The inspection took place on 25 July 2017. The inspection was unannounced. This meant the staff and provider did not know we would be visiting.

Fir Tree House is a residential care home based in Darlington. The home provides personal care for people with learning disabilities or people living with a mental health illness. It is situated close to the local amenities and transport links to the town centre. The service is registered to provide support to eight people and on the day of our inspection there were seven people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 2008 and associated Regulations about how the service is run.

We last inspected the service in May 2014 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

People who used the service were relaxed in their home environment and the service had a homely atmosphere.

Staff were comfortable, relaxed and had an extremely positive rapport with the manager and also with each other.

We saw staff interacting with people in a person centred and caring way. Person centred is when the person is central to their support and their preferences respected.

We spent time observing the support that took place in the service. We saw that people were always respected by staff and treated with kindness.

We saw staff offering people choices, being considerate and communicating with people well.

People were supported to set and achieve goals for themselves.

We saw that people were encouraged to enhance their wellbeing on a daily basis by taking part in activities at home and in the community that encouraged and maximised their independence.

People were supported to maintain their independence as much as possible.

We spoke with care staff and relatives who told us they were supported and that the manager was approachable.

Care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm.

People’s health was monitored and referrals were made to other health care professionals where necessary, for example: their GP or speech and language therapy team.

People who used the service were supported by sufficient numbers of staff to meet their individual needs and wishes.

When we looked at the staff training records, they showed us staff were supported and able to maintain and develop their skills through training and development opportunities were available.

We viewed records that showed us there were robust recruitment processes in place.

Medicines were managed, stored and administered safely.

People were actively encouraged to participate in activities that were personalised and meaningful to them.

We saw staff spending their time positively engaging with people as a group and on a one to one basis. We saw evidence that people were supported to go out regularly too.

People were encouraged to eat and drink sufficient amounts to meet their needs. The daily menu that we saw was reflective of people’s likes and dislikes and offered varied choices and it was not an issue if people wanted something different.

The provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

People had their rights respected and access to advocacy services if needed.

People were supported to play an active role within their local community and were on first name terms at the local cafes in the town centre.

The provider had an effective quality assurance process in place and staff told us they enjoyed thei

Firtree House is a care home for up to ten people and seven people were living there when we visited. The home provides care and support to people with a learning disability and complex needs. The home is located in a residential area with parking to the side of the property and gardens to the front and back. There is ramped access into the home. Bedrooms are on the ground and first floor, which is accessed by a chair lift.

Because of their complex needs some people were limited in what they could tell us verbally about their experiences. So we spent time with people to see what their daily lives were like. We saw staff were kind and caring towards people and treated them with respect. Staff showed a good understanding of people’s care and support needs.

The home has gone through significant changes over the last six months following a number of incidents. All of the incidents had been fully investigated and reported to safeguarding and CQC. There had been a high turnover of staff and a new registered manager was employed at the home in August 2013. The service recognised significant improvements were needed and voluntarily agreed not to take any new admissions and this agreement was in place when we visited. We spoke with the Local Authority before the inspection who confirmed the home were working with them to make improvements to the service.

Staff were trained in safeguarding, had a good understanding of abuse and knew the reporting systems to use if abuse was suspected. However, we found recruitment processes were not robust enough to make sure staff were suitable and safe to work with people.

Although some people’s bedrooms were personalised and comfortably furnished, we found other areas of the home were shabby and poorly maintained. There was a planned refurbishment programme, which was due to start this month. Access into and around the home was difficult for wheelchair users because of the design of the building. There was no call bell system in the home, which meant people were unable to summon support when they needed it.

We saw staff were kind, caring and compassionate and supported people without rushing them, They knew people’s needs well. Care records were well recorded but there was no evidence to show how people had been involved in planning their care. Although some people attended regular community groups, for others there were fewer opportunities. There were no planned activities within the home to meet people’s individual needs and preferences. Opportunities to go out were on an ‘ad hoc’ basis. People nutritional needs were met and they were offered a choice of meals and drinks.

Staff treated people with dignity and respect. We saw they were discreet when talking to people about personal care requirements and made sure this was carried out in private. Staff we spoke with described and gave examples of how they ensured people’s privacy, dignity and independence was maintained.

Staff had received training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). However, the manager was not able to tell us if people’s capacity had been assessed or provide us with evidence to show it had. People were not provided with information about the complaints procedure.

Although there were checks in place to monitor the quality of the service we found the home lacked strong and effective leadership.

