West Farm House 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.

West Farm House accommodates 10 people in one adapted building. At the time of the inspection there were seven people living at the home.

This inspection took place on 19 and 26 June 2018. The first day of the inspection was unannounced.

At the inspection in June 2016, we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued three warning notices to ensure the provider made improvements. An inspection in November 2016 showed the provider had addressed the shortfalls, as identified in the warning notices. Further improvements were identified at the last inspection, which took place on 22 February and 03 March 2017. However, some areas needed further development and to be embedded over time. We made one recommendation for the provider to consider current guidance on safe recruitment practices and take action to update their practice accordingly.

At this inspection, further improvements had been made but there were remaining shortfalls in some areas.

A registered manager was not required due to the registration of the service. The provider was responsible for the day to day management of the home. They were available throughout the inspection.

At this inspection, safe recruitment practice was not being followed. This did not ensure people’s safety, as the provider could not be assured prospective staff were suitable to work at the service.

The required checks had been undertaken in relation to the fire safety systems. However, the checks had identified some of the internal fire doors did not close properly when the fire alarm was activated. This did not ensure any smoke would be sufficiently contained in the event of a fire. There was no evidence to show any action had been taken to address this. A Fire and Rescue Service inspection had identified external fire doors compromised effective evacuation in the event of a fire. New fire doors were in the process of installed.

People medicines were not always safely managed. There was information about “as required” medicines but it was not specifically related to each person. Staff had not always signed the medicine administration record to show they had applied people’s topical creams. There had been three errors with people’s medicines in the last five months.

Improvements had been to the structure and content of people’s care plans. Some plans were detailed and person centred although there were areas that lacked clarity. Staff had recorded some entries in people’s daily records that were subjective, rather than being factual. All care plans were up to date and regularly reviewed.

Whilst the quality auditing systems had been developed, they were not fully effective. This was because the audits had not identified the shortfalls we found during the inspection.

People and their relatives were encouraged to give their views about the service. This was informally through general conversation or by the completion of surveys. Whilst feedback was positive, it was not co-ordinated to give an overview of people’s views.

People were happy with the care they received. There was a strong focus on promoting independence and encouraging people to have a good quality of life. People were encouraged to follow their own routines and make decisions about their care. People’s privacy and dignity was promoted. New opportunities were being developed to enhance social activity provision. People were encouraged to help out within the home if this is what they wanted to do.

People had enough to eat and drink. The food was varied, of a good quality and well presented. All food was cooked “from scratch” with an emphasis on fresh produce and people’s preferences.

There w

We carried out this comprehensive inspection over two days, on 22 February and 3 March 2017. The first day of the inspection was unannounced. Following an inspection in June 2016 the service was placed in special measures. This inspection was conducted to ensure improvements had been sustained and action had been taken regarding the requirement notices that were issued following the inspections in June and November 2016. In addition, the overall rating for the service was reviewed.

West Farm House is registered to provide accommodation and personal care for up to 10 people. During the inspection, there were six people living at the home.

A registered manager was not required due to the registration of the service. 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. The provider was responsible for the day to day management of the home. They were not available during the inspection due to being on holiday although we spoke to them on the telephone, on their return.

At this inspection, the improvements previously identified in November 2016 had been sustained. However, there remained some shortfalls regarding staff recruitment. Other areas such as care planning and quality auditing had received focused attention but were being further developed. Both systems required time in order for all developments to be properly embedded. There was a commitment to improve the service. People’s safety had been enhanced through developments to the environment. The laundry room had been fully refurbished, which enabled an effective space, which could be cleaned easily.

People were happy with their care and were encouraged to follow their own interests and preferred routines. There was emphasis on the environment being homely with a relaxed atmosphere. People enjoyed regular visitors and going out with them. Opportunities for additional social activity were being considered, with a newly introduced exercise group, appearing popular.

There were many positive interactions between people and staff. Staff were responsive to people’s needs and relaxed conversations were a regular occurrence. Staff knew people well and consistency of care was assured due to a relatively small staff group. The deployment of waking night staff was continuing to work well and there were sufficient staff available to support people, at all times.

Improvements had been made to the management of people’s medicines. This minimised the risk of error and increased safety. People received good support from various healthcare professionals, to remain healthy. People told us they felt safe at the home and had not seen any practice which concerned them. Staff were aware of their responsibilities to report any suspicion or allegation of abuse or poor practice.

People had no hesitation in talking to staff or the provider if they were not happy with any aspect of the service. They were confident any issue would be quickly and satisfactorily resolved. People were able to post any complaints into a newly introduced box in the hallway, if they wanted to.

