Archived: Firs Court

Firs Court is part of a charity, the Fircroft Trust. It is divided into three parts, a care home offering accommodation and personal care for up to nine people in purpose-built accommodation, supported living services for six people, and four adjacent houses for independent living for five people. All the people who live at Firs Court have a learning and/or physical disability, or need support to maintain their mental health. There were eight people living in the care home, six in supported living, three in the more independent houses and two people who were completely independent and don’t receive any support other than tenancy support.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

The service was not always safe for people to live and staff to work in. The whistle-blowing policy and procedure was not effective at senior management, board or trustee level. The culture was not always transparent at the senior management, board and trustee level. This was regarding the organisation’s duty of candour, board director recruitment, areas of responsibility, accountability and auditing which were not clear, above registered manager level. The supervision of the registered manager was not focused on them and their support needs.

People and their relatives told us they enjoyed living at Firs Court and the staff were nice, kind and supportive. People had risks to themselves assessed, that enabled them to take acceptable risks, live safely and enjoy their lives. Accidents, incidents and safeguarding concerns were appropriately reported, investigated and recorded. There were enough appropriately recruited staff to meet people’s needs. Medicines were safely administered. Health care professionals felt the home and supported living scheme were run safely.

The home and supported living service had a culture that was open, positive and honest, at the operational level with transparent management and leadership. The organisation’s vision and values were in the statement of purpose and understood by staff. Areas of responsibility and accountability were identified, within the home and supported living service with quality frequently reviewed. The home carried out audits and records were kept up to date. Good community links and working partnerships were established. Health care professionals were very positive about the way the registered and deputy managers ran the home and supported living scheme and staff provided care.

People were not always supported to have maximum choice and control of their lives regarding being asked to move their accommodation in the interests of the organisation, not themselves. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service 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 always able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. In a trustees’ report dated February 2021, it was proposed to consult with two people currently living in one part of the service about moving to another part to free up that area for the organisation’s mental health resource centre staff until new premises could be found for a day centre. It was also suggested, in future, that area of the service could be used for transition for younger people or could be rented out commercially. This impacted on people by asking them to move from their home, although still within the same scheme, to benefit the service rather than them.

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

The last rating at the last inspection

The rating at the last inspection for this service was good (published April 2020).

Why we inspected

The inspection was prompted in part due to concerns received about senior management leadership, conflicts of interest, audits, record keeping and monitoring systems not always identifying issues in relation to people’s care and safety. A decision was made for us to inspect and examine the risks associated with these issues.

The CQC has introduced focused/targeted inspections to check specific concerns. We undertook a focused inspection approach to review the key questions of Safe and Well-led where we had specific concerns about record keeping, monitoring systems and audit management.

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.

As no concerns were identified in relation to the key questions is the service Effective, Caring and Responsive, we decided not to inspect them. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 the provider’s oversight, support, duty of candour and governance systems that had failed to address issues we identified at this inspection. This included issues relating to the whistleblowing policy, person-centred decision-making, duty of candour, board director recruitment and registered manager supervision.

Follow up

We will request an action plan for 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.

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

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

Firs Court can accommodate a total of 25 people and 21 people were living at Firs Court on the day we visited, of which ten were receiving a regulated activity.

The service was registered before the development of Registering the Right Support guidance. However, the service follows the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service

People and their relatives told us they were safe and well treated. Staff understood their roles in safeguarding people from harm. Risks to people had been assessed and staff knew how to manage these risks safely. Staff worked with people to support them to understand possible risks. There was a process to identify learning from accidents, incidents and safeguarding concerns. There were enough staff to meet people’s needs and recruitment checks were carried out before staff started work. There were robust measure in places to protect people from the risk of infection. Medicines were managed safely but arrangements for as required medicines did not always follow best practice guidance.

We have made a recommendation that the provider consult best practice guidance on the administration of as required medicines and incorporates that into its processes.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People received personalised care that was responsive to their changing needs, empowered them and offered them choices. People were supported to develop interests and engage in opportunities to socialise and be a part of the wider community. The registered manager was proactive in supporting people’s communication needs to ensure they had information in a format that met their needs.

People’s needs were assessed before they started using the service. Staff received a range of training and support to meet people’s needs effectively. People were supported to maintain a balanced diet. Staff worked closely with a range of health professionals and ensure people had access to a range of healthcare services when needed. Health professionals were positive about the care and support people received from the service and how well staff knew and understood them.

