The Firs Residential Care Home

The Firs Residential Care Home is a residential care home providing personal care up to a maximum of 29 people. The service provides support to older and younger adults, people living with dementia and people who have a physical disability. At the time of our inspection there were 21 people using the service in one adapted building. There is a shared lounge, a dining room, and a conservatory on the ground floor. Bedrooms are single occupancy and are on the ground and first floors.

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

The quality of the service provided, the external building and internal facilities and décor had significantly declined since the last inspection. The provider once again failed to have a robust oversight of the service, this included when repairs were required and when safety concerns were raised. The provider failed to appropriately respond to promote safety and improve care quickly enough.

Fire safety risks, cleanliness concerns and environmental health risks to people found during this inspection meant that the CQC made referrals to the fire safety service and environmental health.

The provider had failed to learn from the 4 previous CQC inspections of this service since they registered in September 2018. This demonstrated to us that the provider had little understanding of the Health and Social Care Act 2008 Regulations and what standards were required to achieve compliance and provide good accommodation and a good service to the people in their care.

Accidents and incidents records did not give enough information to establish any patterns and trends and what action was required to reduce the risk to people. The governance system and audits in place to monitor the quality of the service provided were not robust. Actions to make improvements including improvements to safety were not acted upon quickly enough to reduce the risk of harm to people. Improvements made during the time the provider had registered with the CQC, were not embedded, or sustained to keep people safe and well cared for.

The had been numerous manager changes at the service during 2023. As such, people and their relatives had mixed opinions about communication in the service, as they were not always updated as to who was in charge. Some people and their relatives felt their suggestions and concerns were acted upon and some told us they did not feel listened to.

There were not enough appropriately trained staff to meet peoples' complex needs. As such, staff although kind towards the people they supported, were working in a task led approach. Lessons were not learnt when things went wrong, and as such, people were not always protected from harm. Safety risks following incidents were not appropriately identified, reviewed, and acted upon by staff. Again, the provider oversight of this was not robust, safe, or effective.

Due to the changes in management, staff had not received regular supervision. People’s relatives also told us that relatives’ meetings, where they could receive updates about the service had also stopped taking place.

People’s meaningful social opportunities, engagement and activities were limited, and this put people at risk of social isolation. This meant people spent long periods of time without stimulation.

The new computerised care record system did not robustly show that people’s records, including their dependency needs were updated following health changes, changing needs and or following a significant incident. People’s care records used to guide staff held conflicting information in them. People, their relatives where appropriate were not supported and or encouraged to be involved in their, or their family members care decisions and reviews.

In the main people were given choices and this choice respected, however this did not happen all the time and we found there were missed opportunities. People enjoyed their meals and were supported to eat and drink. However, robust records of people at risk of weight loss and any actions taken to reduce this risk were not in place.

In the main, 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.

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 service is now rated Inadequate. This service has been rated requires improvement for the last three inspections (published 27 May 2022, 24 December 2020, and 17 October 2019). The service was also previously rated inadequate (published 25 May 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 we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the cleanliness of the service, staffing, lack of staff understanding about safeguarding people and supporting peoples known risks, the state of disrepair of the building internally and externally and a general lack of financial investment by the provider. A decision was made for us to inspect and examine those risks.

We found evidence during this inspection that people were at risk of harm from these and other concerns. Please see the safe, effective, caring, responsive and well-led sections of this full report.

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 breaches in relation to safeguarding people from abuse; safe care and treatment; premises and equipment; staffing; person-centred care; and good governance 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Firs Residential Care Home is a residential care home registered to provide personal care and support to up to 29 people. At the time of our inspection there were 23 people using the service in one adapted building. There is a shared lounge, a dining room, a visiting pod and a conservatory on the ground floor. Bedrooms are single occupancy and are both on the ground and first floors.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Cambridgeshire and Peterborough. To understand the experience of social care providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

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

Improvements had been made since the last CQC inspection. People’s medicines were managed safely which decreased the risk of harm to people. Improvements had been made around staffs’ infection control practices in the main. However, some staff practice demonstrated that whilst improvements had been made, good practice was not always fully embedded.

