Archived: Fir Trees

We found the following examples of good practice.

The provider was following best practice guidance in terms of ensuring visitors to the home did not spread COVID-19. Staff were adhering to personal protective equipment (PPE) guidance and practices, and there was a dedicated room for staff to meet socially distanced and change before and after their shift.

Communal areas were well spaced and residents had formed informal bubbles on each floor to maintain social distancing. Clear plans were in place for those who were required to self-isolate. For those residents who struggled with social distancing additional support was provided.

During this inspection we checked to see if the breaches in regulation had now been met. We found the provider had taken the necessary action to meet the regulations.

Fir Trees 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.

Fir Trees is situated in the Dukinfield area of Tameside and provides accommodation for up to 46 people who require accommodation and personal care. All rooms provide single accommodation and have en-suite facilities. Bedrooms are located over two floors and can be accessed by stairs or passenger lift. Communal bathrooms and toilet facilities are available throughout the home. The home is divided into two floors; each floor consists of a lounge and dining area there is a small laundry area and a kitchenette upstairs used by staff to make snacks and drinks. There is also a lower ground floor area that is currently used for storage and meetings. The main laundry and large kitchen are located on the ground floor. There is an enclosed garden area for people to use.

At the time of the inspection there were 42 people living at the home.

The service had a registered manager. 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.

Clear management systems were in place to monitor and review the quality of service provided. Opportunities were provided for people who used the service, their visitors and staff to comment on their experience and share ideas. This enabled people to experience safe and effective care and support.

The management and administration of oral medicines was safe. Action had been taken to improve records for the administration of topical creams and the thickening of fluids.

Systems were in place to minimise the risk of cross infection. Improvements had been made to the laundry so that soiled items were managed safely. The home was found to clean, tidy with no malodours.

Risks identified within the environment and to people’s care had been assessed and planned so that people’s health and well-being was maintained.

Effective systems were in place to ensure the premises and equipment were regularly serviced and safe to use. Plans were in place to enhance the environment, particularly for those people living with dementia.

Staff knew how to keep people safe and understood their responsibilities in protecting people from abuse and knew what to do should an incident arise.

People’s autonomy, choice and community presence was promoted with a range of activities and opportunities both in and away from the home. Consideration was also given to people’s religious and cultural needs.

Systems were in place to ensure sufficient number of staff were provided. Relevant information and checks were obtained when recruiting new staff. Opportunities for staff training and development were provided helping to ensure staff had the knowledge and skills needed to meet the specific needs of people safely and effectively.

Suitable arrangements were in place to meet people’s nutritional needs. Relevant health care support was provided to ensure people’s health and well-being was maintained.

Relevant authorisations were in place where people were being deprived of their liberty. Care records show that capacity and consent had been considered when planning people’s care and support.

People had a plan of care which identified their wishes and preferences and how they were to be supported by staff in meeting their individual needs. People told us, and we observed, staff treat them with dignity and respect when offering care and support. Staff were said to be helpful and caring and understood people’s individual needs and wishes.

Systems were in place for the reporting and responding to any complaints and concerns. People and their visitors said they were able to raise any issues or concerns and felt they would be listened to and acted upon.

This inspection was carried out over three days between 23 and 27 March 2017. Our visit on 23 March was unannounced.

We last inspected Fir Trees in April 2015. At that inspection we rated the service as good in all domains.

Fir Trees is one of 14 care homes in Tameside owned by Meridian Healthcare, part of the organisation HC-One. Fir Trees is situated in the Dukinfield area of Tameside and provides accommodation for up to 46 people who require accommodation and personal care. All rooms provide single accommodation and have en-suite facilities. Bedrooms are located over two floors and can be accessed by stairs or passenger lift. Communal bathrooms and toilet facilities are available throughout the home. The home is divided into two floors; each floor consists of a lounge and dining area there is a small laundry area and a kitchenette upstairs used by staff to make snacks and drinks. There is also a lower ground floor area that is currently used for storage and meetings. The main laundry and large kitchen are located on the ground floor. There is an open patio and lawned area next to the car park; there is no accessible, enclosed garden area for people to use without supervision.

At the time of our inspection there were 44 people living at Fir Trees.

The service had a registered manager in place. 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.

We carried out this inspection in response to information of concern we received around safeguarding of people from the risk of harm. These concerns were regarding safe and effective pressure care practice.

Care records at the home showed us that people received input from health care professionals, such as opticians and podiatrists. We found people had received the necessary care and support when they needed it. For example, referrals to district nursing team for assessments due to concerns for someone’s skin integrity.

We identified breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were around infection control, risk assessments, medication errors and management oversight. You can see what action we told the provider to take at the back of this report.

We made three recommendations in relation to the provider reviewing arrangements in place to establish where there are Lasting Power of Attorney (LPA) arrangements in place and what these say so the service know what decision’s the LPA can make; researching how to make the home more dementia friendly; implementing measures to assist people at the home who live with dementia to help them move around the home easier; and personalised activities being provided at the home.

People, their relatives, visiting professionals and staff spoke highly of the service; one person told us, “I like this place. It’s very clean and I can’t grumble.”

During this inspection we found that there were enough staff available to meet people’s needs and they were being cared for by people who knew them well. Staff we spoke with were aware of each person’s individual care needs.

People were supported by staff who were kind and caring and ensured people’s dignity was respected when providing care and support.

