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Inspection carried out on 5 September 2018

During a routine inspection

The inspection took place on 5 September and was unannounced.

Fir Trees House 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 House provides care for up to seven people with learning disabilities or mental health support needs. At the time of our inspection there were four people living at Fir Trees House.

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.

There was no registered manager in post. The previous registered manager had left the service in May 2018. 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. A new manager had been appointed and supported us during the inspection. They informed us they had applied to register with the CQC and our records confirmed this was the case.

Sufficient numbers of staff were available to support people and robust recruitment processes were in place. Staff had completed safeguarding training and understood their role in protecting people from the risk of harm. Risks to people were identified and managed in a way which kept people safe whilst supporting them to take reasonable risks to promote their independence. People’s medicines were stored administered and recorded safely. Health and safety checks were completed and a contingency plan was in place to ensure people would continue to receive their support in the event of an emergency. People lived in a clean and well-maintained environment and safe infection control practices were followed.

The provider had systems in place to ensure people’s needs and compatibility to live with others were considered prior to someone moving into the service. People were supported by staff who received on-going training and supervision to support them in their role. The principles of the MCA were followed to ensure people’s rights were protected. People received support to access healthcare services. A choice of food and drinks were available to people.

People liked the staff supporting them and staff knew people well. There was a positive and relaxed atmosphere and people and staff communicated well. People's privacy and dignity was respected and people were supported to practice their religious beliefs. Visitors were made to feel welcome to the service and people were supported to maintain relationships with those who were important to them.

People and staff were involved in developing and reviewing care plans. Care plans were detailed and reflective of the support people required. However, we found that information regarding the support people wanted at the end of their life had not been discussed or incorporated into people’s care records. We have made a recommendation regarding this. People told us that staff responded to requests for support and staff understood people’s needs and personalities. People were encouraged to participate in activities both when spending time at home and within the local community. The provider had a complaints policy in place and people were aware of how to raise concerns.

People were supported by staff that understood their roles, responsibilities and the ethos of the organisation. Systems were in place to monitor the quality of the care people received and people and staff were able to voice their opinions regarding the service. Records were

Inspection carried out on 17 August 2017

During a routine inspection

Fir Trees House is a care home providing accommodation and personal care for up to seven people with learning disabilities or mental health support needs. There were six people living at the service at the time of our inspection.

The inspection took place on 17 August 2017 and was unannounced.

There was no 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.

Since our last inspection a new manager had been appointed and was present on the day of the inspection. The manager told us they were in the process of registering with the Care Quality Commission and our records confirmed this

At our previous inspections in November 2016 and May 2017 we found concerns regarding the governance of the service, risks to people not being adequately assessed and safeguarding concerns not being reported to the local authority. In addition we identified that staff training was not effective in supporting staff in their roles and people’s needs were not being responded to in a person centred manner. At our inspection in May 2017 nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found. Following this inspection the provider sent an action plan detailing the action they proposed to take to ensure these breaches were met. At this inspection we found that significant improvements had been made. People were now receiving care that met their needs and no breaches of legislation were identified. We will continue to monitor the service to ensure that systems in place continue to develop and are embedded into practice.

There were sufficient staff deployed and staff worked flexibly to meet people’s individual needs. Safe recruitment practices were followed to help ensure that staff employed were suitable to work at the service. Staff received training and support that provided them with the knowledge and skills required to support people in an effective, person centred manner. Staff told us they felt supported by the management of the service and records showed they received regular supervision to monitor their performance.

Staff had received training in safeguarding people from abuse and understood their responsibilities in this area. Where safeguarding concerns were identified these were shared with the local authority and appropriately investigated. Risks to people’s safety were assessed and control measures implemented to keep people safe. Staff were aware of triggers to people’s anxiety and offered support to help people remain calm. Accidents and incidents were reported and monitored to ensure action was taken to prevent them happening again. The property had recently been refurbished and any maintenance concerns addressed. A contingency plan was in place to ensure people would continue to receive a safe service in the event of an emergency.

