Archived: Firbank Nursing Home

At this inspection we found the provider had made improvements to some of these areas but was continuing to breach two regulations of the Health and Social Care Act 2014. You can see the action we have told the provider to take at the end of this report.

Firbank Nursing 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.

Firbank provides nursing care for up to 21 people. Firbank is located close to Bramhall and the local amenities. The accommodation is arranged over two floors accessed via stairs or a passenger lift. The home has a communal lounge that leads into the dining room area with doors that lead onto the enclosed rear garden. There is a large garden at the rear and patio areas.

At the time of our inspection the home did not have a registered manager, but interviews were taking place. Shortly after our inspection a manager was appointed. 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.

We found some hot water outlets in the home reached temperatures where people would have been at risk of scalding. We also found some hot water outlets where the temperature was not high enough to destroy bacteria and so minimise the risk of infection.

We made the provider aware of these issues and they immediately called a plumber to try and rectify the issues. By the second day of our inspection the plumber had fitted temperature control valves on most of the outlets, however one of the showers in the home wasn’t able to be restricted and so the management put the shower room out of use until an appropriate shower could be fitted.

Portable Appliance Testing (PAT) in the home had not been carried out since 2014 meaning potentially unsafe electrical items may have been in use in the home.

People we spoke with told us they felt safe. One person told us; “I do feel safe. I don’t know what makes me feel safe but I do.” A relative we spoke with told us; “[My relative] is being cared for well and they like it here.”

People’s medicines were managed safely in line with national guidelines. During the inspection we saw people being asked for their agreement to take medicines.

Rather than having fixed breakfast times, people were able to have breakfast whenever they got up. There was a choice of meals available and if people didn’t like either option the chef was happy to make them other meals. People were involved in planning the menus and enjoyed the food. One person we spoke to told us; “[My lunch] was delicious. It really was very, very nice.”

People and their relatives were involved in planning their care and people’s needs were kept under regular review.

Many staff working in the home had worked there for a long time. When people were recruited appropriate checks were done before the person was allowed to start work. New staff underwent training in a number of areas to enable them to deliver care safely and their competency was kept under review.

Care workers told us they felt valued and supported by management and were able to speak with them to discuss any concerns or suggestions they had. Staff worked well together and treated each other, as well as people living in the home with respect.

During the inspection we found the atmosphere in the home to be calm and relaxed. Staff knew the people living in the home well and made a point of engaging them in conversation whenever they passed through a communal area. Where people preferred to stay in their rooms we observed staff making regular checks to ensure they were ok and whether they needed anything.

People living in the home told us they were happy and we observed numerous caring interactions between care workers and people living in the home.

At the June 2014 inspection, we told the provider they needed to take action; we received an action plan. At this inspection we found the provider had met their action plan.

At this inspection we found the home had breached four regulations.

Firbank Nursing Home provides nursing care for up to 21 people. Firbank is located close to Bramhall and the local amenities. The accommodation is arranged over two floors accessed via stairs or a passenger lift. The home has a communal lounge that leads into the dining room area with doors that lead onto the enclosed rear garden. There is a large garden at the rear and patio areas.

At the time of the inspection the home did not have a registered manager. 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.

We found some areas of the premises did not comply with current Health and Safety guidance and some risks to people had not been identified. We saw some quality monitoring systems were working well, but others needed to be improved to ensure people received a consistent quality service. The home lacked adequate leadership.

There were not enough staff on duty to make sure people’s care needs were met. It was not evident whether staff had received all training as recorded by the provider and supervisions had not routinely taken place in line with the provider’s policy. Recruitment processes and the induction programmed were not fully robust. Staff had received an annual appraisal in 2016.

Activities were not provided on a regular basis to ensure people were kept occupied and stimulated.

Staff told us how they supported people to make decisions. We have made a recommendation that the registered provider review the Mental Capacity documentation in people’s care plan with a view to including decision specific mental capacity assessments and to ensure staff knowledge is up to date regarding Deprivation of Liberty Safeguards (DoLS).

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines safely. People received good support which ensured their health care needs were met.

Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe.

People’s care plans mostly contained sufficient and relevant information to provide consistent, care and support. People’s mealtime experience was good; however, we have made a recommendation that the registered provider review the involvement of people regarding the development of the food menus and to ensure people were routinely offered choice at all mealtimes. Staff were aware and knew how to respect people’s privacy and dignity.

