The Firs Residential Care Home

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls.

The service was in breach of legal regulation in relation to people’s nutritional and hydration needs.

This service scored 35 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not always treat colleagues from other organisations with kindness and respect.

We observed staff treating people with dignity, kindness, compassion and respect. People told us they had developed trusting friendships with staff and enjoyed spending time with them. However, people we spoke with were not clear on who the registered manager was of the home. Staff we spoke with consistently told us they were not treated with kindness or dignity by the management team. One staff member said, “It can be awful, I have witnessed a colleague being shouted at in front of other staff and residents for taking too long supporting someone who was very ill.” Another staff member said, “The provider and manager barely speak to us or the residents, the only feedback I have ever received has been negative.” This meant people and staff were not always supported in a culture and environment that promoted care and compassion.

The provider did not treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. The provider did not take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Care plans did not contain any social history for people or their likes and dislikes. People’s goals and aims within their care plans were generic and not person-centred. We saw evidence of boards in the kitchen which contained people’s preferences however this also contained information for people who no longer resided at the home and omitted new people into the service. We spoke with people in the presence of staff, people described their career history and interests to us, staff acknowledged they were not aware of this information. This meant that people were not always treated as individuals or supported to express their preferences and needs.

The provider did not promote people’s independence, whilst there was a range of appropriate equipment to support and maximise people’s independence and outcomes from care and treatment staff had not received the relevant training to enable safe support. The registered manager did not provide the us with any evidence of how they supported people to understand their rights through different methods of communication. For example, where people lacked capacity, mental capacity assessments were not undertaken in line with best practice guidance. Care plans did not show any relative, professional or advocate involvement to ensure people had been assessed and supported appropriately. Despite requests, the registered manager did not provide any policy or procedures to evidence how the service supported people to have choice and control.

The provider did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Care plans did not contain clear guidance on how staff should support people. For example, one person’s care plan described an ‘emergency bag’ which contained glucose gel in case their blood sugars were too low. We asked staff where this bag was located, and staff were unaware. This was raised with the registered manager who stated, “There is no bag, everyone knows to give [name] 3 jelly babies if this happens.” Another person who was supported with their nutrition and hydration needed thickener adding to this drink to prevent them choking. We found 2 tins of thickener located in the kitchen with different prescribed doses. We asked staff which prescription they followed and we received mixed responses. The care plan did not guide staff on the amount to use. This meant the person was at risk of choking from not having their immediate needs met.

The provider did not care about or promote the wellbeing of their staff. They did not support or enable staff to deliver person-centred care. All staff we spoke with raised concerns about their ability to support people safely and their lack of training, supervision and support. One staff member said, “The [registered] manager does not respond to calls, we have no one we can ring at night or in an emergency, it’s just not safe.” Another staff member said, “We have repeatedly asked for training especially with the hoist, I have never received this training and I know others haven’t either.”

Other staff described their concerns over long and extensive shift patterns that could involve them being awake and working for over 35 hours at a time. Records and rotas we reviewed confirmed this was a regular occurrence. We also spoke to the registered manager about concerns with agency staff who undertook a lone working shift each weekend. Agency staff did not have access to the electronic care plans which meant they were not aware of people’s needs. The registered manager advised there were paper copies of care plans for them to access. However, we were only able to locate 1 paper care plan which was not reflective of the person’s needs and had not been updated for 6 months.