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Inspection carried out on 18 September 2019

During a routine inspection

About the service

Firth House is a residential care home providing personal care for up to 41 people and mainly supports people over the age of 65, some of whom are living with dementia. At the time of the inspection, the service supported 40 people.

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

Risk assessments were not consistently in place for areas of identified needs. Actions were taken during the inspection to address this. People told us they felt safe living at Firth House but gave mixed feedback about staffing levels. Staffing levels were increased, following the last inspection, and continued to be reviewed. People received their medicines as prescribed. Accidents and incidents were responded to appropriately. The service smelt clean and fresh throughout.

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; the policies and systems in the service supported this practice. The relevant people were involved when decisions had been made in people’s best interests. Staff understood the importance of seeking people’s consent.

Staff received training, supervisions and appraisals to support them in providing people with effective care. A variety of food, drinks and snacks were available according to people’s dietary needs and preferences. Staff supported people to maintain their health and well-being and people had access to healthcare professionals.

Staff spoke about people with respect and took measures to protect people’s privacy. People told us staff were kind and caring towards them. The staff treated people as individuals and were patient and attentive in their approach. People had access to independent support to aid them in their decision making when required.

Person-centred care plans were in place to guide staff about the support people required. Detailed information was available about people’s life histories and the activities they enjoyed. The management team arranged a variety of activities and recognised the importance of people having mental and physical stimulation. Complaints had been responded to appropriately and were recognised as a further learning opportunity. Information about people’s end of life wishes was sought.

We have made a recommendation about training and support for senior members of the care team to aid them in their leadership.

The registered manager was passionate about people receiving person-centred care and was actively involved in supporting people. The provider and management team completed regular checks of the safety and quality of the service. Any identified actions were completed. People had the opportunity to share their views about how the service could be improved.

For more details, please see the full report which is on the CQC website at

Rating at last inspection

The last rating for this service was requires improvement (published 26 September 2018). This rating has now improved to good.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 26 July 2018

During a routine inspection

This inspection took place on 26 July and 1 and 9 August 2018. The first day of this inspection was unannounced.

Firth House is a residential care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Firth House can accommodate up to 41 people who may be living with dementia or a physical disability. At the time of our inspection, 37 people lived at the service.

The home is over two floors and separated into four smaller units each with their own distinct name. Each unit has a dining area with a small kitchenette for the use of people who live at the service and staff. There is a large lounge for everybody to use which opens out into the secure garden. Each person has their own room with en-suite facilities.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Although the service was staffed in accordance with the provider’s dependency tool, there were insufficient staff to meet people’s needs in a timely manner due, in part, to the layout of the building. We discussed our concerns about staffing with the registered manager and provider who took immediate actions by increasing the staffing levels.

On the first day of our inspection, risk assessments were not consistently in place for areas of identified risk. These were completed by the second day of our inspection. When risk assessments were completed, they were thorough and provided clear instruction for staff to follow to safely support people and reduce the potential risks.

A series of health and safety checks of the environment were completed, however some essential checks, including of bed rails, had not been completed in the two weeks prior to our inspection.

The temperature of the medicines storage was too high due to an ineffective air conditioning unit. The registered manager arranged for a contractor to assess the unit. Overall, medicines were managed safely and people received their medicines as required. Staff received medicines training and their competency was assessed annually.

The registered manager and provider completed a series of checks to monitor the quality and safety of the service provided to people. There remained some outstanding actions from these audits at the time of our inspection and the checks had not highlighted some of the issues we found during our inspection. The registered manager and provider were responsive and immediately addressed the issues.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. Mental capacity assessments and best interest decisions were completed when required and involved people’s family members and professionals, when required. Staff sought people’s consent before providing care.

People told us the food was of good quality and a variety of options available. People’s weight and nutritional and fluid intake were monitored and the staff responded to any concerns.

People had access to healthcare professionals and staff sought their advice and input into people’s care.

Staff received supervision and appraisals and told us they were well supported in their role. New staff completed an induction and had a probation period to ensure they had the necessary skills and knowledge for their new role. Staff undertook training the provider considered to be mandatory and completed refresher training to ensure their knowledge and practice was up to date.

People told us the staff were kind, caring and promoted their dignity. We obse

Inspection carried out on 1 July 2016

During a routine inspection

This unannounced inspection took place on 1 and 4 July 2016. The service was last inspected on 16 September 2014 when the service was found to be compliant with the regulations inspected.

Firth House is owned by Anchor Trust and is registered to provide personal care and accommodation for up to 41 older people, some of whom may be living with dementia. The home is purpose built, set in its own gardens and there is parking available. The home is divided into four small living units, over two floors. Each unit has its own dining room, with a small kitchen area attached. One large lounge on the ground floor is provided. All bedrooms have en-suite facilities. At the time of our inspection there were 38 people using the service.

There was a registered manager in place. 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.

People said they trusted the staff and felt safe. Staff had received training on how to keep people safe from harm. Staff were employed following a robust recruitment and selection process, to ensure they were safe to work with vulnerable people and did not pose a risk to them.

Staff involved people in making choices about their lives and demonstrated a positive regard for the promotion of their personal dignity and privacy. Staffing levels were assessed according to the individual needs and dependencies of the people who used the service. People’s private records were securely held and information about them was maintained in a confidential manner.

The registered manager and staff followed the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and ensured people were not being deprived of their liberty in an unlawful way.

