Archived: Firbank Residential Care Home

Firbank Residential Care Home is a care home registered to provide accommodation and personal care for up to 26 people in one adapted building. At the time of the inspection 17 people were living at the home.

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

Although people told us they felt safe, we found that people did not receive a service that ensured they were safe. Not all people living at Firbank Residential Care Home had appropriate care plans and risk assessments in place, in order to guide staff how to meet their needs and keep them safe.

People were not cared for in a safe environment and we found a number of safety concerns in relation to the environment throughout the inspection. Including, but not limited to, a lack of effective window restrictors, fire safety concerns; including unsafe escape routes and cluttered communal areas.

Risks associated with infection prevention and control were found at the inspection, including, but not limited to; areas of the home which could not be effectively cleaned due to wear and tear, lack of cleaning systems and staff not always wearing personal protective equipment in line with government requirements.

There were sufficient numbers of staff available to meet people’s needs in a timely way. However, the recruitment of staff did not always ensure people were protected against the risks of unsuitable staff being employed. People were supported to take their medicines safely.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Robust systems were not in place to help ensure staff had received adequate training in a timely way to equip them to do their roles, safely and effectively. This had resulted in a system being implemented by the management team and a new training provider being introduced to the service. However, at the time of the inspection we could not be assured that all staff had received essential training.

Although peoples care records did not always contain detailed and clear information for staff on how to best support people with their health conditions, most staff demonstrated they understood people’s needs and how these should be managed. People were supported to access healthcare services when needed. People were supported to eat a varied and nutritious diet.

Feedback from people, relatives and staff was positive about the management of the service and the level of care received. We did observe interactions by staff that were caring, and kind and people were treated with dignity and respect. People were confident that if they had any concerns, these would be dealt with effectively by the management team.

Quality and safety monitoring systems were not adequate, and we found there was a lack of governance processes and systems in place to help ensure the safe running of the service. Without these systems, the provider and manager could not be proactive in identifying issues and concerns in a timely way and acting on these.

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 8 January 2018).

Why we inspected

The inspection was prompted in part due to concerns received about unsafe medicines management, infection control, staffing, training, recruitment practices, fire safety and poor management and leadership. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements.

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 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 the safe care and treatment for people, consent, recruitment, training, deprivation of liberties, premises and equipment and good governance at this inspection.

Following this inspection we served a Notice of Proposal to cancel the providers registration. The provider had 28 days to appeal this proposal. No appeal was received. Therefore the providers registration was cancelled.

The home was based on three floors, connected by a passenger lift and stairwells. Two bedrooms had en-suite facilities and there were toilets and bathrooms available on each floor. There was a choice of communal spaces comprising of two communal lounges and one dining room where people were able to socialise.

The inspection was conducted on 13 and 17 November 2017 and was unannounced. There was a registered manager in place. 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.

At our last inspection, on 18 and 22 August 2016, we identified breaches of Regulations 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to maintain a clean, hygienic environment; had failed to manage individual risks to people effectively; had failed to protect people from the risk of being deprived of their liberty without lawful authority; and had failed to operate effective quality assurance systems.

The provider wrote to us, detailing the action they would take to address the concerns. At this inspection, we found action had been taken to address all areas of concern and there were no longer any breaches of the regulations.

People felt safe living at the home. Staff knew how to identify, prevent and report abuse. They assessed and managed risks to people and risks posed by the environment effectively.

Arrangements were in place for the safe management of medicines. People received their medicines as prescribed. The home was clean and hygienic and staff followed best practice guidance to control the risk and spread of infection.

There were enough staff to meet people’s needs in a timely way. Appropriate recruitment procedures were in place and pre-employment checks were completed before staff started working with people.

People’s needs were met by staff who were competent, trained and supported in their role. Staff acted in the best interests of people and followed legislation designed to protect people’s rights and freedom.

People’s dietary needs were met and they received appropriate support to eat and drink enough. Adaptations had been made to the home to make it supportive of people living with dementia.

People were supported to access healthcare services when needed. Staff made information available to other healthcare providers to help ensure continuity of care.

People were cared for with kindness and compassion. Staff knew people well and supported people to maintain relationships that were important to them.

Staff protected people’s privacy and dignity. They encouraged people to remain as independent as possible and involved them in planning the care and support they received.

People’s needs were met in a personalised way. Each person had a care plan that was centred on their needs and reviewed regularly. Staff empowered people to make choices and responded promptly when people’s needs changed.

People had access to a meaningful activities based on their individual interests, including regular access to the community. They knew how to make a complaint and a complaints procedure was in place.

Staff took account of people’s end of life wishes and preferences. They supported people to remain comfortable and pain free.

People and their relatives felt the service was run well. Staff were organised, motivated and worked well as a team. They enjoyed working at the home and told us they felt valued.

