We carried out a review of the data available to us about The Firs on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about The Firs, you can give feedback on this service.
The Firs is a care home, without nursing, accommodating up to 22 people. At the time of our inspection there were 16 people using the service. The accommodation is arranged over two floors with a passenger lift, and stairs, available to access the upper floor. Some rooms are ensuite. There is an accessible, mature garden surrounding the home and a patio area with seating areas. Some of the people using the service were living with dementia.
People’s experience of using this service and what we found
The assessment of risks to people’s safety had improved which supported people to stay safe. Staff recruitment checks promoted safety. There were sufficient staff deployed to meet people’s needs. The manager was embedding best practice guidance in relation to the safe management of medicines. We have made two recommendations about this. Improvements had been made to ensure that appropriate records were maintained of the cleaning that took place. The home continued to looked visibly clean with high standards of cleanliness and hygiene throughout. The provider’s approach to visiting aligned with government guidance. People told us they felt secure living at The Firs and relatives were confident that their family members were safe from abuse.
The leadership team had been working effectively with a range of external organisations to drive improvements within the service. Feedback from these organisations about progress was positive. Overall, the audits that were in place were being used more effectively to monitor the quality of care that was being provided. Further work was needed to ensure that guidance and frameworks relating to assessing mental capacity were fully implemented. People and their relatives told us that staff provided person centred support and encouraged them to have freedom of choice and control over what they did. The leadership team had created a more positive work culture where staff felt valued. The manager was visible within the service, undertaking checks and audits but also supported with the delivery of care when needed. The manager actively sought the views of people, staff and relatives about the quality of care and how the service might improve. The manager had a clear vision for the direction of the service and understood the areas where the service still needed to make improvements.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 6 January 2022) and there were breaches of Regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 16 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safety of recruitment procedures and the robustness of the governance arrangements.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Firs on our website at www.cqc.org.uk.
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.
The Firs is a care home, without nursing, accommodating up to 22 people. At the time of our inspection there were 20 people using the service. The accommodation is arranged over two floors with a passenger lift, and stairs, available to access the upper floor. Some rooms are ensuite. There is an accessible, mature garden surrounding the home and a patio area with seating areas. Some of the people using the service were living with dementia.
People’s experience of using this service and what we found
Whilst the manager had carried out appropriate recruitment checks, including checks with the Disclosure and Barring Service (DBS) we found that in one case they had not risk assessed the information they had received. Whilst we did not find evidence that people had been harmed, we identified that some risks to people’s health and wellbeing had not been adequately assessed and planned for. We identified concerns regarding the effectiveness of the governance arrangements and with the completeness of records relating to people’s care and support.
Sufficient improvement had been made to the safety of medicines, however, there remained areas where further improvements could be made. The home looked visibly clean and there were no malodours, however, we found some areas where the measures in place for preventing and controlling infection, and more specifically COVID-19, needed to be implemented more effectively. The provider and manager are reviewing the numbers of staff deployed to ensure that people’s needs are met in a timely and safe manner. More needed to be done to ensure that each person had sufficient opportunities to be part of regular and meaningful activities.
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. However, further work was required to ensure that the systems in the service supported this in practice and to ensure these measures were taking place within the context of legal frameworks governing consent.
We continued to receive mixed feedback about the effectiveness of the leadership of the service. Some staff expressed a cautious confidence in the new manager and in their ability to drive improvements, whilst others continued to raise concerns about morale and teamwork. We are confident that the manager is taking action to address these concerns.
People felt safe living at The Firs. Recent safeguarding concerns had been appropriately reported and outcomes showed that action had been taken to reduce further risks to people. People were positive about the care they received, and felt their individual needs were mostly being met. Relatives told us the service had a clear person centred focus, they all said they would recommend the home to others. The service worked in partnership with other organisations to help improve the health and well-being of people.
We have made two recommendations in the report. We have recommended that the provider review their legionella risk assessment to ensure this complies with relevant best practice guidance. We have also recommended that the provider explore how information can be made available in alternative formats to help ensure that this is more accessible to people living with communication and cognitive needs.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (Published February 2021).
Why we inspected
This inspection was in part prompted by concerns we had received in relation to people’s care and support and the culture within the service. In addition, at our last inspection of this service, breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance in the home.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led.
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 coronavirus and other infection outbreaks effectively.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Firs on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment, staffing and good governance.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider, the local Clinical Commissioning Group (CCG) and the local authority (LA) to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.
The Firs is a residential care home providing personal and nursing care to 15 people aged 65 and over at the time of the inspection.
The care home accommodates up to 22 people in an adapted property with a large, purpose-built extension. Most rooms were single occupancy, and all had ensuite facilities.
