The inspection took place on 17 January 2019 and was unannounced.

We previously inspected this service in March and April 2018, where we found repeated breaches of Regulation 17, 9, and 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We had have already taken enforcement action by imposing conditions on the providers registration. These conditions mean the provider has to inform us of actions which have or are being taken to mitigate identified risks on a monthly basis. We also met with the provider and registered manager to discuss our expectations going forward.

This inspection in January 2019, found improvements had been made in relation to people’s safety and care delivery, and the service was no longer in breach of Regulations in relation to consent, person-centred care and governance. We did however find some areas requiring further improvement to ensure people received care that fully met their needs. The overall rating for this service is now ‘Requires Improvement’.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Church 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.

Church Farm accommodates up to 40 people in one adapted building. At the time of the inspection there were 32 people living in the service, some of whom were living with dementia.

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.

There were various auditing processes in place which helped to identify shortfalls in the quality of care provided. However, these had not been wholly effective in identifying issues that we found during this inspection and therefore some improvements are still needed in this area.

Records showed that overall people living at the service received their medicines as prescribed. However, improvement was needed to ensure that people received their medicines in a timely manner. The service had not considered the risks around self administration of medicines. Medicines were not always stored securely.

People told us that staffing levels were adequate and staff responded to requests for assistance promptly. However, the deployment of staff was not always effective which impacted on people receiving their medicines in a timely manner.

There was improvement in the general recording of people’s food and fluid intake. However, for people requiring fortified food, drinks, and snacks the recording of these was not always consistent.

People told us and we observed, that food was plentiful and there were several choices on offer. The mealtime experience was calm, staff were available to support people with eating, and we saw people socialising together.

Feedback we received from people indicated that the provision of activity was not meeting people’s individual and specialist needs. Whilst events outside of the service had been arranged, day to day stimulation was lacking for some people. The activity co-ordinators role was under review by the registered manager.

We found some environmental risks in the wider building which placed people at risk of harm; the service had not identified this.

So

We carried out an unannounced comprehensive inspection of Church Farm on the 20 and 28 March and 6 April 2018.

During our previous inspection on 30 and 31 August 2017, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to, safe care and treatment, person centred care, consent, and good governance. We also found a breach of Regulation 18 of the Registration Regulations 2009. The overall rating for this service was 'Inadequate' and the service was placed in 'special measures'. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, are to be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Following the inspection, we undertook enforcement action placing positive conditions on the provider's registration. This meant the provider had to submit to CQC a monthly report of the actions taken to improve the quality of the service.

During this inspection in March and April 2018, we found some positive improvements had been made which meant the provider was no longer in breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, or Regulation 18 of the Registration Regulations 2009. We did however find repeated breaches of Regulation 17, 9, and 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have already taken enforcement action in relation to Regulation 17 and 9 following our last inspection, by imposing conditions on the providers registration. These conditions will remain in place, and the provider will continue to send us reports on their progress.

Church 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.

Church Farm accommodates up to 40 people in one adapted building. At the time of the inspection there were 35 people living in the service.

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.

We found that the provider had not made all the improvements required since our last inspection. However, auditing and quality assurance systems had improved and were in place. We found at this inspection that whilst they identified some concerns, they did not pick up all of the shortfalls we found, and therefore are not yet fully effective.

There were improvements in the management of risk, and we saw that assessment of risk in relation to choking, weight loss, and risk of developing pressure sores, was accurate and reviewed regularly. Further improvements were needed with moving and handling risk assessments to ensure staff had clear instructions on how to move people safely.

People who used the service received appropriate support to eat and drink sufficient amounts to maintain a healthy and balanced diet. Meals we observed looked appetising and well presented. However, recording of people’s food and fluid intake was not always consistent or accurate.

Records showed people living at the service received their medicines as prescribed. However, some improvements were still required to ensure documentation was clear, and reflected people’s most up to date medicines.

The registered manager had applied for Deprivation of Liberty Safeguards when people who lacked capacity to consent, had their liberty restricted. However, we did not see that a ca

The inspection took place on 30 and 31 August 2017, and was unannounced.

Church Farm residential care home provides accommodation and personal care for up to 40 people. At the time of this inspection, there were 37 people using the service, some of whom were living with dementia.

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.

At our previous inspection in 2015, we rated the service as ‘good’ overall. During this inspection in 2017 we found the registered provider to be in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

We took enforcement action to impose conditions on the providers registration. We asked them to advise us what action is being taken to improve the quality of the service in relation to the assessment and monitoring of risk and staff competency. This will include the implementation of quality and monitoring audits, how the quality assurance system is identifying issues, and what action has or is being taken to mitigate any shortfalls. This condition continues on a monthly basis, whereby the provider informs us of actions which have or are being taken to mitigate identified risks. We decided to impose these conditions on the providers registration because people may be exposed to the risk of harm.

The registered provider did not have sufficient oversight of the service's operations. Quality assurance systems and audits were not in place to monitor the service provided to people, and as a result shortfalls in the safety and quality of the service were missed. The provider had not undertaken regular checks to ensure the quality of care or to drive improvement. Additionally, the registered manager had not notified us of serious injuries which had occurred in the service, which is required by law.

