Archived: The Firs Residential Care Home

This unannounced inspection took place on 12 January 2017.

At the time of the inspection there was a registered manager in place. 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.

At the last inspection on 17 March 2016 we asked the provider to take action to make improvements to the staffing levels, fire safety and complying with the requirements of the Mental Capacity Act, and these actions had been completed.

The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was not acting in accordance with the requirements of the MCA including the DoLS. The provider was able to demonstrate how they supported people to make decisions about their care. Where people were unable to do so, there were records showing that decisions were being taken in their best interests. DoLS applications had been submitted to the appropriate authority. This meant that people did not have restrictions placed on them without the correct procedures being followed.

Staff knew what actions to take if they thought that anyone had been harmed in any way. Local safeguarding procedures had been followed when necessary. Risk assessments reduced risks to people without restricting them from doing the things they enjoyed.

There were enough staff available to meet people’s needs. The recruitment process was followed to ensure that people were only employed after satisfactory checks had been carried out. Staff received the training they required to meet people’s needs and confirmed that they felt supported in their roles.

Staff were kind and compassionate when working with people. They knew people well and were aware of their history, preferences, likes and dislikes. People’s privacy and dignity were upheld. Visitors were made to feel welcome to the home and staff supported people to visit their family members when needed.

Staff monitored people’s health and welfare needs and acted on issues identified. People had been referred to healthcare professionals when needed. People received their medication as prescribed. Medication was stored securely.

People were provided with a choice of food and drink that they enjoyed. When needed people received the support they needed to eat and drink. This was carried out in a respectful manner.

Staff supported people to maintain their interests and their links with the local community to promote social inclusion. Measures were taken to promote people’s safety if they wanted to access the community on their own.

Care plans and risk assessments gave staff the information they required to meet people’s individual care and support needs. The care provided was based on people’s preferences.

There was a complaints procedure in place and people felt confident to raise any concerns either with the staff or the registered manager.

There was an effective quality assurance process in place to identify when any improvements were needed. The registered provider obtained the views from the people, their relatives and staff about the quality of the service and took action when improvements were suggested.

This unannounced inspection took place on 17 March 2016.

At the time of the inspection the manager was in the process of applying to the Care Quality Commission [CQC] to become the registered manager. 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.

The CQC is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was not acting in accordance with the requirements of the MCA including the DoLS. The provider could demonstrate how they supported people to make decisions about their care but not how the requirements of the MCA were being followed. Where people were unable to do so, there were no records showing that decisions were being taken in their best interests. This also meant that people were potentially being deprived of their liberty without the protection of the law.

There were not always enough staff on shift to ensure that people were kept safe. In addition, staff told us and our observation confirmed that care was sometimes task lead. This meant that people were at risk of receiving care and support that did not meet all of their needs.

Action had not been taken to ensure that the risks to people from a fire had been adequately reduced. An action plan had been written in 2014 about how to reduce fire risks: however,this had not been completed. This placed people at risk of avoidable harm in the event of a fire.

Staff knew what actions to take if they thought that anyone had been harmed in any way.

The recruitment process was followed to ensure that staff were only employed after satisfactory checks had been carried out. Staff received the training they required to meet people’s needs and confirmed that they felt supported in their roles.

Staff were kind and caring when working with people. They knew people well and were aware of their history, preferences, likes and dislikes. People’s privacy and dignity were upheld.

Staff monitored people’s health and welfare needs and acted on issues identified. People had been referred to healthcare professionals when needed. People received their medication as prescribed.

People were provided with a choice of food and drink that they enjoyed. Staff supported people to maintain their interests and their links with the local community to promote social inclusion.

Care plans and risk assessments gave staff the information they required to meet people’s care and support needs.

There was a complaints procedure in place and people and their relatives felt confident to raise any concerns either with the staff or manager.

People’s views about the quality of the service had been obtained and action had been taken when improvements were identified.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary, please read the full report.

This was an unannounced inspection. We spoke with four people who lived at the home. We could not speak with some people due to their needs. We also spoke with the manager and three other members of staff. We looked at written records, which included copies of people's care records, medication systems, staff personnel files and quality assurance documentation.

Is the service safe?

We found the home to be warm and clean. The accommodation was adapted to meet the needs of people living there and was appropriately maintained. The provider had a suitable plan in place to enhance the facilities further.

The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. People were protected by safe recruitment practices. There were proper processes in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

We saw that care plans and risk assessments were informative and up to date. Staff we spoke with were familiar with their contents, which enabled them to deliver appropriate and safe care. People were cared for by staff who were properly trained and supported to develop professionally.

People we spoke with were satisfied with the care and support they received.

Is the service caring?

We spoke with four people who used the service. One person said to us, "The staff are great here. I couldn't wish for any better." Another person said to us, "They always keep the home very clean. Also the food is very good, just like mum used to make it."

We observed a good rapport between staff and the people who lived at the home. We witnessed the care and attention people received from staff. Staff were friendly, were attentive to people's needs and people were treated with dignity and respect.

Is the service responsive?

People were consulted about and involved in their own care planning and the provider acted in accordance with their wishes. Care plans and risk assessments were regularly reviewed.

Three staff members told us that the manager was approachable and they would have no difficulty speaking to them if they had any concerns.

Is the service well led?

Two staff members said that they felt well supported by the management team and they were able do their jobs safely. The manager had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving.

We found that there was not always enough care staff on shift to meet people's needs in a timely and safe manner.

People told us they enjoyed living at the home, one person who was just in the home for a period of respite told us, "There is nothing the staff could better, I shall miss them when I go back home".

The records show that staff respond to people's changing needs and when needed, other professionals are involved. One person told us, "We get all the doctors ' they're very good.'

The staff records showed that staff have to pass recruitment checks before they are employed.

There was a complaints procedure in the home. All of the people that we talked to said they would complain if there were not happy about anything in the home.