People’s experience of using this service and what we found
The provider had systems and processes in place for the safe administration, use and storage of medicines. However, these processes were not always followed. We could not be assured that medicines were always given as the prescriber intended or that medicines and records were always secure.
Staff were trained in safeguarding and were clear that if they suspected abuse had taken place this should immediately be reported. Staff gave mixed feedback concerning whistle-blowing. They understood the process however did not all believe that the current management team would deal with issues or maintain confidentiality.
Risks were assessed and mitigated, and accidents were reviewed to look for patterns and ways to minimise reoccurrences.
Staff recruitment was safe and all necessary pre-employment checks were completed prior to commencing in post.
Staffing levels were sufficient to meet people’s needs, however some senior staff members were working very long hours. We raised our concerns and found this was due to a number of staff not being available to work at short notice.
The infection prevention and control practice at The Firs was appropriate with suitable cleaning products in use and quality control in place to maintain standards.
Appropriate arrangements had been made to enable safe visiting during the pandemic and video and phone calls were in use to supplement visits.
The registered manager did not always notify significant events in the service such as missed medicines that had a detrimental effect on the person.
There were regular audits of hygiene, spot checks of beds and cleaning schedule reviews. We did not see audits of care plans, daily care records or rates of infection that may have provided valuable information about well-being and enable earlier detection of issues.
Staff meetings were held, usually in person but as a result pf the pandemic using Zoom calls. These calls were not minuted however were recorded for staff to watch later should they be unable to attend.
Quality assurance processes were continued throughout the pandemic. People were frequently asked their thoughts on meal provision and staff received questionnaires to complete.
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 9 November 2017).
Why we inspected
We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about medicines, moving and assisting, staffing, care delivery and choking. A decision was made for us to inspect and examine those risks.
We inspected and found there were concerns about medicines, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for the Firs on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to the safe use, storage and record keeping of medicines.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 our last inspection in August 2016, we found that the service was not meeting a number of the fundamental standards and was in breach of four Regulations. This inspection checked to see whether the required improvements had been made.
Improvements had been made which ensured that people were appropriately protected from harm or abuse. Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect. Staff were confident the manager would act upon any concerns they raised.
Improvements had been made to ensure that risks to people’s safety and wellbeing were fully assessed and planned for.
The registered manager had taken action to ensure that serious injuries were notified to the Care Quality Commission (CQC). This is important as it enables the CQC to effectively monitor the safety and quality of the service provided.
Improvements had been made to ensure that all of the required checks were made before new staff started working at the service.
Medicines were managed safely and there were sufficient numbers of experienced staff to meet people’s needs.
The home was clean and good infection control practices were followed.
Staff worked in accordance with the Mental Capacity Act 2005 and the deprivation of liberty safeguards were applied appropriately.
Staff received training, supervision and an induction which ensured they had the skills and knowledge to support people appropriately.
The Firs provided a secure but comfortable and homely environment that was appropriate to people’s needs.
There was a strong emphasis on the importance of eating and drinking well and people told us the food and drink provided was good and met their individual preferences.
Where necessary a range of healthcare professionals had been involved in planning and monitoring people’s support to ensure this was delivered effectively.
People were cared for by staff that were kind and caring and with whom they had developed good relationships. Staff were attentive, showed people kindness and patience and displayed a genuine interest in the people they supported. People were treated with dignity and respect.
The service was focused on providing person centred care. Staff had a good knowledge and understanding of the people they were supporting which helped to ensure people received care and support which was responsive to their needs
Staff looked for ways to meet people’s needs in a creative way so that they might have positive experiences and receive care that was meaningful to them and met their needs in a person centred way.
People were supported and fully engaged in activities that were meaningful to them.
People were at the heart of the service, their opinions mattered and there was evidence that they were being consulted about the running of the home on an ongoing basis.
Complaints procedures were in place and information about how to make a complaint was freely available within the service and within the service user guide.
People spoke positively about how well organised and managed the service was.
There were systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving appropriate support.
The registered manager had nurtured a friendly and homely environment where people felt valued and part of a family.
The Firs provides accommodation for up to 22 older people who are physically frail or may be living with mild to moderate dementia. At the time of our inspection there were 20 people living at the home. The home provides long term care and respite care. It does not provide nursing care. Most people needed some assistance with managing daily routines such as personal care. A small number of people needed support with eating and drinking or support with moving and positioning. The home is located in a residential area of Locks Heath. There is a small car park located at the front and there is a secure garden to the rear of the property. The accommodation is arranged over two floors with both a lift and stairs available for accessing the first floor. The home offers 16 single rooms and three shared rooms. All of the rooms have ensuite facilities.
