Fir Trees House

Updated 22 April 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

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

Two Inspectors carried out the inspection.

Service and service type

Fir Trees House 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 inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke/communicated with five people who live at Fir Trees House and one relative and two friends about their experience of the care provided.

We spoke with five members of staff including the registered manager, the area manager, the deputy manager and two support workers.

We reviewed a range of records. This included five people’s care records and five medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with one professional who knew the service.

Updated 22 April 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Fir Trees House is a residential care home providing personal care to five people with mental health needs and/or learning disabilities and a variety of associated health and support needs at the time of the inspection. People live in one large house. The service can support up to seven people.

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

Right Support

People and relatives told us staff did not always support people to have a fulfilling and meaningful everyday life. Support was safety focused, one example being people could only access the kitchen with staff support and this was kept locked with a sign on the door reminding people to not enter without staff. Some staff spoke of health and safety concerns about people using the kitchen. Support plans did not always include guidance for staff about positive risk management to encourage skills development in line with peoples wishes. The registered manager and provider were in the process of reviewing support plans to include consideration of positive risk taking with a focus on people’s strengths and promote what they could do. Staff worked with people to plan for when they experienced periods of distress and demonstrated an awareness of individual interventions and techniques to support people with this. People had a choice about their living environment and were able to personalise their rooms.

Right Care

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. Staff consistently demonstrated their awareness of people’s cultural needs this included dietary choices and terms of address. People received kind and compassionate care. We observed staff providing support in a personalised sensitive manner which demonstrated genuine regard for people. Relatives and friends spoke highly of the staff, one said, “So far they have been excellent.” Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right culture

People did not always lead inclusive and empowered lives. The registered manager had recently joined the service and had identified the need to ensure the ethos, values, attitudes and behaviours of the management and staff always focused on people’s needs and aspirations. They were working with people and staff to improve in this area. Relatives and friends had spoken positively about the influence of the new registered manager and expressed their hopes to be informed and involved with reviews with people. Staff placed people’s wishes, needs and rights at the heart of everything they did. People told us they were happy living at Fir Trees House and the staff knew how to support them when they were upset and were kind.

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 23 October 2018)

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture. The inspection was prompted in part due to concerns received about safeguarding. A decision was made for us to inspect and examine those risks

We have found evidence that the provider needs to make improvements. Please see the effective and well led sections of this full report.

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 COVID-19 and other infection outbreaks effectively.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care at this inspection.

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

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.