People in the main, had risk assessments and care plans in place that guided staff on how to monitor people's assessed risks. Staff knew the people they were supporting well. However, not everyone at the service had detailed care plans and risk assessments in place to help to guide staff particularly new staff.

There were enough staff to support people safely, however staff worked hard and had become task led. This meant that people on occasion did not received person centred care.

Audits had made some improvements to the service provided but had not identified the shortfalls found during this inspection. This was in relation to records not always being maintained, or up to date, or on occasion person centred care not being carried out.

Staff were kind, and respectful towards the people they supported. People’s equality, diversity and human rights were promoted and respected. Pre-assessments were undertaken on potential new people to the service. This helped make sure there were enough suitably trained staff to support people in line with current guidance and legislation. Staff were trained and had spot checks undertaken to review their competency.

Staff were encouraged to discuss and review their performance with their manager through supervision. Potential new staff to the service had a series of checks carried out on them to make sure they were suitable to work with the people they supported.

Staff understood how to keep people safe from harm or poor care. Staff knew to report any concerns they may have had to their manager or CQC. When people wanted to discuss their end of life wishes this information was recorded to guide staff. Systems were in place to learn lessons when an incident, accident or near miss occurred or there was a risk of this.

Staff supported people with their food and fluid intake. People were encouraged to make their own choices and these choices were respected by staff. Staff helped promote and maintain people’s privacy and dignity. The manager and staff, when required, worked with external health and social care professionals. This helped people to receive joined up care and support. There was a process in place to investigate complaints.

People, and their relatives and staff were asked to feedback on the service. Information was available in different formats when needed to help enable a person’s understanding.

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.

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 24 December 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Following the last inspection (published 24 December 2020), and the identified breaches, we had serious concerns about the quality monitoring systems of this service and so we took enforcement action. The provider was required to send us reports each month including actions taken to ensure people receive safe and effective care and treatment.

At this inspection we found some improvements had been made and the provider was no longer in breach of Regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service continues to be in breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service remains rated requires improvement. This service has been rated requires improvement for the last inspection (published 24 December 2020) and requires improvement for the previous inspection (published 17 October 2019). The service was also previously rated inadequate (published 25 May 2019).

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We undertook this inspection to check they had followed their action plan and to confirm that they had met the legal requirements. We have found evidence of some improvement and that the provider also needs to make further improvements. Please see the responsive and well-led sections of this full report.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

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.

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 will take further action if needed.

We have identified breaches in relation to a continued breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. We also found a new breach of Regulation 9 (Person centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Firs Residential Care Home is a care home that was providing accommodation and personal care to 21 people at the time of the inspection. The service can support up to 29 people.

The Firs Residential Care Home accommodates people in one adapted building. There are shared lounges, a dining room and a conservatory on the ground floor. Bedrooms are single occupancy and are both on the ground and first floors.

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

Peoples medicines were not always managed safely which increased the risk to people. Some staff did not always follow current national guidance on when to wear personal protective equipment when supporting people.

People had risk assessments and care plans in place to give guidance to staff on how to monitor people’s assessed risks. However, some of these records lacked information to guide staff fully.

Audits had made some improvements to the service provided but had not identified the shortfalls found during this inspection. Staff had been trained on how to keep people safe from poor care and harm. However, there were delays in staff taking action and seeking advice when people had missed their medication. These delays had also not been identified in the governance monitoring of the service.

Relatives of people who lived at the service told us that communication was good, and they felt listened to and involved in their family members care decisions.

There were enough staff to meet people’s care and support needs. Staff involved and worked with external professionals to help people maintain their health and well-being. Recruitment procedures were in place to check whether a proposed new staff member was suitable to work at the service.

The registered manager made sure appropriate people and organisations such as the local authority safeguarding team, were informed when things went wrong. They gave people and their relatives opportunities to feedback and make suggestions on the running of the service.

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 17 October 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve (November 2019). At this inspection enough improvement had not been sustained 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 inspection (17 October 2019) and rated inadequate prior to that (published 25 May 2019).

