Health chiefs – who have threatened a Cambridgeshire care home with closure unless it improves – heard from a resident who told them “the place is full of flies”. The resident told them: “The place is full of flies, it is disgusting. It is horrible when you have your meals, and all the flies are there.”
Care Quality Commission inspectors – who rated the Firs at Little Downham as inadequate – also found “the kitchen was visibly dirty, a bin overflowing, had out of date food and food not labelled.
“There was also a fly infestation within the fridge in the kitchen and the staff fridge.
“As such, we made a referral to the local authority environmental health team”
Their inspection of The Firs at Tower Farm, Tower Road, Little Downham, Ely, was carried out on 28 September 202, 10 October 2023, and 24 October 2023.
Toothbrushes left on top of dirty sink
In their report, inspectors conclude: “People were at risk of poor infection control practices.
“Three hand gel dispensers were empty on the first floor; some equipment used to support people was seen to be unclean.
“We also found areas of the service including shared toilets and bathrooms were visibly unclean. We observed that a person’s personal items such as toothbrushes were left on top of a dirty sink.
“Flooring on the ground floor was significantly damaged.
“As such, these floors would be very difficult to keep clean due to the cracks and damage.
“Also, a staff member was seen using the same disposable gloves to support several people without changing their gloves.”
Inspectors said: “All of this increased the risk to people at the service of poor infection control practices. The provider had failed to ensure people had safe care and treatment.
“Systems had not been established or embedded to assess, monitor, and mitigate fire safety risks to people using the service.
“Work to make the service compliant with the fire safety regulations had not been carried out quickly enough. “There was conflicting information to guide staff on how to support people safely.
“Areas of the service and equipment were visibly unclean.”
Inadequate rating by CQC
Their ‘inadequate’ rating applies to all aspects of the running of the home which the Care Quality Commission (CQC) inspected.
They also responded to a family’s concerns expressed to them to that “the home smells of urine when you walk in.”
“The strong malodour was found during our two inspection site visits. This did not demonstrate to us this was a service that supported people’s dignity”.
The Firs is a residential care home providing personal care up to a maximum of 29 people. It is run by Barrels UK Care Ltd which is owned by Mr Arasaratnam Kumanan
It provides support to older and younger adults, people living with dementia and people who have a physical disability.
At the time of their inspection there were 21 people living there in one adapted building.
There is a shared lounge, a dining room, and a conservatory on the ground floor.
“The quality of the service provided, the external building and internal facilities and décor had significantly declined since the last inspection,” says the report.
“The provider once again failed to have a robust oversight of the service, this included when repairs were required and when safety concerns were raised.
“The provider failed to appropriately respond to promote safety and improve care quickly enough.”
The report says: “Fire safety risks, cleanliness concerns and environmental health risks to people found during this inspection meant that the CQC made referrals to the fire safety service and environmental health.
“The provider had failed to learn from the 4 previous CQC inspections of this service since they registered in September 2018.
Audits of running care home ‘not robust’
“This demonstrated to us that the provider had little understanding of the Health and Social Care Act 2008 Regulations and what standards were required to achieve compliance and provide good accommodation and a good service to the people in their care.”
Accidents and incidents records did not give enough information to establish any patterns and trends and what action was required to reduce the risk to people.
And the CQC says the governance system and audits in place to monitor the quality of the service provided were not robust.
“Actions to make improvements including improvements to safety were not acted upon quickly enough to reduce the risk of harm to people,” says the CQC.
“Improvements made during the time the provider had registered with the CQC, were not embedded, or sustained to keep people safe and well cared for.”
The CQC says there had been numerous manager changes at the service during 2023. As such, people and their relatives had “mixed opinions about communication in the service, as they were not always updated as to who was in charge.
“Some people and their relatives felt their suggestions and concerns were acted upon and some told us they did not feel listened to.
“There were not enough appropriately trained staff to meet peoples’ complex needs”.
And due to the changes in management, staff had not received regular supervision.
“People’s relatives also told us that relatives’ meetings, where they could receive updates about the service had also stopped taking place,” CQC concludes.
“The service is now rated inadequate”.
The care was rated ‘requires improvement’ for the last three inspections (27 May 2022, 24 December 2020, and 17 October 2019).
And it was also previously rated inadequate (25 May 2019).
“The provider completed an action plan after the last inspection to show what they would do and by when to improve,” says the report.
Breach of regulations
“At this inspection we found the provider remained in breach of regulations.”
CQC says they conducted a new inspection prompted in part due to concerns received about cleanliness, staffing, lack of staff understanding about safeguarding people and supporting peoples known risks, the state of disrepair of the building internally and externally and a general lack of financial investment by the provider.
“A decision was made for us to inspect and examine those risks,” it says.
“We found evidence during this inspection that people were at risk of harm from these and other concerns.
“We have identified breaches in relation to safeguarding people from abuse; safe care and treatment; premises and equipment; staffing; person-centred care; and good governance at this inspection.”
The CQC says the overall rating of ‘inadequate’ means the Firs is now in special measures. This means they 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,” it says.
“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 of their 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 CQC inspect it, and it is no longer rated as inadequate for any of the five key questions they pose, it will no longer be in special measures.
CQC says when they inspected it, they found The Firs “had significantly declined since the last inspection.
“The provider once again failed to have a robust oversight of the service, this included when repairs were required and when safety concerns were raised.,” it says.
CQC says their inspection was prompted in part due to concerns received about the cleanliness of the service, staffing, lack of staff understanding about safeguarding people and supporting peoples known risks, the state of disrepair of the building internally and externally and a general lack of financial investment by the provider.
