Archived: Firgrove House

At our last inspection, the service received an overall rating of Good. They had received an outstanding rating in Well Led. At this inspection, we found evidence continued to support the outstanding rating in Well Led and in addition, in Caring and Responsive. This meant the overall rating for the service had improved to Outstanding.

A new manager had been in post since April 2018 and registered with CQC in June 2018. 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 provider told us, “Our new manager brings to Firgrove House years of management experience, passion and fresh vision. Having previously managed an Outstanding service we know that she has already brought an incredibly positive outcome to many clients at Firgrove and our team who support them. We strive to add additional areas to our current Outstanding in Well led and know she is the right manager to make this possible”.

We were introduced to people throughout our visits and they welcomed us. People were relaxed, comfortable and confident in their home. The feedback we received from people was extremely positive throughout. Those people who used the service expressed great satisfaction and spoke highly of all staff and services provided.

Staff involved in this inspection demonstrated a genuine passion for the roles they performed and their individual responsibilities. Visions and plans for the future were understood and shared across the staff team. They embraced new initiatives with the support of the provider, registered manager and colleagues. They continued to look at the needs of people who used the service and ways to improve these so people felt able to make positive changes.

People experienced a lifestyle that met their individual expectations, capacity and preferences. There was a strong sense of empowering people wherever possible and providing facilities where independence would be encouraged and celebrated. People’s health, well-being and safety were paramount.

Staff had the knowledge and skills they needed to carry out their roles effectively. They enjoyed attending training sessions and sharing what they had learnt with colleagues. There was an emphasis on teamwork and unison amongst the staff at all levels. People were supported to enjoy a healthy, nutritious, balanced diet whilst promoting and respecting choice. The ‘residents’ annual surveys consistently reflected how much they enjoyed the quality of food, the variety and the constant access to beverages and snacks through the day.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). For people who were assessed as not having capacity, records showed that their advocates or families and healthcare professionals were involved in making decisions.

Staff had an excellent awareness of individuals' needs and treated people in a warm, loving and respectful manner. They were knowledgeable about people's lives before they started using the service. Every effort was made to enhance this knowledge so that their life experiences remained meaningful.

People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. People were involved throughout these processes. This ensured their needs were clearly identified and the support they received was meaningful and personalised.

Staff were proud and felt privileged when supporting people during the end of their life. They did this with empathy, love and respected people’s wishes to the very end in order to ensure a peaceful, dignified death.

Regular monitoring and reviews meant that referrals had been made to appropriate health and social care professionals and where necessary care and support had been changed to accurately reflect people's needs. People lived meaningful lives and that suited their personal interests and hobbies. The service had developed a creative and active community life at the home.

People and relative feedback was a vital part of the quality assurance system either through annual surveys, ‘residents’ meetings, complaints or reviews. People, relatives and staff were listened to and action was taken to make improvements where required. The registered manager monitored and audited the quality of care provided, striving to meet the ever-changing needs of people living in the home.

This report only covers our findings in relation to these specific areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Firgrove House’ on our website at www.cqc.org.uk.

At the time of this inspection the service was looking after 17 people. The service has a registered manager who had worked at the home for many years. 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.

At this inspection we have looked at some aspects of the management of medicines, the pre-admission assessment process and compliance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Also we have checked how the service responds to people’s care and support needs.

Because we did not look at the procedures in place and working practice for all 17 people in residence, we have not revised our rating of this service.

We did find that improvements were required with the records the staff kept regarding people’s medicines. This was to ensure that the potential for errors and mistakes to be made were removed. The provider took immediate action to address the issues identified.

Capacity assessments should be undertaken with every person and regularly reviewed. Staff need to be familiar with and understand capacity and the Mental Capacity Act 2005 in their day to day role.

Where people had specific identified care needs any action the care staff were required to take to meet those needs should be recorded accurately. This would evidence that any identified risks were acted upon and safe person-centred care was delivered. The provider took immediate action to address the issues identified.

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.

People were safe because staff received safeguarding adults training and were knowledgeable about the issues. They knew what to do if there were concerns about a person’s welfare and who to report their concerns too. Safe recruitment procedures were followed to ensure only suitable staff were employed. The appropriate steps were in place to protect people from being harmed.

Risk assessments were undertaken for each person and where risks were identified a management plan was written to reduce or eliminate that risk. Personal emergency evacuation plans were written for each person just in case there was a fire. The premises and equipment were well maintained and all maintenance checks were completed on a regular basis.

