The Firs Residential Care Home

We found the following examples of good practice.

The Firs Residential Care Home had robust arrangements for visitors which reflected government guidelines. Clear signage was displayed on the front door and Personal protective equipment (PPE) was available for visitors. Visitors were required to show negative Lateral Flow Test (LFT) result and were screened for symptoms of COVID-19 prior to entry to the service. Vaccination status for visiting professionals was recorded and stored securely.

There was a comprehensive infection prevention and control (IPC) policy in place and monthly audits were conducted that highlighted issues effectively. The service had implemented actions plan accordingly to rectify and mitigate risk to people living within the home, this ensured care was delivered safely.

The home looked clean, hygienic and maintained to a high standard. Domestic staff carried out regular cleaning with additional cleaning and disinfection of high touch points such as door handles or handrails.

The provider had processes in place that ensured the safe admission of new people to the home. The provider also assessed the impact of isolation on people’s wellbeing. This included increased time spent by staff with people in their bedrooms to offer support and reassurance. All new admissions had to meet required vaccination status and negative LFT result before entry was granted to the home.

The Firs Residential Care Home provides accommodation and personal care for up to 12 people, including people living with dementia, in one adapted building. At the time of the inspection 11 people were living at the service.

The service is also a domiciliary care service. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection five people were receiving personal care as part of their care package.

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

Systems and processes were in place to regularly assess and monitor the health and safety of the environment, premises and equipment, including fire safety and risks associated with legionella. However, governance procedures had not identified the shortfalls in the fundamental standards found during this inspection.

Improvements with medicines were required. This was particularly in relation to the storage of medicines and the guidance for staff of how to administer prescribed medicines.

Incidents and accidents required further review and analysis, to ensure known risks were sufficiently assessed, monitored and mitigated and lessons learnt.

Guidance provided for staff about people’s care needs and routines were overall individually personalised. However, information relating to people’s health conditions lacked detail in places. At the time of the inspection, care plans and risk assessments were being reviewed to ensure they were sufficiently detailed and up to date.

Staff were aware of their role and responsibilities to safeguard people from abuse and avoidable harm. Additional and refresher training had been planned to ensure all staff were knowledgeable and competent in meeting people’s individual care needs.

People who used the service and feedback from relatives were in the main positive. This included comments about the staff and management teams caring and responsive approach.

People receiving care in their own homes were introduced to new staff before they provided care. In the main care calls were provided on time and staff stayed for the duration of the call. At the time of the inspection, checks by the management team to assure themselves staff were meeting people’s individual needs such as spot checks were not happening. However, the management team had regular contact with people and or their relatives and addressed any concerns raised immediately.

The provider completed recruitment checks when staff commenced their role to ensure as far as possible staff were safe to care for people. A dependency tool was used to determine what staffing levels were required to meet people’s individual needs and safety in both the service and people in their own homes the community.

Since the last inspection, the registered manager had left the service and the new manager was in the process of registering with CQC. Staff reflected on the change of management and overall were positive about the new managers support and leadership.

The provider had submitted statutory notifications to notify CQC of events they are required to report. Staff worked well with external health care professionals to meet people’s individual care needs.

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

Rating at last inspection

The last rating for this service was Good (published 24 April 2018).

Why we inspected

The inspection was prompted in part by notification of a specific incident. The information CQC received about the incident indicated concerns about the management of risks associated with choking. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. This inspection examined those risks. We found no evidence during this inspection that people were at risk of harm from this concern.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has deteriorated to Requires Improvement.

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 one breach in relation to governance of the service. 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 for 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-inspection programme. If we receive any concerning information we may inspect sooner.

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 Firs Residential Care Home accommodates up to 12 people over two floors. On the day of our inspection, 11 people were using the service and one person was in hospital.

The Firs Residential Care Home is also a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection, two people were receiving a care package where personal care was provided.

