Fethneys Living Options - Care Home Physical Disabilities

Updated 23 November 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by 2 inspectors.

Service and service type

Fethneys Living Options – Care Home Physical Disabilities is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Fethneys Living Options – Care Home Physical Disabilities is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 19 October 2023 and ended on 27 October 2023. We visited the location’s service on 19 October 2023.

What we did before the inspection

We reviewed information we had received about the service, including safeguarding concerns we had been informed of which were being investigated by the local safeguarding authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with the provider’s interim service manager, registered manager, deputy manager, administrator, 5 care staff (including 2 agency staff), 5 people and 4 relatives. We reviewed a range of records including staff recruitment, 3 care plans, risk assessments and audits.

Updated 23 November 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Fethneys Living Options – Care Home Physical Disabilities is a residential care home providing personal care to 10 people at the time of the inspection. The service can support up to 10 people with a physical disability such as cerebral palsy; some people also had a learning disability; people used verbal communication. Their physical needs were supported in an adapted building, with a lift, overhead tracking hoists and accessible outdoor space.

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

Right Support: People did not always receive personalised care that met their preferences, and people were not offered enough opportunities to enable them to live the lives they chose. For example, the high use of agency staff at the home meant people could not always go out when they wanted to. Two people wanted to go swimming, but there were no specifically trained staff to ensure safety when swimming. The home had an accessible minibus, but no staff were qualified to drive it, so people could not go out unless they hired accessible transport. People were not supported with their independence. For example, one person had a standing frame, but their relative said they had never seen them using it. Another person did not receive physio support in line with the requirements of their care plan.

People were not always 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.

Right Care: People received support from staff who were kind and caring. However, care was not always person-led and staff were reactive to people’s needs. One person used picture reference cards to help staff understand how they were feeling. However, these cards were tangled up on their wheelchair and could not be easily reached by the person to use. Staff asked one person what they would like to do in the morning, colouring or sand play, but gave the person no time to respond. A staff member sat down and started to make moulds with the sand, but the person made it very clear they did not want to do this, delivering a strong, negative, verbal response.

Right Culture: People lived with a range of physical disabilities, and some had a learning disability. Staff were understanding of people’s care and support needs, but the culture of the home did not encourage people’s independence, and focused on what they could not do, rather than enabling people to have fulfilling lives. A relative was concerned about their loved one’s mental wellbeing because they did not have enough to do or activities that were planned in line with their preferences. People were not empowered to have a good quality of life, were accepting of staff support, but had limited opportunities to do what they wanted in the wider community.

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 8 March 2019).

Why we inspected

This inspection was prompted due to concerns received about monitoring of risks, such as constipation and bowel management, and safeguarding referrals made to the local authority. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe 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 Fethneys Living Options – Care Home Physical Disabilities on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to unsafe care and treatment, the lack of person-centred care, and ineffective governance of the service 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 continue to monitor information we receive about the service, which will help inform when we next inspect.