Firbank House

Firbank House is a residential care home providing personal care to up 42 people. The service provides support to older people. At the time of our inspection there were 32 people using the service.

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

People told us they felt safe. Risks to them were identified and managed. Where required people were supported safely with their medicines. Infection control measures were in place to prevent cross infection and staff wore appropriate PPE.

The home was clean throughout although some parts of the décor required some improvement. This was part of the provider’s ongoing improvement plan for the service.

The provider had robust recruitment systems to ensure staff were safely recruited. Staff spoke knowledgably about the systems in place to safeguard people from abuse.

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.

The management of the home promoted a person-centred service. There was an open and transparent culture and good partnership working with others. The quality and safety of the service was monitored through regular checks.

Audits were in place and the provider had oversight of the service and the ongoing improvements. Necessary referrals were being made and the provider spoke about being open and honest when things go wrong. Staff worked in partnership with other agencies to support people and enhance their quality of life. Staff spoke highly of the registered manager and people using the service spoke positively of the care they received. Feedback from relatives was mixed; however, the provider has a continuing improvement plan in place.

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 8 February 2023) and there were 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 and the provider was no longer in breach of regulations.

Why we inspected

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Firbank House on our website at www.cqc.org.uk.

Follow up

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

About the service

Firbank House is a residential care home providing accommodation and personal care to up to 42 people. The service provides support to older people and people with dementia. At the time of our inspection there were 34 people using the service. The service is provided across 2 adapted buildings on the same site.

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

People's care plans and associated risk assessments were not always current, accurate and did not always provide staff with the correct information they required to safely meet people's needs. People’s medicines were not always managed safely. We were not assured medicines were always stored and administered safely. The home was not always clean, and staff did not always follow infection prevention and control measures. Staff had undergone safe recruitment checks prior to working the home. People were cared for by staff who understood how to safeguard people and how to report any concerns.

We saw improvements been made to the home. However, we had continued concerns about the environment in terms of décor and cleanliness. Systems and processes to ensure oversight of the service were not always effective. Audits completed had not always identified and actioned the concerns we found on inspection. We identified two breaches of regulations. The management team were helpful and quick to act when we fed back our findings during the inspection. Staff told us improvements had been made in the management of the service by the new registered manager.

People were supported to have 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. However, we found concerns regarding the signing of consent forms.

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 (5 October 2021).

At our last inspection we recommended that the provider work closely with the local authority medicines team and pharmacist to develop best practice across the service. We also recommended the provider ensure that staff have the relevant knowledge and training to meet the specific needs of the people living at the service. At this inspection we found the provider had not always made the recommended improvements.

The last rating for this service was requires improvement. The service remains rated requires improvement. This service has now been rated requires improvement for the last four consecutive rated inspections.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

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

The provider was responsive throughout the inspection and took action to attempt to mitigate the risks we identified.

You can read the report from our last inspection, by selecting the 'all reports' link for Firbank House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicines, risk management, infection prevention and control and governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

Firbank House is a residential care home providing personal care to 39 people aged 65 and over at the time of this inspection. Care is provided across two separate buildings, the original house called Windsor was home to 19 people and the newer building called Balmoral was home to 22 people. Meals are prepared in the main kitchen on Windsor with Balmoral having a kitchenette where drinks and snacks could be made. People had their own individual bedroom and shared communal areas and adapted bathrooms. The service is registered to support up to 42 people.

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

People’s risks were assessed, and incidents analysed to ensure lessons were learnt. There were enough staff to meet people’s needs and people felt safe at the service. The service was clean and tidy and there were regular checks completed to reduce risk to people. We have made a recommendation about the management of medicines to ensure good practice across the service. The service was following guidance regarding the management of Covid-19 and PPE was available and used by staff.

People, relatives and staff felt positive about the ongoing changes across the service. We noted improvements within the service but there were still areas for further development and a need to demonstrate that change and improvement was sustainable. A manager was in place and people and staff told us they were approachable and proactive. Systems for checks and involving people, relatives and staff in service development were in place or being developed and the provider and manager were keen to work in partnership and drive improvement across the service.

People’s needs were assessed and care plans in place to meet these needs. People were supported to eat and drink, and referrals made to health care services when additional assessment and advice was needed. Improvements had been made to the décor of the service and work was ongoing. Staff spoke positively about the induction, training and support they received. We have made a recommendation about training that is specific to the needs of the people living at Firbank House.