At the last inspection in March 2016, the service was rated ‘Good’, in the key questions and at this inspection; we found the service remained ‘Good’ again in all areas.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks associated with people’s needs including the environment, had been assessed and planned for and these were monitored for any changes. People did not have any undue restrictions placed upon them. There were sufficient staff to meet people’s needs and safe staff recruitment procedures were in place and used. People received their prescribed medicines safely and these were managed in line with best practice guidance. Accidents and incidents were analysed for lessons learnt to reduce further reoccurrence.

People continued to receive an effective service. Staff used nationally recognised assessment tools to effectively support people’s needs. Staff received an induction, ongoing training and support. People were supported with their nutritional needs; food and drink choices were offered and provided. The staff worked well with external health care professionals, people were supported with their needs and accessed health services when required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Advocacy information was available should people have required this support.

People continued to receive a responsive service. People’s needs were assessed and planned for with the involvement of the person and or their relative where required. People received opportunities to pursue their interests and hobbies, and social activities were offered. People were also supported to participate in community activities and interests. The provider had made available the complaint procedure.

The service continued to be well-led. There was an open and transparent culture and good leadership, oversight and accountability. People received opportunities to share their feedback about the service and staff felt valued. The provider had quality assurance checks in place on quality and safety. The registered manager had implemented innovative ways of supporting people with their wishes.

Further information is in the detailed findings below.

The service had a registered manager in place at the time of our inspection. 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.

People’s safety was promoted because systems were in place to keep people safe from harm. Staff knew how to report any concerns to the authorities where they suspected someone was at risk of harm or abuse.

People were supported by a sufficient number of staff who had the time to meet their care and social needs. People had the assistance they required to take their medicines as prescribed.

People were provided with care and support by staff who were trained and supported to deliver care safely and appropriately. People’s human rights to make decisions for themselves were respected and they provided consent for their care when needed.

People received the assistance they required to have enough to eat and drink. People received support from staff who understood their health conditions and arranged for them to see healthcare professionals when needed.

People were able to try the home to see if it was to their liking before making a decision to move there. They were actively involved in preparing and reviewing their care and support so this was exactly how they wished it to be. People were given the encouragement and practical support they needed so they could follow their hobbies and interests and maintain links and friendships with their own local community.

People were asked how their service could be improved any action needed could be taken without them needing to make a complaint. People felt comfortable to raise any issues that they wished to and were confident these were listened to and addressed.

People had opportunities to express their views on what it was like to live in the service and how they felt this was run. People knew the registered manager well and trusted them to look after their welfare. There were systems in place to monitor the quality of the service and make improvements when needed.

We found where people were able to they gave consent to their care and support. A person who used the service told us, 'I decide what I want to do. My routine is what I want it to be.'

We found people were provided with a varied and nutritional diet. A person who used the service told us, 'The meals suit me and I am a fussy eater. I don't know how they manage to feed me, there are so many things I do not like.'

We found that suitable arrangements were in place to manage people's medication and ensure they received any medication they needed. A staff member told us how one person liked to take their medication in a particular way and this was recorded in the person's care plan for medication.

We found there were sufficient staff to meet people's needs and the provider maintained records that were accurate and fit for purpose. A person who used the service told us, 'There are always plenty of staff if you want any assistance. There are no problems there.'

We had a discussion about the home with three people around the dining table. They made a number of complimentary statements about their experience within the home. These included, 'The staff do everything they can to make it right for you', 'The food is wonderful', 'We have great activities' and how welcoming everyone was to their friends and family. One person told us, 'The Queen could not be looked after better. If we can't look after our selves at our homes we couldn't be in a better place.' Another person who was listening nearby to our discussion came over and said, 'Every word they said is true.'

People told us they felt safe in the home. One person said, 'It is very safe here, it looks safe.' Someone else said, 'If you say you need something they are there. I feel very safe.'

One of the people who lived in the home said, 'They are fully trained, I know it is good training because the results are good. If the training wasn't good the results wouldn't be good.' We were told by someone else, 'You see bad reports about care homes in the press, there is nothing like that here.'