The Firs has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The registered manager was also registered manager for one of the provider's other services.
The registered manager had not always submitted statutory notifications on time. Staff recruitment checks needed to be more robust.
Staff displayed a commitment to protect people from harm and to protect them from abuse. However, we found that the registered manager had not appropriately escalated a potential safeguarding concern to the local authority safeguarding teams.
Improvements were needed to ensure that all of the risks to people’s wellbeing and those associated with the environment were effectively assessment and managed.
Audits needed to be more robust to ensure they were driving improvements.
There were sufficient numbers of staff deployed to meet people’s needs. Supervision had not been taking place regularly, although we saw that this was an improving picture. Further improvements are planned to extend the training programme which staff felt was adequate and helped them to provide effective care.
Action was being taken to embed the principles of the Mental Capacity Act 2005 within the care planning process. Where people's liberty or freedoms were at risk of being restricted, the proper authorisations had been applied for.
People’s medicines were managed safely.
People told us they enjoyed the food provided and staff were informed about whether people were nutritionally at risk.
The home worked effectively with a number of health care professionals to ensure that people received co-ordinated care, treatment and support.
People were treated with dignity and respect. Staff were kind and caring in their interactions with people and had developed positive relationships with people. People took part in a range of activities which they enjoyed.
People knew how to make a complaint and information about the complaints procedure was included in the service user guide and displayed within the home.
Everyone spoke positively about the friendly atmosphere within the home. There was a positive culture with staff working well as a team to meet people’s needs effectively.
People and staff could make suggestions about how the service might improve and the provider acted upon these.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the end of this report.
At our inspection in October 2014, we identified that the service was failing to ensure that medicines were stored appropriately, that an accurate record of the medicines administered was maintained and that medicines were disposed of safely. On the 12 May 2015 we conducted a focused inspection. This inspection found that the required improvements had not been made. In addition we found a number of new concerns in relation to how medicines were managed within the service. After our inspection of 12 May 2015, the provider was served a warning notice. This required the service to be compliant by 31 July 2015.
On the 25 August 2015 we undertook this unannounced focused inspection to check that the breaches of legal requirements, concerning the use and management of medicines, which had resulted in enforcement action, had been addressed. We checked to see that the provider had followed their plan and to confirm that they now met legal requirements.
The Firs Care home provides accommodation for up to 22 older people who are physically frail or may be living with dementia. The home provides long term care, respite care and day care. It does not provide nursing care. Most people needed assistance with managing daily routines such as personal care. A small number of people routinely needed support with eating or support with moving and positioning. The home is located in a residential area of Locks Heath. There is a small car park located at the front and there are accessible gardens. The accommodation is arranged over two floors and there is a lift available for accessing the first floor. There are 16 single rooms and three shared rooms. All of the rooms have ensuite facilities.
The Firs did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A new manager has been appointed and is in the process of applying to CQC to become registered.
The service had improved the use and management of medicines. Medicines were safely stored, administered and recorded as prescribed including the exact quantity administered for variable dose oral medicines. Supporting information for example allergy information was consistent and protocols were available to support staff with “if required” and “variable dose” medicines
Medicine audits were being effectively used to drive improvements and to ensure that people's medicines were being managed safely.
This report only covers our findings in relation to the focused inspection of 25 August 2015. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.
We could not improve the overall rating for this service because to do so requires consistent good practice over time. We will consider whether it is appropriate to revise the overall rating awarded to this service during our next planned comprehensive inspection.
We carried out an unannounced comprehensive inspection of this service on 3 and 6 October 2014. A breach of the legal requirements was found and we issued a compliance action for a breach in relation to the safe management of medicines. The provider sent us an action plan saying they would have made the required improvements by 2 April 2015.
As a result we undertook an unannounced focused inspection on 12 May 2015 to follow up on whether action had been taken to meet the legal requirements. You can read a summary of our findings from both of these inspections below.
Comprehensive inspection 3 and 6 October 2014
This inspection took place on 3 and 6 October 2014 and was unannounced.
The Firs Care home provides accommodation for up to 22 older people who are physically frail or may be living with dementia. At the time of our inspection there were 20 people living at the home. The home provides long term care, respite care and day care. It does not provide nursing care. Most people needed assistance with managing daily routines such as personal care. A small number of people routinely needed support with eating or support with moving and positioning. The home is located in a residential area of Locks Heath. There is a small car park located at the front and there are accessible gardens. The accommodation is arranged over two floors and there is a lift available for accessing the first floor. There are 16 single rooms and three shared rooms. All of the rooms have en-suite facilities.
