This inspection took place on 11 December 2018 was announced. We gave the service 48 hours notice of our inspection visit because the location was a small residential home for adults who were not accustomed to having strangers enter their home. We needed to be sure that we would not cause them any unnecessary distress. The inspection team consisted of one inspector and one pharmacist inspector. Fir Tree Lodge is registered to provide accommodation for up to 10 young adults with a physical disability, learning disability, sensory impairment and autism spectrum disorder. At the time of our inspection there were 10 people living in the service.
Fir Tree Lodge is a care home. People in care homes receive accommodation and personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided. Both were looked at during this inspection.
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.
The service 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.
At the last inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014.
At this inspection we found the provider had made improvements so they were no longer in breach of two regulations.
At the last inspection we found the provider had failed to provide person centred care and had delivered care which was task orientated and was not designed around people’s individual needs or preferences.
The provider had also failed to appropriately document decisions about people’s care and treatment made in their best interests. In addition, staff were not always able to identify the principles of the Mental Capacity Act 2005 and how they should be applied when caring for people.
At this inspection we identified one new breach and two continued breaches of the regulations.
Medicines were not managed safely. We had received several statutory notifications from the provider about medicines incidents since our last inspection.
Staff did not always follow best practice guidance for infection control.
The provider could not produce evidence that staff were appropriately trained to administer some types of medicines for people.
The registered manager used systems and process for assessing, monitoring and improving quality and safety within the service. These were not effective, as they failed to prevent reoccurrence of medicines errors.
The provider had systems and processes in place to protect people from harm and abuse. Staff had completed safeguarding training which was regularly refreshed.
The registered manager deployed sufficient numbers of staff to maintain people’s safety. They used safe recruitment processes to ensure only staff who were suitable to work in a care setting were employed
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People received care from trained staff. Staff were supported with regular supervision and training to help develop their knowledge. Staff were aware of the legal protections in place to protect people who lacked mental capacity to make decisions about their care and support.
People were supported to maintain a balanced diet. People were supported to maintain a healthy weight. Referrals were made to dieticians as appropriate.
Staff knew people’s needs well and interacted with them in a caring and sensitive way. Staff supported people to communicate their needs and protected their privacy, dignity and independence.
Care plans contained specific details about the type of care and support people required and reflected their personalities and interests.
There was a complaints policy in place and evidence showed complaints were investigated promptly and thoroughly.
Staff had plans in place for supporting people during their last days to ensure they had a comfortable and pain free death.
Staff responsibilities were clear.
The provider used different methods to engage staff, people and the public in the service and sought feedback about the care provided to make improvements to care. The provider worked effectively with health and social care professionals to meet people's needs.
We found one breach, and two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of the report.