Archived: The Firs Nursing Home

The Firs Nursing Home is a care home providing nursing and personal care to up to 40 people. The home specialises in the care of older people but is able to cater for some younger people who have physical nursing needs. At the time of the inspection there were 30 people living at the home.

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

At the last inspection we identified concerns with governance, staffing levels and skills, cleanliness and recognising and reporting abuse. These concerns led to five breaches of regulations.

At this inspection we found that considerable improvements had been made and the service was no longer in breach of regulations.

People lived in a home where the new registered manager was committed to ongoing improvements. They had implemented a number of changes to the way care was delivered and how this was monitored. This enabled shortfalls to be addressed in a timely manner to ensure people received a good standard of care.

People felt safe at the home and with the staff who supported them. Staff knew how to recognise and report any concerns about possible abuse. People felt able to share any worries or concerns with staff. People said that staff were kind and caring.

People were supported by sufficient numbers of staff to meet their needs. Staff were happy in their jobs which created a pleasant environment for people to live in.

People’s health was monitored by trained nurses. Nurses worked with other professionals to make sure people received the care and treatment they needed. People received their medicines safely from trained staff.

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 told us they were able to make choices about their day to day lives. This included deciding when they got up and when they went to bed.

People received food and drinks in accordance with their preferences and needs. People told us they were happy with the quality and choice of food.

People were supported to stay in touch with friends and family. Staff had followed all government guidance, regarding visitors, throughout the COVID-19 pandemic. This helped people to stay connected to the people who were important to them.

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 29 December 2020) and there were breaches of regulations.

At the last inspection conditions were imposed on the provider’s registration. These were complied with fully and have now been removed.

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 and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Firs Nursing Home is a care home providing nursing and personal care to up to 40 people. The home specialises in the care of older people but is able to cater for some younger people who have physical nursing needs. At the time of the inspection there were 31 people living at the home.

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

People were not always supported by adequate numbers of staff to meet their needs and keep them safe. The provider used a dependency tool to assess hours required to meet people’s needs but on a number of occasions the home was not staffed to the assessed level.

The senior management team were not always working together to create an inclusive atmosphere and ensure there was a consistent plan to achieve improvements to the service provided. Some staff felt undervalued and this had led to poor staff morale which did not always create a happy and relaxed atmosphere for people to live in.

People did not always benefit from a clean and hygienic environment. The monitoring of infection prevention and control practices was not robust which could place people at risk of harm.

Since the last inspection there had been some improvements in how quality was assessed and monitored but this did not always lead to improvements in people’s quality of life. However, relatives spoken with felt there had been a number of improvements in the home.

People felt safe at the home and with the staff who supported them. People looked relaxed when staff supported them and told us they were always treated with kindness.

People received their medicines safely from registered nurses or senior staff who had received specific training to carry out the task. Clear records were kept of all medicines administered or refused which enabled staff to monitor the effectiveness of prescribed medicines.

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 requires improvement (published 14 August 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 enough improvement had not been made, or sustained, and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 17 and 18 July 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. Breaches identified related to Regulation 12 (safe care and treatment) Regulation 17 (Good governance) Regulation 18 (Staffing).

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. At this inspection we found the provider continued to be in breach of regulations.

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 not changed. 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 Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach of regulation in relation to safeguarding service users from abuse and improper treatment at this inspection.

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

We also identified continued breaches in relation to staffing, safe care and treatment and good governance.

We have added conditions to the provider's registration for this location.

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.

The Firs Nursing Home is registered to provide personal and nursing care to up to 40 people. The home specialises in the care of older people. Accommodation was arranged over two floors with a passenger lift between. At the time of the inspection there were 32 people living at the home.

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

People did not live in a home which was consistently managed or well led. The home had had a number of managers since the last inspection and the provider had not been robust in monitoring the day to day running of the home. The systems to assess, monitor and improve the quality and safety of the care people received were not robust and effective. They had not identified and addressed shortfalls in the service. This placed people at risk of receiving poor quality care which was not person centred and did not promote their well-being.

People were not always being supported by sufficient numbers of suitably skilled and experienced staff. Comments from people and staff showed that on occasions people had not received their care and support in a timely manner due to poor staffing levels. This had also had a negative impact on staff morale which meant people were not living in a happy atmosphere.

Record keeping needed to be improved so that people’s care could be effectively monitored to ensure the care provided was in accordance with, and met, people’s assessed needs.

Improvements were needed to the environment to make sure it provided a pleasant home for people to live in. The manager informed us refurbishments were planned but no timescales for this were given.

People did not always have information available to them in a format which met their specific needs. We have made a recommendation regarding making information available to people in appropriate formats.

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 who were able to express their views said they were given choices and only received care with their support.

People were cared for by staff who were kind and helpful. One person said, “Staff are brilliant they will do absolutely anything for you.” Another person told us, “Staff are very good. They always help you.”

People were complimentary about the food served at the home and in most cases received the support they required to eat and drink in a dignified manner.

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. (Report published April 2017)

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels which was said to be impacting on the standards of care people were receiving. A decision was made for us to bring forward our comprehensive inspection to examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

At the last inspection, the service was rated Good

At this inspection we found some minor improvements could be made to make sure people received effective care but the overall rating for the service remained Good.

Why the service is rated Good.

People received safe care because the provider made sure there were enough staff available to meet people’s needs and ensure their safety. People’s medicines were safely administered by registered nurses and staff knew how to report any concerns or suspicions of abuse.

People were at risk of not being supported to have maximum choice and control of their lives because staff did not all have a clear understanding of people’s legal rights in relation to the Mental Capacity Act 2005. People’s health and well-being was monitored and staff sought appropriate advice and support to meet people’s healthcare needs.

People were cared for by kind and compassionate staff. One person said “I don’t think you would find better or more caring staff anywhere.” Care was provided to people in a way that respected their privacy and dignity.

People received care that was responsive to their needs and took account of their wishes and preferences. Staff made sure people received the right level of care and support when their needs changed. People said they would be comfortable to make a complaint if they were unhappy.

People lived in a home that was well led by the registered manager and provider. The provider was committed to continually improving the service and facilities for people. People were kept informed of changes and there were opportunities to share their views.

Further information is in the detailed findings below

When we visited 35 people were using the service. We met with 16 people who lived at the home, three members of staff and the manager. We also spent time observing how staff interacted with the people who lived at the home.

People were positive about the care and support they received. Comments included 'I am very happy with everything. The staff are lovely. I have no complaints' and 'I feel well looked after here. If I need anything, I only have to ask.' Staff interactions were kind and respectful and people appeared to enjoy the company of staff.

We met with four people who were being nursed in bed. All appeared clean and comfortable and records showed that staff checked people at least hourly. We saw that people had access to a call bell. People told us that staff responded promptly to any requests for assistance.

Improvements in how people's care plans and assessments were audited meant that risks were identified and managed in a timely manner.

We found care records up to date and well maintained. This improvement reduced the risks of people receiving unsafe or inappropriate care.

At the time of the inspection there were 33 people living in the home. We spoke with five people who lived in the home, two of their relatives and observed how people were cared for and treated. People living in the home and their relatives told us they were very happy with the care and treatment that was received. They also said they would recommend the home to others. One person said 'staff are very kind and helpful, the home is lovely, no concerns or areas for improvement'. We found that when observing staff their interactions with people were sensitive and respectful.

We looked at four individual care records which showed people's needs had been assessed. Although some care records did not reflect people's current needs.

We found the home was well maintained and action was taken to address any maintenance that was necessary to keep people safe. We found the manager carried out appropriate checks on its staff to ensure they were of good character and skilled to carry out the role.