Fir Close

Fir close is a care home providing accommodation and personal care for people with dementia, learning disability, mental health needs or physical disabilities. The care is provided in two separate buildings. The service can support up to 40 people. There were 28 people living at the service at the time of the inspection.

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

People living at the service were safe. The risks to their safety were assessed and measures put in place to reduce them. They were supported by a caring group of staff who received appropriate training for their roles and had been safely recruited. There was enough staff to meet people’s needs.

People’s medicines were well managed, and people were protected from the risks of infection as staff followed safe infection prevention and control practices when they supported people.

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.

People received care in a person-centred way from a staff group who knew their needs well. Staff worked to support people with their independence and treated them with respect.

There were processes in place to maintain the quality of the service through quality monitoring processes.

The registered manager was visible and managed the service in an open and transparent way. Staff felt supported by her, and relatives felt able to raise any issues or concerns with her.

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 able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People received personised care. They were involved in planning their care to ensure the structure of their daily lives was as far as possible supported by their own choices.

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

The last rating for this service was Good (published 25 April 2019)

Why we inspected

We received concerns in relation to the management of people’s care needs, staff training and staff attitude. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, caring and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fir Close 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.

Fir Close is located in the market town of Louth and compromises of two separate buildings. River View provides care for up to 21 older people with age related conditions, including dementia, that prevent them from living independently. Field View provides care for 13 older people, 10 of these beds provide an Intermediate Care Service, in partnership with Lincolnshire NHS. Intermediate care is a short term period of intensive support to help people regain their independence after illness or injury. The home is in a quiet residential area and is close to local amenities and bus routes. At the time of our inspection there were 26 people using the service.

People’s experience of using this service

People who used the service were safeguarded from the risks of abuse and staff knew what action to take if they suspected abuse. Risks associated with people’s care were identified and staff were aware of risks and knew how to manage them to keep people safe. Staff were available to support people in a timely and person-centred manner. Safe arrangements were in place to ensure people received their medicines as prescribed.

Staff received training and support to ensure they had the skills and knowledge to carry out their role effectively. Staff received support both individually and within team meetings. People had access to healthcare professionals as required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We observed staff interacting with people who used the service and found they were patient, kind, caring and supported people in line with their preferences.

People received personalised care which met their needs and took in to consideration their preferences. People were supported to maintain links with the community and took part in social activities of their choice. Activities during quieter times could be improved.

Audits took place to ensure the service was providing support in line with the providers policies and procedures.

Rating at last inspection

Good (Report published 20 May 2016)

Why we inspected

This was a planned comprehensive inspection based on the rating at the last inspection.

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

Fir Close is registered to provide accommodation for personal care for up to 34 older people or people living with dementia. There were 32 people living at the service on the day of our inspection. The service was accommodated in two buildings: Field View and River View.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment.

People were kept safe because staff undertook appropriate risk assessments for all aspects of their care and care plans were developed to support people’s individual needs. The registered manager ensured that there were sufficient numbers of staff to support people safely. People were given their medicine safely.

People were cared for by staff that had knowledge and skills to perform their roles and responsibilities and meet the unique needs of the people in their care. Staff received feedback on their performance through supervision and appraisal

People had their healthcare needs identified and were enabled to access healthcare professionals such as their GP, district nurse and community mental health team.

People where able were supported to make decisions about their care and treatment and staff supported people to maintain their independence. People were treated with dignity and respect by kind, caring and compassionate staff.

People were treated as individuals and received care that was person centred. People were involved in planning the menus and staff supported them to have a nutritious, varied and balanced diet.

The registered provider had robust systems in place to monitor the quality of the service, including regular audits and feedback from people, their relatives and staff.

At lunchtime we undertook a Short Observational Framework for Inspection (SOFI) in River View. SOFI helps us to understand people's perceptions of the care and treatment they receive when they are unable to tell us themselves. We have used this to find out about the lunchtime experience of people living with dementia.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their visitors and the staff supporting them. We also looked at three care records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom.

The home had policies and procedures in relation to safeguarding vulnerable adults and whistle blowing. We spoke with care staff who understood what was meant by abuse and knew how to report their concerns.

