CQC report explained · a residential care home
What the CQC found at The Farmhouse
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, January 2024
Overall rating remains Inadequate and the home is in special measures; inspectors found unsafe staffing and medicine practices.
This was an unannounced, targeted inspection on 21 December 2023. Inspectors looked at concerns about staffing and medicines after an incident in which a person sustained a serious injury. They observed care, spoke with five staff members and reviewed information and documents.
The provider had recruited new staff and was using fewer agency workers. However, inspectors saw people left without supervision in communal areas while staff supported people in bedrooms or carried out other tasks. They also found that staff did not always know which people needed medicines to be given when required.
The inspection did not cover the whole service or all parts of the key questions. It did not change the previous overall Inadequate rating. The home remains in special measures.
More regular staff
The provider had recruited new staff, which reduced the use of agency staff. Agency workers who remained were regular staff familiar with the home and the people living there.
“The residents here are now seeing regular staff on a day to day basis.” from the report
Controlled medicines
Inspectors found that controlled drugs were locked away and administered with two staff members signing for them. Storage temperatures were also checked.
“However, controlled drugs were stored and administered safely.” from the report
People left without supervision
seriousCommunal areas were not always supervised while people were using them. Inspectors said this placed people at risk of harm.
“During our inspection we observed whilst in use by people these areas were unsupervised.” from the report
Staffing remained insufficient
seriousThe provider had not made enough improvement in ensuring sufficient suitable and experienced staff were deployed to meet people's needs. The home remained in breach of Regulation 18.
“Not enough improvement had been made at this inspection and the provider was still in breach of regulation 18” from the report
As-required medicines
seriousStaff gave different answers about which people needed as-required medicines. Inspectors said the provider could not be assured that all staff had clear guidance, and the home remained in breach of Regulation 12.
“This meant the provider could not be assured that all staff had clear guidance on who required PRN medicines.” from the report
Limited interaction
needs fixingStaff had little interaction with people because they were busy with other tasks. Inspectors were not assured that staff understood people's communication needs.
“Staff had little interactions with people as they were busy completing other tasks and were unable to provide support or observe people.” from the report
- 01How many staff will be available at different times to supervise communal areas safely?
- 02What changes have been made to make sure staff know exactly who needs as-required medicines and why?
- 03How are you checking that staff understand and respond to each person's communication needs?
- 04What action plan is in place to address the breaches of Regulations 18 and 12?
- 05What progress has been made since this inspection, and when will the next CQC inspection take place?
This was a targeted inspection of specific concerns about staffing and medicines; it did not assess the whole of any key question, so the other ratings were not reviewed. This explanation was written from the published report of 30 January 2024 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, December 2023
Rated Inadequate and placed in special measures; inspectors found people were at risk because safety, staffing, care planning and management were not reliable.
This was an unannounced inspection on 6 and 9 September 2023. Inspectors reviewed care records, medicines, staff files, rotas, audits and incidents. They spoke with staff and relatives, observed care and checked infection control.
The inspectors found serious and widespread problems. Risks were not always properly assessed or managed. Medicines records and covert medicine arrangements were not safe enough. There were not enough permanent staff, agency staff lacked some training, and some recruitment checks were incomplete.
Care plans were unclear, conflicting or did not show people's choices and goals. Staff did not always support communication, activities, dignity or independence well. The provider's checks did not identify or correct these problems, and some serious incidents were not reported to the CQC.
The overall rating fell from Requires Improvement to Inadequate. Safe, Effective and Well-led were rated Inadequate. Caring and Responsive were rated Requires Improvement. The home is in special measures and will be re-inspected to check for significant improvement.
Healthcare support
People's health needs were recorded and the home worked with healthcare professionals. One person with complex health needs received support from several professionals.
“People were supported with their healthcare needs.” from the report
Food and drink support
People were supported to eat and drink, and care plans included dietary needs, preferences, allergies and religious restrictions.
“People were supported to eat and drink to maintain their health and nutrition.” from the report
Complaints
Complaints were investigated and answered appropriately. Relatives said they felt able to raise concerns.
“We reviewed complaints records and could see these were investigated and responded to appropriately.” from the report
Visitors and infection controls
Visitors could visit without restrictions. Inspectors were assured about several infection control arrangements, including safe admissions, use of protective equipment and managing outbreaks.
“Visitors were allowed to visit their loved ones whenever they wanted.” from the report
People could be harmed by unmanaged risks
seriousSeveral risk assessments were incomplete, out of date or contradictory. A bedroom window restrictor was not fully secured, creating a high risk of avoidable harm.
“This meant there was a high risk of the person coming to avoidable harm should they access one of the windows.” from the report
Medicines were not managed safely
seriousStorage temperature records were incomplete. Guidance and required reviews for covert medicines were missing, and medicine audits had not found these problems.
“Medicines were not managed safely and effectively.” from the report
Staffing and training were inadequate
seriousThe home relied heavily on agency staff, with 70% of weekend shifts covered by agency staff in the rota reviewed. Some regular agency staff had not completed important training, and people sometimes had to wait for care.
“High use of temporary agency staff meant that service users were at risk of receiving inconsistent care from staff that were not familiar with their needs or preferences.” from the report
People were not always engaged or supported
needs fixingInspectors saw limited interaction with people, including people with little or no speech. There were few activities and staff did not always follow communication guidance.
“There was little in the way of activities in the home at the time of our inspection.” from the report
Poor management oversight
seriousAudits did not identify major problems. Incidents were not consistently reviewed for lessons, and the provider failed to notify the CQC about some reportable incidents.
“The system in place did not ensure the safety or quality of the service.” from the report
- 01What has changed since the inspection to make sure risk assessments are complete, current and followed?
- 02How are medicines now stored, recorded and reviewed, particularly covert medicines?
- 03How many permanent staff are now employed, and how do you make sure there are enough suitably trained staff on every shift?
- 04How have care plans been rewritten to record each person's communication, preferences, goals and safe support?
- 05What action has been taken to improve audits, incident reviews and reporting to the CQC?
This was an unannounced inspection of all five key questions, including infection prevention and control; the circumstances of a specific serious-harm incident were not examined because it was subject to a criminal investigation. This explanation was written from the published report of 14 December 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk. The report was longer than we could read in one go; the later sections may not be reflected.
Every inspection of The Farmhouse
5 rated inspections over 9 years: the service has slipped, from Good to Inadequate.
- January 2024Inspected but not ratedcurrent ratingSafe: Inspected but not rated
- December 2023Inadequatedown from Requires improvementSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- September 2023Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2021
Registered with the Care Quality Commission on 5 March 2021.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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