Faycroft

Faycroft is a residential care home providing personal care to six people with a learning disability at the time of the inspection. The service can support up to seven people.

The home is split over two levels with most of the bedrooms and bathrooms on the first floor. Downstairs there is an open plan lounge, kitchen and dining room with a separate lounge for people wanting some personal space. The home is located close to local amenities.

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

The overall governance of the home had improved. The manager and the provider completed monitoring checks to ensure people’s care was in line with the standard required.

People and the staff were able to communicate more openly which had improved the culture within the home.

People’s care plans had been updated and a standardised format was being used. Best practice guidance was reflected in the updated care plans. Daily record and incident reports were being monitored and action was taken to address any concerns.

Improvements were needed to the environment to improve the homes ability to mitigate the risk of infection spreading. The provider also needed to ensure all staff were confident donning and doffing personal protective equipment (PPE) and ensure staff documented their Covid-19 test results at the time the test was taken.

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 07 May 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we reviewed the action plan and improvements had been made but the service remained in breach as the improvements were yet to be embedded.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

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.

Faycroft is a residential care home providing personal to six people with a learning disability at the time of the inspection. The service can support up to seven people.

The home is split over two levels with the majority of bedrooms and bathrooms on the first floor. Downstairs people have access to communal facilities, and a secure garden. The home is located close to local amenities.

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

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not supported this practice.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. A closed culture had begun to develop. A closed culture can be described as a poor culture where the risk of harm is increased due to a range of different factors such as, poor leadership and restrictive practice.

People were not always protected by the systems in place and risks to their safety were not always considered. Accident and incident forms were completed and reviewed but lessons were not always learnt. The guidance in place for the administration of ‘as required’ medicine was often generic and did not give clear enough guidance to ensure it was given at the right time. The audits and process in place had not identified all the issues found prior to recent concerns being raised.

People were supported by sufficient numbers of staff who were recruited following a check to their background, qualification and character.

We were somewhat assured by aspects of how the home was able to manage the risks associated with COVID -19 such as visitor access and touch cleaning. We were assured by the use of personal protective equipment, COVID -19 testing, and the homes ability to manage a potential outbreak.

People’s care needs were not always clearly defined, and gaps were noted in the care planning process. Staff were trained in subjects relevant to their role, but we found limited evidence of specialist training especially around mental health.

People were supported to access enough to eat and drink, but we questioned whether all people were being supported to have a balanced diet. The staff worked with other agencies and plans were in place to improve the environment.

People were observed being treated with kindness and respect. However, we found aspects of people’s care plan that recommended a dedicated time to talk had not happened consistently. People were able to express their views on a daily basis and their independent living skills were promoted.

The provider was able to demonstrate an understanding of their duty of candour and was working with other agencies to improve the quality of care people received.

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 17 April 2019).

Why we inspected

The inspection was prompted in part due to a specific incident and concerns received about the processes in place to protect people from harm, the management of risk, leadership and culture. A decision was made for us to inspect and examine those risks. The specific incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring 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 Faycroft on our website at www.cqc.org.uk.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people being safe from potential abuse, safe care and treatment, consent and good governance 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Registering the Right Support has values which include choice, promotion of independence and inclusion. This is to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen. The home was meeting the principles of this policy.

People’s experience of using this service:

People received safe and effective care. Staff were skilled to meet people’s needs and preferences. People were supported to manage risk and were protected from the risk of abuse.

People were supported by kind and caring staff who knew them well and understood their preferences. People were supported to maintain their privacy and their dignity was respected. People were encouraged to make decisions and choices for themselves and live an independent life.

People could follow their interests and were involved in planning their care and support.

People were asked for their views about the care they received and they were listened to. There were systems in place to monitor the quality of care and these were effective in identifying improvements.

The interim manager encouraged a positive culture and understood their responsibilities. Learning and partnership were encouraged and promoted to improve people’s quality of life.

The service met the characteristics of Good in all areas; more information is available in the full report below.

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

Rating at last inspection: At the last inspection the service was rated Good Improvement (report published 1 September 2016).

Why we inspected: This was a scheduled inspection based on previous rating.

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 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. The registered manager received support from a staff team, which included a deputy manager, team leaders and support workers.

People were kept safe by the service. Staff protected people from the risk of harm and understood how to report concerns. Staff understood how to identify and manage risks to help keep people safe. Employment of staff only took place following pre-employment checks and there was enough staff to keep people safe. People received their medicines as prescribed and staff administered them safely.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service had systems in place to assess people’s mental capacity. Where required the registered manger made applications to the authorising agencies for a DoLS. Staff understood the principles of the MCA and DoLS and could apply these when delivering care and support.

People had support from skilled and trained staff who understood how to meet their needs and provide effective support. People had support to maintain a healthy diet and could access food and drinks as and when they wanted. Mealtimes were relaxed and people had plenty of choice. People had individual health action plans in place and access to health care professionals when they needed them, which helped people maintain their health and wellbeing.

People had positive relationships with others living at the home and members of staff. Staff showed people respect and were caring whilst delivering their care and support. Staff involved people in planning their care and encouraged people to be independent. People had their dignity and privacy respected by the staff who provided their care and support.

People’s care and support was personalised and responded to their needs. Staff gave consistent care to meet people’s needs and preferences, Staff understood care needs through the detailed care records, which people had been involved in designing and which got reviewed regularly. People could access a range of different things to do and could choose on a daily basis how to spend their time.

People gave feedback about the service on a daily basis through informal discussions with staff and managers they also provided feedback at regular house meetings. People and their relatives understood how to make a complaint and felt the registered manager would address their complaints.

People shaped the service through their suggestions; the registered manager promoted an open culture and encouraged people to share their ideas about improving the service. The registered manager understood their role and responsibilities. The registered manager monitored quality and improvements to the service were undertaken as a result. Staff had support from the registered manager to understand their roles and ensure they had the skills to support people.

People were involved in making decisions about their lives as far as they were able. We saw people being treated with dignity and respect by the staff.

We found that care plans were very person centred and contained lots of information about people's choices, preferences and their likes and dislikes.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

We found that medicines were safely stored, handled and administered. All the medicine records we checked were accurate.

We found that the provider regularly monitored the quality and performance of the service it provided.

People's dignity and independence was respected and promoted. People took part in their care and daily living tasks, had stimulation and attended worship if they wished to.

People who used the service, their representatives and other professionals were involved in planning care and treatment and made best interest decisions. They worked together to monitor and adjust care and treatment as necessary, which had improved people's health and wellbeing.

Staff had training from the health specialists to understand people's specific conditions. Health professionals told us the staff team now had a consistent approach and managed complex behaviours well.

The provider carried out checks to make sure that staff were fit for their roles before they started work. People got along with the staff, and staff felt well supported by management. There were effective systems in place to act upon and learn from safeguarding concerns, incidents and complaints.