Meal provision was based on people’s preferences. People told us they were happy with the food provided and had regular drinks of their choice. The menus were varied and based on fresh produce. If people did not like the main meal, alternatives were offered. Lunch was seen as a social occasion, where people enjoyed conservation with others.

Staff were confident when talking about promoting people’s rights to privacy and dignity. Staff were well supported and worked well as a team. Additional focus had been given to staff training. All staff had completed or were in the process of completing the Care Certificate This was a recognised format, gen

At the last comprehensive inspection of this service on 14, 16 June and 4 July 2016, breaches of legal requirements were found. This was because potential risks were not being identified and the provider was not always responsive to people’s changing needs. In addition, audits were not identifying shortfalls in the service, medicines were not safely managed and staffing levels at night were not adequate to meet people’s night time care needs. We issued three warning notices to ensure the provider made improvements and the service was placed into ‘special measures’. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches we identified.

We undertook this focused inspection to check the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for West Farm House on our website at www.cqc.org.uk.

West Farm House is registered to provide accommodation and personal care for up to 10 older people. During the inspection, there were 9 people living at the home.

A registered manager was not required due to the registration of the service. 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. The provider was responsible for the day to day management of the home and was available throughout the inspection.

The provider had been working closely with staff and the local authority to make improvements to the service. As part of this work, people’s care plans had been rewritten. The new format was better organised and gave greater information about people’s needs and the support they required. Further work was being undertaken to ensure the plans were more person centred, with added detail. However, the care plans had not been updated as people’s needs changed. Daily records did not always show the follow up action staff had provided, to ensure people’s wellbeing.

Work had been undertaken to develop the quality monitoring systems in place. However, the systems were not fully effective and required greater focus. The provider demonstrated a positive attitude to enabling change and ensuring a good service was provided.

A waking member of night staff had been deployed in order to meet people’s night time care needs. People and staff told us this had been a positive development. They told us there were now added safeguards and people were able to safely use the bathroom in the night, rather than relying on continence aids.

Improvements had been made to the safety of the environment. The pipework in the downstairs toilet had been boxed in and covers had been fitted to all radiators. The hand wash basins in people’s en-suite facilities, the bathroom and downstairs toilet had been fitted with regulators. These actions minimised the risk of people burning or scalding themselves from hot surfaces or excessively high water temperatures.

Fire safety had been improved upon. This was because fire doors were being held open appropriately and the fire panel had been properly labelled. Staff had received fire safety training and a fire drill had taken place.

The laundry room was in the process of being fully refurbished. The walls had been painted and new flooring applied. A hand wash basin had been installed and all items such as recycling had been removed. Work was being undertaken to replace the existing right hand side of the room with a window and brick surround. Disposable red bags had been purchased to enable staff to place soiled linen directly into the washing machine. This reduced the nee

We carried out this inspection over three days on 14 and 16 June and 4 July 2016. The first day of the inspection was unannounced. There was a delay until the inspection was completed due to the availability of the provider.

The last inspection to the service was on 16 September 2014. The provider had satisfied the legal requirements in all of the areas we looked at.

West Farm House is registered to provide accommodation and personal care for up to 10 people. During the inspection, there were 9 people living at the home.

A registered manager was not required due to the registration of the service. 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. The provider was responsible for the day to day management of the home. They were not available on the first two days of the inspection due to being on holiday but were present during the whole of the third day.

Quality auditing systems were not effective as shortfalls in the service were not being sufficiently identified. A monthly audit was undertaken but this did not cover specific areas, such as infection control, medicine administration or the environment. Not all management systems such as recruitment were being properly managed.

Potential risks to people’s safety were not being identified and properly addressed. The hot water was of an excessively high temperature, which increased the risk of scalding. Radiators in corridors and communal areas were not covered and there was a hot pipe in the downstairs toilet. These issues increased the risk of people burning themselves if they touched or fell against the hot surfaces. Some fire doors were propped open and not all doors closed properly, when the fire alarm was activated. These issues meant fire and smoke would not have been properly contained, in an emergency. The fire panel was not clearly marked and staff were not aware of the different areas of the home, identified as zones. This lack of knowledge increased the risk of delay, when trying to locate and manage a fire.

Whilst there were enough staff on duty to assist people effectively during the day, people were not properly supported at night. A member of staff undertook a “sleeping in” role but there were no waking night staff. This impacted on people’s safety and did not ensure those people with night time care needs, were appropriately supported. The lack of waking night staff compromised some people’s dignity. Staff were not always responsive to people’s changing health care needs particularly in terms of skin integrity and mobility. Each person had a plan of their care but the information was insufficiently detailed and did not identify individual needs or the support required.

