Fouracres Care Services

Updated 10 February 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008,

Inspection team

The inspection team consisted of one senior specialist, one inspector, and, two pharmacist specialists.

Service and service type

Fouracres Care Services is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement dependent on their registration with us. Fouracres Care Services is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. The registered manager was away from work during the inspection.

Notice of inspection

We carried out the inspection visits on 13, 14, 20, 21 and 29 December 2023. This was an unannounced inspection. The visits on 21 and 29 December were announced at short notice to enable staff to be available to assist us with the inspection.

What we did before the inspection

Before our inspection, we reviewed the information we held about the home.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We also looked at complaints made and any feedback from people using the service, their relatives and/or other professionals involved with the service. We used all this information to plan our inspection.

During the inspection

After the first day of the inspection, the provider and the registered manager were away from work for the rest of the inspection. The provider had asked a management consultant company to run the home in their absence. We met with the consultants on two occasions and they assisted us with the inspection by providing us with information we requested and acting on concerns we found.

We spoke with 7 support workers, the provider, a personal assistant and the 6 people living in the home. We spoke to 2 relatives of people living in the home and 2 professionals who were involved with the home. We spent time observing staff interactions with 4 people to help us understand the experience of people who could not tell us about their experiences. We also observed 4 mealtimes. We looked at 5 people’s care records and medicines records for 5 people; we also looked at various documents relating to the management of the service. This included staff training, provider audits and health records.

We completed a tour of the building and we looked at medicines’ management and food safety. We requested further information from the registered manager and provider which we reviewed as part of the inspection and we held a further meeting with them to discuss concerns.

Updated 10 February 2024

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Fouracres Care Services is a care home providing accommodation and personal care for up to 6 people. The care home accommodates people who have a learning disability and older people. At the time of the inspection there were 6 people living in the home.

People’s experience of using this service and what we found

Right Support

People were not supported to have maximum choice and control of their lives. Staff did not support them in the least restrictive way possible or in their best interests. The policies and systems in the service did not support this practice. There were restrictions on people’s rights and freedom. We found people were expected to be in their bedrooms by 8.00pm and stay there until 8.00am. The provider could not demonstrate any rationale for this. The kitchen was locked and people were unable to access food for the rest of the evening until 8.00am the following morning. Staff on duty at night were on call but able to sleep. It was not clear how people could alert staff if they needed support or wanted to eat or drink at night.

People could not always choose how they wanted to spend their time. People had very limited opportunities to leave the home and take part in activities in the community. There was a lack of activities to take part in within the home and no opportunity to take part in any leisure activities in the evening. People did not receive support or opportunity to live an ordinary meaningful life.

Right Care

There were some positive caring interactions where staff were kind and supportive to people.

Staff had not been provided with any training in understanding what a learning disability is and how to and interact with people with a learning disability or autistic people.

There was no written assessment of people’s care needs at night. Some people required support with continence. As there were no routine checks on people during the night it is possible that people could be left requiring support with personal care for up to 12 hours during the night. There were no call bells for people to get help from staff if they require personal care or if they were unwell. Staff relied on people shouting out to wake them up. The provider did not recognise the risks and poor quality of this practice and only took action to increase staffing when we pointed this out during this inspection.

There was no written fire evacuation procedure for night time and people were reliant on staff to leave the building in an emergency as the front door and back gate were locked. These concerns were addressed during the inspection but had not been identified as concerns by the registered provider.

Medicines were not always managed safely. People with serious medical conditions such as cancer and diabetes did not have written care plans detailing their health needs with guidance for staff to follow to ensure their health needs were met.

Right Culture

There was a lack of evidence of a positive person-centred culture which promoted people’s rights and autonomy. The service was not able to demonstrate they were meeting the underpinning principles of right support, right care, right culture.

The environment was not homely as there was a poor standard of cleanliness in some rooms and broken and damaged furniture.

Management oversight was not effective. Although systems were in place to monitor the quality of care provided by the service, we found the audits carried out by the manager and the provider were not always accurate. They did not identify all the concerns that we found during this inspection about care plans, medicines management, financial management and the environment.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection we rated this service good (published 26 February 2022).

Why we inspected

The inspection was prompted in part due to concerns received about the management of people’s personal finances. A decision was made for us to inspect and examine those concerns. We have found evidence that the provider needs to make improvements.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services. We found concerns about infection prevention and control measures as this the standard of décor and cleanliness and the condition of the furniture in the home did not meet infection prevention and control standards.

Enforcement and Recommendations

We have identified breaches in relation to providing person centred care, dignity, safe care and treatment, medicines management, safeguarding people from the risk of abuse, meeting people’s nutrition and hydration needs, safety of the environment, infection control, staffing and the overall management and governance of the home.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.