Archived: Fircroft Home

Fircroft Home provides residential care and accommodation for up to 18 older people who have a learning disability. Some people are living with dementia. At the time of our inspection there were 16 people living at the service.

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.

Based on our review of Safe and Well-led the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support

People were supported by sufficient levels of suitably trained staff and were encouraged to be as independent as possible. Staff worked well with people to support them to pursue their hobbies and interests.

Right care

Staff knew people well and ensured that people received the support they needed to meet their individual care needs. People's rights were promoted, and they were protected from discrimination. People were treated with dignity and their privacy was respected.

Right culture:

The culture of the service was open and supportive to people. The management team had ensured that there was a positive ethos at the service which enabled people to feel more confident and encouraged them to take on new challenges if they wanted to.

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

People told they felt safe at the service. Staff had a good understanding of people's needs and knew how to manage risks associated with their care. Staff understood their responsibilities in terms of keeping people safe from abuse and avoidable harm. People received their medicines safely and the environment was clean and hygienic.

The registered manager was approachable and supportive, staff told us they enjoyed working at the service and were listened to. The service worked well with health and social care professionals to achieve the best possible outcomes for people. There were quality monitoring systems in place to ensure any shortfalls were identified and actions were taken to make changes when needed.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 08 August 2019) and there was a breach of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 27 March 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance at the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 Requires improvement to Good. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fircroft Home on our website at www.cqc.org.uk.

Follow up

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

We found the following examples of good practice.

A heated outdoor visiting pod had been built in the garden to help facilitate safe visiting for residents during the COVID-19 pandemic.

Staff were using picture cards to help communication with people who found it difficult to understand staff who were wearing face masks.

Steps had been taken to reduce the risk of transmission of infection on surfaces. This included increased cleaning and replacing light switches with sensors in the bathrooms.

Staff received regular training about Infection Prevention and Control. Management carried out observations of staff donning and doffing PPE and hand hygiene to ensure there was good practice in these areas.

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. 'Registering the Right Support' Care Quality Commission (CQC) policy.

People’s experience of using this service:

There was a lack of management oversight in some areas of the service. Audit systems had not been effective in identifying shortfalls in the quality of the service people received. Records regarding the support people required were not always comprehensive and person-centred. People lived in a safe environment although consideration was required regarding ensuring the service was dementia friendly and that planned refurbishments were completed. We have made a recommendation regarding this.

Detailed guidance was provided to staff regarding how people should be supported to manage risks in most instances although continuous re-assessment of people’s needs was required to ensure people continued to receive safe care. We have made a recommendation regarding this.

People were supported by staff who knew them well and positive relationships had developed. Staff treated people with dignity and respected their privacy. We observed staff and people sharing jokes and stories and the atmosphere was relaxed. People told us they enjoyed the food provided and were involved in planning the menu. People had access to a range of activities which they enjoyed. However, there were few opportunities for people who spent the majority of their time in their rooms to engage with staff socially. We have made a recommendation regarding this.

People had access to a range of healthcare professionals and guidance provided was followed by staff. Medicines were managed safely and people received their medicines in line with their prescriptions. People were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and staff told us they felt the service was well-led. Staff told us they felt supported in their roles and had the opportunity to contribute ideas and suggestions. Surveys were sent to people and their relatives and responses received were positive.

Rating at last inspection: At the last inspection the service was rated Good (report published on 25 October 2016)

Why we inspected: This was a planned inspection based on our last rating of the service.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

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

Fircroft Home provides residential care and accommodation for up to 18 disabled people. People are predominantly aged 60 and over and have a learning disability, and some people are living with dementia. Bedrooms and communal bathroom facilities are located on either the ground floor or the first floor and the premises are served by a passenger lift. At the time of this inspection there were 16 people living at the service.

This inspection took place on 31 August and 2 September 2016. The first day of the inspection was unannounced. At our last inspection on 2 May 2014 we found the provider was meeting regulations in relation to the outcomes we inspected.