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’s needs and preferences were recorded in electronic care plans. Plans to improve end of life care planning for people living at Firbank House were in place. Activities were available to people including trips out of the home. People felt able to raise concerns and these were investigated by the manager.

Staff were kind and patient with people and understood their needs. Dignity and independence were promoted where possible and people were supported to make choices regarding their daily lives.

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 29 October 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last comprehensive 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. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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.

Firbank House is a residential care home providing personal care to 37 people aged 65 and over at the time of the inspection. Care is provided within two separate buildings. The original house, called Windsor, was home to 18 people, and the newer building, known as Balmoral, was home to 19 people. Meals are prepared within the main kitchen on Windsor, and Balmoral has a kitchenette where drinks and snacks can be prepared. Each unit has a variety of shared communal areas, including a lounge, dining area and shared bathrooms. The service is registered to support up to 42 people.

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

We received information raising concerns about staffing and how infection prevention and control was being managed within the service to keep people safe. This inspection looked specifically at these areas.

The service had additional staff to support with the cleaning and running of activities within the service. We observed there were enough staff to meet people's needs, and staff confirmed this was the case. Staff were generally knowledgeable and told us they felt well supported within their role.

At the time of the inspection the service was in the process of a full deep clean from an external service. New furniture was in place and the service was clean and free from unpleasant smells. This will be reveiwed at our next inspection to ensure thorough cleaning practices are embedded within the service. The laundry room had been relocated and there were improvement to the processes to ensure good infection control. However, we found some equipment was not clean, and there were still areas for improvement within the service, including the kitchen.

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 29 October 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.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about staffing levels, and infection control risks. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns.

Please see the safe section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Firbank House 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 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 in relation to the ongoing cleanliness of equipment and the premises at this inspection.

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.

Firbank House is a residential care home providing personal care to 34 people aged 65 and over at the time of the inspection. Care is provided within two separate buildings, the original house called Windsor was home to 14 people and the newer building known as Balmoral was home to 20 people. Meals are prepared within the main kitchen on Windsor and Balmoral has a kitchenette where drinks and snacks can be prepared. The service is registered to support up to 42 people.

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

The risks to people's safety were not always well managed. The management of the premises and equipment placed people at potential risk of harm. People were not always protected from the risks of infection as some areas of the home were not clean and there were no clear systems for managing people’s laundry. We found that there was not always enough staff to ensure the home was clean, or that people were stimulated and supported safely at meal times. People told us they felt safe in the home and appropriate systems for supporting people to take their medicine were in place

Assessments and care plans were in place which considered people’s capacity. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. People spoke positively about the food provided and staff understood how to support people who required a modified diet. We have made recommendation to ensure the home is suitably adapted to meet the needs of people living with dementia. Staff felt well supported by the manager and told us that training had significantly improved since our last inspection.

Care plans were in place and people’s needs were regularly reviewed. People felt able to make suggestions and raise concerns and that generally action was taken. However, there was no formal system for collecting people’s views. The registered manager advised that they intended to introduce resident meetings in the near future. There was no activity co-ordinator in place at the time of the inspection and people complained about being bored and lacking stimulations.

The registered manager had implemented a number of systems to audit and check the running of the home which had not been in place at our last inspection. However, these checks were not sufficiently robust to have identified our findings during inspection. People knew the registered manager and found them approachable and responsive to addressing concerns. The home was working closely with the local authority to drive improvement.

Staff were caring and knew the people they were supporting well and spoke about them with genuine affection. People were supported by a consistent staff team. People generally felt that they had choice and their independence was supported.

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 26 September 2018) and there were two 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 enough improvement had not been made 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 two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified five breaches of regulation. These relate to the cleanliness of the home (Regulation 12, Safe care and Treatment), the safe maintenance of the premises (Regulation 15, Premises and equipment), insufficient staffing to meet people’s needs (Regulation18, Staffing), providing care which met with people’s needs and preferences (Regulation 9, Person-Centred care) and the systems for oversight were not sufficiently robust to have identified all of the issues we identified (Regulation 17 Good Governance) at this inspection.

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.

Firbank House is owned by Partnership Caring Limited, which is a private company. Firbank House is a ‘care home’. 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.

Firbank House consists of two buildings and can accommodate up to 42 people. One building is known as the Windsor Unit and can accommodate up to 22 people. The other building is the Balmoral Unit and provides facilities for up to 20 people. The home is registered to provide residential care and accommodation only. At the time of this inspection there were a total of 27 people using the service.

