The Firs Residential Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to person-centred care.

This service scored 38 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. Care plans and review records did not evidence people’s involvement and relatives told us they were not included in any care plan reviews. Everyone we spoke with told us they had not seen their care plan and did not know what it contained. However, staff knew people and their care needs well. Despite the lack of recorded detail in care plans staff were able to explain and describe the care they provided to people that was relevant to their health conditions. Staff attempted to support people with their communication needs and choices by offering them options however they did not have aids available to support this such as picture menus for mealtimes or dementia-friendly signage in the home. We raised this with the registered manager who acknowledged the lack of signage but stated the provider felt it detracted from the feel of the home and had decided not to use it.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards. Some people living at The Firs Residential Care Home were cared for in bed. Due to health conditions and limited mobility people were at risk of pressure sores and required repositioning to mitigate this risk. Care plans did not detail this information or give staff guidance on when or how to support people being repositioned. The registered manager confirmed that people cared for in bed required 4 hourly turns to relieve pressure. We reviewed records that staff signed to state they had repositioned people. However, these records consistently showed gaps in care and repositioning with gaps between 6 and 23 hours. This meant people were at increased risk of developing pressure sores and ulcers.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

We spoke with several professionals who worked with the service. Most professionals stated while staff tried hard to deliver good care the lack of presence by the registered manager affected the care people received. One professional said, “We found areas for improvement but there were repeated visits where the [registered] manager was not present to respond to actions needed.” Another professional said, “I can’t fault the staff, I attend the home multiple times a week and they try so hard but the way the [registered] manager speaks to them is very unprofessional. I have attended while they [registered manager] have been here, and they never acknowledge me, not even a hello.”

This meant opportunities to ensure people received joined up care and support and appropriate improvement had been missed which placed people at the risk of harm from ineffective care.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Records did not always reflect actions taken by staff. For example, we observed people participating in activities both in group settings and on an individual basis between people and staff. Care records did not reflect these activities had taken place and there was no record of any health benefits or improvements experienced by people. We saw evidence within resident meeting minutes that people had regularly requested activities such as day trips or activities in the community, however people and staff confirmed these activities were not currently supported or offered by the provider.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. Care records and care plans did not reflect the level of support and care people required. The registered manager had failed to complete risk assessments to understand people’s level of need. For example, 1 person recently admitted to the service had not received a risk assessment on their mobility. The record stated, ‘unable to assess but mobilises independently’, however upon speaking with staff it was clear this person was unable to mobilise and required the use of a wheelchair. This meant the person was at risk of not receiving care appropriate to their needs or having any improvement or deterioration identified and supported safely and effectively.

The provider did not always inform people of their rights around consent and did not always respect their rights when delivering care and treatment. Care plans did not evidence that people or their relatives, where appropriate had consented or been involved in developing care plan and support needs. People’s wishes were not recorded so we were not assured that people received care in line with their wants, needs or aims. However, our observations during the onsite assessment showed staff were knowledgeable about people’s likes and dislikes and were proactive in gaining people’s consent prior to completing care. We saw staff taking time to speak with people and explain options and asking for consent prior to undertaking any sort of support. People responded well to staff which demonstrated a trusting and open relationship.