19 October 2023
During an inspection looking at part of the service
About the service
Fethneys Living Options – Care Home Physical Disabilities is a residential care home providing personal care to 10 people at the time of the inspection. The service can support up to 10 people with a physical disability such as cerebral palsy; some people also had a learning disability; people used verbal communication. Their physical needs were supported in an adapted building, with a lift, overhead tracking hoists and accessible outdoor space.
People’s experience of using this service and what we found
Right Support: People did not always receive personalised care that met their preferences, and people were not offered enough opportunities to enable them to live the lives they chose. For example, the high use of agency staff at the home meant people could not always go out when they wanted to. Two people wanted to go swimming, but there were no specifically trained staff to ensure safety when swimming. The home had an accessible minibus, but no staff were qualified to drive it, so people could not go out unless they hired accessible transport. People were not supported with their independence. For example, one person had a standing frame, but their relative said they had never seen them using it. Another person did not receive physio support in line with the requirements of their care plan.
People were not always supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Right Care: People received support from staff who were kind and caring. However, care was not always person-led and staff were reactive to people’s needs. One person used picture reference cards to help staff understand how they were feeling. However, these cards were tangled up on their wheelchair and could not be easily reached by the person to use. Staff asked one person what they would like to do in the morning, colouring or sand play, but gave the person no time to respond. A staff member sat down and started to make moulds with the sand, but the person made it very clear they did not want to do this, delivering a strong, negative, verbal response.
Right Culture: People lived with a range of physical disabilities, and some had a learning disability. Staff were understanding of people’s care and support needs, but the culture of the home did not encourage people’s independence, and focused on what they could not do, rather than enabling people to have fulfilling lives. A relative was concerned about their loved one’s mental wellbeing because they did not have enough to do or activities that were planned in line with their preferences. People were not empowered to have a good quality of life, were accepting of staff support, but had limited opportunities to do what they wanted in the wider community.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 8 March 2019).
Why we inspected
This inspection was prompted due to concerns received about monitoring of risks, such as constipation and bowel management, and safeguarding referrals made to the local authority. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fethneys Living Options – Care Home Physical Disabilities on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to unsafe care and treatment, the lack of person-centred care, and ineffective governance of the service at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.