The Firs has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
There were systems and processes in place for managing people’s medicines, for example staff had received appropriate training. However the systems were not effective in ensuring that medicines were administered, stored and disposed of correctly.
Risks to people’s safety were identified and managed effectively. However some risk assessments contained conflicting or out of date information. Some risk assessments needed to be more detailed about the actions staff needed to take to ensure that people were protected from harm.
There were some quality assurance systems in place to monitor and review the quality of the home. However these needed to be more robust to ensure that they were an effective tool in identifying any shortfalls or areas for improvement.
There were sufficient numbers of suitably qualified staff. Some staff told us that at times they felt that care could be enhanced further by having some additional staff on duty. Three people told us that at times, there could be a slight delay in staff being able to assist them as they were busy supporting other people. New staff had been recruited to ensure that staffing levels remained responsive to the needs of people using the service.
Safe recruitment practices were followed which made sure that only suitable staff were employed to care for people in the home.
People told us that they felt safe and we saw that there were systems and processes in place to protect them from harm. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to their management team. Staff were aware of the importance of disclosing concerns about poor practice or abuse and were informed about the organisations whistleblowing policy
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made and how to submit one and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.
Staff understood how the Mental Capacity Act (MCA) 2005 was applied. Mental capacity assessments had been undertaken which were decision specific. Where people were deemed to lack capacity, appropriate consultation had been undertaken with relevant people such as GP’s and relatives to ensure that decisions were being made in the person’s best interests.
People told us that their staff members provided them with the support they needed. Staff told us that the registered manager supported them to develop their skills and knowledge by providing a programme of training which helped them to carry out their roles and responsibilities effectively. Staff received regular supervision which considered their development and training needs.
Staff worked effectively with healthcare professionals, for example, links had been developed with the continence service to help ensure that staff were following best practice guidance. People were supported to see healthcare professionals such as GP’s, chiropodists, community nurses and opticians.
People were positive about their care and the support they received from staff. Interactions between staff and people which were kind and respectful. Staff were aware of how they should respect people’s dignity and privacy when providing care.
Staff were aware of what people needed help with and what they were able to do for themselves. They supported and encouraged people to remain as independent as possible.
People’s preferences, likes and dislikes had been recorded and we saw that support was provided in accordance with people’s wishes. People were involved, where able, in decisions about their care which helped them to retain choice and control over how their care and support was delivered.
People knew how to make a complaint and information about the complaints procedure was included in the service user guide, including how to raise concerns with the Care Quality Commission. People were confident that any complaints would be taken seriously and action taken by the registered manager.
There was a programme of activities in place which people seemed to enjoy, although some health and social care professionals told us that they felt the activities offered could be more diverse.
The registered manager who actively sought feedback from people and staff in order that improvements could be made to the home. The registered manager told us that the provider visited the home frequently and was supportive of the management team which included provided the resources needed to effectively meet people’s needs.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.
Focused inspection 12 May 2015
At our inspection in October 2014, we identified that the service was failing to ensure that medicines were stored appropriately, that an accurate record of the medicines administered was maintained and that medicines were disposed of safely. We issued a compliance action in relation to Regulation 13 relating to the management of medicines. We were sent an action plan which described the improvements the provider planned to make in order to comply with the above Regulation. This plan stated that the provider would have made the required improvements by 2 April 2015.
On the 12 May 2015 we conducted a focused inspection. This inspection found that the required improvements had not been made. The provider had failed to remedy the breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. In addition we found a number of new concerns in relation to how medicines were managed within the service.
We reviewed a number of medication administration records (MAR’s) and found that many of these contained gaps in recording with no reason noted as to why. Information about allergies was incomplete or potentially incorrect. For example, one person was prescribed an Epipen. There were no protocols in place to guide staff on the circumstances in which they might need to use ‘as required’ or ‘PRN’ medicines.
Medicine audits were not being effectively used to drive improvements and to ensure that medicines were being managed safely. None of the concerns we found during the inspection had been identified by the provider. Therefore we could not be assured that the medicines administration systems were monitored effectively to ensure that people received their medicines as prescribed.
This was a breach of Regulation 12 (2)(g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.
The service had made improvements to way in which medicines were stored. The service now had a dedicated medicines fridge and the temperature of this was being monitored on a daily basis. All medicines viewed were within their use by date which meant that they were safe to use.
This inspection took place on 3 and 6 October 2014 and was unannounced.
