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Firlawn Nursing Home Requires improvement

We are carrying out checks at Firlawn Nursing Home using our new way of inspecting services. We will publish a report when our check is complete.

Reports


Inspection carried out on 1 February 2017

During a routine inspection

Firlawn Nursing Home provides nursing care to up to 40 people. The home consists of two buildings on one site, which are separated by a large garden. At the time of the inspection, there were 37 people using the service.

The inspection took place on 01 and 02 February 2017. The first day of the inspection was unannounced.

At our last inspection in November 2015, the provider was not meeting the requirements of Regulations 11 and 12 of the Health and Social Care Act 2008 (Registered Activities) Regulations 2014 and we found breaches of some of the legal requirements in the areas we looked at. Some improvements were seen during this inspection which demonstrated the service had responded to our feedback. However, not all actions had been completed. Improvements to the safe management of medicines and documentation around decisions made in line with the Mental Capacity Act 2005 had not been made and repeated breaches were identified in these areas.

There was a registered manager in post at this service although at the time of the inspection, they were not available. 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 2008 and associated Regulations about how the service is run.

We received a notification from the provider to confirm the registered manager was absent for more than 28 day consecutive days. The deputy manager was managing the service with support from the operations director and the clinical team lead in the absence of the registered manager. At the time of the inspection, it could not be confirmed when the registered manager would be returning.

At this inspection, medicines were not managed safely. The documentation to confirm how some medicines should be given and when medicines had been administered had not been consistently completed and therefore the provider could not be assured people were receiving their medicines as prescribed. People were not always supported to receive their medicines safely because staff did not always ensure people had taken the medication they were handing out. Medicines were not always securely stored.

Systems to monitor the quality of the service were not always effective and did not ensure all issues were properly identified and addressed. Regular checks were not undertaken to identify and mitigate risks.

Areas of the home were in poor state of repair which put people, staff and visitors at risk of trips and/or falls. When we spoke to the deputy manager they told us there was a refurbishment program in place. However, these areas had not been prioritised.

Incomplete records in relation to nutrition and hydration meant the provider could not ensure people were protected against the risk of dehydration. Whilst charts to monitor the care for people at risk of developing pressure ulcers were in place and were completed in line with people’s care plans, the documentation to confirm when people who were at risk of dehydration was not consistently completed and therefore there was the risk that issues were not promptly identified.

People and staff told us the quality of the food was poor and there was a limited variability of choice. One staff member told us they had been “embarrassed” to serve a meal and it was “so awful” they had to throw it away. The operations director was aware of the concerns about the food and had recruited a new chef who was due to start in two weeks.

People, their relatives and staff told us there was not always sufficient numbers of staff to support people in line with their needs. Whilst people and their relatives said they had recently seen improvements to staffing, one member of staff told us there were still not enough staff to meet people’s needs.

People told us staff supported them well and had the necessary knowledge and skills to do this.

People told us staff treated them with dignity and respect and always knocked and waited before entering their rooms. However, this was not consistently evident from our observations during the inspection and people were not always treated with dignity and respect.

There were mixed responses from people we spoke with about the caring nature of staff. People and their relatives told us most staff that supported them were kind and caring. However, this was not always the case and some people expressed concerns about two staff members.

Staff received regular supervision and appraisals and told us these meetings were productive and helpful.

People told us they felt safe and staff were able to explain how they would identify signs of potential abuse and how they would report safeguarding concerns.

Staff we spoke with demonstrated a good awareness around the principles of the Mental Capacity Act 2005. They told us decisions had been made in people’s best interests for people who lacked the capacity to make specific decisions and these had been made with the least restriction as possible. However, documentation to support these decisions were not available in people’s care records.

The quality of documentation in people’s care plans had improved since the last inspection. The service had implemented new monitoring tools to ensure care plans were reviewed in a timely manner and people’s health needs were met.

Whilst there was an activities program which some people told us they enjoyed, there was limited opportunity for some people to take part in meaningful activities of their choice and ability. People who chose to remain in their room or were nursed in bed were not offered the same degree of contact as those who spent their time in the communal areas of the home.

People, relatives and staff told us the management team were approachable and they would feel confident in raising any issues or concerns if they arose. One person told us “I feel valued and listened to”. However, some people and staff told us during the period of time the registered manager had been absent; they had not been kept well informed. They told us resident and staff meetings which used to occur regularly now did not happen.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of the report. We are taking further action in relation to this provider and will report on this when it is completed.

