Archived: The Firs Care Home with Nursing

The Firs Care Home with Nursing provides accommodation, nursing and personal care for up to 42 people, including people who lived with dementia. There is an extra care unit within the location providing specialist dementia care for up to 12 people. At the time of our inspection, 33 people lived at the home.

The service had a new manager. They had not yet applied to be a registered manager with the Care Quality Commission. The provider assured us that the manager intended to register. 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.

People felt safe, and were supported by staff who understood how to keep them safe from the risk of abuse or preventable harm. Care and activities were risk assessed and people were supported to take part in activities whilst remaining safe.

People received care and support from a trained and motivated group of staff. There were enough staff to meet people’s needs, and staff supported people when they needed it. The provider ensured they recruited staff who were suitable to work in a caring environment, and provided new and existing staff with training to ensure they had the right skills and knowledge to meet people’s needs.

People received their medicines as prescribed. Staff were trained to manage medicines in a safe way and in accordance with professional guidance.

Staff obtained consent from people before providing support. Where they were not able to do this, staff understood the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards.

People were supported to maintain a balanced diet by staff who understood people’s individual needs and preferences.

People were supported by staff who demonstrated kindness and a positive caring attitude. We saw staff consistently support people in a patient and respectful way, and people’s dignity was promoted at all times.

People were supported to maintain relationships that were important to them, and relatives were welcomed to visit and participate in life at the home. People were supported to remain active and to take part in activities and hobbies they enjoyed both in the home and their local community.

People were involved in making decisions about their care as much as possible, and staff understood people’s specialist needs, particularly in the area of dementia care.

The provider had a clear complaints policy, and people and relatives felt able to make a complaint or raise concerns. The provider investigated complaints according to their policy, and created opportunities for people to provide regular feedback about the service, which was acted on.

There were systems to monitor and review all aspects of the service, and these were undertaken regularly. This meant the provider was able to identify areas of good practice and areas for improvement, and to make changes to improve the quality of the service.

The provider had appropriate recruitment procedures in place and we saw that relevant checks were being carried when staff were employed.

We saw that the provider had adequate arrangements in place for the obtaining of medicines, as well as appropriate arrangements for the recording of medicines given. We saw that people were receiving their medicines when they needed them and that appropriate 'as required' protocols were in place.

We found that some people received their medicines on time. However, we found that appropriate protocols were not in place for 'as required' medication, some medicine that people were prescribed was out of stock and the temperature of the room storing medication was too high.

We also found that some care plans did not contain sufficient information about people's needs or how the needs were to be met to ensure people were receiving safe and appropriate care.

People who used the service provided positive comments about the home. We observed staff interactions with people who use the service and this interaction was positive and provided appropriate assistance. Staff had a good knowledge of people and their particualr needs.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. The provider did not have protocols in place for 'as required' medication, which they said they had implemented after our inspection of 11 September 2012. People were not always receiving their medication when required.

We found that although the provider did carry out some checks on staff they emplyed, such as criminal record checks, they were not carrying out the full checks required by the regulations.

We saw that the provider had systems in place to obtain feedback from people who use the service, their relatives and staff about how the service is run.

The people we spoke with said that staff respected their personal preferences and felt that their needs were met at The Firs. They felt that a range of suitable activities were offered, with one person describing them as, 'stimulating.' The relative we spoke with told us, 'I'm very happy with [my parent's] care and [my parent] is very happy here.'

Most of the people we spoke with said they felt there were normally sufficient staff on duty to meet their needs. They all felt that they were cared for properly, by staff, during the day and night and thought that staff were competent at their job. One person said staff were, 'very efficient'they look after me tremendously.'

Some of the people we spoke with knew how to access personal records. The relative we spoke with said, 'I know I can ask to look at [my parent's] care plan'. They all thought that these personal records were kept safe and confidential.

Comments from staff, and our observations, generally supported people's views and experiences. However, although people felt safe and confident with staff administering their medicines we found evidence of poor medicine recording practices and these are detailed in this report.