People told us the quality of their food was good and their nutritional status was monitored to ensure risks from malnourishment and dehydration were acted on with involvement of specialist health care professionals when required.

People told us they were happy with the way support was delivered to them by staff who were caring and kind. A good variety of social opportunities were provided for stimulation and interaction to enable people’s wellbeing to be promoted. People and their relatives were involved in the planning of their support, which was reviewed on a regular and on-going basis. A complaints policy was available to ensure people could raise any concerns about the service when required.

People told us the management were approachable and supportive and were encouraged to express their views and opinions to enable the service to continually improve. The registered manager was aware of their responsibilities and submitted notifications about incidents affecting the health and welfare of people to enable the service to be monitored. Auditing systems were in place to ensure the quality of the service could be effectively assessed. The registered provider promoted an open and transparent culture that supported staff through regular training, supervision, team meetings and annual appraisals to help them develop their careers.

Inspection carried out on 16 September 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary, please read the full report.

This is a summary of what we found.

Is the service safe?

People were treated with dignity and respect by the staff. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. Systems were in place to ensure that the manager and staff learnt from incidents such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act (MCA), 2005 and Deprivation of Liberty Safeguards, (DoLS). All staff had been trained to understand when an application should be made, and how to submit one. Documentation was available in people's care files to support this.

Staff had received up-to-date training in all mandatory areas, as well as those specific to their job role. Staff recruitment procedures were thorough and in accordance with the provider's policy. Staffing levels were determined based on the individual needs of each person living in the care home.

Policies and procedures were in place to make sure unsafe practices were identified and people were protected.

The home had policies and procedures in place for the safe handling and dispensing of medication. The medication error which had occurred since our last inspection was efficiently dealt with and procedures put in place to prevent a recurrence.

Is the service effective?

Staff had the skills and knowledge to meet people's needs. The manager gave effective support to staff including induction training, supervision and appraisal. This was supported by a comprehensive training programme. The care home worked well with other agencies and health care services to ensure a co-ordinated approach to people's care was achieved.

Is the service caring?

People living in the care home were supported by kind and attentive staff. They were cared for sensitively and given encouragement. People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

The complaints procedure was understood by staff, people living in the care home and their relatives. The manager was in the process of encouraging relatives to have greater involvement in the care offered to people who used the service.

Is the service well led?

There was a quality assurance process in place. Records showed that any adjustments needed were dealt with promptly. This enabled the quality of the service to continually improve. Staff told us they were clear about their role and responsibilities. The staff we spoke with felt they were strongly supported by the manager. Staff had received ongoing training in order that they may continue to provide effective care. The manager monitored the needs of the people who used the service and adjusted staffing levels accordingly. This meant that people were safe and their health and welfare needs were met by sufficient numbers of appropriate staff.

Inspection carried out on 24 February 2014

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

In September 2013 we carried out an inspection of this service. We judged, at that time, that improvements were needed to some areas of cleanliness in the home and how infection control was being managed. At this inspection, we found improvements had been made and the issues we identified had been addressed.

We did not speak directly to people about the cleanliness of the home on this occasion. However, we did observe people during our visit to the home and saw that some people were sitting in the main lounge chatting whilst they were knitting, whilst other people had chosen to spend time in their rooms. We observed that people looked well cared for.

Inspection carried out on 27 September 2013

During a routine inspection

We spoke with fourteen people who used the service and seven members of staff, including the manager. Everyone we spoke with told us they were satisfied with the care they received. We saw records that showed people were involved in developing their care plans and that relatives or their representatives had been involved, if the person was unable to give their consent. Before people received any care or treatment they were routinely asked for their consent.

We saw how staff supported people, through observing care practice. People were assisted at their own pace, and staff were able to demonstrate they had an in-depth knowledge of the people they were caring for.

We looked at how clean the home was. Although we noted the house was fresh-smelling and well maintained, we did find that deeper cleaning and some infection control procedures were not being followed. This was in some toilet areas and kitchenettes. We also found that the records for cleaning schedules and audits were not accurate or up to date.

There were effective recruitment and selection processes in place. People were supported by suitably qualified, skilled and experienced staff. Staff were described as �very kind and thoughtful.� People told us they were well looked after. People gave us the impression that their experiences at the service were positive and that they received a good standard of care.

There was an effective complaints system available.

Inspection carried out on 26 April 2012

During a routine inspection

We spoke with the relative of one person. They told us; "The care is very good here."

A good proportion of the people we met during our visit were able to tell us what they thought about the service. Two people said they were 'very happy' at Firth House. One person said "Staff know what I like and I can talk to them about my family and anything really." 10, out of the 15 people we spoke with said they were involved in their care, with their preferences being sought and taken into consideration. This included being enabled and supported to live their lives as independently as they wished. Two people said they were able to express their views freely and that they felt able to talk to any member of the staff team if they felt they needed clarification or something was worrying them. One person explained how staff were 'sensitive' when she was being helped to dress and undress and that staff 'never made her feel embarrassed.'

People told us that they were happy with the care and treatment they were receiving. One person said "I am mad about food, and have never gone hungry yet" and another person said, "It can't be like your own home but it is quite good." One person told us they sometimes had to wait to be attended to, because they could not dress or undress themselves. But they also made the point that they understood there were other people to attend to and that they never had to wait too long.

People said they 'felt looked after and safe' at Firth House. One person said "You feel safe and cared about" and eight other people told us they thought staff 'protected' them. People said they were clear about how and who to report any concerns about their safety to. People we spoke with knew staff by name.

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