Midtown Farm

At our last inspection in we found the service to be in breach of Regulation 15: Premises and equipment; because some areas of the building were not suitable for purpose or were not properly maintained. At this inspection in April 2018 we saw that structural work had been completed that had dealt with the problems related to water ingress and that broken and obsolete furniture and equipment had been removed or replaced. We judged that the service was no longer in breach.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Effective and Well-led to at least good. This was completed in a timely manner and with suitable levels of detail. We had evidence in this inspection in April 2018 to show that the action plan had been put into effect.

Midtown 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.

The service consists of a main house for two people, and two separate living areas created for sole occupancy. The home can accommodate up to four people with learning disabilities. Each of the houses provides people with single bedrooms (some with ensuite facilities) suitable toilets and bathrooms, kitchen and dining areas and lounge areas for each person. There were suitable outside areas where people could walk or sit in good weather. The home was situated in the village of Broughton Moor and is near to the amenities of the village and within easy travelling distance of the larger towns of Maryport, Cockermouth and Workington. Each person had their own transport which staff used to take them out.

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.

The home has an experienced and suitably qualified registered manager who had been in post since the home opened. 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 staff team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and spoke to us about how they would identify any issues and report them appropriately.

Risk assessments and risk management plans supported people well. Good arrangements were in place to ensure that new members of staff had been suitably vetted and that they were the right kind of people to work with vulnerable adults. There had been no accidents or incidents reported to the Care Quality Commission and the registered manager was aware of her responsibilities if there were any issues in the home.

We judged that there were suitable staffing levels in place by day and night. The registered manager was reviewing the deployment of staff to ensure that people continued to have suitable support as their needs changed.

Staff were suitably inducted, trained and developed to give the best support possible. We met team members who understood people's needs and who had suitable training and experience in their roles. A new method of supervision had been introduced.

Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. People in the home saw their GP and health specialists whenever necessary. The team made sure that strong medicines and any sedation were kept under review by consultants and specialist nurses.

We had evidence to show that people were encouraged to eat a balanced diet. Staff were helping people to reach a healthy weight.

The four separate areas of the home had been redecorated and were now well maintained. The home was warm, clean and comfortable on the day we visited.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005. Deprivation of Liberty authorities were in place and reviewed on a regular basis. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice.

We observed caring interactions and we saw genuine affection and respect between staff and people in the home.

Risk assessments and care plans provided detailed guidance for staff in the home. The management team had ensured the plans reflected the person centred care that was being delivered.

Staff could access specialists if people needed communication tools. Staff communicated well with people, despite their disabilities.

Each person in the home had their own planned activities that met their needs and abilities.

The registered manager ensured that staff understood the vision and values of the registered provider. Staff were able to discuss good practice, issues around equality and diversity and people's rights.

The service had a comprehensive quality monitoring system in place and people or their relatives were consulted, where possible. Quality assurance was used to support future planning.

There had been no concerns or complaints received but the registered manager was aware of the registered provider's policies and procedures.

Records were now well organised, easy to access and stored securely.

Further information is in the detailed findings below.

The five questions we ask about services and what we found