CQC report explained · a residential care home
What the CQC found at Fir Tree Lodge Residential Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found that medicines, risks, staffing, recruitment and infection control were managed safely. Two staff records initially lacked a full employment history, but this was corrected during the inspection.
- Effective?
- Good
- Staff had training and competency checks for people's specific needs, including PEG care, food and medicines. People had access to health professionals, suitable food and drinks, and an accessible environment.
- Caring?
- Good
- Staff treated people with kindness, respect and compassion. They understood people's communication, preferences and backgrounds, and supported choice, privacy and independence.
- Responsive?
- Good
- Care plans were personalised and reviewed regularly. People were supported with activities, holidays, community links, relationships and communication in accessible formats.
- Well-led?
- Good
- The home had monitoring systems, audits and an improvement plan. The manager and provider had acted on earlier problems and created an open, person-centred culture.
What inspectors found, February 2020
Rated Good, improved from Requires Improvement; inspectors found safe, kind and person-centred care, with two staff vacancies and a larger-than-guidance home.
This was an unannounced planned inspection following the previous Requires Improvement rating. Two inspectors observed care, medicines administration and staff interactions. They spoke with staff, relatives and professionals, and reviewed care, medicines, recruitment and management records. They could not ask people living at the home for their views directly.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that medicines were now managed safely, risks were assessed, staff were trained, and people received kind and personalised support. People were supported with health care, activities, relationships and independence.
The home had improved since the previous inspection in March 2019. It was no longer in breach of regulations about medicines, staff training and quality monitoring. Inspectors noted two full-time vacancies, but found there were enough competent staff to meet people's needs.
Kind and respectful care
Staff knew people well and responded to their communication and preferences. Inspectors saw warm relationships and support that promoted dignity and independence.
“Staff were observed to treat people in a kind and caring manner at all times and this was reflected in relatives' and professional feedback.” from the report
Personalised support
Care plans covered people's physical, emotional and communication needs. Staff helped people set and achieve personal goals.
“People's care plans documented their strengths, what was important to them, how best to support them and their preferences.” from the report
Activities and community life
People took part in activities inside and outside the home, including walks, cooking, holidays, concerts and community activities. Staff supported important family relationships.
“People were supported to participate in activities which were of interest to them, both inside the service and externally.” from the report
Improvement since the last inspection
The provider had acted on earlier concerns. Inspectors found the home was no longer in breach of regulations about medicines, staff training and quality monitoring.
“At this inspection we found improvements had been made and the provider was no longer in breach of regulations.” from the report
Two staff vacancies
minorThe home had two full-time vacancies and was using bank staff and consistent agency staff to cover shifts. Inspectors still found enough competent staff at the time of the inspection.
“The registered manager told us they had been recruiting staff and there were currently two full-time vacancies.” from the report
Home larger than current guidance
minorThe home was larger than current best practice guidance for this type of service. Inspectors said the design and the way staff supported community involvement reduced the possible negative impact.
“The service was a large home, bigger than most domestic style properties.” from the report
Incomplete employment histories
minorTwo staff files did not initially contain a full employment history as required. The manager acted promptly during the inspection and provided evidence of further checks afterwards.
“Two staff records reviewed did not contain a full employment history as required.” from the report
- 01How are the two full-time vacancies currently being covered, and are bank or agency staff familiar with people's individual needs?
- 02What checks have now been completed to make sure every staff file contains a full employment history?
- 03How do you involve people in decisions when they cannot express their views directly?
- 04How do you make sure the home's larger size does not affect people's privacy, choice or community life?
- 05What medicines checks and competency assessments are currently in place to prevent errors?
This was an unannounced planned inspection covering all five CQC areas; inspectors observed care and medicines, spoke with staff, relatives and professionals, and reviewed selected records, but could not ask people living at the home for their views directly. This explanation was written from the published report of 29 February 2020 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, March 2019
Requires Improvement; inspectors found kind, personalised care but medicines, training and quality checks were not reliable.
The inspection was announced and took place on 11 December 2018. One inspector and a pharmacist inspector visited after the CQC received several notifications about medicines incidents. No harm was reported from those incidents.
The home supported 10 young adults with physical disabilities, learning disabilities, sensory impairments and autism. Inspectors found enough staff, safe recruitment and good safeguarding arrangements. They also found caring staff, personalised care plans, individual activities and good support for people's choices and dignity.
There were important safety problems. Medicines were not always stored or managed safely, infection control practices were not always followed, and the home could not show that staff had been trained to give medicines through feeding tubes. Quality checks had not stopped medicines errors happening again.
The overall rating was Requires Improvement. Safe, Effective and Well-led were rated Requires Improvement, while Caring and Responsive were rated Good. The home had improved since the previous inspection and was no longer in breach of the rules about person-centred care and consent, but three regulations were breached at this inspection.
Kind and respectful care
Staff had positive relationships with people and supported their privacy, dignity, independence and communication.
“Staff treated people with dignity and any personal care was given in a way which respected people's privacy and promoted their independence.” from the report
Personalised support
Care plans included people's interests, relationships, communication methods and preferred ways of receiving support.
“People's needs and choices were fully reflected in their care plans which contained detailed assessments.” from the report
Individual activities
People were supported to choose different activities and were consulted about outings and places they wanted to visit.
“Each person was engaged in a different activity and was supported by a member of staff.” from the report
Safeguarding and staffing
Inspectors found safeguarding training and reporting arrangements in place. Staffing levels were sufficient, with cover arranged for absences.
“Sufficient numbers of staff were rostered to provide people with care and support.” from the report
Medicines errors and storage
seriousMedicines were still not managed safely. Refrigerator temperatures were not always recorded accurately, and staff did not always act when temperatures were outside the recommended range.
“From April to December 2018 we received 10 statutory notifications from the provider regarding medicines incidents and errors.” from the report
Feeding tube training
seriousThe home could not produce records showing that staff were trained to give food and medicines through people's feeding tubes. This left inspectors unable to confirm that staff were competent for this task.
“We could not be assured that staff were appropriately trained to give people food and medicines through a PEG.” from the report
Infection control
seriousEquipment used to give medicines through feeding tubes was stored while still damp, with condensation inside storage boxes. Inspectors said this created a risk of bacteria and infection.
“These syringes had not been fully dried and condensation had formed inside the storage boxes which posed a risk of bacteria growing inside the boxes.” from the report
Weak quality checks
seriousThe home's audits had not identified unsafe refrigerator temperatures or stopped medicines errors from recurring. New procedures had not been in place long enough to show they were effective.
“Systems to assess, monitor and improve quality and safety in the service were ineffective.” from the report
- 01What has changed since the inspection to prevent medicines errors, and how many medicines incidents have there been since then?
- 02How are medicines refrigerator temperatures recorded now, and what happens immediately if a temperature is outside the safe range?
- 03Which staff are trained and assessed to give food and medicines through feeding tubes, and can you show the training records?
- 04How are syringes and other feeding tube equipment dried and stored to prevent infection?
- 05How do you check that the new medicines procedures are working in practice, rather than only being written down?
This was a brought-forward inspection following several medicines incident notifications; it covered the home, care records, medicines, staffing, training and management systems, and gave ratings for all five questions. This explanation was written from the published report of 5 March 2019 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 Tree Lodge Residential Home
4 rated inspections over 4 years: the service has held its Good rating throughout.
- February 2020Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Fir Tree Lodge Residential Home →
- March 2019Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Fir Tree Lodge Residential Home →
- April 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- November 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Requires improvement
- February 2014
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 15 December 2010.
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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