The Firs Care home provides accommodation for up to 22 older people who are physically frail or may be living with dementia. At the time of our inspection there were 20 people living at the home. The home provides long term care, respite care and day care. It does not provide nursing care. Most people needed assistance with managing daily routines such as personal care. A small number of people routinely needed support with eating or support with moving and positioning. The home is located in a residential area of Locks Heath. There is a small car park located at the front and there are accessible gardens. The accommodation is arranged over two floors and there is a lift available for accessing the first floor. There are 16 single rooms and three shared rooms. All of the rooms have en-suite facilities.
The Firs has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
There were systems and processes in place for managing people’s medicines, for example staff had received appropriate training. However the systems were not effective in ensuring that medicines were administered, stored and disposed of correctly.
Risks to people’s safety were identified and managed effectively. However some risk assessments contained conflicting or out of date information. Some risk assessments needed to be more detailed about the actions staff needed to take to ensure that people were protected from harm.
There were some quality assurance systems in place to monitor and review the quality of the home. However these needed to be more robust to ensure that they were an effective tool in identifying any shortfalls or areas for improvement.
There were sufficient numbers of suitably qualified staff. Some staff told us that at times they felt that care could be enhanced further by having some additional staff on duty. Three people told us that at times, there could be a slight delay in staff being able to assist them as they were busy supporting other people. New staff had been recruited to ensure that staffing levels remained responsive to the needs of people using the service.
Safe recruitment practices were followed which made sure that only suitable staff were employed to care for people in the home.
People told us that they felt safe and we saw that there were systems and processes in place to protect them from harm. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to their management team. Staff were aware of the importance of disclosing concerns about poor practice or abuse and were informed about the organisations whistleblowing policy
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made and how to submit one and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.
Staff understood how the Mental Capacity Act (MCA) 2005 was applied. Mental capacity assessments had been undertaken which were decision specific. Where people were deemed to lack capacity, appropriate consultation had been undertaken with relevant people such as GP’s and relatives to ensure that decisions were being made in the person’s best interests.
People told us that their staff members provided them with the support they needed. Staff told us that the registered manager supported them to develop their skills and knowledge by providing a programme of training which helped them to carry out their roles and responsibilities effectively. Staff received regular supervision which considered their development and training needs.
Staff worked effectively with healthcare professionals, for example, links had been developed with the continence service to help ensure that staff were following best practice guidance. People were supported to see healthcare professionals such as GP’s, chiropodists, community nurses and opticians.
People were positive about their care and the support they received from staff. Interactions between staff and people which were kind and respectful. Staff were aware of how they should respect people’s dignity and privacy when providing care.
Staff were aware of what people needed help with and what they were able to do for themselves. They supported and encouraged people to remain as independent as possible.
People’s preferences, likes and dislikes had been recorded and we saw that support was provided in accordance with people’s wishes. People were involved, where able, in decisions about their care which helped them to retain choice and control over how their care and support was delivered.
People knew how to make a complaint and information about the complaints procedure was included in the service user guide, including how to raise concerns with the Care Quality Commission. People were confident that any complaints would be taken seriously and action taken by the registered manager.
There was a programme of activities in place which people seemed to enjoy, although some health and social care professionals told us that they felt the activities offered could be more diverse.
The registered manager who actively sought feedback from people and staff in order that improvements could be made to the home. The registered manager told us that the provider visited the home frequently and was supportive of the management team which included provided the resources needed to effectively meet people’s needs.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.
We observed the care and support given to people in the communal areas of the home. We saw that staff were friendly and caring, aware of people's needs and preferences, and responsive to them.
We spoke with four members of staff and the manager, and reviewed records related to people's care and the management of the service. We found people's care needs were assessed and their care plans reflected their needs. Care and support were delivered according to their plans, which were reviewed regularly. If people were not able to consent to their care, arrangements were made to ensure decisions were made in their best interests. There were enough skilled and experienced staff to meet people's needs. People were cared for in suitable premises that were decorated and adapted to meet their needs. However, we could not find evidence that recommended electrical maintenance had been carried out to ensure people's safety.
They told us that most of the staff spoke to them in a "nice way" and felt they were treated with respect. People we spoke with informed us they had choices on how they spent their time and could take part in activities if they wanted. One person told us that they preferred to stay in their own room where it was quiet. They told us that they were very pleased with the care and support they received.
People living in the home told us that if they had any concerns or complaints they would raise these with a member of staff or the manager. People said they were confident any complaints they made would be taken seriously and investigated. Two people we spoke with had raised concerns with the manager and felt they were being dealt with appropriately.
They also told us they were involved in decisions about their needs and were able to express their views and talk about the care and support they needed, were treated as an individual and their privacy and dignity was respected at all times.
None of the residents spoken with expressed any dissatisfaction regarding any outcome area.