Fig House

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The overall rating for this key question is requires improvement. We reviewed all the quality statements for well-led and identified 2 breaches of regulation. We found a breach of Regulation 17 as improvements were needed to the providers quality assurance system. For example, the provider was not identifying shortfalls found to people’s care plans around their diabetes care, end of life care, skin care risk assessments, and mental capacity assessments. Improvements were also needed regarding a dependency tool for safe staffing levels and the safe recruitment of staff. Where one person had been refusing their medicines, this had not been raised with the GP and there was no overall monthly analysis of incidents and accidents or safeguarding referrals, only individual analysis. Complaints were not being handled in line with the providers policy. We also found a breach of Regulation 18 (registration) as not all serious injury and safeguarding notifications were being submitted as required. Staff felt supported by the registered manager and the provider. Staff gave examples of how they had been supported in their work. The registered manager worked with external professionals and agencies to improve partnership working and people’s care and support. The management of the home were accessible to people and their relatives.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff knew the aims and objectives of the organisation. From the provider’s statement of purpose these were, “To provide all our residents with a homely, secure, relaxed and happy environment in which their care needs and independence can be supported.” We observed staff reflecting these aims and objectives in their work practice. A staff member said, “We aim to protect people with dementia, ensuring that residents feel at home. Another staff member said, “We always give people a choice and promote independence.”

There organisational aims and objectives were not on display in the service. However, systems were in place such as meetings, training and supervision to support staff working together as a team and promoting the homes aims and objectives. There was a fun and happy atmosphere observed at the home. We saw people were comfortable, relaxed and supported to remain independent.

There was a clear staff structure. Staff knew each other’s roles and responsibilities. A staff member said, “Yes there is a clear structure. I’m allocated people to support. For example, if people need 1:1 support.” Another staff member said, “There is good team work.” Staff told us the registered manager was available, approachable and they could raise any concerns. A staff member said, “I can talk to managers.”

The registered manager attended managers meeting within the organisation to share learning and to access support. The registered manager demonstrated a calm and individual approach to people.

Staff told us they were able to raise concerns and ideas directly to managers, in meetings and in their appraisals. Staff knew the processes to report any concerns both internally and externally to CQC or the local authority.

There were feedback systems in place through meetings, questionnaires and a complaints process. Posters displayed around the service explained the process to raise any concerns or complaints. Additional posters encouraged people, relatives and staff to speak up about any issues and were directed to the home’s wellbeing lead.

Staff told us they were well supported by senior staff, managers and the provider. The registered manager had an open door policy. A staff member said, “I feel supported in my role. I can always ask questions.” Staff gave us some individual examples where they felt supported by the service. For example, when a staff member was unwell.

The service employed a diverse workforce. Flexible working was considered for staff based on their individual needs and circumstances. Staff had access to support services to support their wellbeing, such as therapy. Staff were recognised through a programme to ensure individual contributions were celebrated and valued. Staff were supported with accommodation when arriving from overseas.

All staff felt supported by the management of the service. The registered manager confirmed they were responsible for undertaking quality assurance reviews of incidents and accidents and if there were enough staff to support people with their individual care needs. They monitored if the person needed any referrals and medical reviews, and they liaised with health and social care professionals and external agencies to improve people’s care. The registered manager as part of our inspection visit confirmed improvements were needed and they had started to work with an external company to identify these improvements

The provider undertook reviews although there were no quality assurance audits identifying shortfalls found during this inspection. For example, we found improvements were needed to people’s care plans including their diabetes care, end of life care, and some mental capacity assessments. And 1 person needed a risk assessment around their skin care and another person around their moving and handling equipment and how staff should use this. There were also shortfalls in notifications being made as required, safe recruitment procedures, and a lack of a dependency tool to ensure there were safe staffing levels. Although individual shortfalls had not been identified through quality assurance audits the registered manager confirmed they had recognised improvements were needed. This included ensuring there were quality assurance systems in place, a dependency tool being completed and that the providers policies were up to date and being followed. The registered manager had a service improvement plan in place although this action plan identified areas for improvement, it had not included the shortfalls found during this inspection. People’s care plans were being reviewed by the registered manager and the provider undertook assurance reviews of these care plans. However, there was no quality assurance tool being completed so there was a lack of consistency of what was being reviewed and when, along with what improvements were required. One health care professional confirmed improvements were needed to the completion of documentation as they needed this to make decisions about a person’s care and support. The service was displaying the rating in the lobby of the home and on the providers website.

People spent time in their room or the communal area of the home. They could participate in activities within the service and people had visits from their friends and families.

The registered manager and deputy manager confirmed they worked in partnership with other agencies so improvements could be made to people’s care and support. They confirmed this included the GP, district nurses, physiotherapists, occupational therapists and, as needed, other health and social care professionals.

Positive feedback was provided from one health care professional we spoke with. They confirmed care provided was good and communication with the service and registered manager was positive. Although this feedback was positive we found during our assessment 1 person had been refusing their medicines for the last week and this had not been raised with the GP surgery prior to our assessment.

The registered manager was liaising and working with external partners when required so that improvements could be made to the service and people’s individual care and support. Regular medical reviews were undertaken every fortnight or sooner if needed.

The registered manager wanted to provide good care to people and their families. They were open about the areas of improvement they wanted to make within the service, this included a new staff dependency tool and a new call bell system. They also confirmed they were working with external agencies such as the local authority and health and social care practitioners when required to make these improvements.

People and relatives we spoke with confirmed they were satisfied with the care and support provided. Positive feedback had been shared with the service through thank-you cards. Comments included, ‘Thanking all the lovely Fig House staff’ and ‘Thank-you very much for your care.’ All people and relatives we spoke with felt happy to raise any concerns should they need to. Prior to our assessment we had received a complaint which we shared with the registered manager. At this assessment we followed up this complaint and although we found the registered manager had been liaising with the person about their concerns this had not formally been handled in line with the provider’s complaints policy. The provider had recently sent out surveys to people, staff and relatives. At the time of our assessment this feedback was not available. Staff meetings were an opportunity to make improvements to people’s care and support such as any learning from incidents or sharing of important information.