Staffing numbers were based upon the care and support needs of each and every person in residence. This meant there were sufficient staff available to meet everybody’s needs. Staff felt that the staffing numbers were sufficient and would be adjusted as necessary. Medicines were well managed and people received their medicines as prescribed by their GP.

Staff had a programme of mandatory training to complete. This ensured they had the necessary skills and knowledge to care for people correctly. New staff completed an induction training programme at the start of their employment and this was in line with the Care Certificate requirements. Care staff were encouraged to complete nationally recognised qualifications in health and social care.

People were encouraged to make their own choices and decisions and to maintain their independence for as long as possible. An assessment of each person capacity to make decisions was made and people were always asked to consent before receiving care. We found the service to be meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were provided with sufficient food and drink. They were asked what they liked to eat and provided with a varied menu. People were encouraged to eat well and would be provided with fortified food and drinks if they lost weight. There were measures in place to reduce or eliminate the risk of malnutrition or dehydration. Arrangements were made for people to see their GP and other healthcare professionals when they needed to.

People were looked after by staff who were kind and caring. Each person had a keyworker who would link with the person’s family or friends and make sure their care plan was up to date. People were given the opportunity to take part in a range of different meaningful activities.

Assessment and care planning arrangements ensured people were provided with care and support that met their needs. Daily records were maintained which evidenced the support delivered to each person. Staff were kept informed of any changes in people’s needs.

The staff team was led by an experienced registered manager who provided leadership and led by example. They were supported by a deputy and a well-established team of care staff. The registered manager was visible and worked alongside the staff regularly. There was a programme of regular staff meetings and meetings with the ‘residents’ and relatives.

The registered provider had a regular programme of audits in place which ensured that the quality and safety of the service was checked. These checks were completed on a daily, weekly or monthly basis. Feedback from people, visitors to the service, relatives and healthcare professionals was actively sought and acted upon where improvements could be made to make the service better.

Each person we met and spoke with told us they felt safe living at the home. People told us, 'I feel safe knowing staff are around to call on when I need help', 'the staff care for me very well and I have no worries' and 'I feel safe and well looked after'.

People were supported by staff who were aware of their responsibilities to safeguard them from harm and to report any concerns.

Care files contained detailed risk assessments, daily notes, mobility profiles, medical history, weight charts, nutrition information and person centred care plans. We saw evidence documents were used by staff to refer to because they explained the support people needed to meet their needs and identified any risks.

Is the service effective?

There was a record within every file of interventions by health care professionals including doctors, dentists and chiropodists. We saw from looking at peoples care records appropriate referrals had been made following a specific event, for example if a person had become unwell their GP was contacted.

Records demonstrated people had been involved in making decisions about their care. Within the completed care documents we saw information about peoples past history, how people liked to be cared for and evidence of how their dignity and privacy was maintained. An example seen was one person had asked staff to assist them to maintain their appearance and to prompt them to wear makeup. We observed the staff were respectful of the persons wishes.

Is the service caring?

We observed that staff spoke respectfully to people and spent time interacting with people on a social basis as well as meeting their personal care needs. They also took time to understand and respond to peoples' different communication styles. We observed staff responded quickly when people used their call bell to summon assistance.

People who lived at Firgrove House spoke highly about their experiences of the home. People we spoke with told us, 'The care given to me is very good' and 'The staff kind and caring and assist me with all the things I cannot do for myself'.

Is the service responsive?

Staff told us that they spent time with people on a monthly basis to review their care plan and ensure that their care continued to be appropriate to their needs. We spoke with staff who told us staff had contributed to peoples care plan, reviews and updated peoples records in order to ensure that people received a service which met their assessed needs.

There was evidence learning from incidents / investigations took place and appropriate changes were implemented. We looked at other records to ensure people's safety was being maintained. These included compliments/complaints records and notes from safeguarding investigations. These records were detailed, up to date and in order.

Is the service well led?

People who used the service and their representatives were asked for their views about their care and treatment and they were acted on. The home had a quality assurance (QA) monitoring system in place.

Staff we spoke with told us they felt supported by the registered manager, had completed a comprehensive induction and were given the opportunity to work shadowing shifts with experienced staff.

The home had a suitable auditing system to manage the health, safety and welfare of people living at the home. Health and safety audits of the home were completed monthly by the registered manager, which checked the safety of water temperatures, fire safety, electrics and identified trip hazards. Required improvements were noted by the registered manager with the appropriate follow up action taken.