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Inspection carried out on 12 August 2019

During a routine inspection

About the service

Firstlings provides accommodation and personal care for up to 32 older people, some of whom may be living with dementia. At the time of our inspection, 29 people were living at the service. The building had been adapted and was set on three floors with a large accessible garden.

People’s experience of using this service:

People received an outstanding service from Firstlings which was exceptionally person centred, individual and focussed on the outcomes for people. People were fully involved in their assessment of need and in their planning, delivery and end of life care. The service was enthusiastic and skilled in the way it responded to people’s needs, wishes and preferences.

Staff were wonderfully caring, kind and compassionate. They created a homely and warm environment where people could be themselves. People’s independence was actively promoted and encouraged and staff went the extra mile to ensure people had autonomy, self worth, dignity and respect.

Staff had an excellent understanding of people's needs and were imaginative in the way they provided person centred care which placed people at the heart of the service. They continued to find creative ways of supporting people to have an exceptional quality of life. People’s well-being and social life was enriched by a range of group and individualised opportunities and activities, within the home and the local community.

Everyone was immensely positive about the way the service was led and managed. The registered manager was an outstanding visible role model, led by example and maintained high values and standards. Staff were aware of their roles and responsibilities and all, regardless of their role, worked as a strong team. There were a variety of checks in place to monitor the quality of the service and drive improvements.

People and their relatives felt safe. Staff knew how to recognise abuse and to report any concerns. Risk assessments were in place to manage potential risks within people's lives, whilst also promoting their independence. People’s medicines were managed safely. Incidents and accidents were investigated, and actions taken to prevent recurrence. Effective infection control processes were in place.

There were enough staff available to ensure people's security, safety and wellbeing. Recruitment processes were robust to ensure prospective new staff had the right skills and were suitable to work with people living in a care setting. Staff received an induction, on-going training, supervision and observations of their practice to ensure they continued to have the skills and knowledge to be competent in their role, and support people safely and effectively.

People were supported to have enough to eat and drink and people enjoyed the meals provided. The service worked well with other health care professionals and referrals were made in a timely way to ensure people’s health needs were met.

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 supports this practice. Where people had been deprived of their liberty, appropriate referrals had been made to the local authority.

People and relatives were encouraged to be involved in the running of the service. People knew how to raise a complaint and felt confident any issues would be addressed. Where there had been incidents or complaints, these had been responded to appropriately and the provider had systems to monitor and learn from these.

Rating at last inspection: Good (report published 28 December 2016)

Why we inspected: This was a planned inspection, based on the rating at the last inspection.

Follow up: We will continue to monitor the service and will return to carry out an inspection in line with our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on t

Inspection carried out on 11 October 2016

During a routine inspection

This inspection took place on 11 October 2016. Firstlings is a residential care home that provides accommodation and personal care for up 32 people, some of whom may have needs associated with dementia.

A registered manager was in post at the service but unavailable on the day of the inspection. We were accommodated by the deputy manager. 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.

There were sufficient staff who had been recruited safely and who had the skills and knowledge to provide care and support in ways that people preferred.

Staff had received training in keeping people safe and they knew how to raise any concerns if they suspected someone was at risk of abuse or harm. Staff understood the risks people could face day to day and how to to ensure their safety.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider had followed the MCA code of practice in relation to DoLS.

People knew how to complain and felt confident their concerns would be listened to and people's complaints were valued and used to improve the service.

People's medicines were managed safely and staff received training and support in order to maintain their knowledge and skills in delivering quality care.

People had a nutritious and balanced diet and enjoyed the meal time experience.

There were systems to monitor and improve the quality of the service. Checks were carried out to ensure care was delivered safely and effectively.

Inspection carried out on 31 October 2014

During a routine inspection

We inspected on 31 October 2014 and this was unannounced. Firstlings provides accommodation and personal care for up to 32 older people who require 24 hour support and care. Some people are living with dementia. There were 31 people living in the service at the time of this inspection.

A registered manager was 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 who used the service and their relatives told us that the service was a safe place to live. There were procedures in place which advised staff about how to safeguard the people who used the service from abuse. Staff understood the various types of abuse and knew who to report any concerns to.

There were procedures and processes in place to guide staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments relating to people’s health and welfare. As a consequence risks to people were minimised.

There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

There were sufficient numbers of staff who were trained and supported to meet the needs of the people who used the service. People and their relatives told us that the staff were available when they needed them.

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner.

People, or their representatives, were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions. The service was up to date with recent changes to the law regarding the Deprivation of Liberty Safeguards and at the time of the inspection they were working with the local authority to make sure people’s legal rights were protected.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People spoke highly about the quality of the food and the choices available. Their nutritional needs were being assessed and met. Where concerns were identified about a person’s food intake, or ability to swallow, appropriate referrals had been made for specialist advice and support.

People were comfortable to raise any concerns with the staff, manager or provider. People confirmed that where they had made comments about the service they had been kept informed of the changes made and their concerns were acted upon promptly.

People, their relatives and staff were complimentary about the management of the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service identified shortfalls in the service provision and took actions to address them.

Inspection carried out on 6 November 2013

During a routine inspection

We spoke with several people who lived and worked at the home. One person said, "I have no complaints; this is a very nice home." Another person told us how they had chosen to come to Firstlings themselves because, "It was nicer than all of the other homes I looked at." One staff member commented that starting work at Firstlings was, "Like joining a nice family."

The accommodation was appropriately designed and suitable to meet the needs of the people living there and risks within the home had been assessed. The home was clean and was personalised to the people who lived there.

We saw that support plans and risk assessments were informative and up to date. Staff were aware of their contents, which supported them to deliver appropriate and safe care. The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. Staff recruitment and induction systems were robust.

Inspection carried out on 1 November 2012

During a routine inspection

People who lived at Firstlings had a range of complex needs including those associated with dementia. People who were able to speak with us told us that they were well looked after and were given choices about food and daily activities. One person said “We have a great time here; the staff really go out of their way to entertain us.”

A number of people were not able to tell us directly about their experiences. However, we observed that they were relaxed and they interacted positively in different ways with the staff. We saw that staff assisted people to eat in a sensitive and gentle way.

Firstlings had all the necessary policies and procedures in place. We saw that records and quality assurance monitoring systems were working well for the protection of people who used the service. People and their families were involved in people’s care arrangements and were consulted appropriately. Staff were trained and supported and carried out their caring responsibilities well.

One relative said “We looked at other homes and this was the best. It was important that [my relative] had all the care that they deserved. We wanted most of all to maintain their dignity. They get that here.”

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