Festing Grove

Festing Grove is a residential care home providing personal and accommodation to up to 4 people. The service provides support to people with a learning disability and/or autism. At the time of our inspection there were 4 people using the service.

People’s experience of the service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support

Risks to people's health, safety and well-being had not always been assessed or managed and this had placed people at risk of harm. Support plans and risk assessments did not always include information to guide staff on how to provide care and support. This had placed people at risk of not having their needs met.

Right Care

The home had a medicines policy and safeguarding policy in place, but these had not always been followed.

People were not always supported to live full, active lives and encouraged to increase their independence. Staff did not have the right training or detail in support plans to meet people's needs, goals and wishes. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff were observed to know people well and be able to communicate with them.

Right Culture

The provider's monitoring processes were not always effective in helping to ensure people consistently received good quality care and support. This had led to shortfalls found during the inspection. Staff did not always feel supported, and supervisions did not take place as planned. A staff member told us, “We are a good team, we try to sort things out ourselves…there isn’t a person in charge today, the new manager tries but can’t be here all the time, so we do our best.”

The home manager stated, “I welcome this inspection and will use this as a starting point for where we need to improve.”

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 March 2022). At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and the management of safeguarding incidents. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Festing Grove on our website at www.cqc.org.uk.

During the inspection we found there was a concern with consent so we widened the scope of the inspection to include the key question effective.

Enforcement and Recommendations

We have identified continued breaches in relation to safeguarding, safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report. We will continue to monitor the service and will take further action if needed.

We have made a recommendation about recruitment processes, adherence to the Mental Capacity Act and infection prevention at Festing Grove.

Follow Up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Festing Grove is a residential care home providing personal care to four people at the time of the inspection. The service is registered to provide support for up to four people.

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

Right Support

The service did not always check and maintain the premises and equipment to ensure people were safe. Most people benefited from engagement with community services such as an external day support centre. However, it was not always evident how people were supported to take part in activities and pursue their interests within the home. The service was in a residential area and people had access to the local community. People’s rooms were personalised with their own belongings and to reflect their interests.

Right Care

Staff did not always respond to concerns in a timely way to ensure people were safe and protected from poor care and abuse. Not all people had up to date and accurate care and support plans to reflect their range of needs and their wellbeing. Three people’s relatives who maintained regular contact with people in the service, told us they believed their relative was, ‘happy and well cared for’ and were confident their relatives would tell them if they were not.

Right culture

There was a lack of consistency in the on-site management and leadership of the service. The lack of oversight and culture of the service did not always support the delivery of high quality or safe care. Staff were not always clear about their roles and responsibilities and did not have adequate on-site leadership support to ensure risks and quality were managed effectively.

We found risks to people from the management of medicines, infection control and finances. Not all risks to people’s health and wellbeing had been assessed or were safely managed. Staff did not always receive a robust induction into the safe operation of the premises or incident management. We have made a recommendation about this.

Staff were safely recruited, and relatives told us those staff they had spoken with were kind and compassionate. People told us they thought staff were kind and two people told us they were happy at the service. Other people living at the service told us about issues which had been raised with the registered manager.

During and following the inspection the provider took action to address the concerns we found and improve the service. The registered manager is now consistently on site at the service to support staff and drive improvements to the quality and safety of the service.

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 14 November 2019).

Why we inspected

This inspection was prompted in part due to concerns about infection control following a site visit on 27 January 2022. As a result of concerns, we found during that visit, 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 full report. You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safeguarding, safe care and treatment and governance at this inspection. Please see the action we have told the provider to take at the end of this report. We will continue to monitor the service and will take further action if needed.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Festing Grove is a residential care home providing personal care to four people living with a learning disability, autistic spectrum disorder or physical disability. The service can support up to four people in one adapted building.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People continued to receive safe care at Festing grove. Risks associated with people’s needs were assessed, and guidance was in place for staff to follow to reduce and mitigate risks. Staff understood how to safeguard people from abuse and the registered manager acted on any concerns raised. Staff were safely recruited and there were enough staff available to meet people’s needs. People’s medicines were managed safely, and staff followed safe practice to prevent the spread of infections. The service used learning from incidents to make improvements

People were 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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having opportunities to gain new skills and become more independent.

People’s needs were assessed, and staff completed training to support them to meet people’s needs effectively. Staff used a positive behavioural approach to support people to manage behaviours that may challenge others or cause them harm. People’s healthcare and dietary needs were assessed and met.

Staff demonstrated a kind and caring approach to people. This included helping people to make decisions about their care and treatment and treating people with dignity and respect.

Care plans were person centred and focused on meeting people’s aspirations, so they achieved positive outcomes. People’s communication needs were known, recorded and met. People enjoyed activities that met their interests and preferences and were able to maintain their relationships with friends and family. A complaints procedure was available to people in an accessible format and any concerns raised were promptly responded to.

The registered manager promoted a positive culture in the home. They were aware of their regulatory responsibilities and acted to ensure people received safe and appropriate care. We found some notifications had not been made to CQC as required and prompt action was taken to address this oversight. A quality assurance system was effectively used to monitor the quality and safety of the service people received to continually improve the service.

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 16 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Festing Grove on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Festing Grove provides care and accommodation for four people who have a learning disability. People who also have a physical disability can be accommodated on the ground floor.

The service had not had a registered manager in place since December 2016. However at the time of our inspection there was a manager in place who had the intention to register themselves with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The manager and regional manager were present from mid-morning and stayed throughout the remainder of the inspection.

Risks to the health and safety of people using the service were assessed and reviewed in line with the provider's policy.

Medicines were managed, administered and stored safely. Staff were trained and had their competency regularly checked to help ensure safe administration of medicines.

There were arrangements in place to deal with foreseeable emergencies and there were safeguarding adult's policies and procedures in place.

Accidents and incidents were recorded and acted on appropriately. Care plans were reviewed following accidents when necessary.

There were safe staff recruitment practices in place and appropriate numbers of staff to meet people's needs.

There were processes in place to ensure staff new to the home were inducted into the service appropriately and existing staff received regular training, supervision and appraisal.

There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves.

People's nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with respect and were consulted about their care and support needs. Staff respected people's dignity and privacy.

People's support needs and risks were identified, assessed and documented within their care plan.

People were provided with information on how to make a complaint. Management demonstrated they knew how to deal with complaints should they be received.

There were robust systems and processes in place to monitor and evaluate the service provided.

People's views about the service were sought and considered through service user meetings and satisfaction surveys.

We looked at four people's care records and saw each person's needs were assessed and updated regularly. Care plans contained a risk assessment and we saw these had been reviewed regularly. We looked at staff personnel and training records and saw all staff had received training in safeguarding vulnerable adults. The staff we spoke with were able to identify different types of abuse and were aware of how to report any concerns. We were told by all staff we spoke with that they would speak to the manager if they had any concerns and the regional manager if the manager was not available.

Staff told us they were well supported by supervisions and training they received. They said the manager was approachable and always available to talk to. We reviewed a number of records relating to the management of the service. These were consistent and regularly updated.

During our visit we inspected the storage and records of medicines held in the home. We saw that all medicines were stored in a locked cabinet. This meant that medicines were kept safely

We saw that staff the processes for recruitment protected people from being supported by unsuitable staff. We observed staff to be confident and competent and saw that the training and development supported them in their jobs.