Inspection carried out on 3, 5 and 24 November 2015

During a routine inspection

Firlawn Nursing Home provides nursing care to up to 40 people. The home consists of two buildings on one site, which are separated by a large garden. At the time of the inspection, there were 37 people using the service.

The inspection took place on 01 and 02 February 2017. The first day of the inspection was unannounced.

At our last inspection in November 2015, the provider was not meeting the requirements of Regulations 11 and 12 of the Health and Social Care Act 2008 (Registered Activities) Regulations 2014 and we found breaches of some of the legal requirements in the areas we looked at. Some improvements were seen during this inspection which demonstrated the service had responded to our feedback. However, not all actions had been completed. Improvements to the safe management of medicines and documentation around decisions made in line with the Mental Capacity Act 2005 had not been made and repeated breaches were identified in these areas.

There was a registered manager in post at this service although at the time of the inspection, they were not available. 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 2008 and associated Regulations about how the service is run.

We received a notification from the provider to confirm the registered manager was absent for more than 28 day consecutive days. The deputy manager was managing the service with support from the operations director and the clinical team lead in the absence of the registered manager. At the time of the inspection, it could not be confirmed when the registered manager would be returning.

At this inspection, medicines were not managed safely. The documentation to confirm how some medicines should be given and when medicines had been administered had not been consistently completed and therefore the provider could not be assured people were receiving their medicines as prescribed. People were not always supported to receive their medicines safely because staff did not always ensure people had taken the medication they were handing out. Medicines were not always securely stored.

Systems to monitor the quality of the service were not always effective and did not ensure all issues were properly identified and addressed. Regular checks were not undertaken to identify and mitigate risks.

Areas of the home were in poor state of repair which put people, staff and visitors at risk of trips and/or falls. When we spoke to the deputy manager they told us there was a refurbishment program in place. However, these areas had not been prioritised.

Incomplete records in relation to nutrition and hydration meant the provider could not ensure people were protected against the risk of dehydration. Whilst charts to monitor the care for people at risk of developing pressure ulcers were in place and were completed in line with people’s care plans, the documentation to confirm when people who were at risk of dehydration was not consistently completed and therefore there was the risk that issues were not promptly identified.

People and staff told us the quality of the food was poor and there was a limited variability of choice. One staff member told us they had been “embarrassed” to serve a meal and it was “so awful” they had to throw it away. The operations director was aware of the concerns about the food and had recruited a new chef who was due to start in two weeks.

People, their relatives and staff told us there was not always sufficient numbers of staff to support people in line with their needs. Whilst people and their relatives said they had recently seen improvements to staffing, one member of staff told us there were still not enough staff to meet people’s needs.

People told us staff supported them well and had the necessary knowledge and skills to do this.

People told us staff treated them with dignity and respect and always knocked and waited before entering their rooms. However, this was not consistently evident from our observations during the inspection and people were not always treated with dignity and respect.

There were mixed responses from people we spoke with about the caring nature of staff. People and their relatives told us most staff that supported them were kind and caring. However, this was not always the case and some people expressed concerns about two staff members.

Staff received regular supervision and appraisals and told us these meetings were productive and helpful.

People told us they felt safe and staff were able to explain how they would identify signs of potential abuse and how they would report safeguarding concerns.

Staff we spoke with demonstrated a good awareness around the principles of the Mental Capacity Act 2005. They told us decisions had been made in people’s best interests for people who lacked the capacity to make specific decisions and these had been made with the least restriction as possible. However, documentation to support these decisions were not available in people’s care records.

The quality of documentation in people’s care plans had improved since the last inspection. The service had implemented new monitoring tools to ensure care plans were reviewed in a timely manner and people’s health needs were met.

Whilst there was an activities program which some people told us they enjoyed, there was limited opportunity for some people to take part in meaningful activities of their choice and ability. People who chose to remain in their room or were nursed in bed were not offered the same degree of contact as those who spent their time in the communal areas of the home.

People, relatives and staff told us the management team were approachable and they would feel confident in raising any issues or concerns if they arose. One person told us “I feel valued and listened to”. However, some people and staff told us during the period of time the registered manager had been absent; they had not been kept well informed. They told us resident and staff meetings which used to occur regularly now did not happen.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of the report. We are taking further action in relation to this provider and will report on this when it is completed.

Inspection carried out on 31 October 2013

During an inspection to make sure that the improvements required had been made

We carried out a follow-up inspection to check the provider had achieved compliance with Outcome 7 Safeguarding people who use the services from abuse. At the previous inspection we set compliance actions because the provider was not fully meeting essential standards of quality and safety.