People received their medicines as prescribed and safe medicines practices were followed. People had access to healthcare professionals and received support to plan and attend appointments. Regular monitoring of people’s health needs was completed including measuring people’s weight. People had a choice of foods and were involved in menu design and meal preparation. People’s legal rights were protected as the principles of the Mental Capacity Act 2005 were followed.

People were supported by staff who treated them with respect and understood the importance of developing and maintaining people’s independence. We observed people were actively involved in the running of their home. People were supported to maintain relationships with those important to them. People’s religious and cultural needs were respected. Staff wer

Inspection carried out on 10 May 2017

During a routine inspection

Fir Trees House is a care home providing accommodation and personal care for up to seven people with learning disabilities or mental health support needs. There were six people living at the service at the time of our inspection.

The inspection took place on 10 May 2017 and was unannounced.

There was no registered manager 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. A manager had been in post for seven months and supported us during our inspection. A manager was in post and supported us on the day of the inspection.

At our last inspection in November 2016 we found that there had been limited improvements made in the care and support people received. However there were continued concerns regarding the governance of the service, risks to people not being adequately assessed, safeguarding concerns not being reported to the local authority, staff training not being effective in supporting them in their role and people’s needs were not being responded to in a person centred manner.

At this inspection we found that there were on-going concerns about the care and support people received. Risks to people’s safety and well-being were not always identified and addressed. Staff were not aware of how they should support people with their behaviours and there was an atmosphere of tension within the service. Staff did not demonstrate an understanding of their responsibility to safeguard people from abuse and incidents of verbal abuse had not been reported to the local authority. Accidents and incidents were not effectively monitored to mitigate the risk of them reoccurring. Medicines were not always administered safely although medicines were stored and monitored appropriately. Maintenance concerns were not addressed in a timely manner and not all areas of the service were cleaned to a satisfactory standard.

Sufficient skilled staff were not effectively deployed. Two people living at the service had been assessed as requiring one to one support for periods of the day although this was not always provided. Staff spent their time performing tasks rather than actively engaging with people. The manager had not completed a dependency tool to assess the number of staff required to meet people’s needs. Staff did not receive the training they required to complete their role. Not all staff had completed training in supporting people who may display behaviours which challenge and not all mandatory training had been completed. Staff told us they received regular supervision and felt supported by the manager. However, staff expressed concerns regarding the support they received from the provider. Recruitment checks were not fully completed to ensure that staff employed were suitable to work in the service.

People’s rights were not always protected as the framework of the Mental Capacity Act 2005 was not followed. People’s healthcare needs were not always met and guidance from professionals was not always followed. People did not receive person centred support in line with their needs. Support plans lacked detail and did not provide guidance to staff on how to support people well. There was a lack of activities provided to people and people were not supported to follow their interests.

There was a lack of positive interaction from staff and people were not always treated with kindness. Staff did not acknowledge or demonstrate understanding of the impact that repeated incidents of shouting and abusive behaviour had on people’s well-being. People were not supported to develop their independent living skills. Staff were not always respectful of people’s home. Staff were observed to use an exasperated tone with people and on one occasion a staff memb

Inspection carried out on 18 November 2016

During a routine inspection

Fir Trees House is a care home providing accommodation and personal care for up to seven people with learning disabilities or mental health support needs. There were seven people living at the service at the time of our inspection.

The inspection took place on 12 November 2016 and was unannounced.

There was no registered manager 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. A manager had been in post for three months and supported us during our inspection. Records showed that the manager had begun the process of registration with the CQC.

At our last inspection in October 2015 we found breaches of the legal requirements in relation to risks to people’s safety not being adequately addressed, the requirements of the Mental Capacity Act 2005 not being followed and the lack of management oversight of the service.. The provider wrote to us to inform us of the action they planned to take to address the concerns. This comprehensive inspection was conducted to check that the action had been taken by the provider and that they were now meeting their legal requirements. We found that the provider had made improvements in some areas which had led to positive changes for people. However, the provider had failed to address a number of issues in relation to people’s safety and well-being, protecting people’s rights and the management oversight of the service.

