Fethneys Living Options - Care Home Physical Disabilities

About the service

Fethneys Living Options – Care Home Physical Disabilities is a residential care home providing personal care to 10 people at the time of the inspection. The service can support up to 10 people with a physical disability such as cerebral palsy; some people also had a learning disability; people used verbal communication. Their physical needs were supported in an adapted building, with a lift, overhead tracking hoists and accessible outdoor space.

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

Right Support: People did not always receive personalised care that met their preferences, and people were not offered enough opportunities to enable them to live the lives they chose. For example, the high use of agency staff at the home meant people could not always go out when they wanted to. Two people wanted to go swimming, but there were no specifically trained staff to ensure safety when swimming. The home had an accessible minibus, but no staff were qualified to drive it, so people could not go out unless they hired accessible transport. People were not supported with their independence. For example, one person had a standing frame, but their relative said they had never seen them using it. Another person did not receive physio support in line with the requirements of their care plan.

People were not always 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.

Right Care: People received support from staff who were kind and caring. However, care was not always person-led and staff were reactive to people’s needs. One person used picture reference cards to help staff understand how they were feeling. However, these cards were tangled up on their wheelchair and could not be easily reached by the person to use. Staff asked one person what they would like to do in the morning, colouring or sand play, but gave the person no time to respond. A staff member sat down and started to make moulds with the sand, but the person made it very clear they did not want to do this, delivering a strong, negative, verbal response.

Right Culture: People lived with a range of physical disabilities, and some had a learning disability. Staff were understanding of people’s care and support needs, but the culture of the home did not encourage people’s independence, and focused on what they could not do, rather than enabling people to have fulfilling lives. A relative was concerned about their loved one’s mental wellbeing because they did not have enough to do or activities that were planned in line with their preferences. People were not empowered to have a good quality of life, were accepting of staff support, but had limited opportunities to do what they wanted in the wider community.

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 8 March 2019).

Why we inspected

This inspection was prompted due to concerns received about monitoring of risks, such as constipation and bowel management, and safeguarding referrals made to the local authority. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

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

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fethneys Living Options – Care Home Physical Disabilities on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to unsafe care and treatment, the lack of person-centred care, and ineffective governance of the service at this inspection.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service: People were involved and consulted about how the service was run. People were aware of changes that had occurred at the home and of issues relating to the management of the home in the past few months. A registered manager was not in post, but the new manager was in the process of registering with CQC. Concerns had also been raised by the local authority in relation to safeguarding issues. People indicated they had no worries and were happy with the way the home was managed and with the staff who supported them. Residents’ meetings provided opportunities for people to be engaged in the running of the home and to make suggestions. We observed the new manager being introduced to people as it was their first day in post. People were comfortable in the company of senior managers and support staff. People were involved in the interviewing and recruitment of new staff. A relative felt that improvements had been made following an unsettled period. They stated, ‘I’m not sure how Fethneys can improve further as they are a cut above the average home in my opinion’. People, their relatives and staff now felt the home was well-run. A range of quality assurance systems measured and monitored the quality of care and the service overall, which was of a good standard.

People were safe and were supported by staff who were trained to recognise the signs of any potential abuse or harm. Staff had been trained in safeguarding and knew what action to take if they had any concerns about people’s safety. People’s risks were identified and assessed appropriately. Any accidents or incidents were recorded and lessons learned to prevent any reoccurrence. There were sufficient staff to meet people’s needs, to enable them to engage with activities outside the home and to provide the support they required. People were supported by staff whose suitability was checked at recruitment. People’s medicines were managed safely.

We observed people were comfortable in their surroundings and felt safe and happy. We spent time talking with people who were relaxed and comfortable to have a conversation with us. Throughout our inspection, we observed positive interactions between people and staff, underpinned with banter and laughter. Staff spent time with people and listened patiently to anything they had to say. People were treated with dignity and respect and had the privacy they required. Staff had completed equality and diversity training and treated people equally, regardless of their disability.

Before they came to live at the home, people’s needs were fully assessed and referrals made by local authorities and commissioners. Staff completed training and were experienced in their roles to provide effective care to people. Staff received regular supervisions. People were encouraged with a healthy diet and contributed to the planning of menus and food preparation. People had access to a range of healthcare professionals and services. 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.

People received personalised care that was tailored to meet their individual needs, preferences and choices. Care plans were detailed in the information and guidance provided to staff. Staff encouraged people in decisions relating to their care and in care planning. People chose their keyworker who supported them in all aspects of their care, including the planning of activities. Complaints were logged and managed appropriately. No-one living at the home required end of life care at the time of the inspection.

This service met the characteristics of Good in all areas except for Well Led, which was Requires Improvement because safeguarding issues had not been notified in a timely manner. The overall rating is Good. More information is in the Detailed Findings below.

Rating at last inspection: Good. The last inspection report was published on 29 July 2016.

Why we inspected: This was a planned comprehensive inspection. We were made aware of safeguarding issues and concerns from the local authority and these contributed to the planning of this inspection. The home had also been without a manager for several months. The inspection took place in line with CQC scheduling guidelines for adult social care services.

