Hill Farm

The service was a larger house which was bigger than most domestic style properties. This is larger than current best practice guidance. However, the size of the service did not have a negative impact on people as this was mitigated by the building design. One of the bedrooms had been converted into a sensory room. The provider had plans in place to make further changes to the design and layout of the service to further meet best practice. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support: Model of care and setting maximises people's choice, control and independence. People had been supported to gain new skills. Right care: Care is person-centred and promotes people's dignity, privacy and human rights. Most staff demonstrated a person-centred approach and supported people to communicate with others in a way which respected the person. Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. There was a culture of striving for better quality of care and support enabling people to lead improved lives.

We observed people interacting with each other and staff and being involved in their day according to their wishes. People were smiling and staff knew them well. A relative told us that that communication was good, and they were kept updated and involved. They were happy with the care and support their loved one received.

Staff had been recruited safely to ensure they were suitable to work with people. Staff had completed their training to give them the skills and knowledge they needed to support people with complex needs safely. Staffing levels when we inspected were suitable to meet people's needs, because extra senior staff were on duty as a meeting had been scheduled. Staffing rotas showed four staff were deployed on shift each day 08:00 to 20:00 to support five people. Two people received one to one support from a member of staff which left the remaining two staff to provide support for the remaining three people.

Medicines had been well managed. Risks to people's health, safety and welfare had been assessed, managed and reviewed. There was guidance for staff on how to reduce risks to people and support plans mirrored the information to ensure that staff knew how to provide safe care and support. One person's medical needs had changed, and they had a medical device fitted to maintain their health, a risk assessment was in place in relation to the fitting of this device. The provider updated the risk assessment after we inspected to make it clearer for staff what the day to day risks were and how to manage these. Risks to the environment had been considered. The equipment and the environment had been maintained.

We were somewhat assured that the provider was promoting safety through the layout and hygiene practices of the premises. Some areas of the service were not completely clean, the provider had also identified this and was arranging for some deep cleaning to take place and a review of cleaning schedules.

The provider had effective safeguarding systems in place to protect people from the risk of abuse. Staff continued to know how to spot signs of abuse and mistreatment. Training records showed all staff had attended safeguarding training. The provider continued to have monitoring systems in place to review accidents and incidents.

People continued to be supported to eat and drink to maintain a balanced diet and good health. People's weights were regularly monitored to make sure they remained as healthy as possible. People received medical assistance from healthcare professionals when they needed it. Staff recognised when people were not acting in their usual manner, which could evidence that they were in pain.

The building was suitable for the needs of the people who lived there. People had chosen the decoration for their own room where they were able to. Where people had specific interests and hobbies these were reflected in their room décor. The provider was in the process of making plans to renovate and modernise the service.

The provider had completed regular checks and audits to monitor the quality and safety of the service. The audits had identified concerns in places and action plans had been created. Actions had been completed in a timely manner. The provider had met the previous breaches of regulations identified in November 2019 and was working to continuously improve the service. The provider was working on embedding the changes made and working on further changes and improvements to the service. This included recruiting a new manager for the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.