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Inspection Summary


Overall summary & rating

Good

Updated 21 April 2018

The inspection visit took place on 27 February 2018 which was an unannounced comprehensive inspection. We returned announced on 7 March 2018 so we could review the provider’s quality assurance systems, talk with more staff and to see how the provider supported those people who smoked, to be kept safe.

The Firs is a mental health nursing home, which provides care for up to 25 people over two floors. At the time of our inspection there were 23 people living at The Firs.

People in care homes receive accommodation and nursing and/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.

A requirement of the service’s registration is that they have a registered 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 and the associated Regulations about how the service is run. At the time of our inspection visit there was a registered manager in post who had been registered at this location since July 2016.

At our last comprehensive inspection in September 2016, we rated the service Requires Improvement overall. We found a breach of the regulations because risks were not managed safely. We found further improvements were needed to ensure learning was taken to identify patterns and trends when accidents and accidents occurred. Staff did not always support people in line with the mental capacity act and the provider’s quality assurance systems needed to be improved.

We completed a focused, follow up inspection to look only at ‘Safe’ in July 2017, to check whether improvements had been made. We found sufficient improvements had been made so the service was no longer in breach, but further improvements were still needed to show how they analysed accidents and incidents. Medicines management had improved but further improvements were needed around medicine protocols, for 'as and when required' medicines. This was because there was no information for staff about when to administer this type of medicine.

At this inspection we found improvements had been made since our last inspection visit but further improvements were still required in their quality monitoring systems. Analysis of incidents and accidents had been undertaken although the system required more simplification so it provided a clear picture of what had happened. The registered manager was confident any accidents and incidents were brought to their attention and any action needed, was taken. Medicines protocols for ‘as and when’ medicines were in place and being followed. Staff supported and offered people choice, even if they lacked capacity but improvements were still needed in the recording of best interest decisions.

People were pleased and satisfied with the quality of care provided. People were encouraged to make their own decisions about how they lived their lives.

People received care and support in line with their expressed wishes and goals that promoted and improved people’s social skills. Staff encouraged people and supported them to remain as independent as possible so they did not de-skill people. People maintained important relationships with those closest to them and people were happy with living in a shared home.

For people assessed as being at risk, care records included information so staff knew how to minimise risks to those in their care. Staff knew how to support people to minimise identified risks to the person and others.

Care plans contained information for staff to help them to provide the individual care people required, but more detail was needed to support the provider’s vision of person centred care. Staff knowledge of people was comprehensive, but these details were not always included

Inspection areas

Safe

Good

Updated 21 April 2018

The service was safe.

At the last inspection this home was rated as ‘requires improvement’ in this area, because some aspects of medicines administration were not managed safely and risks to people were not always recorded. At this inspection, systems were much improved. Regular checks on medicines ensured potential errors were kept to a minimum, and that people received their medicines safely and as prescribed. People felt safe living at the home. They were supported by enough experienced staff who were available to provide their care and support at times people preferred. Staff understood their responsibilities to report any concerns about people's safety or if they believed people were at risk of abuse. The registered manager analysed incidents and accidents but needed to improve their systems.

Effective

Good

Updated 21 April 2018

The service was effective.

At the last inspection this home was rated as ‘requires improvement’ in this area, because staff did not support people in line with the Mental Capacity Act 2005. At this inspection improvements had been made. People were involved in making day to day decisions about their care and support needs. People received support from a staff team that were trained and had the knowledge to meet people’s needs. People were offered meals and drinks that met their dietary needs. Links with other healthcare professionals were in place to respond to people’s changing needs, limiting further interventions or hospital visits. The environment supported people to live their lives as they wanted and provided space for people to meet friends and family or spend time on their own.

Caring

Good

Updated 21 April 2018

The service remained caring.

Responsive

Good

Updated 21 April 2018

The service remained responsive.

Well-led

Requires improvement

Updated 21 April 2018

The service was not always well led.

At the last inspection this home was rated as ‘requires improvement’ in this area, because the provider and registered manager's management systems were not effective. Actions identified as requiring improvement at our last inspection visit continued to require further improvements. There were a number of continued shortfalls in relation to the quality assurance systems and processes. Staff found the registered manager supportive, approachable and responsible in solving problems and responding to concerns.