Fethneys Living Options - Care Home Physical Disabilities

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment, the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. Improvements have not been made since the last inspection and this is a continuing breach of the legal regulation relating to safe care and treatment.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honestly. Lessons were not always learnt to continually identify and embed good practice. With very recent changes in management, people told us they now felt they could share any concerns they had about their safety. However, a relative told us about a serious incident concerning an ex-staff member and felt the provider had not managed the issue well. We discussed the incident with the management team who explained the actions they took at the time. Residents’ meetings enabled people to voice any concerns. However, 1 person said, “I’ve not felt listened to. Residents’ meetings are pointless. Sometimes I don’t go as they are rubbish. I listen to what others say, but no-one else listens to them.” We requested feedback from local authority professionals who had recent involvement with the home. The professionals voiced their concerns about the lack of improvements made since their last visit, particularly with regard to daily recording and management oversight. Professionals had provided support to the home over several months, and told us they would continue to work closely with the home until progress was made. Incidents were not reported and lessons learned were not always shared with staff. Systems were not sufficiently robust to ensure actions were recorded to demonstrate how improvements would drive changes to be made .

The provider had not developed systems that were sufficiently robust to demonstrate how people’s risks were managed or how staff were aware and informed about these risks. Information about 2 people’s care and support needs was shared with the home before they moved in, but when we visited the home on the first day, care plans for these people had not been written. This put people at risk of unsafe care and support. Continuity of care was achieved throughout people’s care journeys. Two people had moved into the home recently. A relative explained the process for their family member to move into the home, with an assessment of the person’s needs being completed at home, and a planned admission.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting them from avoidable harm. The provider did not always share concerns quickly and appropriately. People were not always protected from the risk of harm because incidents were not always reported or managed well to prevent reoccurrence. Another person had shared a serious concern about a staff member (who has since left the service), but the incident had occurred a year previously. Although the Commission received a notification, this was an incident reported to the police, and not a notification relating to abuse or alleged abuse.

The provider did not work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. There was no effective risk management process to keep people safe or to evidence how people understood and managed any risks. One person required a modified diet to protect them from the risk of choking. The person understood the risk, but often chose to eat food that had not been prepared in line with their speech and language therapist guidance. However, staff did not take reasonable all steps to prevent the risk of choking, such as reminding the person of the risks associated with eating high-risk foods and recording this. . Processes for monitoring people’s food and fluid intake were poor. At the last inspection monitoring charts had not been completed fully by staff. The interim manager had set up a new system for monitoring;, we observed that but staff still failed to fully record how much people had eaten or drank. Staff completed training on dysphagia which is when people have difficulty swallowing. We asked staff about their completion of monitoring charts and they agreed this had been an issue since charts were neither completed fully nor accurately..

People were not always cared for in a safe environment that was designed to meet their needs. People were accommodated in a large, detached Victorian house. The house was not designed to cater for people using electric wheelchairs. Whilst ramps and a lift enabled people to navigate around the building, there was insufficient space for all people to meet together in communal areas. The kitchen and dining areas could be accessed by people, but only through 1 doorway, as the other doorway was too narrow. There was insufficient space in the dining area for everyone to eat together, had they wanted to. We observed a person going into the back garden, which they could access independently; they were able to push the button to open the door. This person was reliant on staff noticing when they had gone into the garden, and if staff were busy elsewhere, this could delay the person coming back inside. There was no risk management plan for this. People were involved in fire drills and these took place every 3 months. Records confirmed people had emergency evacuation plans which staff had access to. Checks and audits were completed with regard to fire safety, emergency lighting, fire alarms, fire extinguishers and maintenance.

There were sufficient levels of trained staff to support people safely. Staffing levels were in line with rotas we reviewed. Agency staff were only used occasionally and the deputy manager approved requests with agency staff who knew people well and had worked at the home before. Records confirmed that staff received regular supervision with their line managers but some supervision notes lacked detail or were incomplete. For example, it was identified within 1 staff member’s supervision record that 3 items of training remained outstanding, but the record did not state what training this was. The record also included the staff member wished to other topics, but no further reference was made, so it was not clear whether the topics had been discussed or not. People were involved in the recruitment of staff. Interviews were in progress to recruit a new manager. One person had met a candidate for the post, but voiced their concerns about their inability to engage with people. Recruitment systems were effective and appropriate checks were made to ensure new staff were safe and suitably qualified to work in a care setting. All staff completed training related to supporting people with a learning disability/autistic people which was organised by the provider.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Processes were in place to audit infection prevention and control of the home and any infection risks were identified.

The provider made sure that medicines were safe and met people’s needs, capacities and preferences. Medicines were managed safely. There had been incidences in the past when some medicines had not been ordered promptly and had run out. However, the interim manager had set up a new system for the monitoring and management of medicines, to prevent similar events from occurring again. We observed a member of staff giving people their lunchtime medicines. This was done sensitively and in accordance with the prescriber's instructions. Stocks of medicines were checked routinely, and electronic records were completed when people received their medicines. This electronic system also generated audits so the management team had oversight of how medicines were managed. Medicines were not used to control people’s moods or manage behaviour. The provider’s policy on restrictive practices and intervention reflected this. A variety of policies ensured medicines were managed safely, and medicines audits had been completed. Protocols relating to ‘as required’ medicines had been completed for people and were person-centred.