Firlawn

About the service

Firlawn is a residential care home providing personal care to 4 people at the time of the inspection. The service can support up to 4 people.

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

Right Support: 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.

Right Care: People received care that was person-centred. Staff promoted people’s dignity, privacy and human rights.

Right Culture: Staff and the provider promoted inclusion of both people and relatives in the general day to day life in the home. The registered manager worked closely with all staff to support them to provide a good level of care in line with the provider’s positive values and attitudes. There wasn’t always clear oversight of audit processes within the home. We have made 3 recommendations in relation to concerns found.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 21 October 2017).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

There was a registered manager in post. 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 and associated Regulations about how the service is run. The registered manager assisted us with our inspection.

We last inspected Firlawn in August 2016 where we found the registered provider was in breach of two regulations. These related to assessing people’s capacity to make decisions and the effectiveness of their quality assurance systems. Following this inspection the registered provider sent us an action plan of how they would address these two issues. At this inspection we found that both concerns had been addressed by the provider.

Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. The registered manager had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained. The provider had effective systems in place to monitor the quality of care and support that people received.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected. Staff understood the need to assess people’s mental capacity to make decisions and they followed the requirements of the Mental Capacity Act (2005) in this respect.

People lived in an environment that staff helped ensure was safe for them. People were safe at Firlawn because there were sufficient numbers of staff who were appropriately trained to meet the needs of the people who live here. Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. Accidents and incidents were recorded. We found very few incidents had taken place.

Staff had a good knowledge of their responsibilities in relation to safeguarding vulnerable people. Staff recruitment procedures were safe to ensure staff were suitable to support people in the home. The provider had carried out appropriate recruitment checks before staff commenced employment. People received their medicines when they needed them.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. People had enough to eat and drink, and received support from staff where a need had been identified. People’s individual dietary requirements where met.

The staff were kind and caring and treated people with dignity and respect. People had developed positive relationships with the staff who supported them and they enjoyed their company. People received the care and support as detailed in their care plans. People and relatives were involved in reviews of care to ensure it was of a good standard and meeting the person’s needs.

Support plans had been developed which detailed the support people required and how they preferred their care to be provided. These were reviewed regularly to help ensure they contained the most up to date information about people.

People had access to activities that met their needs. A proportion of the activities were based in the local community giving people access to friends and meeting new people. The staff knew the people they cared for as individuals, and had supported them for many years.

There was an opportunity for people to complain should they feel they need to and the registered manager had instigated a compliments book which visitors could contribute to. We found no complaints had been received, but there were several compliments.

Staff told us the registered manager was approachable and supportive. Staff enjoyed working at Firlawn and felt they offered a personalised, caring service for people.

The home is presented across one floor with access to the first floor via stairs. People’s bedrooms are single occupancy. Communal space consists of two lounge. There is a private garden with a patio at the rear of the property, which is shared with one of the providers other homes.

There was a registered manager in post. 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.

The home was well decorated and adapted to meet people’s needs. Flooring was smooth and uncluttered to aid people’s mobility needs. The home had a homely feel and reflected the interests and lives of the people who lived there.

The inspection took place on 22 July 2016 and was unannounced. We have identified two breaches in the regulations. You can see what action we told the provider to take at the back of the full version of this report.

There was positive feedback about the home and caring nature of staff from relatives and the people who live here. A relative said, “I am very happy with the care received by my family member.” A friend of a person said the staff are focused, “Primarily with the care, comfort and safety of the residents.”

This is a small family owned business and the registered manager and provider had a hands on approach to the care of people, however they had let the management of quality assurance processes stop, so records of care had become disorganised. Out of date information was mixed in with current care information. The risks to people were low, as the service did not use agency staff, and the staff knew people’s current support needs. The registered manager and provider agreed they needed to review their records management, and quality assurance processes.

People’s rights under the Mental Capacity Act (2005) were not completely met. Where people could not make decisions for themselves best interest decisions were made on their behalf. Although the requirements of the act were met, the records management could be improved. Staff were heard to ask people for their permission before they provided care.

The Staff and management had an understanding of the requirements of the Deprivation of Liberty Safeguards (DoLS), however they had not yet submitted applications in accordance with the act, for some people who were under constant supervision. The registered manager said they would do this.

People were safe at Firlawn. There were sufficient numbers of staff deployed to meet the needs and preferences of the people that lived here.

Risks of harm to people had been identified and plans and guidelines were in place to minimise these risks. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported.

People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

People would be protected in the event of an emergency. There were clear procedures in place to evacuate the building. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency.

People had enough to eat and drink, and had the food they liked to eat. They received support from staff where a need had been identified, and had access to specialist equipment to maintain their independence and feed themselves.

People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. When people’s health deteriorated staff responded quickly to help people and made sure they received appropriate treatment. People’s health was seen to improve due to the care and support staff gave.

The staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout the day of our inspection, such as staff talking with them and showing interest in what people were doing. People looked relaxed and happy with the staff. People could have visitors from family and friends whenever they wanted.

Care plans were based around the individual preferences of people as well as their medical needs. They gave a good level of detail for staff to reference if they needed to know what support was required. People received the care and support as detailed in their care plans. Details such as favourite foods in the care plans matched with what we saw on the day of our inspection, and with what people told us.

People had access to activities that met their needs, including regular trips and meals out. The staff knew the people they cared for as individuals, and had supported them for many years.

People knew how to make a complaint. No complaints had been received since our last inspection. Staff knew how to respond to a complaint should one be received.

People had the opportunity to be involved in how the home was managed. A relative said, “The managers are qualified professionals with many years of experience dealing with clients with profound learning and health issues. Their holistic and individual approach to the clients is, in my opinion, the way a good home should be run.”

We observed staff talking to people with respect and compassion and assisting them with activities of daily living.

We read in care records that every person had a personalised care and support plan that was suitable to their needs and reviewed regularly. We saw from reading people's daily notes that care plans were being followed by staff.

We saw that regular audits of the service were completed by staff ensuring that people who used the service benefited from a service that constantly monitored its quality of care provided.

We spoke to and observed staff caring for people and they displayed a thorough knowledge of the people that they cared for including personal preferences. As some of the people were unable to verbally communicate the provider demonstrated the importance of non-verbal communication.

We inspected staff training records and saw that all staff had received safeguarding training and that their responsibility was well understood.

We saw that there was a system in place to report incidents and accidents and that staff knew how to use this. We saw evidence that care plans and risk assessments were updated on a regular basis.

We looked at whether people and their relatives were able to give consent to care and treatment, and found that within the severe limitations of their conditions people were able to give some consent, and that their relatives were also able to do so. However, we noted that there were no written consent forms to document this.

We looked at the care of people in the home and found that people and their relatives were generally happy with their care, and that there was an effective care planning process in operation.

We looked at the safety and suitability of the premises and found that they were accessible for wheelchair users, well maintained and secure. However, although the owner told us he conducted regular inspections there was no record of works and maintenance.

We looked at support for staff and found they had received proper training and induction, and were offered regular supervision and appraisal.

Finally we looked at the assessment and monitoring of service quality, and whilst we found that the provider was taking steps to do this, we were unclear how often some of these processes were being undertaken.