CQC report explained · a residential care home
What the CQC found at Fir Trees House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, April 2022
Fir Trees House was rated Requires Improvement; inspectors found kind and safe care, but restrictions and care planning did not always promote people's independence.
Inspectors visited without notice on 24 February 2022. They spoke with all five people living at the home, a relative, two friends, five staff and a health professional. They also checked care, medicine and staff records, training and quality checks.
The home was rated Good for Safe. People were protected from abuse and avoidable harm, staffing was sufficient, medicines were managed safely and infection control was effective.
Effective and Well-led were rated Requires Improvement. The kitchen had been kept locked and people could only use it with staff support. Care plans did not always set out personal goals or ways to build independence. The new manager had started improvements, but these were not yet complete.
The home had been rated Good at the previous inspection, published in October 2018. The report identified a breach of Regulation 9, Person-centred care, and said the provider must send an action plan. CQC will continue to monitor the home.
People were kept safe
Staff knew people well and understood how to protect them from abuse and avoidable harm. Risks in the home and emergency evacuation needs were assessed and managed.
“People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse.” from the report
Kind and respectful support
Inspectors saw staff provide sensitive, personalised support. Staff respected privacy, dignity, cultural needs and people's choices.
“People received kind and compassionate care. We observed staff providing support in a personalised sensitive manner which demonstrated genuine regard for people.” from the report
Safe medicines practice
Medicines were stored, administered and recorded safely. Staff supported people to make their own decisions about medicines where possible.
“Only staff who had been trained and assessed as competent were able to administer medicines to people.” from the report
Supportive staff development
Staff received induction, supervision, training and competency checks. Staff said managers were available to answer questions and support their learning.
“New staff received support in the form of induction, continual supervision and appraisal.” from the report
Improving management
The recently appointed manager had identified problems, improved staff morale and started reviewing care plans and the way the service supported people.
“The registered manager was in the process of reviewing peoples support plans and had identified a need for further work to increase the level of involvement and participation.” from the report
Kitchen access was too restricted
seriousThe kitchen had been kept locked because of risks linked to one person who had since left. This restriction applied to everyone and had not been properly reviewed or considered under the Mental Capacity Act.
“This meant all people living at the service were subject to this restriction.” from the report
Care plans did not promote independence
seriousPlans did not always include people's goals, strengths or positive risk strategies. This meant people could miss opportunities to develop skills and take part in activities such as cooking.
“Support plans did not always provide guidance for staff or contain strategies to actively promote people's skills” from the report
People were not always encouraged and involved
needs fixingSome relatives and friends felt staff did not always provide enough structure, encouragement and stimulation. Inspectors found people did not always lead inclusive and empowered lives.
“People did not always lead inclusive and empowered lives.” from the report
Some care plan language was not person-centred
needs fixingSome records used negative or unclear descriptions rather than respectful, specific language about people's needs and distress.
“These terms demonstrate a lack of understanding of maintaining people's dignity and are not person centred.” from the report
Health decision support was incomplete
needs fixingOne person had not received all available support to make an informed decision about treatment for a health condition. The manager began reviewing this during the inspection.
“One person had not been provided with all available support for them to make a considered decision about treatment to manage a health condition.” from the report
- 01Has the kitchen door remained unlocked, and how are risks assessed so people can use the kitchen as independently as possible?
- 02Does each person's current care plan include their wishes, goals, strengths and positive risk strategies?
- 03What changes have been made to help people take part in cooking, household tasks, garden activities and community activities?
- 04How do managers check that restrictions are lawful, in people's best interests and the least restrictive option?
- 05What action was taken in response to the Regulation 9 breach, and what evidence can you show that the changes are now working?
This was an unannounced inspection focused on applying Right support, right care, right culture, with detailed ratings given for Safe, Effective and Well-led; separate ratings for Caring and Responsive were not shown. This explanation was written from the published report of 22 April 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, October 2018
Rated Good; inspectors found safe, kind and person-centred care, with end-of-life planning and incident reporting needing improvement.
This was an unannounced inspection on 5 September 2018. One inspector spoke with all four people living in the home, observed care, spoke with staff and managers, and reviewed care plans, medicines records, risk assessments, incident records and other documents.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines practice, suitable training, clean surroundings and good support with healthcare, food, relationships, activities and independence.
There were two areas to improve. People's wishes about end-of-life care had not been discussed or recorded. Two incidents had not been reported to the CQC correctly, although the people involved had received appropriate support and the notifications were sent after the inspection.
Enough trained staff
Staffing levels were sufficient, and staff had safeguarding training and appropriate recruitment checks. Bank staff worked alongside permanent staff when covering shifts.
“Sufficient numbers of staff were available to support people and robust recruitment processes were in place.” from the report
Safe medicines
Medicines were ordered, stored, given and recorded safely. Records showed no gaps in administration.
“People's medicines were managed and administered safely.” from the report
Kind relationships
People appeared relaxed with staff. Staff knew people's likes, dislikes and communication styles and treated them with dignity.
“People were supported by caring staff who had developed positive relationships with people.” from the report
Choice and independence
People were supported to make decisions, follow their own routines, do household tasks and take part in activities in the home and community.
“People were supported to follow their individual routines and to access the community.” from the report
End-of-life wishes
needs fixingThe home had not discussed or recorded how people wanted to be supported at the end of their lives. Inspectors made a recommendation for the provider to improve its planning processes.
“There was no information available regarding the support people would like when approaching the end of their life.” from the report
Incident notifications
needs fixingTwo incidents had not been reported to the CQC appropriately. The provider sent the notifications retrospectively after the inspection, and the CQC said it would monitor reporting closely.
“There were two incidents which had not been reported appropriately.” from the report
Change in manager
minorThere was no registered manager in post because the previous manager had left in May 2018. A new manager had started less than a week before the inspection and had applied to register with the CQC.
“There was no registered manager in post.” from the report
- 01How do you now discuss and record each person's wishes about end-of-life care?
- 02What checks are in place to make sure all reportable incidents are notified to the CQC on time?
- 03Is there now a registered manager, and what has happened with the manager's registration application?
- 04How do you assess compatibility and plan introductions when a new person may move into the home?
- 05What changes followed the reduction in incidents after people moved to more independent accommodation?
This was an unannounced inspection of the whole home and its care, covering all five CQC questions; four people were living there at the time. This explanation was written from the published report of 24 October 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Fir Trees House
6 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- April 2022Requires improvementcurrent ratingdown from GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2018Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- October 2017Requires improvementup from InadequateSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2017Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: InadequateResponsive: InadequateWell-led: Inadequate
- January 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- March 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- February 2013
Registered with the Care Quality Commission on 4 February 2013.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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