The Firs Residential 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 assessment we rated this key question good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 78 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

The manager had systems to effectively monitor and review incidents and accidents. This supported a strong, open learning culture within the service, where staff worked together to reflect on practice and improve outcomes for people. We found monitoring included patterns, location and trends, this helped the manager to consider safe staffing deployment, specific safety measures, equipment or technology. Care plans were reviewed after incidents to help identify changes which could reduce future risk or minimise impact. Staff told us they felt included in learning to further improve care provision and safety.

Management reviews of incidents were thorough, and a proactive approach to learning was evident. Information was shared with staff in writing and during team meetings, this supported continuous improvement and shared learning across the team. For example, we found a reduction of incidents of distress had occurred for 1 person following thorough review of their needs and what situations and times of day may increase the likelihood of occurrence. We also received positive feedback from relatives relating to staff approach to incidents and how their reviews led to positive outcomes.

The manager told us their process enabled them to have a clear oversight of staff responses to situations and ensured actions were taken in a timely way. It also provided a clear understanding of how incidents were managed and identified further opportunities to strengthen people’s safety and reduce occurrence. This demonstrated a proactive and well-established culture of learning and improvement that enhanced people’s care and experiences.

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.

Staff worked closely with healthcare partners, maintaining regular contact to help improve services and ensure continuity of care. Healthcare professionals told us communication with the staff team was good. They said their feedback was actively sought and used to further develop systems, helping to ensure people received coordinated and consistent care.

The manager reviewed notable events monthly, including occasions where emergency healthcare support was required and how staff responded. This provided regular opportunities for staff to reflect on practice, receive feedback and learn from experiences.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe. For example, 1 person told us, “I do feel really safe [at the care home]. The carers are always checking on me and asking if I am alright. I think they protect us really well.” People’s relatives told us they felt their loved ones were safe and well cared for. Staff had completed safeguarding training and told us they would not hesitate to report concerns to managers. Staff knew how to report concerns to other agencies outside of the organisation if required.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. The provider was able to identify when people were potentially being deprived of their liberty, complied with the basic principles of the Act, and made applications or/and urgent authorisations in a timely manner.

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.

People were supported to be involved in managing risks related to their care. Staff worked with people, and where appropriate, their relatives to discuss risks and agree how these could be managed safely while maintaining independence. For example, people who were at risk of falls had specialist alarmed mats in place, and we observed staff responded promptly when these were activated to promote people’s safety.

However, we found some care plans and risk assessments did not always contain sufficient detail and in a small number of cases information was inconsistent. For example, 1 person’s care plan did not reflect professional advice regarding the frequency of positional changes. Another person’s risk assessment did not clearly reflect the texture of food they had been assessed to require and were receiving. The manager responded promptly to these findings and took immediate action.

The provider detected and controlled potential risks in the care environment through a range of audits. When safety concerns were identified, actions were taken. They made sure equipment, facilities and technology supported the delivery of safe care. Regular environmental checks were also completed to help maintain safety, and external contractors were used for specialist services when required.

The provider was responsive to fire safety requirements identified by the local fire officer before our assessment began and environmental improvements were taking place. This included replacement of fire doors, redecoration, refurbishment of the communal conservatory, and plans for additional social space for people living at the care home.

People’s relatives told us they welcomed the environmental updates being made to the care home. One relative told us, “Once the renovations are complete. It will be better.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider followed safe recruitment processes to help ensure staff were suitable to work with people using the service. The manager demonstrated clear oversight of staffing requirements. A dependency tool was used to calculate safe staffing levels, and we observed staffing was adjusted in line with people’s needs when required. This helped ensure people received care and support in a timely way. Staff were supported to complete training relevant to their roles and encouraged to undertake additional professional qualifications in health and social care

People told us staff responded to their needs promptly. For example, 1 person said, “If I ever need help, I know I can ring my buzzer, and they will come to me.” Another person said, “[Staff] are very quick to answer the bell. There always seems to be a lot of staff here.” People’s relatives told us they felt staff were well trained, welcoming and approachable.

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. We found the care home was clean on both of our unannounced visits.

Staff told us they had received infection prevention and control training, and training records confirmed this. We observed staff wore appropriate Personal Protective Equipment (PPE) when required, in line with good practice.

We observed domestic staff working safely, with appropriate supplies and following appropriate procedures to maintain a clean and hygienic environment. People told us they were satisfied with the cleanliness of the care home, for example, 1 person told us, “[Staff] keep everywhere clean and they clean my room for me.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff knew how to support people in a way which met their individual needs.

People received their medicines safely and as prescribed. Staff followed safe administration practices, and we found no issues with the completion of medication administration records. Medicines were stored securely, with regular environmental checks carried out. Where people needed extra support with their medicines, this was provided in line with legal requirements and professional guidance, with appropriate authorisations in place.

Staff worked well with doctors, district nurses, and the pharmacy to meet people’s needs and reduce unnecessary prescribing where possible. They shared information appropriately and followed professional advice. The medicines lead carried out monthly audits, regular stock checks and competency-based training for staff. The provider introduced an electronic MAR (e-MAR) system during our assessment timeframe to further improve oversight. There was also a clear process to identify and learn from errors and near misses.