There was a manager in place who was currently in the process of registering with the Care Quality Commission. 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.

Care staff were knowledgeable about how to recognise and report safeguarding issues they may encounter and said they would not hesitate to report any poor practice they may witness.

Staff recruitment required some improvements to ensure it was satisfactory. There were sufficient staff to meet the needs of the people who used the service.

There was a key code in place to help ensure safety, however, an outside area presented a potential risk. This was addressed immediately following the inspection.

There were some issues relating to infection prevention and control. The sluice rooms and laundry areas were cluttered and there was no clear system in the laundry to prevent the risk of cross infection. We also found that some cleaning equipment was stored unsafely, which presented a potential risk to people who used the service.

Individual risk assessments, relating to issues such as mobility, falls, mental capacity and nutrition were not presented in an acceptable format. The manager had commenced changing the care files but as yet appropriate risk assessments were not in place for people who used the service. This meant that risks to people’s health and well-being had not been addressed appropriately.

¿Accidents, falls and incidents were recorded and actions to address any issues had been put in place. Learning was taken from these issues to help ensure improvement to service delivery. Medication systems were robust and staff competency checks were undertaken regularly.

The on-going service improvement plan had identified issues relating to staff training and support, which was now in hand. Staff supervisions had not been in place, but had now been re-commenced.

Amendments were being made to the format of care files, but they contained essential information about people’s health and well-being. Care charts relating to areas such as pressure care and nutrition were completed appropriately and referrals to other agencies were made as required.

We observed one meal time and saw that people enjoyed their food and staff provided support and prompting for people as required. We looked around the premises and found that the décor was tired and worn in places. For example, we saw some peeling wallpaper in one of the corridors.

People we spoke with were all positive about the care they received at Firbank House. People told us they were treated with the utmost kindness and consideration. We observed care throughout the day and saw that staff spoke with people with kindness and compassion and supported people appropriately and at a suitable pace.

People’s bedrooms were clean and tidy and had been personalised with their possessions. Staff were aware of the service’s confidentiality policy and personal information was held securely at the service.

There was an activities co-ordinator who had begun to implement a programme of daily activities and was keeping records of all the activities undertaken. The activities co-ordinator also ensured that they spent meaningful one to one time with people who required this.

The staff had not undertaken training in end of life care but this was to be organised in the future.

The complaints procedure was available within each unit so people knew who to raise concerns with. There had been no recent complaints, but a log was in place and would be used to record any issues raised and responses and actions put in place.

Policies and procedures were in place but were in need of reviewing and updating. There was a statement of purpose which set out the aims and objectives of the service. Management audits and safety checks were now in place, though some needed to be more meaningful with follow up actions. The home had links within the local community.

Firbank House consists of two buildings. The building previously known as the ‘old’ building is now known as the Windsor Unit. This unit has bedroom and communal facilities for up to 22 people. The building previously known as the ‘annex’ building is now known as Balmoral Unit. This unit has bedroom and communal facilities for up to 20 people. The home is registered to provide residential care and accommodation only. At the time of this inspection there were a total of 27 people using the service. One person was in hospital and a total of five people were on respite stays.

At the time of our inspection the registered manager had left their employment with the service early in March 2017. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider of the service had recruited a new manager who was in post at the time of our inspection.

Prior to the registered manager leaving the service the provider had ensured they had received regular and on-going support from their line manager, who had been based at Firbank House for at least three months. This support continued when the new manager came into post, with additional support also being provided by the nominated individual (providers representative). In our conversation with both the line manager and nominated individual, it was confirmed that this support would continue whilst all pre-employment checks had been satisfactorily carried out for the new manager.

We found that that the breaches of regulations identified at the inspection conducted in October 2015 had been satisfactorily addressed.

People and their relatives told us they felt the care and support they received kept them safe and met their assessed needs.

Staff we spoke with were familiar with the safeguarding policy and knew the procedure to follow should they have any concerns. Staff spoken with confirmed they had undertaken mandatory safeguarding training.

We found that all individual care plans and risk assessments had been reviewed regularly and updated where required.

At the time of the inspection we found there to be sufficient staff to meet the assessed needs of the people living at Firbank House.

Medicines were managed safely and people were receiving their medicines in line with the prescriber’s instructions.