We spoke with people who lived in both houses. The five people we asked told us they felt safe. One person told us they often fell and when we asked how staff ensured their safety this person said “Staff say ring the bell but I try to be independent.” Another person said “they (staff) look after you very well and the staff are nice too.” The third person we spoke with said “yes I feel safe. There is nothing to worry about.”

Relatives who were visiting people during our inspection gave us feedback on their experiences with the delivery of care. The three relatives of people who lived at the home told us in their opinion their family member was safe from abuse.

We spoke with six staff and four staff said they had attended safeguarding adults training. These four staff were clear on their responsibilities for safeguarding people from abuse. They knew the signs of abuse and they knew who to report alleged abuse. Staff were aware that it was their duty to report any poor practice they may have witnessed from other staff. Staff knew the procedure for whistleblowing.

On the day of our inspection we observed staff had entered into the spirit of Halloween and were dressed in costume. We saw people enjoyed watching staff in their outfits and we heard one person say “you all look so beautiful.”

Inspection carried out on 8 May 2013

During an inspection to make sure that the improvements required had been made

The five people we asked told us the care delivered by the staff was good. They told us their rights were respected and gave us examples such as “Staff knock the doors before they enter and I say hold on, if I don’t want them to come in” and “when I first came, staff asked me what name they were to use.”

People said the staff asked them how they wanted their care to be delivered. One person said the manager had discussed their care needs with them and to show their agreement they had signed their care plan.

One relative of a person who lived at the home explained the admission process that was followed. We were told the staff were approachable and acted upon their suggestions.

The people we spoke with said they felt safe at the home. One person told us they had complained and the manager had resolved their complaint. However, the staff had not received adequate advice from the provider about the procedure to be followed for whistleblowing.

We observed the lunchtime meal and we saw staff use a respectful approach. We saw staff supported people to eat and encouraged them to eat their meal.

Inspection carried out on 25 September 2012

During an inspection in response to concerns

We spoke with people who lived in both houses and positive comments were made about their care and the staff. One person said “choice is not an issue; there are no rules about getting up and going to bed at night. We can stay in our rooms and use various parts of the home at will. There are never any concerns regarding the attitude or skills of staff, including agency.”

Although people made positive comments about the delivery of care, they were not involved in the planning or the reviews about their care. People said “I am happy here and staff understand my needs”, “The staff know how to care for me” and “I am well looked after by the staff” The people we asked, said they were not frightened of being left alone with staff and they felt confident to approach the manager with complaints.

One person thought there were staff shortages because when staff were summoned for assistance they took too long to answer call bells. Other people we asked said when they summoned staff for assistance they arrived promptly.

People said they felt safe when staff delivered personal care and they felt confident to approach the manager with complaints.

Inspection carried out on 13 June 2012

During an inspection to make sure that the improvements required had been made

Firlawn nursing home consists of two buildings on one site. The buildings are separated by a large garden. The building closest to the main road is called 'The House'. The building at the rear of the property is referred to as 'The Home'.

During our inspection in April 2012, we spoke with people living in both buildings. We found that peoples' diversity, values and human rights were respected. People were very appreciative of the staff saying, "they work very hard, they are absolutely wonderful". One person told us, "I am treated very well and the staff are always courteous". We spoke with many other people who all had positive things to say about the way in which staff treated them and how the home was run.

We revisted Firlawn nursing home in June 2012 to see if improvements had been made regarding staffing arrangements. We spoke with ten members of staff during our visit. Care workers, kitchen and housekeeping staff were positive about the recent changes to staffing levels and procedures.

Two people said the staffing situation had improved. Another person said, "I've never had any problems". Everyone we spoke with said their call bells were answered promptly and staff carried out care without rushing. People said they were very happy living in the home.

Inspection carried out on 4 April 2012

During an inspection in response to concerns

We spoke with people living in both buildings. We found that peoples' diversity, values and human rights were respected. People were very appreciative of the staff saying, “they work very hard, they are absolutely wonderful”. One person told us, “I am treated very well and the staff are always courteous”.

We spoke with many other people who all had positive things to say about the way in which staff treated them.

We spoke with six people living in the home. Many people told us that on some days, there were not enough staff and people had to wait for their call bells to be answered. People said the care they received was excellent. One person said, “they (the staff) do a fantastic job, you have to be understanding”.

Reports under our old system of regulation (including those from before CQC was created)