Fir Trees House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

We identified a breach of the legal regulations relating to good governance. The provider’s governance systems did not identify concerns with the quality of care people received or the environment.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff and the management team told us they found the provider company good to work for. One staff member told us, “The managers are good.” Another staff member said, “The staff understand each other, and we can communicate which is vital. Everyone gets involved. It’s a good culture.” The deputy manager told us, “It’s a very supportive company, they value communication and good training.” The registered manager told us he valued working for the provider as it “is a growing company with many valuable opportunities.”

As described elsewhere in this report, the provider and registered manager struggled to instil a culture of care that truly valued people, promoted their individuality, protected their rights or enabled them to develop and flourish. Staff were task-focussed and supported people with their basic daily needs, rather than encouraging them to thrive. The service was lacking the direction to provide companionship, combat loneliness and to support individuals with their understanding about their own health and goals.

The staff felt supported by the management team. One staff member told us, “If there’s a problem, [deputy manager] will sort it.” The deputy manager had worked at the service for a number of years and knew people and their needs well, However the staff members on shift during the first day of our assessment did not.

Equally, the management team felt supported by the provider. The registered manager told us that the provider company provided resources that he identified were necessary for the service to operate. He said, “Anything I ask for they provide.” They told us their work was supervised by the provider, although he told us that this was on an informal basis. He said, “We speak daily but I don’t need an appointment.”

However, there was little evidence of formal mechanisms by the provider to oversee the registered manager’s work to ensure high standards were being delivered. One staff member told us, “[Provider] is OK. I don’t see her much, so I don’t interact with her much.” This demonstrated a lack of oversight from the provider and accessibility to them for staff.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Although the registered manager had an extensive background in working in support services for people with learning disabilities, autistic people and people who need support to maintain their mental health, they were not promoting a culture within the service that truly promoted their independence and built their skills and confidence.

The deputy manager’s interactions with people were kind and caring and he clearly knew them well. However, he did not motivate the staff members he supervised to provide support that enhanced people’s quality of life. For example, we observed not all staff were engaging people in a proactive way throughout the day. The deputy manager did not identify or challenge this.

Staff told us they were able to raise issues or concerns, and they felt these would be listened to by managers. However, we could not be assured these discussions took place as we did not see any record of this in the team meeting minutes, supervision records or appraisal records that we viewed.

We saw records that indicated people had monthly meetings with their keyworkers. However, these did not include comments about any issues raised and how these had been addressed.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. One staff member told us, “[The provider] came round as a result of the environmental health inspection, and we had been asking for renovation for a while.” This demonstrated that issues identified within the service were not always acted upon proactively by the provider or management team.

The registered manager and deputy manager felt they were clear about their daily roles within the service, as were staff members. The registered manager told us, “My roles are to ensure health and safety, check infection prevention and control, check medicines, do the weekly fire checks, check the food hygiene and fridge temperatures.” However, they did not identify the concerns we found during our assessment around enhancing people’s lives. This meant people were at risk of isolation and their mental wellbeing deteriorating, with one person recently moving out of the service because of this.

Registered persons of a service have a legal responsibility to inform CQC of notifiable events such as deaths of people living at the service and safeguarding concerns. CQC have not received any notifications from this service since January 2022. However, the registered manager told us 2 people who had lived in the home died in hospital in 2023. These deaths were not notified to CQC. Furthermore, the service had not notified us of the safeguarding concerns identified by the Court of Protection which led to one person moving from the service. Therefore, we could not be assured the provider and registered manager were meeting their regulatory responsibilities.

The management team and staffed work with external partners to meet the basic needs of people. This included working alongside health professionals and services such opticians. However, there was no evidence that people were supported to integrate into their local community.

Staff informed us of local organisations that were in place to support people. One staff member told us, “We have links with Sunnybanks which is a charity organisation which has a day centre and do get togethers. Other people from other homes attend so they can have a cup of tea and chat.” However, there was no evidence that the people living at Fir Trees House were supported to visit the day centre and integrate with their peers.

We were unable to gather feedback from any partners for this key question

Professionals involved in people’s care had visited the service in the 2 months prior to our inspection visit. This was demonstrated through them signing in the visitor’s book.

Staff felt there were opportunities to discuss concerns and improvements that could be made. One staff member told us, “If there was a safeguarding problem, they discuss it with staff and discuss what went wrong and how things can change. It will be done with the staff involved or the team as a whole in a staff meeting. We’re planning on installing a stairlift to prepare for future.”

There was some evidence of learning and improvement within the service as a reaction to concerns from other agencies, but little proactive innovation. For example, the service was going through a refurbishment following the concerns raised by the environmental health team. However, there was no evidence of concerns being discussed in team meetings to share good practice and learning, nor was there evidence of this through safeguarding investigations or feedback.

We identified an instance where feedback provided by the local authority was not fully used as an opportunity for learning and improvement. This could lead to poor outcomes for people due to reoccurrence of preventable incidents.

There was little evidence that people were involved with the running of the service. There were no residents’ meetings for people to make decisions or share ideas for improvements.