The recruitment processes which were in place were robust and required pre-employment checks were carried out to ensure staff working in the home were of good character and were suitable to work with vulnerable adults.

The service was working within the legal requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) applications were made appropriately.

People were encouraged to make decisions themselves and consent was sought prior to staff carrying out any interventions with the person.

Within care plans seen, people identified as being at risk of malnutrition had nutrition and hydration assessments in place and were weighed and monitored on a weekly basis.

Complaints were recorded, investigated, resolved and responded to in line with the organisations policy.

Below is a summary of what we found.

The summary is based on speaking with the registered manager of the service and touring relevant parts of the premises, including the 'old' building.

Is the service safe?

We found that some parts of the service were not safe.

During our tour of the 'old' building we had some concerns about the safety and suitability of the premises. Although the provider had carried out some work to some of the bedroom areas, most of the building still required re-furbishing to bring it up to a suitable and safe standard to again be used for residential purposes.

Is the service caring?

During this visit we found that appropriate action had been taken to address the concerns about maintaining the confidentiality and security of service user's records and personal information.

The inspection was undertaken by one inspector. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive and is the service well led?

This summary is based on a visit to Firbank House where we spoke with the registered manager and the provider (owner), and observed staff interactions with people using the service. We looked at records and talked in private with three people using the service, four visiting relatives and a visiting health care professional. We also spoke with an advocate from a local community advocacy service.

The full report contains the evidence to support this summary.

Is the service safe?

Overall the people we spoke with during our inspection visit were positive about the care provided by the service. People told us they felt safe. Relatives we spoke with told us they thought their relative was safe.

Staff told us they were confident that people received the care and support they needed and, when asked, were able to clearly demonstrate a good knowledge and understanding of people's individual needs. Staff also told us that they thought they had good working relationships with other health and social care professionals.

As we viewed some of the bedrooms and communal areas we noted that not all windows accessible to people using the service had appropriate window restrictors fitted. Some had small pieces of chain fitted, others had no restrictors fitted. Where vulnerable people have access to windows large enough to allow them to fall out and be harmed, those windows should be restrained sufficiently to prevent such falls.

On the upstairs corridor it was noted that the carpet was 'rippling' in places and frayed in some other areas creating potential tripping hazards. This could be a risk to people using the service, staff and visitors.

Is the service effective?

The manager confirmed that everyone who received a service had their needs assessed before the service started. This enabled the manager to identify anyone whose needs they could not effectively meet.

Staff spoken with confirmed that each person using the service had an individual care plan and that these plans were used to deliver support and assistance in a way that person wanted.

Many of the people who used the service were unable to fully express their views due to their varying levels of dementia and limited abilities to communicate verbally. Comments from people who were able to talk with us included: 'Everything is smashing here. The food is great and the girls (staff) are wonderful. I'm just very happy here.'

Is the service caring?

During our visit we saw staff working well with people living in the home. People told us they were happy with the way they received care and support from staff and that they could express their views and they felt listened to.

Relatives we spoke with told us, 'We are very happy with the care and support [relative] received. We met with Elaine (manager) before [relative] moved in and she explained everything to us [about the service]. Whenever we visit we are told how [relative] has been by the staff. The staff are really good and there is always someone [staff] around to help the residents.'

Is the service responsive?

There were systems in place to monitor the quality of the service that people received. This meant that the service was able to identify and respond to any shortfalls in the service. The registered manager told us that she had reviewed the care plan format used in the home and had developed a more 'person centred' plan that she intended introducing.

During our visit we saw staff respond to the needs of people living in the home in a timely manner. We saw staff engaging in meaningful conversations with people.

Is the service well led?

The service had a registered manager in post that had the support of senior staff. All the staff we talked with spoke highly of the manager and said she was pro-active and responded to any issues they raised with her.

Care plans and risk assessments had been reviewed and updated on a regular basis. We also saw evidence to indicate that other healthcare professionals such as General Practitioners (GPs), social workers and Speech and Language Therapist (SALT) had been involved in identifying, reviewing and supporting people's needs.

We found that there were sufficient numbers of staff on duty at the time of our visit.

Staff were receiving training that supported them to do the jobs they were employed to carry out.

Systems were in place to demonstrate that the quality of service was being monitored by the provider and registered manager.

Both staff and people living in the home were very positive about the management of the service. The manager had been in post since July 2012 and had previously managed another service belonging to the same provider.