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The Firs Residential Care Home Requires improvement

The provider of this service changed - see old profile

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.

Reports


Inspection carried out on 4 August 2020

During an inspection looking at part of the service

About the service

The Firs Residential Care Home is a care home that was providing accommodation and personal care to 21 people at the time of the inspection. The service can support up to 29 people.

The Firs Residential Care Home accommodates people in one adapted building. There are shared lounges, a dining room and a conservatory on the ground floor. Bedrooms are single occupancy and are both on the ground and first floors.

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

Peoples medicines were not always managed safely which increased the risk to people. Some staff did not always follow current national guidance on when to wear personal protective equipment when supporting people.

People had risk assessments and care plans in place to give guidance to staff on how to monitor people’s assessed risks. However, some of these records lacked information to guide staff fully.

Audits had made some improvements to the service provided but had not identified the shortfalls found during this inspection. Staff had been trained on how to keep people safe from poor care and harm. However, there were delays in staff taking action and seeking advice when people had missed their medication. These delays had also not been identified in the governance monitoring of the service.

Relatives of people who lived at the service told us that communication was good, and they felt listened to and involved in their family members care decisions.

There were enough staff to meet people’s care and support needs. Staff involved and worked with external professionals to help people maintain their health and well-being. Recruitment procedures were in place to check whether a proposed new staff member was suitable to work at the service.

The registered manager made sure appropriate people and organisations such as the local authority safeguarding team, were informed when things went wrong. They gave people and their relatives opportunities to feedback and make suggestions on the running of the service.

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 last rating for this service was requires improvement (published 17 October 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve (November 2019). At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last inspection (17 October 2019) and rated inadequate prior to that (published 25 May 2019).

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm that they had met the legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

The inspection was also prompted in part due to concerns received about staffing levels during the COVID-19 pandemic. A decision was made for us to carry out this focused inspection and examine those risks.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

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.

We have found evidence that the provider needs to make improvements. Please see the safe section of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took

Inspection carried out on 21 August 2019

During a routine inspection

About the service

The Firs Residential Care Home (The Firs) is a residential care home providing accommodation and personal care to 19 people aged 65 and over at the time of the inspection. The service can support up to 29 people.

The Firs accommodates people in one adapted building. There are shared lounges, dining room and sun room on the ground floor. Bedrooms are single and are on both the ground and first floors.

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

Medicines were not always managed safely, which put people at risk of harm. Staff did not always respect people’s privacy and dignity; care plans were not all fully personalised; and some people did not have enough to do to keep their minds and bodies active. Audits had not always identified where there were shortfalls.

We found there had been improvements made since our last inspection. Most of the time there were enough staff to meet people’s needs and the manager had followed good recruitment procedures to make sure new staff were suitable to work at the service. Staff knew how to keep people safe from avoidable harm and abuse and followed good infection prevention and control procedures. The manager ensured that lessons were learnt when things went wrong.

Staff had undertaken training and received support from senior staff to ensure they could do their job well. People enjoyed food that they had chosen and staff involved external professionals to help people maintain their health.

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; the policies and systems in the service supported this practice.

People received kind and compassionate care and were involved in most decisions about their care.

People and their relatives were confident their views would be listened to and complaints would be addressed. Staff provided compassionate and kind care to people at the end of their lives.

The manager had worked hard to ensure improvements had been made and had a plan in place to sustain the improvements. They provided good leadership, made sure appropriate people were informed if things went wrong and involved people and their relatives in the running of the home.

Rating at last inspection and update

The last rating for this service was inadequate (reports published 20 March 2019 and 28 May 2019) and there were multiple breaches of regulation. 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 improvements had been made. However, the provider remains in breach of one regulation.

This service has been in Special Measures since March 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We found evidence that the provider needs to make further improvements. Please see the safe, 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 a breach in relation to safe management of medicines at this inspection. This puts people at risk of harm. The manager took immediate action to reduce the risk.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspec

Inspection carried out on 23 January 2019

During a routine inspection

About the service: The Firs Residential Care Home is a residential care home that was providing personal and nursing care to 26 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

Risks to people were not managed safely. People were at risk of choking due to swallowing difficulties and this was increased because staff did not always follow guidance about food and drink preparation. People had lost weight but not enough action was taken to reduce the risk of this continuing. Staff did not know how to support people with their health conditions, such as diabetes, which put them at risk if these worsened. People were at risk from a lack of staff understanding about moving and handling equipment.

Fire evacuation information was incorrect and had not been updated to include all of the people living at the home. The safety and effectiveness of giving medicines covertly had not always been considered as advice or alternative medicines had not been sought. Safeguarding referrals were not made to the local authority safeguarding team and the manager did not recognise when this was required.

There was a lack of managerial oversight at the home, which lead to low staff morale and a high turnover of staff. The provider’s monitoring process did not look effectively at systems throughout the home. Where issues were identified, there was a lack of action to address them and these continued. There were not enough staff available to make sure people received care in a timely way. People had to wait for care, meals and to go to the toilet. Staff recruitment checks were not always fully obtained before new staff started working at the home.

Lessons were not learned about accidents and incidents and it took time to implement actions to reduce these. Medicines were stored safely, and records were completed correctly. Regular cleaning made sure that infection control was maintained and action was taken to address issues.

People were cared for by staff who had received some training but did not have all the skills or support to carry out their roles. People received a choice of meals, which they liked, and staff supported them to eat and drink. People were referred to health care professionals as needed although staff did not always follow the advice professionals gave them. Adaptations to the environment were made to ensure people were safe and able to move around their home as independently as possible. Staff members understood and complied with the principles of the Mental Capacity Act 2005 (MCA). People were supported to have choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were caring, kind and treated people with respect. People were listened to and were involved in their care and what they did on a day to day basis. People’s right to privacy was maintained by the actions and care given by staff members.

People’s personal and health care needs were met and people were happy with the care they received. Some care plans were written in detail to provide guidance to staff Other care plans were not available and staff did not always have appropriate guidance to care for people. There were activities for people to do and take part in and they enjoyed these when they were available. However, people told us they had little to do when the staff member responsible for these was not working. A complaints system was in place but complaints had not been investigated and responded to when they were first made. Staff had some guidance and support about people’s end of life wishes, although information in care records was limited.

We found several breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, a breach of Regulation 18 of th