Follow up: We will review the service in line with our methodology for ‘Good’ services.

Fethney’s Living Options provides accommodation, care and support for up to ten people living with a physical disability or acquired brain injury. The aim of the service is to promote and build on people’s independence skills so that they can move out of the home into independent or supported living accommodation. Fethney’s Living Options is a large, older style, detached property situated close to the seafront and town centre of Worthing. All rooms are of single occupancy and communal areas include a large dining area/kitchen and a separate sitting room.

A registered manager was in post. 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.

People were looked after by staff who had been trained to recognise the signs of potential abuse and knew what action to take. People’s risks were identified, assessed and managed appropriately and their independence was promoted. There were sufficient numbers of staff on duty to support people and the home benefited from the input of volunteers which the provider had introduced. Medicines were managed so people received them safely from trained staff. People were protected from the risk of acquired infections and the home was clean and hygienic.

Staff had been trained in all essential areas and additional training had been completed to meet people’s specific needs. New staff completed the Care Certificate, a universally recognised qualification. Staff received regular supervisions and attended team meetings. People were supported by staff who understood their responsibilities under the Mental Capacity Act 2005 legislation and put this into practice. People had sufficient to eat and drink and were encouraged to maintain a healthy lifestyle. They had access to a range of healthcare professionals and services.

Staff were kind and caring with people and positive relationships had been formed. People and relatives spoke highly of the staff at the home. People were encouraged to express their views and to be involved in making decisions about their care. They were treated with dignity and respect.

People were supported by their keyworkers, who co-ordinated all aspects of their care. They were encouraged to be as independent as possible, to pursue a range of activities in the home and out in the community. Care plans provided staff with detailed information about people and how they needed to be supported. Complaints were managed in line with the provider’s policy.

People spoke highly of the service and attended residents’ meetings. The provider obtained feedback from people, their relatives and staff on a national basis. Staff felt supported by the registered manager and of the improvements that had been made since he came into post. A range of audits measured and monitored the overall quality of the service and actions were identified and implemented to drive improvement.

Is the service safe?

Individualised care plans detailed the support and care each person required. People confirmed that they received care that they needed in a way that they preferred. The service ensured relevant healthcare professionals were involved as needed.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We also saw that systems were in place for recruitment and selection of qualified and skilled staff with appropriate checks in place.

Is the service effective?

We observed people being supported to make their own choices and direct their day to day activities. Staff were observed to support people in a calm and respectful manner and with dignity. People told us they were involved in decisions about their care and they had choices about how they wished to spend their time. One person we spoke with told us "I'm really happy here. Staff help me to do things for myself."

Is the service caring?

People were positive about the staff and management of the service. We saw that people were supported by staff who were kind, attentive and took the time to support them in a way that empowered them to be as independent as possible.

Is the service responsive?

We saw that care plans were reviewed regularly in line with people's assessed needs and that their views had been taken into account in how their care and treatment had been planned. We observed staff supporting people with meal preparation and planning their schedules to meet their identified needs.

Is the service well-led?

The service was well managed and there were clear lines of leadership and communication in place. We saw a number of feedback processes in place for people, their representatives and staff to provide feedback on the service and we saw that this feedback was acted on.

One person who used the service told us 'It's been fine, it's been good here.' Another said 'It's going really well. I'm learning more independent skills living here.' A relative said there was 'A great atmosphere.' A visiting professional said it was 'Quite a vibrant place.'

People's needs had been assessed and their views had been taken into account in how their care and treatment had been planned. They told us that the support they received had helped them achieve more independence and quality of life. One person told us 'Things are going really well. I get support with meal preparation and food shopping. My keyworkers ask me what I want to do for the next week then they do my timetable and sort things out with me.'

Staff understood how to raise concerns and keep people safe, and people we talked with said they felt safe living at Fethney's.

Staff received appropriate professional training and development. More than 90% of recommended trainings had been completed by staff, and arrangements were in place to ensure staff refreshed their training at the recommended intervals. Staff we spoke with said that they felt well supported. One said 'the manager is approachable.'

The provider took account of complaints and comments to improve the service. The relative of one person who used the service told us 'Things get sorted very quickly if there's a problem.' Records showed that the provider regularly reviewed the quality and safety of the service, and made changes accordingly.

People's needs were assessed and care was delivered in a way that met the needs of most people. We looked at three care plans and observed care and support being delivered. Three of the people we spoke with told us their needs were met. One said, 'The standard of care is really good'. However, another person said, 'They haven't met my needs'.

People we spoke with told us they felt safe. One said, 'If I had any problems I'd go to the manager'. The provider had responded appropriately to an allegation of abuse. We saw that appropriate referrals had been made to the safeguarding authority.

The building had been adapted to meet the needs of people using the service and was well maintained.

There were enough skilled and experienced staff to meet people's needs most of the time. The provider was taking steps to increase staffing levels to address shortages that occurred at certain times of day.

People were asked their views about the service and the provider took account of complaints and comments to improve the service. Additional training was being delivered to address areas of concern.