Fig House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last inspection the overall rating for this key question was good. At this inspection we found it is requires improvement. We reviewed all the quality statements for safe. We identified a breach of Regulations 19 as improvements were needed to the safe recruitment of staff. Improvements were also needed to ensure people had detailed care and support plans with their individual needs such as diabetes care, end of life care and mobility and skin care needs. Where people had an authorised deprivation of liberty in place these were not being recorded within the person’s care plan. Improvements to people’s mental capacity assessments and best interest decisions, risk assessments and medicine records were also needed and not all incidents were being reported to The Care Quality Commission as required. People were admitted to the service safely. The environment was carefully designed to support people living with dementia to move around safely and retain their independence. Systems were in place to regularly check equipment. The service was working to improve standards of cleanliness. Records of cleaning were not always maintained. Staff received an induction, training and regular supervision. Staffing had been increased whilst the service developed a staff dependency tool.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives felt updated about incidents. One relative told us, “They phoned me straight away, and let me know that the doctor came out.”

The registered manager confirmed they monitored the care people received daily so any improvements to their individuals needs could be made. This was done through reviewing daily records and liaising with staff and people. Staff had monthly meetings and this was an opportunity to raise concerns with the management of the service if needed. A member of staff told us it is, “Really supportive here.” The registered manager of the service was open about the continuous improvement they wanted to make.

The registered manager confirmed incidents and accidents were logged onto an electronic system. The registered manager was responsible for reviewing incidents and accidents, falls and any safeguarding concerns. They monitored these regularly and undertook monthly reviews of these incidents so any actions needed were taken to support the person. Although most incidents were being reviewed, we found there was no overall analysis of all incidents and accidents so any themes and trends could be reviewed to improve the quality of the service. Some notifications had not been sent to us as required. We raised this with the registered manager so they could take the necessary action.

People were admitted safely to the service. The registered manager conducted pre assessments with people to ensure the service could meet their needs. Care plans were created, people and families were involved. A person said, “It’s a wonderful place.”

The registered manager and staff told us about the admission process. People and families came to look around and spent some time in the service to view its suitability. People were assessed to ensure the service could meet their needs. A staff member said, “When people are admitted we read the care plan and risk assessments, so we know how to support people.”

We received positive feedback from professionals. The service communicated with external partners and made referrals when needed.

Systems were in place to support people being admitted to the home safely. This included a pre assessment process. People and relatives were involved in developing care plans. Hospital packs supported people if a hospital admission was required.

People and relatives felt the care provided was good. A person told us, “They are very good.” Another person told us, “I definitely feel safe.”

Staff felt people got safe care and all staff had a good understanding of the different types of abuse and who to go to should they have any concerns. A member of staff told us, “Yes, I feel people get safe care here.”

We observed staff supporting people in a kind and caring way. Staff spent time talking to people and supporting them with their individual needs should they need it. Whilst reviewing the incidents and accidents we found not all notifications were being made as required. We raised this with the registered manager so they could take actions needed.

The registered manager was responsible for completing referrals to safeguarding. Individual safeguarding records were reviewed monthly. However, there was no overview of safeguarding raised and when so trends and themes could be reviewed. Prior to our assessment concerns had been raised about the service. This information had been shared with the local authority although the registered manager had not completed a formal notification to The Care Quality Commission (CQC) as required. Mental capacity assessments and best interest decisions were in place for medicines and vaccinations although mental capacity assessments had not been completed for people around their diabetes care, where 1 person was having their diet modified and when needing to be supported with personal care. Deprivation of Liberty Safeguards referrals were made when needed although the outcome of the authorisation was not recorded within the person’s mental capacity assessment or care plan .

People lived in a safe and well maintained environment. The environment supported people’s needs. For example, by having brightly coloured doors, clear signage and a lift which people could access. People’s rooms were individualised with furniture, pictures and belongings. People had their name on their door and a memory box outside their room to support with orientation. A person said, “The best is the grounds, and the light shining in the lounge. I can go out into the garden. I am happy and safe.” A relative said, “[Name of person] can go out into the garden, where they are safe and secure and cannot get lost.”

The registered manager liaised with staff daily, so there was an opportunity to raise any changes to how people were each day. Any changes to people’s care and support was discussed and referrals made. For example, if a person needed a medical review.

We observed staff supporting people in a relaxed manner asking them if they would like support and assistance. People were observed independently walking around the home with walking aids such as a walking frame. Some walking equipment needed new protective rubber as some were worn. The registered manager confirmed on our second day they had replaced these.

Improvements were needed to ensure people had detailed care and support plans in place to provide guidance to staff on how to support people with their individual needs. This included where people needed support with their diabetes care, end of life care and with individual mobility needs. Following our assessment the registered manager sent us an updated copy of 1 person’s care plan which confirmed how staff were to support the person with their diabetes care. Risk assessments were in place risks relating to choking and falling.

People lived in a safe and well maintained environment. The environment supported people’s needs. For example, by having brightly coloured doors, clear signage and a lift which people could access. People’s rooms were individualised with furniture, pictures and belongings. People had their name on their door and a memory box outside their room to support with orientation. A person said, “The best is the grounds, and the light shining in the lounge. I can go out into the garden. I am happy and safe.” A relative said, “[Name of person] can go out into the garden, where they are safe and secure and cannot get lost.”

