks to make sure the staff are looking after people properly and are meeting their needs. Where shortfalls are found they are dealt with and practices are changed to improve the quality of care people receive.

The registered manager is open and approachable and listens to complaints and suggestions for improvement. The registered manager often visits the group homes and stops to chat with people and we saw they have got to know them well.

We found that the service had appropriate arrangements in place for obtaining consent to care. The service had mental capacity assessments in place for people’s day to day decisions but did not always have mental capacity assessments in place for best interest decisions around treatment for health or medical conditions in accordance with the Mental Capacity Act 2005.

We found that the provider had systems in place to maintain the safety and welfare of people who used the service. The service provided staff with specialised training to ensure the safety of people with specific medical needs. We saw that behaviours were monitored, assessed and managed to ensure that people received safe and responsive care.

The provider had good arrangements to promote effective performance of the service. We spoke with three members of staff and the registered manager and viewed the staff rotas in each of the buildings. We found that there were suitable and sufficient numbers of staff on duty to meet people’s needs.

We saw that the registered manager showed clear leadership and that all staff were expected to provide a high quality of care to people. The provider ensured that people’s care was regularly reviewed and that additional provisions to support their care were provided where required. We found that the provider had systems in place to ensure that complaints were appropriately managed and responded to.

We were not able to speak to the people using the service because they had complex needs, which meant they were not able to tell us about their experiences or they did not want to speak with us.

We saw that Blamsters Farm provided a relaxed and homely environment for people. Staff were friendly and respectful in their approach and interacted with people using the service in a confident and considerate manner. During the course of our visit we saw that people were supported to express their views and choices by whatever means they were able to and staff clearly understood each person’s behaviours and their way of communicating their needs. Staff looked after people's healthcare needs in a proactive way.

The staff team were well trained and supported to carry out their role. The provider had effective systems in place to monitor the quality and safety of service that people received.

People living in the home have complex needs, which sometimes result in them becoming very anxious when strangers are around, therefore at the time of our visit it was difficult to obtain the views of people using the service. However, we observed that people were supported by staff in a way that was respectful and dignified. Staff knew people well and undertook them. All of the interactions we observed between staff and those people using the service were positive.

People were clearly supported to take part in a wide range of activities both within the home and in the wider community. This was evident through the coming and going of people during the course of out visit.

The layout of the grounds is such that people can wander around in a pleasant relaxing atmosphere either with or without support dependant upon their individual needs.