“A decision was made for us to inspect and examine those risks,” it says.
Residents ‘at risk of harm’ at Cambridgeshire care home
“We found evidence during this inspection that people were at risk of harm from these and other concerns.
“We have identified breaches in relation to safeguarding people from abuse; safe care and treatment; premises and equipment; staffing; person-centred care; and good governance at this inspection.”
One of many concerns raised by CQC was that the fire alarm was not working properly.
“We made the Cambridgeshire Fire and Rescue Service aware of all the fire safety concerns found during the inspection,” says CQC.
“The lack of prompt action by the provider put people, visitors to the service and staff at an increased risk of harm.
“As the fire alarm had been switched off, all fire doors that had pin coded access on them were not secured.
“This meant that these doors were open allowing people to come and go freely.
“This included the fire door situated directly at the top of the back staircase in the building. This increased the risk of people with poor mobility, having access to and falling down the stairs.”
A bedroom door, which was also a fire door and the surround had been damaged during an incident. This had not been replaced to ensure fire safety compliance.
Also mentioned was an incident in which the home had failed to organise the boarding up of a large broken window in a resident’s room. This window had been damaged during an incident.
The broken window had been left not boarded up from 13 September 2023 to 27 September 2023.
“This put the person and people entering the room during this time, at risk of harm,” says the CQC.
And the CQC queried why gaps in potential new staff’s employment had been not always been explored.
“Robust pre-employment check records were not always held,” says CQC.
References to work at care home not checked properly
“Previous employment references did not always have the full name of the person giving the reference, who they worked for and in what capacity they knew the person.
CQC concluded that they had widespread concerns and there were significant shortfalls in people’s care, support and outcomes.
They criticised the owner for failing to ensure that the building both externally and internally was in a good state of repair.
“This included the fixtures and fittings,” says the report.
“The furniture and décor in the service was in places in need of significant repair and or replacement.
“There were numerous windows broken at the service. This included a shared toilet window and windows in some people’s bedrooms.
“The provider had failed to repair the broken windows quickly and in 1 person’s room, staff had used tape to cover the cracks.
“A communal bath had no taps, there were bedroom doors where the handles had been broken off and the ground floor had damaged flooring which could pose as a trip hazard.
“The conservatory which was supposed to be a shared room for people to use was sometimes locked.
“The provider had failed to ensure that people lived in a safe environment. We found rubbish and broken equipment piled up in the garden. The walkway to the smoking area consisted of a damaged and uneven pathway. People who smoked were risk assessed as being at risk of trip hazards, so this significantly increased this risk to them.”
And the CQC said the boiler at the home had not fully worked since December 2022, and this meant some people’s radiators and hot water in their rooms didn’t work (8 rooms).
A washing machine had stopped working in June 2023 and had not been replaced
“Due to a significant lack of funding by the provider the external building, surrounding areas and internal fixtures and fittings were not safe or of a suitable standard for people,” says the CQC.
They also had concerns about food.
Pictures of meals show a different reality to what is served
“For example, the pictures for lunch were a roast meat with vegetables and a chocolate tart,” says their report.
“However, a sausage plait or a bowl of baked beans with bread and butter followed by rhubarb crumble and cream was the food served”.
The report says they always ask the question “is the service caring?
“At our last inspection we rated this key question good.
At this inspection the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.
“Ensuring people are well treated and supported, respecting equality and diversity.
“Due to a significant lack of provider funding, whilst we saw that staff in the main were kind towards the people they supported, the service itself was not a caring environment to accommodate people in.
“The provider had allowed people to live in a building, which included fixtures and fittings, which were in a significant state of disrepair.”
CQC says that due to the numerous manager changes at the service the provider lacked oversight meaning there had been a level of inconsistency with communication.
County councillor calls for action over care homes
Cllr Mike Black, a member of Cambridgeshire County Council adults and health committee said: “There seems to be a complacency that a certain proportion of private providers will fail inspections and get ‘requires improvement’ or ‘inadequate’ ratings.
“This is simply unacceptable.
“It is clear that the owners of The Firs were not willing to spend money to bring the premises up to adequate standards or to provide sufficient numbers of appropriately trained staff.
“This crisis can only be solved when we get a new Government that is willing to adequately fund social care. But an increase in funding alone is not enough, as most care is now provided by private companies, who may well just use extra money to increase their profits.
“We need a National Care Service as proposed in the Fabian/Unison trade union policy report ‘Support Guaranteed, The Roadmap to a National Care Service” which is likely be the basis of the Labour General Election manifesto.”
He added; “Cambridgeshire has suffered from the chronic underfunding of social care, with the Government cutting spending nationwide by 12% between 2020 and 2019.
“There is a crisis in staffing locally which reflects the 165000 unfilled jobs in adult care nationally, up 52% from 2022.”
The Firs Residential Care Home is run by Barrels UK Care Ltd,which is owned by Mr Arasaratnam Kumanan
Care home ‘deeply regrets shortcomings’
A spokesperson for The Firs has told the BBC that the home “deeply regrets the shortcomings identified” in the report and a “detailed action plan” was already in place.
Steps were already being taken, including “rigorous safety protocols”, increasing staffing levels, a review and upgrade of facilities and improvements in governance and auditing to improve care.
The Firs had also brought in a care consultancy firm “to assist in rapidly improving our compliance and care standards”, a spokesperson said.
“We assure our residents, their families, and the community that every effort is being made to address these issues and restore confidence in our services,” they added.