There was a lack of management oversight of the service. Quality audits were not effective in identifying shortfalls in the service and feedback received was not always acted upon. The manager had been in post for three months. Due to vacancies within the senior management team they were not receiving effective support during their probationary period.

Risk assessments were not completed comprehensively and did not identify control measures to minimise the risks to people safety and well-being. A number of people living at Fir Tree Road displayed behaviours that challenged and records showed there were times people had felt unsafe. Where safeguarding concerns had been recorded these had not been forwarded to the local authority safeguarding team. Incident records were not analysed to identify what actions were required to minimise the risk of reoccurrence.

Staff did not receive effective training to support them in their role and had not put their training into practice in regards to safeguarding and compliance with the Mental Capacity Act 2005. Since the last inspection staffing levels had reduced which meant people were not always offered support flexibly. We have made a recommendation regarding this.

People’s legal rights were not always protected as the staff were not working in line with The MCA and DoLS legislation. Whilst some people’s care plans contained information regarding the likes and dislikes other people’s plans lacked detail and guidance for staff.

A number of activities were provided for people although staff told us they felt more could be achieved. We have made a recommendation regarding developing the opportunities available to people. A number of people living at the service were able to plan their own activities and daily routines.

Medicines were managed safely and staff understood the process involved in supporting people with their medicines. Maintenance of the premises and equipment were monitored and health and safety checks of the environment were completed. There was a contingency plan in place to ensure that people would continue to receive a service in the event the building could not be used.

Safe recruitment practices had been followed to ensure that the staff employed were of a suitable character to provide people with care and support. Staff t

Inspection carried out on 1 October 2015

During a routine inspection

Fir Trees House is a care home providing accommodation and personal care for up to seven people with learning disabilities or mental health support needs. There were five people living at the home at the time of our inspection.

The inspection took place on 1 October 2015 and was unannounced.

The home 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.

Risk assessments for people were not regularly reviewed to ensure staff had the most up to date information. Staff told us they were unsure as to how to support someone in the community which meant their opportunities were limited.

There were sufficient staff deployed in the home. Staffing numbers were flexible to ensure people’s individual needs were met. There were enough staff to enable people to go out and to support the people who remained at home.

Staff had a clear understanding of how to safeguard people and knew what steps they should take if they suspected abuse. There was an effective recruitment process that was followed which helped ensure that only suitable staff were employed.

Medicines were managed well and risk assessments were in place to mitigate the risk of mistakes being made. People were supported to maintain good health and had regular access to a range of healthcare professionals.

Staff did not have a good understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. This meant that decisions made may not always be taken in the persons best interests.

People were involved in choosing what they had to eat and drink and menus were displayed.

Staff received training and supervision to enable them to have the necessary skills to carry out their role. Training was regularly reviewed to ensure staff had the most up to date information.

People interacted with staff in a positive and friendly manner. However, interaction from staff was not always respectful. People were supported by staff who knew people well and respected their privacy. Visitors were welcomed to the home.

People were not supported to develop independent living skills. Care plans did not detail progress for people who wanted to move on to more independent living. People’s needs were assessed prior them to moving into the service but plans were not regularly updated meaning staff did not always have the most up to date information when supporting people.

There was a complaints policy in place which was displayed in an easy read format. Relatives told us they knew how to make a complaint should they have any concerns.

Audits completed by the service did not always identify shortfalls in service delivery and actions to rectify issues were not always recorded. Audits showed that records had been reviewed but did not check the quality of the information presented.

Accidents and incidents were reviewed by the manager to reduce the risk of incidents happening again. A contingency plan was in place to ensure that people’s care could be provided safely in the event that the building could not be used.

During the inspection we found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.