Archived: Firs Court

Updated 13 November 2021

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 Care Act 2014.

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

This inspection was carried out by three inspectors.

Service and service type

Firs Court is both a care home and provides a supported living service to people with tenancy agreements, living in their own flats. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided in the care home, and both were looked at during this inspection.

Firs Court supported living provides support and personal care to people living in their own homes on the same site, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. Not everyone who lives in supported living receives a regulated activity.

The service had a manager registered with the CQC. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

The registered manager was not present during the inspection visit due to illness. The deputy manager and a board director who we understood to be the director of operations were present during the inspection visit. During our inspection we identified some concerns with the provider's registration with CQC that we are looking into further.

Notice of inspection

This one-day inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

During the inspection

We spoke with six people, three relatives, one advocate, ten staff, the deputy manager and a board director, we understood to be the Director of Operations. We also received feedback from five healthcare professionals.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We looked at a range of records that included five care plans of people who received a regulated activity, risk assessments, four staff files and other records relating to the management and governance of the service, including audits, policies and procedures.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We requested additional evidence to be sent to us after our inspection. This included governance and management records, conflict of interest statements, and audits. We received the information which was used as part of our inspection.

Updated 13 November 2021

About the service

Firs Court is part of a charity, the Fircroft Trust. It is divided into three parts, a care home offering accommodation and personal care for up to nine people in purpose-built accommodation, supported living services for six people, and four adjacent houses for independent living for five people. All the people who live at Firs Court have a learning and/or physical disability, or need support to maintain their mental health. There were eight people living in the care home, six in supported living, three in the more independent houses and two people who were completely independent and don’t receive any support other than tenancy support.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

The service was not always safe for people to live and staff to work in. The whistle-blowing policy and procedure was not effective at senior management, board or trustee level. The culture was not always transparent at the senior management, board and trustee level. This was regarding the organisation’s duty of candour, board director recruitment, areas of responsibility, accountability and auditing which were not clear, above registered manager level. The supervision of the registered manager was not focused on them and their support needs.

People and their relatives told us they enjoyed living at Firs Court and the staff were nice, kind and supportive. People had risks to themselves assessed, that enabled them to take acceptable risks, live safely and enjoy their lives. Accidents, incidents and safeguarding concerns were appropriately reported, investigated and recorded. There were enough appropriately recruited staff to meet people’s needs. Medicines were safely administered. Health care professionals felt the home and supported living scheme were run safely.

The home and supported living service had a culture that was open, positive and honest, at the operational level with transparent management and leadership. The organisation’s vision and values were in the statement of purpose and understood by staff. Areas of responsibility and accountability were identified, within the home and supported living service with quality frequently reviewed. The home carried out audits and records were kept up to date. Good community links and working partnerships were established. Health care professionals were very positive about the way the registered and deputy managers ran the home and supported living scheme and staff provided care.

People were not always supported to have maximum choice and control of their lives regarding being asked to move their accommodation in the interests of the organisation, not themselves. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

The service was not always able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. In a trustees’ report dated February 2021, it was proposed to consult with two people currently living in one part of the service about moving to another part to free up that area for the organisation’s mental health resource centre staff until new premises could be found for a day centre. It was also suggested, in future, that area of the service could be used for transition for younger people or could be rented out commercially. This impacted on people by asking them to move from their home, although still within the same scheme, to benefit the service rather than them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating at the last inspection

The rating at the last inspection for this service was good (published April 2020).

Why we inspected

The inspection was prompted in part due to concerns received about senior management leadership, conflicts of interest, audits, record keeping and monitoring systems not always identifying issues in relation to people’s care and safety. A decision was made for us to inspect and examine the risks associated with these issues.

The CQC has introduced focused/targeted inspections to check specific concerns. We undertook a focused inspection approach to review the key questions of Safe and Well-led where we had specific concerns about record keeping, monitoring systems and audit management.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

As no concerns were identified in relation to the key questions is the service Effective, Caring and Responsive, we decided not to inspect them. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the provider’s oversight, support, duty of candour and governance systems that had failed to address issues we identified at this inspection. This included issues relating to the whistleblowing policy, person-centred decision-making, duty of candour, board director recruitment and registered manager supervision.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.