This inspection was carried out over three days between 23 and 27 March 2017. Our visit on 23 March was unannounced.
We last inspected Fir Trees in April 2015. At that inspection we rated the service as good in all domains.
Fir Trees is one of 14 care homes in Tameside owned by Meridian Healthcare, part of the organisation HC-One. Fir Trees is situated in the Dukinfield area of Tameside and provides accommodation for up to 46 people who require accommodation and personal care. All rooms provide single accommodation and have en-suite facilities. Bedrooms are located over two floors and can be accessed by stairs or passenger lift. Communal bathrooms and toilet facilities are available throughout the home. The home is divided into two floors; each floor consists of a lounge and dining area there is a small laundry area and a kitchenette upstairs used by staff to make snacks and drinks. There is also a lower ground floor area that is currently used for storage and meetings. The main laundry and large kitchen are located on the ground floor. There is an open patio and lawned area next to the car park; there is no accessible, enclosed garden area for people to use without supervision.
At the time of our inspection there were 44 people living at Fir Trees.
The service had a registered manager in place. 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.
We carried out this inspection in response to information of concern we received around safeguarding of people from the risk of harm. These concerns were regarding safe and effective pressure care practice.
Care records at the home showed us that people received input from health care professionals, such as opticians and podiatrists. We found people had received the necessary care and support when they needed it. For example, referrals to district nursing team for assessments due to concerns for someone’s skin integrity.
We identified breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were around infection control, risk assessments, medication errors and management oversight. You can see what action we told the provider to take at the back of this report.
We made three recommendations in relation to the provider reviewing arrangements in place to establish where there are Lasting Power of Attorney (LPA) arrangements in place and what these say so the service know what decision’s the LPA can make; researching how to make the home more dementia friendly; implementing measures to assist people at the home who live with dementia to help them move around the home easier; and personalised activities being provided at the home.
People, their relatives, visiting professionals and staff spoke highly of the service; one person told us, “I like this place. It’s very clean and I can’t grumble.”
During this inspection we found that there were enough staff available to meet people’s needs and they were being cared for by people who knew them well. Staff we spoke with were aware of each person’s individual care needs.
People were supported by staff who were kind and caring and ensured people’s dignity was respected when providing care and support.
The staff files we looked at showed us that safe and appropriate recruitment and selection practices had been completed by management to satisfy themselves that suitable staff were employed to care for vulnerable people.
Staff we spoke with were aware of how to safeguard people and were able to demonstrate their knowledge around safeguarding procedures and how to inform the relevant authorities if they suspected anyone was at risk from harm.
People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.
People and their relatives told us they were happy with the menu and food choices provided at the home. Kitchen and care staff were aware of peoples specific dietary needs.
We found concerns regarding the management and administration of medicines during our inspection. We found errors in the accuracy of medication records and we were unable to ascertain if people had received the right medicines in the right amounts at the right time. As a result of these findings, the registered manager immediately contacted the GP and local pharmacy to confirm that no-one had come to harm as a result of the identified errors.
Care files we looked at showed plans and risk assessments documenting people’s specific care and support needs. These were detailed plans outlining how people needed to be cared for in an effective and safe way. However, they did not always accurately reflect people’s current care needs as they had not always been kept up to date. Inaccurate records placed people at risk of receiving inappropriate or unsafe care and support.
During our initial tour of Fir Trees on the first morning of our inspection, we saw that the home was clean and free from malodour. However, we found concerns with infection control in the main laundry area. We reported our concerns to the registered manager and they arranged for this to be remedied the same day.
We found people’s documentation to consent to care and treatment had been signed by family members who did not always have the legal right to provide this consent. The home had not checked with relatives to ascertain whether these legal safeguards were in place.
A part-time activities co-ordinator was employed and a range of activities offered; however, people did not benefit from personalised activities.
There was a complaints policy in place and complaints were acted upon.
People we spoke with were complimentary regarding the registered manager and felt they had made a positive impact on the home since their arrival in July 2016.