Staff asked for people’s consent before they provided care or support. People were 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.

People and their relatives told us staff treated them with care and kindness. People were consulted about the support they received. Relatives told us their views were sought where appropriate and they were listened to. Staff treated people with dignity, respected their privacy and promoted their independence.

People, their relatives and health professionals were very complimentary about the registered manager and the management of the service. There was a clear person-centred culture at the service and staff worked to improve outcomes for people.

There were checks and processes in place to monitor the quality of the service. The registered manager was introducing new more comprehensive system at the time of the inspection. People’s, relatives’ and health professionals’ feedback was sought through an annual survey and feedback was considered for making improvements to the service.

Staff spoke positively about the support they received from the provider and registered manager and told us they worked well as a team. The service worked closely with health professionals who were complimentary about the care provided.

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 21 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

All rooms were en-suite, individually decorated and furnished. The rooms were bright and airy and people told us they could choose what they wanted in their room. Each room has a telephone so people can make and receive calls. There were lounges, dining areas and kitchens in each area and a central courtyard garden. It was close to local amenities including shops, cafes, a library, and churches and had good transport links to the local towns and London.

At the last Care Quality Commission (CQC) inspection in July 2015, the rating for Caring was Outstanding and the overall rating for this service was Good. At this inspection we found the service remained overall Good and Caring remained Outstanding. The service demonstrated they continued to meet the regulations and fundamental standards.

Firs Court provided outstanding care to people. People were supported by caring staff at all times but especially when their physical and mental health needs were changing. Staff worked with multi-disciplinary healthcare professionals to ensure people were cared for in an outstanding way. We saw clear evidence of a person-centred, innovative and creative approach that was taken towards people’s individual rehabilitation so they were able to regain their strength, independence and understand their changing health conditions.

Comments from healthcare professionals to the provider included “The level of care given to this person was like that of a good nursing home, including the use of monitoring charts for sleep patterns and food and fluid intake” and “All the people I discuss with staff are approached as individuals and all the staff team demonstrate flexibility in administering care.”

We could see that support records were comprehensive and staff said that after they had read them, they were aware of people’s background, their skills and their challenges. This meant people were relaxed with staff who knew and cared for them.

Staff treated everyone as an individual and actively promoted the opportunity for people to express their individuality either in gender, religion or sexual orientation.

People remained safe at the home. Staff could explain to us how to keep people safe from abuse and neglect. People had suitable risk assessments in place. The provider managed risks associated with the premises and equipment well. There were enough staff at the home to meet people’s needs. Recruitment practices remained safe. Medicines continued to be administered safely. The checks we made confirmed that people were receiving their medicines as prescribed by staff qualified to administer medicines.

People continued to be supported by staff who received appropriate training and support. Staff had the skills, experience and a good understanding of how to meet people’s needs. We saw that staff encouraged people to make their own decisions and gave them the encouragement, time and support to do so. Staff were providing support in line with the Mental Capacity Act 2005. People were supported to eat and drink sufficient amounts to meet their needs. People had access to a range of healthcare professionals.

People’s needs were assessed before they stayed at the home and support was planned and delivered in response to their needs. People could choose the activities they liked to do. The provider had arrangements in place to respond appropriately to people’s concerns and complaints.

Staff we spoke with described the management as very positive. We observed during our visit that management were approachable and responsive to staff and people’s needs. Systems were in place to monitor and improve the quality of the service. Audits of the premises helped ensure the premises and people were kept safe.

As part of our inspection we spoke with several staff; they gave us some examples of how they sought consent from people. The relatives of two people told us they had confidence in the care and support provided by staff. One relative said "Continuity of care is important and I'm confident that the support provided is very good".

People were provided with a choice of suitable and nutritious food and drink. We looked at a menu choice covering one week and saw that people were provided with food from a variety of cultures.

Medicines were kept safely. Medication was stored in people's rooms in locked medication cabinets. We spoke with one person who gave us verbal consent to look at their medication.

The service had a registered manager and a deputy who worked full time and covered day shifts. The registered manager and deputy shared on-call responsibilities for the home.

We spoke with relatives of two people who commented on their satisfaction with the home and the service offered. One relative said "We cannot fault the staff". Staff records and other records relevant to the management of the services were accurate and fit for purpose.

We found that the home offered a supportive and homely environment to people, with adequate numbers of suitably qualified staff.

We found that the care practice at the home was person-centred and that this was supported through policies and procedures, supervision of staff and communication with other agencies.