• Care Home
  • Care home

The Firs Residential Care Home

Overall: Inadequate read more about inspection ratings

Tower Farm, Tower Road, Little Downham, Ely, CB6 2TD (01353) 699996

Provided and run by:
Barrels UK Care Ltd

Important: The provider of this service changed. See old profile
Important: We are carrying out a review of quality at The Firs Residential Care Home. We will publish a report when our review is complete. Find out more about our inspection reports.

Latest inspection summary

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Background to this inspection

Updated 14 December 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Firs Residential Care Home is a ‘care home.’ People in care homes receive accommodation and personal care as a single package under one contractual agreement dependent on their registration with us. The Firs Residential Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 28 September 2023 and ended on 24 October 2023. We visited the service on 28 September 2023 and 10 October 2023.

What we did before the inspection

The provider did not complete the required Provider Information Return (PIR). This is information providers are required to send us annually with key information about the service, what it does well and improvements they plan to make. We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.

During the inspection

During our site visits we used observations to help us understand the experience of people who could not talk to us. We spoke with 5 people who used the service and 4 of their representatives. We also received feedback from healthcare professional teams who had contact with the service and provided support to people.

We spoke with 7 members of staff. These included the interim manager and deputy manager, care staff, a team leader, catering staff and domestic staff. We spoke with the owner who was also the nominated individual. The nominated individual is the provider, and therefore responsible for supervising the management of the service. Furthermore, we also spoke to a representative of an external agency working with the service.

We reviewed a range of records during the inspection, this included recruitment documentation for 4 staff. We also reviewed care records and risk assessments for 4 people and viewed medicine records during the inspection. We asked the interim manager and deputy manager to send us other records which we reviewed away from the service. These records included care plans, risk assessments, quality monitoring documentation, staff rotas, complaints, compliments, accidents and incidents, and staff training records. Additionally, we requested other records relating to the management and oversight of the service.

Overall inspection

Inadequate

Updated 14 December 2023

About the service

The Firs Residential Care Home is a residential care home providing personal care up to a maximum of 29 people. The service provides support to older and younger adults, people living with dementia and people who have a physical disability. At the time of our inspection there were 21 people using the service in one adapted building. There is a shared lounge, a dining room, and a conservatory on the ground floor. Bedrooms are single occupancy and are on the ground and first floors.

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

The quality of the service provided, the external building and internal facilities and décor had significantly declined since the last inspection. The provider once again failed to have a robust oversight of the service, this included when repairs were required and when safety concerns were raised. The provider failed to appropriately respond to promote safety and improve care quickly enough.

Fire safety risks, cleanliness concerns and environmental health risks to people found during this inspection meant that the CQC made referrals to the fire safety service and environmental health.

The provider had failed to learn from the 4 previous CQC inspections of this service since they registered in September 2018. This demonstrated to us that the provider had little understanding of the Health and Social Care Act 2008 Regulations and what standards were required to achieve compliance and provide good accommodation and a good service to the people in their care.

Accidents and incidents records did not give enough information to establish any patterns and trends and what action was required to reduce the risk to people. The governance system and audits in place to monitor the quality of the service provided were not robust. Actions to make improvements including improvements to safety were not acted upon quickly enough to reduce the risk of harm to people. Improvements made during the time the provider had registered with the CQC, were not embedded, or sustained to keep people safe and well cared for.

The had been numerous manager changes at the service during 2023. As such, people and their relatives had mixed opinions about communication in the service, as they were not always updated as to who was in charge. Some people and their relatives felt their suggestions and concerns were acted upon and some told us they did not feel listened to.

There were not enough appropriately trained staff to meet peoples' complex needs. As such, staff although kind towards the people they supported, were working in a task led approach. Lessons were not learnt when things went wrong, and as such, people were not always protected from harm. Safety risks following incidents were not appropriately identified, reviewed, and acted upon by staff. Again, the provider oversight of this was not robust, safe, or effective.

Due to the changes in management, staff had not received regular supervision. People’s relatives also told us that relatives’ meetings, where they could receive updates about the service had also stopped taking place.

People’s meaningful social opportunities, engagement and activities were limited, and this put people at risk of social isolation. This meant people spent long periods of time without stimulation.

The new computerised care record system did not robustly show that people’s records, including their dependency needs were updated following health changes, changing needs and or following a significant incident. People’s care records used to guide staff held conflicting information in them. People, their relatives where appropriate were not supported and or encouraged to be involved in their, or their family members care decisions and reviews.

In the main people were given choices and this choice respected, however this did not happen all the time and we found there were missed opportunities. People enjoyed their meals and were supported to eat and drink. However, robust records of people at risk of weight loss and any actions taken to reduce this risk were not in place.

In the main, people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The service is now rated Inadequate. This service has been rated requires improvement for the last three inspections (published 27 May 2022, 24 December 2020, and 17 October 2019). The service was also previously rated inadequate (published 25 May 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the cleanliness of the service, staffing, lack of staff understanding about safeguarding people and supporting peoples known risks, the state of disrepair of the building internally and externally and a general lack of financial investment by the provider. A decision was made for us to inspect and examine those risks.

We found evidence during this inspection that people were at risk of harm from these and other concerns. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Firs Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safeguarding people from abuse; safe care and treatment; premises and equipment; staffing; person-centred care; and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.