Archived: Firs and Hewlitt

Updated 20 July 2021

The inspection

This was a focused inspection to check on a specific concern we had about people’s safety and welfare.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by two inspectors.

Service and service type

Firs and Hewlitt is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with two people who used the service and observed interactions between people and staff. We spoke with six members of staff, the registered manager and an area manager. We also contacted the local authority and safeguarding team for their feedback.

We reviewed a range of records. This included care plans, risk assessments, activity records, daily notes and medicines records. A variety of records relating to the management of the service, including training and quality assurance documentation was also reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 20 July 2021

About the service

Firs and Hewlitt is a care home providing accommodation in two buildings for up to 13 people with a learning disability or autism, including older people, some of whom are living with dementia and/or a physical disability. At the time of inspection, nine people were being supported.

People’s experience of using this service and what we found

There were not enough staff available to meet people’s needs in a timely manner. Staff told us people were often left alone in the communal areas, with no staff support for significant periods of time. Not all staff had completed training relevant to their role to safely support people’s individual needs. The service had a high reliance upon using agency staff to provide support to people.

Risk assessments were either not in place or did not provide staff with appropriately detailed management plans. Behaviour management plans were not always sufficiently detailed or current. This meant staff had limited guidance as to how to safely support people to live meaningful lives. The provider had not considered how they could positively manage risks to enhance people’s independence and quality of life.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People’s choice, control and independence were not maximised, and care did not always promote people’s dignity and human rights. The values and attitudes of the provider did not ensure people were able to lead empowered lives.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There was not a formal process for learning lessons and improving the quality of care people received. Incidents that meant people may be at risk of harm were not always reviewed robustly.

We observed extensive cracks within one of the properties walls. The registered manager told us that this had been ongoing for two years. The provider had raised this issue with the landlord but had not considered the impact of the people living there.

The provider failed to operate a robust quality assurance process to continually understand the quality of the service and ensure any shortfalls were addressed. Service level audits had not been completed as required. Incidents had been reported to the registered manager, however, these were not reviewed to identify emerging themes or trends. Staff gave varying feedback about the management of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 28 March 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service, in relation to people’s safety and welfare. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the overall provider oversight at the service, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Firs and Hewlitt on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to staffing, risk management and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.