The Firs Care Home

Updated 7 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 was a comprehensive inspection which took place on 8 and 9 May 2018 and was unannounced. The inspection was carried out by one inspector and an expert by experience. Experts by experience are people who have had a personal experience of care, either because they use (or have used) services themselves or because they care (or have cared) for someone using services.

Before the inspection we reviewed information we held about the service. We reviewed the Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at previous inspection reports and reviewed notifications of incidents the provider had sent us since the last inspection. A notification is information about important events, which the service is required to send us by law.

We used a number of different methods to help us understand the experiences of people who use the service. We spoke with 14 people using the service and six visiting relatives about their views on the quality of the care and support being provided. During the two days of our inspection we observed the interactions between people using the service and staff. We used the Short Observational Framework for Inspection (SOFI). We used this to help us see what people's experiences were. The tool allowed us to spend time watching what was going on in the service and helped us to record whether people had positive experiences.

We looked at documents relating to people’s care and support and the management of the service. We reviewed a range of records which included reviewing care and support plans and daily records for eight people using the service. We looked at staff training records, staff duty rosters, staff personnel files, policies and procedures and quality monitoring documents.

We spoke with the registered manager, deputy manager five care staff and staff from the catering, maintenance and housekeeping departments. We also spoke with five visiting health professionals. One of the providers of the service was present during our feedback at the end of the inspection.

Updated 7 June 2018

The Firs Care Home provides accommodation and care for up to 32 older people, some of whom may be living with varying degrees and types of dementia. 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. The home is all at ground floor level with a communal lounge and dining room. At the time of our inspection 32 people were living in the home.

The last comprehensive inspection of this service took place on 2 and 8 February 2016. The service was rated good overall but care plans did not clearly inform staff of each person's needs, personal preferences and the support they required. This increased the risk of inappropriate or unsafe care. We issued a requirement notice to ensure the provider made improvements. After the inspection in February 2016, the provider sent us an action plan, detailing how the identified shortfalls were to be addressed. During a focused inspection on 13 February 2017, the provider had followed their action plan and improvements had been made. During this inspection we saw the improvements made had been sustained by the provider and that the service had improved to Good in the Responsive domain.

The service was exceptionally caring. The service worked to create a homely, comfortable environment where people were supported to develop strong relationships with each other and care staff. People were treated with kindness, compassion and empathy. Staff explained how they respected people’s privacy and dignity. The service celebrated people’s achievements. People were supported to remain as independent as they wanted to be.

People and their relative’s spoke extremely highly of the care and support received. They felt that the management team and staff often went ‘the extra mile’ for people. We observed, and people told us, that staff worked with them in a caring and person centred way. We observed people were comfortable in the presence of staff.

Staff spoke passionately about wanting to provide people with a high standard of care and support. Their comments included “I love working with the residents and want to give them the best care possible. We treat people as individuals and ask all the time about how they want their care to be” and “We see people as an individual, not their illness or diagnosis. You have to be passionate about this job and we all are, wanting to give everyone the best care.”

The service was very well-led. The registered manager was available on both days of our inspection with one of the providers attending on the second day. 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.

The registered manager was passionate about providing a high standard of care to people. People were supported by staff who shared the registered manager’s commitment to providing an excellent service. Staff, relatives and health professionals spoke highly about the management team and staff and the service being delivered to people.

There was an effective quality assurance system in place to ensure any improvements needed within the service were identified and the necessary action was taken to implement change.

People received a personalised service which was responsive to their individual needs. Care plans contained essential information on people’s preferences and life experiences to help ensure people received person centred care in their preferred way.

There were safe administration systems in place and people received their medicines when required. Medicines were stored securely and disposed of safely. People’s care records showed relevant health professionals were involved with people’s care. People’s changing needs were monitored to make sure their health needs were responded to promptly.

People were supported to eat and drink sufficient amounts. Staff were aware of people’s dietary requirements. Where required, people had access to specialist diets and guidance was in place to ensure staff met these needs accordingly.

People were protected from the risk of harm and abuse. Staff had received training in safeguarding adults from the risk of harm or abuse and were aware of their responsibility to report any concerns. Policies and procedures were in place to advise staff on what they should do if they had concerns. Risks were assessed and reviewed regularly and control measures were put in place to minimise the risks to people. There were effective pre-employment checks for the safe recruitment of staff, including criminal records checks and obtaining character references.

There were sufficient staff on duty to ensure people’s needs were met. We observed throughout the inspection that staff were unhurried and spent time engaging with people. People received care from staff who had the skills, knowledge and understanding needed to carry out their roles. New staff members received a comprehensive induction. Training records confirmed staff received training in a range of core subjects required by the provider.

Further information is in the detailed findings below.