People described an open culture where they were consulted and visitors were welcomed at any time. There were effective quality assurance systems in place to help ensure the safety and quality of the service.

The home was based on three floors, connected by a passenger lift and stairwells. Not all bedrooms had en-suite facilities but there were toilets and bathrooms available on each floor. People had level access to the front garden, but did not have full access to the rear garden due to uneven ground. There was a choice of communal spaces comprising of two communal lounges and one dining room where people were able to socialise.

There was a registered manager at the home. A registered manager is a person who had 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.

Some of the environmental risks had not been assessed by the provider, including visitor access and internal stairs placing the people at risk. Other environmental risks had been identified in an audit completed by the home, however not all risks highlighted had been addressed or rectified.

This included floor covering in bathrooms and toilets and some beds and furniture being in a poor state of repair, resulting in them being difficult to clean effectively and therefore an infection control risk. Individual risks to people, such as the risk of falling or developing pressure sores were not always managed effectively and care plans in place to support staff to manage risks were not always followed. Environmental risks and risks to people were raised with the registered manager at the time of the inspection who agreed that appropriate action would be taken to reduce these risks.

People’s privacy was not always repected by all the staff. Staff were seen entering people’s rooms without knocking or requesting admission and staff were heard talking about the people where they could be over heard.

Staff sought verbal consent before providing care and treatment, however the service did not always follow the principles of the Mental Capacity Act, 2005 (MCA). Where people lacked the capacity to make specific decisions, staff had made decisions on their behalf. Assessments of people’s capacity to make these decisions did not follow the standard two-stage test and family members had not always been consulted. Therefore, the provider was unable to confirm that the decisions had been made in the best interests of people. We have recommended that the provider seek advice and guidance on adopting the latest best practice in respect of recording assessments and decisions under the Mental Capacity Act.

People were having their liberty restricted without appropriate authorisation and applications to restrict people’s movements, where appropriate had not been made. Deprivation of Liberty Safeguards (DoLS) provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely. The service had not gained legal authorisation to deprive people of their liberty, yet the service was restricting people’s movements.

Meaningful activities were not organised to promote people’s welfare. A staff member had been assigned to arrange activities, but the registered manager acknowledged they had not been given sufficient time to do this. They had managed to speak with people about activities they would wish to take part in and these were recorded, but no action had been taken to arrange them. We have recommended that the provider seek advice and guidance on adopting the latest best practice in respect of providing meaningful activities for older people and those living with a cognitive impairment.

People’s needs were met by staff who were suitably trained. The registered manager had a system to record the training that staff had completed and to identify when training needed to be repeated. People were happy with the personal and health care provided and confident in the staff’s abilities.

People and their relatives were complimentary about the quality of the food and the people received a choice of suitably nutritious meals.

Staff demonstrated a good awareness of the individual support needs of people living at the home. They knew how each person preferred to receive care and support. Care plans provided comprehensive information about the people to support staff to provide personalised care in a consistent way.

People were treated with kindness and compassion in their day-to-day care and all of the people we spoke to were very positive in their comments about the caring attitude of the staff. Staff recognised when people became confused or anxious and responded to this with support and reassurance.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident that these would be resolved. Visitors were welcomed and there were good working relationships with external professionals. People were supported to access health care services when needed. Records showed people were seen regularly by doctors, specialist nurses, community nurses and chiropodists. Healthcare support and advise was requested in a timely manner and when appropriate.

There was a clear management structure in place and the people we spoke with enjoyed living at Firbank and told us it was well-led. The staff described the management as ‘supportive’ and ‘approachable’. There was an open and transparent culture at the home.

The registered manager was responsive to concerns we identified during the inspection and made arrangements for these issues to be addressed promptly.

We identified breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have taken at the back of the full version of this report.

During our visit we spoke with five people who used the service and four members of staff including the registered manager. We also spoke with two relatives who visit the home regularly. Due to the nature of people's dementia we were able to obtain limited feedback. We observed how staff interacted and supported people. We saw staff treating people in a sensitive, respectful and professional manner.

All the people we saw looked happy living at Firbank Residential Home. One person told us that they were 'very happy 'and that the food was alright. A relative told us that the 'staff couldn't do enough' and that they were 'very pleased' that their relative was in the home. Another relative told us that the staff were 'pleasant' and that they had no complaints.

We spent time observing care in communal areas. We found that people had positive experiences. We observed that staff were courteous and respectful of people's views. Choices were offered and where necessary informal consent was obtained. The staff knew what care and support people needed and they respected their wishes. The support that we saw being given to people matched what their care plan said they needed.

We found that people received an appropriate diet, medication was correctly managed and adequate staffing levels were provided. Care plans were relevant to people and all other necessary records were maintained and stored securely.