We saw the home had a programme of regular audit and risk assessments to ensure people were cared for in a safe environment.

The service was safe, clean and hygienic. We saw regular checks were made on the cleanliness of the building. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. We observed regular maintenance was carried out, for example on electrical and fire equipment

Is the service effective?

Our observations found that members of staff knew people's individual health and wellbeing needs. There was a process in place to ensure staff were aware of people's changing needs and what to do if a person became unwell. Staff told us that they shared information at handover between each shift. And updated people's care files four times a day.

We found staff attended training courses to meet the individual needs of people with conditions such as diabetes.

Is the service caring?

We observed staff speak to people in a kind and caring way and give them time to answer questions. We saw no was rushed and staff helped people to do things in their own time. We saw all staff groups, including the kitchen and housekeeping staff had a very good rapport with people and there was a lot of chat and laughter.

We observed lunchtime and saw people were treated as individuals and staff promoted and encouraged people to be independent. We saw when staff praised a person for their achievements they treated them as equals.

We asked people if they felt well cared for. One person told us, 'Sometimes I'm a little spoiled but at 95 I'm entitled to it.' Another person told us, 'It's like a hotel, even better. Staff are friendly, they look after you.'

Is the service responsive?

We saw care was responsive to people's individual needs. We saw one person liked to have cold drinks and chocolate bars so they had a fridge in their bedroom with a supply of soft drinks and chocolate. Another person had their own bedroom furniture and double bed because this was their personal choice. Staff told us it helped people maintain their individuality.

We saw when care workers raised concerns about people's health and social care needs, the provider contacted appropriate health and social care professionals. The individual care files identified this and a record of each referral, professional visit and outcome were recorded.

We saw the provider had contingency plans in place in event of an emergency situation.

Is the service well led?

We saw people were well supported by the staff on duty. There was always at least one senior carer on duty each shift.

All the staff we spoke with told us the manager was approachable and supported them with professional and personnel problems. One staff member said, 'XX [manager] is honest, she listens to any problems, be they your own, a client or another member of staff.'

We spoke to people who told us the manager was approachable. One person said, 'Her door is always open.' Another person said, 'We have bus trips, we tell the manager where we want to go and she tells the driver.'

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with three people who used the service and asked them for their views. We were limited in the number of people we could speak to as there was a trip out to a Christmas party. We spoke with three care workers, the infection control lead and the manager. We looked at some of the records held in the service including the care files for three people. We observed the support people who used the service received from staff and carried out a tour of the building.

We found a lack of evidence to show people had consented to their care and their care had not been properly planned, although people were happy with the care they received. A person who used the service told us, 'I get very good care, I have got no grumbles there.'

We found there were systems in place to assess the risk and prevent, detect and control the spread of health care associated infection. There were sufficient staff to meet people's needs and the provider assessed and monitored the quality of the service. A person who used the service said, 'There has always been someone there if I want someone.'

Since our last visit the provider had ensured all issues regarding safe administration of medicines had been reviewed. Records showed people had received their prescribed medication. Information leaflets were in place for staff use.

The provider is going through some changes within the company including a change of manager at this location. The new manager application is being processed by The Care Quality Commission but is not yet complete. The previous manager's names will appear on this report. This was discussed at the time of the visit with the new manager and the area manager.

The people we spoke with told us their care was personalised to their needs. One person said, "Staff tell me what they are writing about me."

There was inadequate monitoring of medication records and the storage of medication. Staff told us they had been trained to give medication. One person who used the service told us how they administered their own medicines stating, "The staff make sure I do it correctly."

People told us they were happy with the standard of cleanliness and the laundry services. One person said, "My clothes are well ironed and clean."

The people who used the service told us they liked living in the home and the staff who looked after them. One person said, "I feel quite safe here."

People who used the service knew how to make a complaint and felt confident any concern would be adequately investigated. One person said, "I have every confidence in the staff and manager to look into any concerns."

Although this report shows a name of a previous manager, Rosa Goodchild the provider has confirmed they no longer work at this location. The provider is currently ensuring the correct cancellation forms are being completed for that person.