Archived: Firs and Hewlitt

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.

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 the inspection there were seven people living in the ‘Firs’ part of the home and six people living in the ‘Hewlitt’ part of the home.

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

People told us they liked living at the service, they felt safe and staff were kind. Relatives also told us this. On arrival people were comfortable and being supported by staff appropriately.

Incident, events and unexplained injuries were recorded and investigated. Where needed, incidents were reported appropriately.

Medicines were managed safely, and staff supported people in way that met their needs and reflected their choices.

Training relating to infection control and COVID-19 had been delivered. There was a risk assessment and management plan in relation to COVID-19. Staff knew what was needed to reduce the risk of infection. However, we did note at times staff pulled their masks down to get air and the bin was not near the door for disposal of personal protective equipment (PPE) on leaving the building. The placement of the bin was immediately rectified to ensure staff did not walk through the building without a mask on.

The environment needed to be refurbished. There was a refurbishment plan in place, but this had not been completed due to delays caused by the pandemic. The manager and the provider were aware of the improvements that were required and were focused on making those improvements.

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.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

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

People told us that they were treated respectfully by staff and were able to choose how to spend their days. We saw staff offer choices and listen to people’s responses before supporting them and explain what they were doing. Although the environment needed refurbishment to make it more pleasant for people, staff behaviour made it feel homely and people were able to move around freely. For one person who spent time on their bedroom floor, staff put shoe covers on before entering to help protect their space from dirt and germs. Staff responded to changes in needs or health to help people feel better and get what they needed. Relatives also felt the staff were kind, supportive, friendly and supportive.

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

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to look at the specific concerns about the safety and welfare of people which we had received about the service. The concerns related to poor treatment of a person with complex needs, poor management of pressure care and false recording of fluids. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns.

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.

Please see the safe section of this full 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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

We found the service continued to meet the rating of a good service. For more details and a copy of the full report, please see the full report which is on CQC website at www.cqc.org.uk

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.

People told us they liked living at Firs and Hewlitt and that staff were kind and caring. People said they did not have to wait to be supported by staff. However, we found deployment of staff was such that people may miss out on important interaction from staff. We also found that the communal environment in which people used required improvement, redecoration and new furnishings. We have issued a recommendation to the registered provider in this respect.

People said they could take part in the activities of their choice and there was evidence in people’s care records they had been fully involved in their care planning.

People were provided with the food of their choice and they were supported to be involved in the running of the service through regular meetings, as well as being able to do things independently.

People were kept safe by the robust processes and procedures in place that related to medicines, recognising safeguarding incidents, identifying risks to people and acting on concerns or worries.

People were cared for by staff who received appropriate training and staff who felt supported by management and enjoyed their role.

People lived in an environment that suited their needs and they were assisted with accessing health care professional involvement when needed. People were supported by other professionals to help ensure their quality of life was improved as staff at Firs and Hewlitt worked in conjunction with other agencies.

Rating at last inspection: We last inspected Firs and Hewlitt on 31 March 2016 when we rated the service as Good. The report was published on 20 May 2016.

Why we inspected: This fully comprehensive inspection was carried out in line with our inspection methodology in that we scheduled the inspection based on our previous rating.

Firs and Hewlitt provides accommodation and personal care for up to 13 people with learning and physical disabilities. At the time of our inspection there were seven people living in The Firs and five people living in Hewlitt and both were located next door to each other.

The service had two managers in post; one was the registered manager, while the other manager was in the process of registering with the commission. Each bungalow was managed independently from the other and the provider was in the process of registering the bungalows as independent homes. 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm. People’s medicines had been managed safely.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who knew them well. Staff also felt that they knew the people they supported well.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices. The service supported people with health care visits such as GP appointments, optician appointment, chiropodists and hospital visits.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service. The provider also had effective quality monitoring processes in place to ensure that they were meeting the required standards of care.

This is a summary of what we found:

Is the service safe?

People told us they felt safe. Safeguarding vulnerable adults from abuse procedures were robust and staff understood how to safeguard people they cared for. Systems were in place to make sure that managers and staff learnt from events such as accidents, incidents, complaints and whistleblowing investigations. This reduced the risks to people and helped the service to continually improve.

The service had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put into place to ensure that people's human rights are protected should their liberty be restricted in any way. Staff had been trained to understand when an application should be made and knew how to submit one.

Staff knew about risk management plans and showed us examples where they had followed them. People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

Staff were sufficiently qualified, skilled and experienced to meet the needs of the people who used the service. We looked at staff rotas which showed us that there was an appropriate level of staffing in place. Policies and procedures were in place to make sure that unsafe working practice was identified and people were protected.

Is the service effective?

People's health and care needs were assessed with them. Specialist dietary, personal care and psychological needs had been identified in care plans where required. People told us that they had been involved in writing their care m and that they reflected their current needs.

Is the service caring?

People were treated with respect and dignity by the staff. People were supported by kind and attentive staff. We saw that support workers showed patience and gave encouragement when supporting people. People we spoke with told us, 'The staff look after me very well here."

People who used the service, their relatives, friends and other professionals involved with the service completed a yearly satisfaction survey. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to raise a concern or complain if they were unhappy.

The service worked well with other agencies and services to make sure people received care in a joined up way.

People completed a range of activities in and outside of the service regularly.

Is the service well-led?

The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. We were therefore assured that the provider had taken steps to continually improve the service.

Staff told us they were clear about their roles and responsibilities and staff demonstrated a good understanding of the ethos of the service.

However, we found that there were very few activities for people unless they attended a day centre. Staff interactions were kind, but concentrated on meal times; there was minimal interaction between staff and people who used the service outside of mealtimes.

People's care plans were not sufficiently detailed, which meant that staff may not be clear on how support people appropriately which may result in differences between how staff care for people.

People who were able to communicate told us that they were generally happy living at the home. One person said, "The staff are all friendly and the food is nice; we get to choose what we want to eat." and, 'I watch the television and my videos and listen to music. It has been a while since I went out shopping or to the pub. We probably go out about once a month. There's not much else to do here, but I'm quite happy with how much I get to do.'

We also reviewed the relatives' survey comments. One of the relatives stated, 'The staff here are really lovely. They always make me feel very welcome, and there is a lovely atmosphere.'

We observed that people were treated with respect, and that staff supported them during the day. However, we observed that activities provided on the day of our visit were limited to watching television.

Staff told us Firs and Hewlitt was a nice place to work, and that they thought they had enough staff to meet the needs of people. They also told us they felt supported by management. We observed that the home was visibly clean and tidy on the day.