The staff files we looked at showed us that safe and appropriate recruitment and selection practices had been completed by management to satisfy themselves that suitable staff were employed to care for vulnerable people.

Staff we spoke with were aware of how to safeguard people and were able to demonstrate their knowledge around safeguarding procedures and how to inform the relevant authorities if they suspected anyone was at risk from harm.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People and their relatives told us they were happy with the menu and food choices provided at the home. Kitchen and care staff were aware of peoples specific dietary needs.

We found concerns regarding the management and administration of medicines during our inspection. We found errors in the accuracy of medication records and we were unable to ascertain if people had received the right medicines in the right amounts at the right time. As a result of these findings, the registered manager immediately contacted the GP and local pharmacy to confirm that no-one had come to harm as a result of the identified errors.

Care files we looked at showed plans and risk assessments documenting people’s specific care and support needs. These were detailed plans outlining how people needed to be cared for in an effective and safe way. However, they did not always accurately reflect people’s current care needs as they had not always been kept up to date. Inaccurate records placed people at risk of receiving inappropriate or unsafe care and support.

During our initial tour of Fir Trees on the first morning of our inspection, we saw that the home was clean and free from malodour. However, we found concerns with infection control in the main laundry area. We reported our concerns to the registered manager and they arranged for this to be remedied the same day.

We found people’s documentation to consent to care and treatment had been signed by family members who did not always have the legal right to provide this consent. The home had not checked with relatives to ascertain whether these legal safeguards were in place.

A part-time activities co-ordinator was employed and a range of activities offered; however, people did not benefit from personalised activities.

There was a complaints policy in place and complaints were acted upon.

People we spoke with were complimentary regarding the registered manager and felt they had made a positive impact on the home since their arrival in July 2016.

Is the service safe?

Some of the people living in the home could not always express their views, but those that did told us they felt happy and safe. Relatives told us that they felt confident with the care and support delivered by staff in the home. One person told us that they could go home feeling happy and confident that their relative was being very well cared for.

During our visit we saw good examples of care practice and noted that staff took time to follow guidance in care plans so that they provided care and treatment in a safe and effective manner.

Records we looked at indicated that people who lacked capacity were fully protected when decisions were necessary regarding their health and personal care needs.

Record provided evidence that staff had received appropriate training so that they had the skills and knowledge to provide care and support in a safe way.

Is the service effective?

All relatives we spoke with told us that they were very happy with the quality and standard of care provided by staff. They told us that the manager and staff team were very open and responsive and addressed any issues they raised in a friendly, professional and timely manner. Relatives told us that they felt very involved in the care planning process and that they were kept up to date and informed regarding any changes in care needs.

Is the service caring?

All the people we spoke with during this visit expressed satisfaction about the care and support provided to people. Comments included : 'The staff are brilliant, they will do anything for us. They are quick to respond to people and they seem to know every single person so well. Nothing is too much trouble for them'.

Care plans were in place and these provided staff with detailed information on how to provide care and support to people in a safe and appropriate way. When we observed staff, we saw that they followed the instructions in the care plans. During our discussions with staff it was evident that they had a good knowledge and understanding of individual care needs. During the day we saw staff engaging in meaningful conversations with people and supporting people to join in activities.

Is the service responsive?

We saw that people's needs were assessed before moving into the home to ensure that their needs could be met by the skill level of staff employed by the service. We saw that care plans were detailed and there was evidence that they were regularly reviewed. When any changes were identified the care plan was updated. We saw several examples where appropriate referrals had been made to healthcare professionals for additional assessments and guidance in respect of care and treatment.

Is the service well led?

The service had a registered manager in post and a number of senior staff. All the staff and relatives we spoke with spoke highly of the manager and her open and transparent approach in managing the home. People told us they felt confident in raising any issues of concern with the manager and that she was always visible and made herself available. We saw that there were robust auditing and monitoring systems in place and there was evidence that people using the service were regularly consulted on how the service was managed.

"The staff are lovely, they can't do enough for me, all I have to do is ask."

"I am impressed by the knowledge the staff have of people, they always seem to know what they are doing."

During our visit we saw that staff provided kind, sensitive and effective care in a way that ensured people's assessed care needs were met. There was evidence to demonstrate that care and support was centred on people as individual's and considered all aspects of their care needs.

We saw that staff supported and encouraged people to maintain an adequate diet and hydration. We saw appropriate action being taken when staff identified people who were at risk of poor nutrition and dehydration. Appropriate care plans and monitoring was in place to ensure that people received a well-balanced diet and adequate hydration.

There was an effective complaints system in place enabling people to express their views and opinions.

During our visit we found the home to be clean and tidy.

The people who used the service said they were happy living at the home and had no complaints to make. Their comments included:

'The staff are nice. I have never been treated badly.'

'Everything is ok, I'm a bit bored but otherwise no complaints.'

Relatives of the people who used the service said they were very happy with the way their relative was looked after and they had no concerns to raise about their safety and welfare. Their comments included:

'My mum is extremely well looked after. The staff are so gentle in the way they look after people.'

'The care is excellent, I couldn't fault any of them. I am very happy with the way my relative is looked after. The girls are always very busy and I have noticed they could do with more staff.'

'My mum feels safe. I have never heard or seen anyone treated badly in this home.'

'The new manager is very nice. She is very keen and appears to well organised.'