People’s medicines were not being safely managed. The medicine administration records were handwritten, which increased the risk of error. Staff had not consistently signed the records to show they had given people their medicines as prescribed. Instructions for topical creams and medicines to be taken “as required” were not clear. This did not ensure staff had sufficient information to administer or apply the medicines as prescribed, for maximum effectiveness.

Good infection control was not being followed. The laundry appliances were located in an outbuilding, which meant the walls and floor could not be wiped hygienically clean. Systems were not in place to reduce the handling of soiled items and such items were inappropriately soaked, before being placed into the washing machine. This increased the risk of contamination.

Staff undertook a range of up to date training to help them do their job more effectively. However, not all topics related to older age or people’s changing needs. Staff had undert

One inspector visited the care home and gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

West Farm House provides support for up to ten people. At the time of our inspection seven people lived in the care home.

The registered manager was also the registered provider. They gave us a tour of the home.

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

Is the service safe?

We spoke with people who told us they felt comfortable with the staff who supported them. One person said, "I feel safe here". We observed staff interacted well with the people they supported. We spoke with staff who were able to tell us how they would recognise abuse, and confirmed the actions they would take if they suspected a person was being abused. Policies, procedures and local guidelines, including contact telephone numbers were available for staff to follow.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider had policies in place with regard to the Mental Capacity Act (2005) and the staff we spoke with had received training.

People who use the service told us that staff administered their medicines. We spoke with one person who received medication every three hours during the day. They said staff were "Excellent", and made sure they received what they needed at the correct time.

Is the service effective?

Staff told us they received appropriate training for their roles. They told us they received regular support from the registered manager who worked alongside them on a regular basis.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Risk assessments and care plans had been completed and were up to date for most people. This meant most people could be confident that care and treatment was planned and delivered in a way that was intended to ensure their welfare and safety.

Is the service caring?

We spoke with staff and observed the interactions they had with people. We found they demonstrated a good understanding of people's needs. We found, without exception, that they spoke kindly and respectfully to the people they were providing care for.

People we spoke with were complimentary about the staff. One person told us, "Nothing is too much trouble [for the staff] and we are well supported".

Is the service responsive?

People generally had their needs assessed on a regular basis. Records confirmed people's likes and dislikes. People who told us their individual preferences were acknowledged and acted upon.

Is the service well-led?

We saw that people were asked for feedback and we found this was acted upon.

We found that quality monitoring processes were in place, but some of the processes were not recorded. We saw some quality checks were not detailed or specific. This meant that inadequacies in systems were not always identified. For example, people were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We looked at four people’s care files and saw they contained sufficient information to enable the staff to care for people safely. There was a comprehensive range of documentation to record assessments and care plans. These included records for personal care, mental health, nutrition, moving and handling and visits from other professionals.

The manager told us, "we have reviewed all the care files to make sure everyone has complete information. We accept there were some gaps."

The manager had recently reviewed the systems in the home to identify, monitor and manage risks to people who used the service. We saw the records of system audits to monitor the quality of service delivery and maintenance of the building. The manager told us, " the last inspection was very much a wake-up call for us. We know what we have to do and we are really getting on with it.”

We saw the home had a policy on safeguarding adults and preventing abuse. This policy was known to staff and they were able to describe what they should do if they suspected abuse was taking place in the home.

The manager told us staff had also received training in the Mental Capacity Act 2005 and safeguarding vulnerable adults. We looked at four staff files and saw they contained certificates of attendance on these courses.

There were eight people living at West Farm House at the time of the inspection. We spoke to six people living in the home during the course of the inspection and two visitors. At the time of the inspection the manager was on annual leave.

One person said of the staff “Just ask and they’ll do anything.” All of the people we spoke with were complimentary about the care they received.

Care records were not always up to date and some potential risks to people using services had not been adequately identified and followed up. The staff team had not always been given opportunities to attend training that would assist them to understand safeguarding issues. However, people benefited from a well-established staff team who knew them very well. The staff team felt well supported by their manager. This strong team spirit coupled with a low turnover of staff offered stability and consistency of care to people living in the home.

Visiting relatives told us that they held the staff in high regard and felt that the staff were professional and the manager was approachable. They felt listened to.

We found that the provider did not have an effective system for monitoring and assessing the quality of the service which regularly took into account the views of people and their representatives.