Firs Residential Home

We found the following examples of good practice.

• The service had a clear policy regarding visits from relatives and friends. Maintenance staff were in the process of making large clear screens to facilitate inside visits in a lounge with direct access from outside. People were also supported to stay in contact with their relatives and friends via the telephone and video calls.

• The premises were clean and well maintained. Additional cleaning schedules had been introduced since the beginning of the coronavirus pandemic. The registered manager undertook regular audits of all areas of infection prevention and control in the home.

• All staff had received recent training in infection prevention and control. Staff were seen to be following correct practice in this area. For example, they followed the correct procedures for putting on and taking off their personal protective equipment. Staff's competency in this area was regularly checked.

• Regular testing for COVID-19 was being undertaken for all people living and working at Firs Residential Home, in line with good practice guidance.

Further information is in the detailed findings below.

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

People were protected from harm and abuse as the staff team had been trained to recognise potential signs of abuse and understood what to do. People had information on how to raise concerns and were confident any issues would be addressed correctly.

It was clear from the findings at this inspection, the quality of the service people received had improved. Due to the many changes of manager since the last inspection, we were unable to evidence these improvements were truly embedded and standards of care delivery were consistently maintained. Future inspection will seek to evidence a sustained and consistent high level of quality has been achieved and that systems of governance are reflective, transparent and robust.

In the main medicine administration systems were effective. However, we found a gap in the medicine administration record that was not picked up by other staff or the audit process. The manager took immediate action to prevent this happening again. Recruitment processes were of good quality. The manager was in the process of gaining from staff information about any physical or mental health conditions which were relevant to the person’s capability to do the job. Enough staff were employed to meet people’s individual needs. New staff received an induction. Staff received training and supervision which was up to date. The home was clean and tidy with no unpleasant odours. Further work to improve the decoration of the home was needed.

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. People received help and support from a kind and compassionate staff team with whom they had developed positive relationships. People were supported by staff members who were aware of their individual protected characteristics like age, gender, disability and religion. People were provided with information in a way they could understand.

People’s care plans needed further work to ensure they were fully up to date, and person centred. The provider had systems in place to encourage and respond to any complaints or compliments from people or those close to them. A minimal number of activities were available to people. Further work was required to ensure these were available more often and were person-centred and meaningful to people. We have made a recommendation about the development of activity provision in the home.

People were supported by a team of staff who were happy in their jobs and well-supported by their managers. An experienced manager and senior staff completed a range of regular checks on the quality and safety of the service. The provider, manager and staff all demonstrated a desire to improve the quality of care provided. People, relatives, staff and visiting professionals had regular opportunities to express their views about 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 and update:

The last rating for this service was requires improvement (published 25 October 2018) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

NOTE: We will describe what we will do about the repeat requires improvement in the follow up section below.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Firs Residential Home 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.

Firs Residential Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 33 older people and older people living with dementia in one purpose-built building. Currently there are 29 people living at the home. Accommodation is provided over one level.

At the last inspection November 2017, the home was rated good. This is the first time the service has been rated Requires Improvement.

A registered manager was not in place. 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. A new manager had been in post since October 2017 and was going through the application process to be registered with the Commission.

People told us they felt safe and staff knew how to recognise and report any concerns about people's safety and welfare.

Not all the required checks were completed before new staff started work to help to protect people. Staff told us the training was good and relevant to their role. However, records did not reflect training had taken place. Staff were supported by the manager and were receiving formal supervision where they could discuss their ongoing development needs.

Overall, there were enough staff deployed. However, we recommended the provider reviews staff levels at busy times of the day and during the night.

People who used the service and their relatives told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion.

Care plans were not all up to date. This meant care plans did not always detail what care and support people wanted and needed.

Individual risks to people's health and welfare were not always identified and managed. Their care plans were not always detailed enough, and this created a risk they would not consistently receive appropriate care which met their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s healthcare needs were being met. Medicines were being stored safely; however, they were not always managed safely.

Staff knew about people’s dietary needs and preferences. People told us the food was very good. There were drinks and snacks available for people in between meals. Improvements were required to the service’s monitoring of nutrition and people’s weight.

Activities were on offer to keep people occupied. Visitors were made to feel welcome and could have a meal at the home if they wished.

The home was spacious but required decoration. Also, two bathrooms and one toilet were out of use, and the sluice room was being used as a store room.

The complaints procedure was displayed. The home had not received any complaints.

Everyone spoke highly of the manager who said they were approachable and supportive. The provider had systems in place to monitor the quality of care provided. However, these were not always effective. Where issues were identified they acted to make improvements; however, the outcome was not documented.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and made one recommendation. We are considering the appropriate regulatory response to our findings.

Further information is in the detailed findings below.

People remained safe at the home. People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. There were policies and procedures in place which minimised the risks of abuse to people. The risks to people had been assessed, recorded and plans were in place to manage these risks and keep people safe. People received their medicines safely and as prescribed from trained staff.

Staff undertook training and received regular supervision to help support them to provide effective care. Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is legislation protecting people who are unable to make decisions for themselves or whom the state has decided need to be deprived of their liberty in their own best interests. We saw people had a choice of food and drinks with snacks also available throughout the day.

People were treated with dignity and respect. People were asked their preferences about how they wanted to be supported and cared for. These details were recorded in people's care plans including their end of life wishes. People were supported to see other health and social care professionals when they required additional support.

Staff adopted a kind and compassionate approach to their work. People's involvement in decision-making was encouraged. People's rights to privacy and dignity were understood and promoted by staff. People's choices were respected.

Person centred plans were in place and people and their relatives were involved in planning the care and support they received. Care plans were regularly reviewed.

People, staff and professionals spoke highly about the registered manager and staff. The registered manager and registered provider continually monitored the quality of the service and made improvements in accordance with people's changing needs. When concerns were raised during the inspection the management were proactive in responding to them. The registered manager promoted an open culture which put people at the centre of the service.

During our inspection visits we spoke with the provider, the manager, four care workers, the activities coordinator and the cook. We spoke with seven people who lived at the home and four relatives and friends of people who lived at the home.

Before people received any care or treatment they were not always asked for their consent to ensure the provider acted in accordance with their wishes.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People said, 'I'm grateful for what the staff do, I would like to be at home but I appreciate the help I get, they're are always around when you need them' and 'It's not bad, staff are not bad, I like to do my own thing, no complaints.'

People were protected from the risks of inadequate nutrition and dehydration. People told us, 'Food is very good and varied, they always ask if we want more, there's no need for people to bring you any extra in, we get plenty' and 'I like the food.'

The home had an appropriate recruitment procedure in place.

There was an effective complaints system available. People told us, 'I've no complaints but would tell someone if I had' and 'Some [staff] listen, some don't. I will open my mouth when I want to.'