Fisher Close

Fisher Close is a nursing care home providing personal and nursing care to up to 15 people. The service provides support to people with a learning disability and autistic people, people with a physical disability and sensory impairment, younger people, older people, people with mental health support needs including dementia. Accommodation is provided within 3 separate bungalows. At the time of our inspection there were 15 people using the service.

People’s experience of the service and what we found:

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 assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Some records relating to medicines were not always in place in line with best practice guidance. One person’s care plan and risk assessment were not reflective of their current needs and risks. Staff were working to review and update all care plans. Accidents and incidents were reported, however they were not always robustly analysed to identify themes and trends to mitigate risk. Systems were in place to oversee the service, however prompt and effective action was not always taken to address areas for improvement.

Person centred guidance was in place and staff worked with people to plan for when they experienced periods of distress.

The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs.

Right Care

People were protected from the risk of abuse because staff understood their responsibilities in relation to safeguarding.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Culture

Feedback was encouraged, and work was underway to ensure equal opportunities to feedback were in place for everyone. People and their relatives felt listened to.

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.

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.

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 10 February 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement

We have identified breaches in relation to safe care and treatment, 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

At the last inspection we found that there were not always enough staff to meet people’s needs and at this inspection we saw that this had improved. There were enough staff and people were supported to be independent and to engage in activities at home and in the community.

Quality audits were completed in the home and were effective in highlighting any actions which needed addressing. The provider’s systems for reviewing the quality of the home and ensuring the registered manager understood what improvements were required were not always effectively implemented.

Risk management remained safe and this included ensuring that people received their medicines as prescribed. People continued to be protected from abuse and lessons were learnt when things went wrong. Infection control was managed to protect people.

Staff were still equipped to do their jobs well through training and support. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. People continued to have enough to eat and drink and their healthcare needs were met in partnership with other organisations. The building was designed and adapted to meet people's needs.

The service remained caring and staff demonstrated kind, patient interaction with people which upheld their dignity and privacy. Relationships with families and important people were encouraged by staff.

The service remained responsive because staff understood people's needs well. Care plans were up to date and people’s support requirements were regularly reviewed and amended. There were no complaints but there was a complaints procedure in place and information about how to complain was on display.

Further information is in the detailed findings below

Was it safe?

We saw that staff supported people safely and mostly followed the Mental Capacity Act 2005. One person was able to consent to their care and their records showed that the provider asked them for their consent before they received care and acted in accordance with their wishes.

Two people's care records did not properly account for their best interests. This was because they did not show the necessary arrangements, where important decisions about their care and welfare had been made by others on their behalf. This meant that where people did not have the capacity to consent, the provider did not always act in accordance with legal requirements.

People were protected against the risks of unsafe or unsuitable premises because the provider had taken steps to ensure the home was adequately maintained and equipped and mostly suitably designed.

Arrangements were in place for dealing with foreseeable emergencies, such as in the event of a fire or accidents or serious accidents and incidents. The local fire authority had inspected the home in March 2014 and found the provider fire safety arrangements were broadly compliant with their fire safety requirement.

The manager had undertaken checks of people's care and safety and the records required for this were mostly kept up to date. They were also introducing checking systems in for medicines and infection prevention and control. This helped to ensure that people were not being placed at unnecessary risk because the provider had systems to assess and manage risks to people's health and welfare.

Was it effective?

Staff understood people's needs and any known risks to their safety, which helped to ensure that people experienced care, treatment and support that met their needs.

Two people's relatives told us they (people), received the care they needed. This was independently described by both as 'excellent.' One person's relative said, 'He's been in a few homes and has been much better here.'

The provider had external management monitoring arrangements, which included a recorded annual audit. This audit was used to check the quality and safety of people's care at Fisher Close. This was completed to show the provider's systems that should be operating to ensure people's safe and effective care. However, the record did not show whether these were met or whether any improvements were needed This meant it was not wholly effective in assuring the quality and safety of people's care.

Was it caring?

Two people's relatives told us that staff, were 'brilliant' and 'caring.'

We saw that staff communicated well with people, in a caring manner. Staff supported people with sensitivity, for example supporting them to move and to eat and drink. They promoted people's privacy and dignity and helped them to make simple daily living choices. For example choice of meals and drinks.

Was it responsive?

We found there was usually enough qualified, skilled and experienced staff to meet people's needs. We saw that staff communicated well with people, in a caring manner. They supported people at their own pace and in a way that recognised their individuality.

Work was in progress to develop approaches to people's care. This included assessing and responding to people's behavioural needs and developing a more person centred approach to meet people's changing and complex care needs.

Some information was provided for people about their care in formats that were easier for them to understand. This included the use of pictures and symbols. A meals toolkit was being developed to further to assist people in choosing their meals. People's care plans showed how they communicated their needs and instructed staff about this.

The home was comfortable, homely and equipped to meet people's mobility and sensory needs. This included personal mobility equipment and sensory quiet rooms and equipment. All people's own rooms were highly personalised. However, the design of the garden in Bungalow 1 restricted people's use. This was because it was too difficult for staff to move people in their adapted wheelchairs on the soft grass and the patio area provided limited space.

We found that the provider properly responded to complaints and concerns they received. This included investigating, acting and responding to the complainant.

Was it well led?

The manager and senior staff involved people's families, advocates and relevant health and social care professionals in people's care when required. This helped to ensure that people's health and social care needs were met, including for their routine health screening.

We found that the manager was consulting with staff and facilitating a review of their skills and deployment arrangements. Their stated aim was to develop proactive approaches to people's care and to secure more flexible staff working across the three bungalows at Fisher Close for benefit the people living there.

The manager monitored accidents and incidents and errors and near misses to check whether improvements were needed to people's care. Improvements being made included, developing care plan approaches for managing people's behaviours that challenged others. This included the commencement of a programme of related accredited staff training.

We found that staff, were asked for their views about people's care and treatment, and consulted about any changes. However, people's views about their care and treatment; or their representatives where required, were not always obtained or accounted for.

One person's care records did not fully account for their safety and welfare needs. This was because some of their personal care needs, relating to risks from their medical condition, were not being regularly reviewed. However, records showed that the manager had identified this and had instructed staff about the action to be taken and by when to rectify this.

We observed staff interacting positively with people. However, care plans did not always identify risks to people or provide guidelines to staff in managing these risks.

People's relatives told us that people had a choice of food and their special dietary needs were catered for. One relative told us that the food was, 'very good.' We noted, from reading records and our observations, that people's nutritional needs were being met.

People felt safe and confident with staff administering their medication and said they received their medicines when needed. We found that medicines were being safely stored, administered and recorded.

Relatives felt there were enough staff to meet people's needs. However, one person who used the service disagreed and we found evidence to show that safe staffing levels were not being consistently met.

Relatives told us they knew how to make a complaint. Staff were able to describe how people's changes of behaviour and facial expressions showed if they were unhappy.

The people we spoke with said that their privacy and dignity was respected at Fisher Close. One person said, 'When I go to the bathroom staff cover me up.' People were involved, as far as possible, in planning their care. Staff respected their personal preferences and people thought that their needs were met. One person told us, 'My one to one worker knows my ways'it makes it easy to be with them.'

People told us they felt safe at Fisher Close and were well treated by staff. Support workers had received training that kept people safe and the people we spoke with felt that staff were well trained to meet their needs. Records we saw supported this.

People were asked for their views, and comments that they made were acted on. One relative told us, 'I feel so lucky [the person] is there.'