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Inspection carried out on 16 October 2017

During a routine inspection

The Firs is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection. The Firs 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 19 people living at the home. The home provides long term care and respite 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 tasks such as feeding 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.

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.

Inspection carried out on 16 August 2016

During a routine inspection

This inspection took place on the 16 and 17 August 2016.

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.

Inspection carried out on 25 August 2015

During an inspection to make sure that the improvements required had been made

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.

Inspection carried out on 12 May 2015

During an inspection to make sure that the improvements required had been made

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.

Inspection carried out on 3 & 6 October 2014

During a routine inspection

The Firs is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection. The Firs 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 19 people living at the home. The home provides long term care and respite 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 tasks such as feeding 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.

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.

During a check to make sure that the improvements required had been made

When we inspected the service on 16 August 2013 we found that people using the service were exposed to the risks of unsafe electrical equipment and the failure of emergency and safety installations, because we did not see evidence routine maintenance was being carried out. After our visit the manager sent us evidence to show the necessary maintenance had been done and routine checks were being made on safety installations.

Inspection carried out on 16 August 2013

During a routine inspection

At the time of our visit there were 21 people using the service. We spoke with six of them, and one relative who was visiting their family member. They were all satisfied with the care and support provided. One described the service as “first rate” and another said it was “very good”. They told us they had agreed to their care plans and care was provided according to their needs. They said there were enough staff to provide support when it was needed.

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.

Inspection carried out on 21 August 2012

During a routine inspection

We spoke with three people who told us that they liked living at the home. They said it was a nice place to live and they could have their own privacy if they wanted. One person told us that they shared a room with someone else but that was okay and they were hoping to have a single room in the near future.

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.

Inspection carried out on 21 December 2010 and 11 March 2011

During a routine inspection

People who use the service told us they were happy with the quality of care they received, the home in general, their accommodation, the activities available, the staff and the standard of cleaning and hygiene in the home.

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.

Reports under our old system of regulation (including those from before CQC was created)