Staff had a good knowledge and understanding of people’s needs and worked together as a team. Throughout our inspection, people were treated with patience and kindness. Staff had a good rapport with people.

Complaints were welcomed and people and family members were able to raise their concerns with the registered provider.

We found breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.

We considered the evidence collected under this outcome and addressed the following question, is the service safe?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

We found that people's needs were met by adequate numbers of suitably qualified, skilled and experienced staff. We saw that staff treated people with respect and warmth and the support we observed was provided in a patient, sensitive, timely and personal way.

The people we spoke with who lived at Firbank Nursing Home, or were visiting relatives, made positive comments about the staff working at the home. Comments we received included '[staff are] very nice', 'everyone is very nice every time you come, very helpful', 'they are wonderful' and 'they know what they are doing'. People told us staff provided 'good' timely care and that people felt safe with staff.

Is the service safe?

Some of the people who were living at Firbank Nursing Home were living with dementia and could not always give their verbal opinions on the service they received. However we observed during our visit that people were treated kindly and with respect. We were also able to understand from the people we spoke with that they were satisfied with the care provided.

At the time of our inspection we noted that the home was clean, tidy and free from unpleasant odours.

We looked at two staff recruitment records and saw that the provider had carried out the appropriate pre-employment checks before they started working at the home.

Is the service effective?

From the two care plans that we looked at we saw there was written information to help staff make sure people received appropriate care to meet their needs. We saw records to confirm that healthcare professionals such as GP's and district nurses also visited the home as requested. Notes were made of the visits on the person's care plan.

We were concerned that a nursing care plan we looked at had been written by the provider but had not been checked as being accurate by the registered general nurse (RGN). This meant that the nursing care plan did not take full account of the person's identified nursing needs and there was a potential for people's health and wellbeing not being fully protected.

Firbank Nursing Home had been adapted to meet people's individual needs. Bedrooms were situated on the ground floor and first floor of the home. The first floor could be accessed via a passenger lift. We saw there was equipment available such as a hoist, assisted baths, wheelchairs, pressure relieving mattresses and cushions to meet people's needs.

Is the service caring?

We spoke with four people who used the service that said they had no concerns about the care provided. People spoken with said that they had no complaints and that the staff were caring. One person said, 'It's not tailor made but the staff are nice'. They also told us that they felt cared for by the staff.

All of the people we saw on the day of the inspection looked clean and comfortable and they were smartly dressed.

We saw staff showing respect to people when delivering their individual care and in a way that promoted their privacy and dignity.

Is the service responsive?

During this inspection we used a short observational tool (SOFI). It looks at the mood and engagement of people using the service and the quality of staff interactions during the inspection process. It is one form of evidence that we use when making a judgment about compliance.

We saw that people's needs were assessed before they were admitted to the home to help make sure that their needs could be met. We saw that care plans were in place that reflected the person's care needs to help make sure they received appropriate care.

We saw that some individual risk assessments to guide staff in managing risks were in place and had been updated regularly to help make sure that people's changing needs were being met. However, we noted that some of the risk assessments lacked detail and did not say how identified risks would be managed.

We saw that staffing levels were adequate for the number of people who were living at the home and to meet the level of their care needs. The people we spoke with said there was enough staff at the home to meet their needs.

People spoken with told us that the GP was called as and when necessary and their medication was always given appropriately.

Is the service well-led?

At Firbank Nursing Home the provider, who is the registered manager, was in charge of the day to day management of the home. The manager was on duty at the time of the inspection.

A relative of a person using the service told us that service user satisfaction questionnaires had recently been provided to people who used the service and their relatives to obtain their views and opinions about the service.

We were told by people who used the service that they could talk to the manager or care staff if they had any concerns about the care being provided.

People were complimentary about the standard of care and support provided by the home. One person who was leaving the home that day said to the staff; 'Thank you for all your lovely care.'

The staff we spoke to were clear on how to maintain people's dignity and privacy and gave examples of how they achieved this. One member of staff told us; 'It's about respecting people's dignity or personal care. We always offer people choices and if they cannot make decisions we ask family.'

Relatives we spoke to confirmed that they were happy with the food provided at the home, they told us; 'Food couldn't be better.'

We spoke to staff who confirmed that they knew what to do if a person made a complaint. Staff we spoke to were clear on what constituted a complaint and how they could deal with minor matters themselves.