We found standards of cleanliness in the home were poor. There were no additional staff employed to assist with cooking, cleaning and laundry tasks. This meant care staff were required to complete these tasks as well as providing care and support to people.

We found staffing levels were insufficient. Staff told us there were not always enough staff on duty to keep people safe, particularly between 3pm and 10pm when staffing levels were reduced.

There were no residents meetings, although the manager was hoping to introduce them. We saw people were consulted about day-to-day decisions such as what they would like to eat, but there were limited opportunities for people to be involved in a meaningful way in decisions about the home and their daily lives. For example, information was not available to people in a format they could easily access such as Easy Read or Makaton. Makaton is a language programme that uses signs and symbols to help people communicate.

You can see what action we told the provider to take at the back of the full version of the report.

We have unable to speak to all of the people using the service because some of the people had complex needs, which meant they were not able to tell us their experiences. However, people were seen to be relaxed and comfortable with staff.

We found people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

Some of the people using the service had complex needs which meant they were unable to tell us their views because of this we used a number different methods to help us understand their experiences.

One person told us that the staff were “alright” and if they had any problems they could talk to them and they listened. They explained to us how they could make their own breakfast and lunch and they had support to cook their dinner. We saw crafts and paintings in their bedroom and they told us how they had made them in the home with the help of the care workers. They also told us how they went on trips out to Newcastle to see exhibitions and showed us DVDs they had bought when they went out shopping.

We spoke to another person who told us they lived in the care home because they “had no where else to go”. They told us how they went for a walk by themselves to the shop for a newspaper and they liked to sit in their room and watch television. They said they did not like to cook, the staff did it for them and they told us there was a wide selection of food available. They said they did get involved in crafts occasionally but they particularly liked to help “wash up”.

We spoke to a visiting healthcare professional who said that “the service users were well looked after and their needs were met as best as possible”. They said they were “impressed with the staff and how well they understood their (people’s) needs”.

People told us that they were happy with the care that they recieved, and the facilites within the home.

This inspection took place on 14 and 15 May 2015 and was unannounced. This meant the staff and provider did not know we would be visiting.

Firtree House provides care and accommodation for up to nine people. On the day of our inspection there were seven older people using the service. The home was spacious and suitable for the people who used the service.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 2008 and associated Regulations about how the service is run.

On 3 April 2014 we completed an inspection and informed the provider they were in breach of a number of regulations including monitoring the quality of the service, safety of premises, respecting people, gaining consent, recruitment of staff and staffing levels.

Whilst completing the visit we reviewed the action the provider had taken to address the above breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that the provider had ensured improvements were made in these areas and these had led the home to meeting the above regulations.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Incidents and accidents were appropriately recorded and included details of any follow up action.

Medicines were administered safely and there was an effective medicines ordering system in place.

Staff training was up to date and staff received regular supervisions and appraisals.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We looked at records and discussed DoLS with the manager. We saw that there were DoLS in place and the requirements were being followed.

People who used the service, their relatives and visiting professionals were complimentary about the standard of care at Firtree House.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

People who used the service had access to a range of activities in the home and within the local community.

The provider had a complaints policy and procedure in place and complaints were fully investigated.

The provider had a quality assurance system in place and gathered information about the quality of their service from a variety of sources.

This inspection took place on 14 and 15 May 2015 and was unannounced. This meant the staff and provider did not know we would be visiting.

Firtree House provides care and accommodation for up to nine people. On the day of our inspection there were seven older people using the service. The home was spacious and suitable for the people who used the service.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 2008 and associated Regulations about how the service is run.

On 3 April 2014 we completed an inspection and informed the provider they were in breach of a number of regulations including monitoring the quality of the service, safety of premises, respecting people, gaining consent, recruitment of staff and staffing levels.

Whilst completing the visit we reviewed the action the provider had taken to address the above breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that the provider had ensured improvements were made in these areas and these had led the home to meeting the above regulations.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Incidents and accidents were appropriately recorded and included details of any follow up action.

Medicines were administered safely and there was an effective medicines ordering system in place.

Staff training was up to date and staff received regular supervisions and appraisals.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We looked at records and discussed DoLS with the manager. We saw that there were DoLS in place and the requirements were being followed.

People who used the service, their relatives and visiting professionals were complimentary about the standard of care at Firtree House.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

People who used the service had access to a range of activities in the home and within the local community.

The provider had a complaints policy and procedure in place and complaints were fully investigated.

The provider had a quality assurance system in place and gathered information about the quality of their service from a variety of sources.