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Archived: Firlawn Nursing Home

Overall: Requires improvement read more about inspection ratings

The Street, Holt, Trowbridge, Wiltshire, BA14 6QH (01225) 783333

Provided and run by:
Firlawn Nursing Home Limited

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Background to this inspection

Updated 22 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 4, 5 and 6 December 2018 and was unannounced. On day one the inspection was carried out by two inspectors, a pharmacy inspector, an assistant inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. On day two the inspection was carried out by two inspectors and an expert by experience. On day three the inspection was carried out by one inspector.

Before our inspection we reviewed the information we held about the service including the providers action plans and previous reports. We also looked at notifications which had been submitted. A notification is information about important events which the provider is required to tell us by law.

We used different methods to help us understand the experiences of people who used the service. This included talking to 10 people, six relatives and their experience and views of the service. During the inspection we also observed the interactions between people living at the service and staff.

We spoke to the registered manager, the head of nursing care, the head of care, 11 members of staff and the provider. We looked at four recruitment files, 10 care and support plans, medicines administration records, risk assessments and other records relating to the management of this service.

Following our site visit we contacted five healthcare professionals for their feedback about the service.

Overall inspection

Requires improvement

Updated 22 January 2019

This inspection was unannounced and took place on 4, 5 and 6 December 2018. At our last inspection in May 2018 Firlawn Nursing Home was rated as ‘Inadequate’ due to concerns about the safety and well-being of people who lived there. We found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Due to these concerns the service was placed in ‘Special measures’ by CQC. Services that are placed in ‘Special measures’ are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the service. We also asked them to provide us with a monthly action plan to keep us updated with the action they were taking. At this inspection we found improvements had been made. This service is no longer in ‘Special measures’, however, the rating reflects that further improvement is required in some areas. In addition the ratings for each key question reflect that it will take time to see the improvements embedded in practice and the areas of improvement sustained.

Firlawn Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Accommodation is provided in two separate buildings (The House and The Manor). The Manor specialised in providing care to people living with dementia. Both buildings shared a large secure garden. At the time of our inspection 20 people lived in The House and five people lived in The Manor.

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.

People received their medicines as prescribed and records were kept of medicines administered. However, we found medicines were not always stored safely. Improvement was required to how the service stored medicines when they were checked into the service. In addition, staff did not always record their actions when the fridge temperature was outside of the recommended range.

Activities were planned and people were encouraged to attend activities they might enjoy. Improvement was required to make sure people living with dementia had opportunity to engage in suitable activities for their needs. People could have visitors without restriction.

People had their own care plan which was personalised. Improvement had been made to how staff recorded daily information. Improvement was required to make sure people had the opportunity to see their care plan and be involved in care planning.

People were being supported by staff who were trained. New staff received an induction and could shadow more experienced members of staff. Further training was required however, this had been identified and a training plan was in place.

Staff had been recruited safely as the provider had completed all necessary recruitment checks. Staff could identify the different types of abuse and knew how to report any concerns. Feedback about staffing levels was mixed. People told us they thought there were enough staff deployed, however some people told us they had to wait for support.

Accidents and incidents were recorded and analysed. A new form had been developed which encouraged investigations to take place following any accident or incident. Any lessons learned were shared at heads of department meetings which took place daily.

Where appropriate, referrals to healthcare professionals had been made. Records demonstrated that people could access healthcare advice and support when needed.

Improvements had been made to make sure people received sufficient food and drink. Where people required additional monitoring of food and fluid this had been completed thoroughly.

People were being cared for by staff who were kind and caring. We observed positive social interactions which demonstrated staff knew people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The environment was clean and cleaning schedules were being followed to maintain cleanliness. Maintenance was carried out and records kept of action taken. Equipment and premises were serviced regularly by external contractors.

Complaints were recorded and responded to within the provider’s timescales. Quality monitoring systems had improved. Since the last inspection the provider had made a decision to appoint a care management service to oversee the management of this service.