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The Firs Residential Home Inadequate

The provider of this service changed - see old profile

Reports


Inspection carried out on 29 August 2019

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

About the service

The Firs Residential Home is a care home. It is registered to provide accommodation and personal

care and accommodation for up to 38 older people. The service supports people living with dementia, a mental illness, and/or a physical disability. Nursing services are provided by the community nursing team. At the time of the inspection there were 28 people living at the service.

The service is on two floors, with access to the upper floor via stairs or a shaft lift. All bedrooms have ensuite facilities. There is an outside shared patio area.

At the time of our inspection the local authority adult safeguarding team were investigating allegations of poor care, and the service was being supported by the local authority quality and improvement team. Because of the concerns identified the provider decided to voluntarily suspend all new placements to the service until improvements were made.

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

The providers overall governance framework to help identify where improvements were required had been ineffective. The systemic failings found at this inspection demonstrated the provider had failed to ensure people received a well-managed service which was safe and compassionate; placing people at risk of potential and continued harm.

Since our last inspection, the ratings for all key questions had deteriorated.

People told us they felt safe living at the service. However, not all practices were safe enough. People were supported by staff who had been recruited safely. However, people expressed there was not always enough staff to meet their needs. The manager was actively recruiting for new staff, but in the meantime was using temporary agency staff to cover staffing vacancies. We found the reduction of permanent staff was impacting on the service, as the high use of agency staff meant new systems and processes were not always communicated or embedded.

Risks associated with people’s care were not always documented and/or known by staff. This meant there was a risk people received unsafe or inconsistent care. People’s medicines were managed safely.

People lived in a clean environment and were protected from the spread of infection. The environment had been assessed for safety.

Some people were supported with some aspects of choice and control in their lives. Overall, staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were unsatisfied with the quality of meals provided and did not receive a positive dining experience. Overall, people had their health care met in a personalised way but told us, they did not feel fully involved in their care and support. Records were not always in place to describe to staff how people wanted their health and social care needs to be met.

People and relatives told us staff were kind and caring and overall, people’s privacy and dignity was promoted.

Social opportunities existed, however during our inspection people sat all day in the lounge, without any stimulation, with two people walking up and down the corridors. In addition, it was not detailed in people’s care plans or from our observations, how social care was being individually planned.

Overall people and staff told us the service was well managed. The culture of the service was developing as the new manager continued to make required changes; some of which were causing discontentment within the staff team. There were ineffective monitoring checks in place, however a new system was being developed and implemented.

People did not always have confidence in the complaints process and were not involved in the ongoing development of the service.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We recommended the provider refers to the Commissions ‘smiling matters, oral health care in care homes’ to

Inspection carried out on 28 June 2017

During a routine inspection

This was The Firs Residential Homes first inspection since registering with the Care Quality Commission.

The inspection took place on the 28 June 2017 and was unannounced. The Firs Residential Home provides care and accommodation for up to 38 older people, some of whom are living with dementia. On the day of the inspection 35 people lived at the home.

The service had a registered manager in post. 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.

One person said when asked; “Safe- of course. Why wouldn’t I be?” A relative said; “Yes she is safe.” Professionals spoken with all felt people were safe living in the service.

People were engaged in different activities and enjoyed the company of the staff. There was a calm and relaxed atmosphere within the service. People said they were happy living at the service.

People were satisfied with the care the staff provided. They agreed staff had the right skills and knowledge to meet their needs. People were encouraged and supported to make decisions and choices whenever possible in their day to day lives.

People were protected from harm as staff had completed ‘safeguarding of vulnerable adults’ training. Staff understood how to report any concerns and what action they would take to protect people.

People who did not have capacity to make decisions for themselves were supported by staff to make sure their legal rights were protected. Staff worked with other professionals in people’s best interests. The registered manager worked in the service most days and had taken action where they thought people’s freedom was being restricted. Applications were made and advice sought to help safeguard people and their human rights.

People were protected by safe recruitment procedures. Staff were supported with an induction and ongoing training programme to develop their skills, and staff competency was assessed. People, staff and relatives said there were sufficient staff on duty.

People had their privacy and dignity maintained. Staff were observed supporting people with patience and kindness.

People had visits from healthcare professionals. For example, speech and language therapists, to ensure they received appropriate care and treatment to meet their healthcare needs. Professionals confirmed staff followed the guidance they provided. People received the care they needed to remain safe and well. For example, people had regular visits by district nurses to attend to dressings. People’s end of life wishes were documented and respected.

People’s medicines were managed safely. Medicines were stored, and disposed of safely. Senior staff administered medicines. They confirmed they had received training and understood the importance of the safe administration and management of medicines.

People were supported to maintain a healthy balanced diet. People told us they enjoyed their meals and there was plenty of food available. We observed people, who required it, being supported at mealtimes. One person said; “The food is exceptional!”

People’s risks were considered, well-managed and regularly reviewed to help keep people safe and well. Whenever possible, people had choice and control over their lives and were supported to engage in activities. Records were updated to reflect people’s changing needs. People and their families were involved in the planning of their care. People’s care records were of a good standard, were detailed and recorded people’s preferences.

People said the registered manager was very approachable and made themselves available to them. Visiting professionals and staff confirmed the registered manager made themselves available and were very good at supporting them.