There was a registered manager in post, who has managed the service for over a year. 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 told us they felt safe with staff. Risk assessments were in place to guide staff about how to minimise identified risks to people’s safety and protect them from the risk of possible harm. Safe systems were used to ensure people’s medicines were properly managed. The registered manager understood and complied with the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS). Staff had received relevant training and understood their responsibilities to protect people’s rights.

There were effective recruitment processes in place and sufficient staff were deployed to ensure people were safely cared for. Staff received suitable training, supervision and support to meet people’s needs. The quality of the food was good and people were supported to meet their nutritional needs.

Staff knew people well and provided their care and support in a kind and caring way. People’s dignity and confidentiality were respected. People’s needs had been assessed and their care and support plans addressed their health and social care needs in a detailed manner. Clear information was provided to people and relatives about how to make a complaint, and any complaints were investigated in an open and professional way.

People were supported to access the healthcare they needed and the provider liaised well with external healthcare professionals. There were effective measures in place to provide people with compassionate care at the end stage of their lives.

The service was well managed. The provider had clear systems in place to monitor the quality of the service and seek the views of people and their supporters, however we found that there was one incident reportable to the Care Quality Commission in accordance with legislation that the provider omitted to inform us about. We have issued one recommendation in relation to this finding.

Below is a summary of what we found. The summary is based on our observations during our visit, discussions with people who used the service, their relatives, the staff supporting them and looking at records.

Is the service safe?

People told us they felt safe. Relatives told us they felt assured and safe in the knowledge that the home was a place of safety for their family members to live. Safeguarding procedures were robust and staff understood their role in safeguarding the people they cared for.

The service was clean, hygienic and safe and provided people with safe access to all areas of the home.

Appropriate security checks were undertaken on staff to ensure people's welfare and safety were protected. We looked at staff training arrangements in place and saw that staff were provided with the appropriate training to ensure safe and appropriate care was provided for people who used the service.

Is the service effective?

People's health care needs were assessed with them whenever possible and included in individual care plans. Arrangements were in place for people who used the service to have support from other health care professionals. A GP commented the home provided excellent care.

We saw there was district nurse provided support to oversee clinical procedures, and for staff who were undertaking these procedures.

Is the service caring?

We saw people were supported by kind and caring staff who spoke to people in a polite and respectful manner. People told us that staff were caring and always treated them kindly. Relatives said the staff were very professional and always had time to reassure them. Comments included, "Its simply the best care ever", "No matter what time I come the staff are always cheerful and kind".

People's preferences, interests and aspirations were taken into account as to how their care was to be undertaken. Family links were maintained and a person told us that staff supported them to write letters and cards to relatives and this was very important to them.

Is the service responsive?

The service was responsive to the needs of people who used the service. When a risk had been identified for example frequent falls, the provider responded with the provision of a sensory mat, and reallocation of staff to monitor the frequency of falls and to minimise the risk. When a person who used the service required a soft diet the provider made provision for a speech and language assessment and a visit from the dietician to promote nutrition.

Is the service Well lead?

The home is very well managed by an experienced manager who had been in post for fourteen years. She had a sound knowledge of people's needs and the management requirements of the home.

The service had quality assurance systems in place. We saw surveys were sent to people who used the service, relatives, staff and health care professionals in March 2014 and the service had a good response to this. People said the home was caring and the staff very supportive and knowledgeable of peoples needs and expectations.

The manager had regular auditing systems in place for the monitoring of service provision. Health and safety was also monitored to promote the welfare of people who used the service and maintain a safe working environment.

Our observations showed that some people used different methods of communication. For example, the use of body language or facial expressions. We observed that staff recognised these non verbal communication methods and responded appropriately. We saw that staff spoke to people before supporting with any care in order to gain their consent and to ensure they were happy to be supported.

People we spoke with told us they liked living in the home and felt safe. Comments included "It's nice here" and "I feel nice and safe". People said that staff are "Nice" and that they were looked after "Very well".

Staff told us that they "Liked" working at the home and felt supported by their manager.

We found that appropriate checks were in place to confirm the suitability of staff to work with vulnerable people.