The Firs Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last inspection we rated this key question requires improvement. At this inspection the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. At our last inspection, we found a breach of legal regulation in relation to safe care and treatment. This was because fire doors had been propped open, and windows had been taken off their restrictors. At this inspection not enough action had been taken and the service remains in breach of legal regulation for safe care and treatment.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Since the last inspection, improvements had been made to incident management and staff were now completing incident forms following all incidents. The provider had produced a more detailed incident form which included information for staff to record all actions taken. There was a lessons learned section which reviewed actions taken and identified action to prevent recurrence. The management also completed a monthly managers report to review all incidents and identify themes and trends. The care manager told us there were opportunities for staff to discuss what incidents had occurred and to reflect on what had happened. If any changes to ways of working were identified staff shared these during handovers and meetings. One member of staff said, “We do discuss and think about what we could have done differently, did we escalate the situation with our actions.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. The new manager told us there were systems for when people went to hospital and were discharged. This included sharing key health information with medical professionals. If people were admitted to hospital for over 48 hours, staff re-assessed their needs when they were ready for discharge. This helped to make sure the service could safely meet people’s needs or source any additional equipment which may be required.

The provider did not always share concerns appropriately with all relevant professionals. The registered manager was aware of the local authority thresholds for safeguarding and how to report to the local authority. However, we found 3 safeguarding incidents which had not been notified to CQC. Staff had informed the local authority but not shared details of the incidents with CQC as required by law. The new manager was not aware of the requirement to submit notifications of alleged abuse to CQC. The provider told us a new regional manager was appointed to the service to support the new manager with their induction. Staff received training on safeguarding and recognised different types of abuse. Staff were aware of the need to report any safeguarding concern to their management.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. At our last inspection there was shortfalls in how the service managed bed rails. At this inspection improvement had been made and the risks of using bed rails was being monitored. At our last inspection we found people who experienced distress did not have enough guidance in place for staff to support them safely. At this inspection this area of care had improved, and behaviour risk plans had been reviewed. Guidance was available for staff and staff told us they were informed if any of the guidance was changed. Risks to people’s safety had been identified. The provider used a range of risk assessment tools to help identify people at risk of areas such as malnutrition, pressure damage and falls.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care. At our last inspection we found fire doors had been propped open with various objects which prevented them from closing in the event of a fire. We also found staff had taken windows off their restrictors which placed people at risk of harm. This was a breach of the legal regulation in relation to safe care and treatment. At this inspection, enough improvements had not been made which placed people at continued risk of harm. We found doors were still propped open and 1 window was off the restrictor and open wide. The provider told us the person living in the room had capacity and wanted their window open. We found the room was unlocked and unattended which meant there was a risk people could leave the building undetected. In addition, intruders could gain access to the building through this window. These risks had not been mitigated. One person told us they could not find the wooden door wedge which usually held their room door open. This meant a door wedge was being used regularly to prop open a fire door preventing it from closing in the event of a fire. We had seen this door wedge when we arrived at the service, but it had been removed once management had arrived. The registered manager told us they would review all the door guards and replace batteries where needed. Door guards hold room doors open safely as they close when fire alarms are sounded.

The provider did not always make sure there were enough qualified, skilled and experienced staff. After our last inspection the provider informed us, they had reviewed staffing numbers and increased night staff from 2 per night to 3. Prior to this inspection night staff numbers had been reviewed and decreased to 2 members of staff per night. The provider told us this was due to a decrease in people using the service. However, staff told us there were at least 7 people who required 2 members of staff to help them at night with personal care. This meant 2 night staff would be with people in their rooms with the door closed which left no staff supervising or supporting other people. People, staff and professionals told us there were enough staff during the day. We observed there were enough staff available to support people safely when all the day staff started work.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff had stocks of personal protective equipment to use and we observed staff using this appropriately. The service was clean and smelt fresh, and people told us they were satisfied with the cleaning taking place in their rooms. A member of staff was identified as the infection prevention and control lead. They were responsible for completing monthly audits and making sure the service was cleaned regularly.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. People had their medicines as prescribed. People’s feedback about medicines management was positive. People were happy with how staff managed medicines for them. We observed medicines being administered and saw staff followed safe practice. People had an individual medicines profile and medicines administration record (MAR). There were no gaps in recording on the MAR we reviewed. Where people had ‘as required’ medicines there was a protocol available for staff to know how to administer this type of medicine. Medicines were stored safely and reviewed regularly by the GP.