Staff and leaders told us the home was well maintained and regularly checked. Staff knew the process to report any maintenance issues. A staff member said, “This is a lovely building.” Staff members told us, “We report any maintenance concerns,” and “Things get repaired promptly.”

The home was in good repair and well kept. The home was tidy and free from clutter to ensure people could mobilise safely around their environment. We observed people moving around the home as they wished, with or without support. People could safely access the level garden when they chose. There was seating in different parts of the service. This enabled people to rest where they needed, to experience views and be with other people or alone as they pleased.

Regular checks were conducted in areas such as fire, water and electricity. Equipment was tested to ensure it was safe for use. Environmental risk assessments were completed in areas such as the laundry, garden and kitchen. A business continuity plan was in place to support in unforeseen circumstance such as severe weather or loss of utilities. Personal emergency evacuation plans (PEEPs) were completed to direct the individual support people would require in an emergency situation.

People told us about staff availability. One person said, “There is always someone [staff] walking around, they are always willing to help.” However, one person said, “Sometimes there are not so many [staff].” People and their relatives told us they were well supported by staff. There was a consistent team of staff who knew people well. A relative said, “They [staff] are lovely. Staff are ideal. I see familiar faces.” People told us staff were friendly and helpful. A person said, “The staff are very good.”

We were told by staff and leaders that staffing levels had been increased in the last month. Staff had welcomed this change and said the increase in staffing levels was needed. Staff spoke positively about the induction process and said they had regular training to meet people’s needs. A staff member said, “I was well supported [in the induction] and could ask questions.” Staff had regular one to ones with their line manager to discuss their performance and development. Staff were observed and assessed in their competency and knowledge in different areas of support for people. For example, fire safety, medicines and dealing with emergency situations. A staff member said, “Yes, it is supportive. I can talk to managers.”

We observed staff being available and attentive to people. Staff were around in communal areas. Staff supported people to engage in meaningful tasks such as preparing vegetables and laying the table. A person said, “We do the knives and forks, if we can.” We observed staff supporting people with activities, such as puzzles, a quiz, games and singing and dancing. Staff sat and spoke with people. Staff helped to create a happy and relaxed atmosphere.

The service had not operated safe recruitment processes. Recruitment records did not always show a full education and employment history. Gaps in employment were not ascertained or evidenced. Previous employment in health and social care was not always explored. Interview records were not always available. One interview record reviewed did not demonstrate fully the candidate’s suitability or skills for the role. Staff did not always have references in place in line with the providers recruitment policy. Disclosure and Barring Service (DBS) checks had been conducted and were now being reviewed at regular intervals. The provider had recently developed a recruitment audit to identify gaps in the recruitment process and to ensure all areas were fully completed before a staff member begun employment. The service was not currently using a tool to support with ascertaining safe staffing levels. This meant the provider could not demonstrate how safe staffing numbers were currently determined. The provider said a tool was being developed. New staff had an induction to the service which included, orientation to systems and shadowing more experienced staff. Records of induction had not been consistently documented. Staff received regular supervision, competency assessments and training. Records of these were accurate and up to date.

People were protected from the risk of infection. People’s rooms were regularly cleaned. A person said, “It’s lovely and clean.” A relative said, “The best is the cleanliness, it doesn’t smell.” Safe laundry procedures were followed. Staff wore personal protective equipment as appropriate. A person said, “The staff wear gloves and aprons when they do personal care.”

The provider and registered managed explained staff shortages in the domestic team had been managed. A staff member described the impact of staffing on standards of cleanliness saying, “It is getting better.” Staff told us they had received training in infection, prevention and control. Staff knew where PPE was stored and in what situations to use. Domestic staff had access to the equipment and products they required. These were stored safely.

We observed the home to be visibly cleaner on the second day of our visit to the first. We observed domestic staff systematically cleaning rooms and communal areas. We observed staff wearing PPE as appropriate. A relative said, “It could be cleaner, especially the chairs.”

Cleaning schedules were in place. However, these had not been consistently completed. This meant the provider could not accurately demonstrate which areas of the home had been cleaned. Chairs had been identified as requiring additional cleaning which was being completed. A programme to reupholster chairs was underway and the progress of this was monitored.

People had their medicines administered by staff who had received training. Staff approached people with kindness and compassion whilst giving them their medicines.

The registered manager confirmed the service was supported by the local GP practice and local pharmacy team should people need their medicines or individual needs reviewed. Visits by the GP were undertaken fortnightly. Visits outcomes were recorded including if any referral was discussed or made.

Medicines were stored safely and people received their medicines safely. However, we found not all people had appropriate risk assessments in place for certain medicines and not all staff were aware of protocols for medicines not prescribed. Improvements were needed to recording if the person had known allergies and where 1 person had been refusing their medicines no advice or referral had been made to seek advice. People were being supported with topical creams after their personal care rather than at the same time. This meant some people were declining their topical cream as they were already dressed. One professional provided us with positive feedback that medicines were ordered and collected as needed each month.