27 February 2018
During a routine inspection
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 in people’s care plans.
All staff understood what actions they needed to take if they had any concerns for people's wellbeing or safety. Staff felt confident to raise concerns to the management and provider. People’s care and support was provided by a caring and consistent staff team and there were enough staff to provide care when people needed it.
Staff received essential and regular refresher training to meet people’s needs, and effectively used their skills, knowledge and experience to support people.
Staff worked within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge ensured people received consistent support so the right decisions and outcomes were made. Staff understood the importance of seeking people’s permission, before any care and support was provided. Best interest decisions did not always record how decisions had been reached.
People were supported and encouraged to be involved in leisure interests to keep them active and to have fulfilling lives. People and staff worked together to help promote their social and lifestyle skills.
Staff supported people to ensure they maintained a balance diet. People had choice of food and drink at mealtimes and throughout the day.
People received support from other healthcare professionals to ensure their overall mental health and physical wellbeing was maintained. Some people took responsibility for some of their own medicines such as inhalers, while staff supported them with their other medicines for their safety. Regular checks and monitoring ensured medicines continued to be given safely.
Examples of audits and checks were completed that assured the registered manager and the provider that people received a good service. Some improvements to audits and checks had been made by the registered manager but they continued to fall short in some areas, of what was required by the regulations. Training schedules were not completed, falls analysis required further improvement and records to support people’s best interest decisions needed to be completed. Policies in relation to people smoking had not been identified as being incomplete, even though they were reviewed in November 2017.
The registered manager told us they were committed to continually improve the service and wanted people’s experiences to remain positive. The actions and thoughts given to improving people’s experiences was noted when we returned for our second day.
Further information is in the detailed findings below.