Records relating to MCA and DoLS were not clear. Mental capacity assessments were not completed without delay where a person was regularly refusing medicines.

Two people living in the service did not have a care plan which meant that staff did not have clear and accurate guidance on how to care for and their needs. This put people and the staff delivering their care at risk. Some information was not documented fully in care plans.

Risk assessments were not in place for two people who had complex health needs. Risk assessments in relation to nutrition and moving and handling were not always completed accurately, and there were no risk assessments for people who were at risk of choking.

Clear and accurate records were not being kept of medicines administered by staff. This meant we could not be sure people were always given their prescribed medicines.

Infection prevention and control procedures were ineffective and we found that hygiene in the service was poor.

A risk assessment for legionella was in place. However, cold water temperatures had not been taken, despite the service having been advised to do this in November 2016.

We could not be assured that suitably competent and skilled staff were deployed to ensure that people's care and treatment needs were met. Staff’s competence in risk assessing and administration of medicines was not being checked by the management team.

People's food and fluid intake was not always monitored effectively.

There was an activity co-ordinator in the service. However, the provision of activity was not meeting the individual and specialist needs of all people using the service.

Staff were observed to be kind and caring, but the staffing level arrangements in the service meant that staff did not always have time

During our visit we spoke with people living at Church Farm and some of their visitors. We observed how people were cared for and the way staff interacted with people. We watched how some people took part in sociable activities such as singing with staff, attending the hairdresser and saw some people preferring to stay in their own rooms.

One person told us: "It’s not like your own home of course, but the staff keep me going, some like to sing while they work and it can be quite uplifting." Another person said: "I am quite content here, they look after me well now that I can't do things for myself. The food is very tasty, I have put on weight."

One of the visitors told us: "They look after them very well here, the activities lady is very good at organising events and individual things." "My relative is very well looked after and the staff keep me up to date about their assessments."

We observed lunch time and saw people were offered their choice of meal, were given appropriate utensils, and assisted when required so people could enjoy their meal at their own pace.

We looked at records of people living at the home, how staff were recruited, checked the premises and how equipment was maintained to ensure that people living and working at Church Farm was safe.

During our visit to Church Farm Residential Home we spoke with six people living there, six members of staff, one visiting professional and the manager and deputy manager.

Everyone we spoke with said they felt satisfied with the service. They told us that staff were kind and respectful and very patient.

Some people who use this service had various communication difficulties expressing their views with some gesturing thumbs up or down depending on the questions we asked while others were able to respond appropriately without hesitation.

People were satisfied with the 'homemade' meals and the choices from the menu.

None of the people we spoke with had any complaints but they told us they felt confident the manager would take action if they felt the need to complain.

We observed that people were treated with respect by staff who took their time in supporting them with their individual needs.

We spoke to five people who live at Church Farm who clearly expressed they receive a good standard of care. 'The staff are friendly, polite and take their time to help'.

Two visitors with whom we spoke confirmed the care of their relative was 'second to none' and they were 'very happy with the care and attention the staff gave her'.

People confirmed that they were comfortable with the service and that the 'food was tasty, and there was plenty of it'.

Two members of staff said 'this is a good place to work, there is support from the manager, and we do loads of training'.

This inspection was undertaken by one inspector on 23 and 28 January 2015 and was unannounced.

Church Farm Residential Care Home provides accommodation and care for a maximum of 40 older people, most of whom are living with a dementia. At the time of our inspection there were 37 people living in the home.

The home 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, 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.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the manager and staff were knowledgeable about when a request for a DoLS would be required regarding changes in case law.

Staff had a good understanding with regard to identifying abuse and knew the reporting procedure, if they suspected people were experiencing abuse. Staff had also received appropriate training in respect of protecting people.

Everyone we spoke with, who was living in the home, confirmed that they felt safe living there. Relatives we spoke with also confirmed that they had no concerns about their family members’ safety.

People were supported by sufficient numbers of staff, who received regular support and supervision, as well as training that was relevant to their roles. Staff confirmed and personnel records showed, that staff were only employed within the home after all pre-employment checks had been completed satisfactorily.

Medicines were stored, managed and administered safely.

People’s care records contained appropriately detailed risk assessments and guidance for staff to follow, which covered relevant aspects of people’s daily lives. These helped ensure that people were supported and cared for safely and that risks to their health, welfare and safety were minimised.

Staff’s attitudes towards people living in the home were warm, caring, kind and patient and people’s dignity and privacy was consistently respected.

People’s individual dietary needs were catered for in line with their care plans and people were supported to have sufficient quantities to eat and drink.

People or their relatives were involved in planning their own care and care plans provided clear information regarding people’s histories, as well as their needs, preferences and choices. Activities and events were available for people to take part in when they wished. People were also able to choose when and what they wanted to do and where they wanted to spend their time.

All the people we spoke with said that they could speak with the manager or any of the staff if they ever needed to raise concerns or make a complaint. A complaints procedure was also available for people, relatives and others who used or visited the service.

The home was being effectively managed and regular audits were completed, covering areas such as health and safety, medication, care plans, accidents, incidents, falls and nutrition.