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm that they had met the legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

The inspection was also prompted in part due to concerns received about staffing levels during the COVID-19 pandemic. A decision was made for us to carry out this focused inspection and examine those risks.

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 remained the same. 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 Residential Care Home on our website at www.cqc.org.uk.

We have found evidence that the provider needs to make improvements. Please see the safe section of this full report. You can see what action we have asked the provider to take at the end of this full report.

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 have identified breaches in relation to the safe management of medicines, infection prevention and control and governance at this inspection. This puts people at an increased risk of harm.

Following the inspection, and the identified breaches, we had serious concerns about the quality monitoring systems of this service and so we took enforcement action. The provider is now required to send us reports each month including actions taken to ensure people receive safe and effective care and treatment.

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 set up a meeting with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 Residential Care Home (The Firs) is a residential care home providing accommodation and personal care to 19 people aged 65 and over at the time of the inspection. The service can support up to 29 people.

The Firs accommodates people in one adapted building. There are shared lounges, dining room and sun room on the ground floor. Bedrooms are single and are on both the ground and first floors.

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

Medicines were not always managed safely, which put people at risk of harm. Staff did not always respect people’s privacy and dignity; care plans were not all fully personalised; and some people did not have enough to do to keep their minds and bodies active. Audits had not always identified where there were shortfalls.

We found there had been improvements made since our last inspection. Most of the time there were enough staff to meet people’s needs and the manager had followed good recruitment procedures to make sure new staff were suitable to work at the service. Staff knew how to keep people safe from avoidable harm and abuse and followed good infection prevention and control procedures. The manager ensured that lessons were learnt when things went wrong.

Staff had undertaken training and received support from senior staff to ensure they could do their job well. People enjoyed food that they had chosen and staff involved external professionals to help people maintain their health.

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 received kind and compassionate care and were involved in most decisions about their care.

People and their relatives were confident their views would be listened to and complaints would be addressed. Staff provided compassionate and kind care to people at the end of their lives.

The manager had worked hard to ensure improvements had been made and had a plan in place to sustain the improvements. They provided good leadership, made sure appropriate people were informed if things went wrong and involved people and their relatives in the running of the home.

Rating at last inspection and update

The last rating for this service was inadequate (reports published 20 March 2019 and 28 May 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. At this inspection we found improvements had been made. However, the provider remains in breach of one regulation.

This service has been in Special Measures since March 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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

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

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 a breach in relation to safe management of medicines at this inspection. This puts people at risk of harm. The manager took immediate action to reduce the risk.

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 from 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.

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

People’s experience of using this service:

Risks to people were not managed safely. People were at risk of choking due to swallowing difficulties and this was increased because staff did not always follow guidance about food and drink preparation. People had lost weight but not enough action was taken to reduce the risk of this continuing. Staff did not know how to support people with their health conditions, such as diabetes, which put them at risk if these worsened. People were at risk from a lack of staff understanding about moving and handling equipment.

Fire evacuation information was incorrect and had not been updated to include all of the people living at the home. The safety and effectiveness of giving medicines covertly had not always been considered as advice or alternative medicines had not been sought. Safeguarding referrals were not made to the local authority safeguarding team and the manager did not recognise when this was required.

There was a lack of managerial oversight at the home, which lead to low staff morale and a high turnover of staff. The provider’s monitoring process did not look effectively at systems throughout the home. Where issues were identified, there was a lack of action to address them and these continued. There were not enough staff available to make sure people received care in a timely way. People had to wait for care, meals and to go to the toilet. Staff recruitment checks were not always fully obtained before new staff started working at the home.

Lessons were not learned about accidents and incidents and it took time to implement actions to reduce these. Medicines were stored safely, and records were completed correctly. Regular cleaning made sure that infection control was maintained and action was taken to address issues.

People were cared for by staff who had received some training but did not have all the skills or support to carry out their roles. People received a choice of meals, which they liked, and staff supported them to eat and drink. People were referred to health care professionals as needed although staff did not always follow the advice professionals gave them. Adaptations to the environment were made to ensure people were safe and able to move around their home as independently as possible. Staff members understood and complied with the principles of the Mental Capacity Act 2005 (MCA). People were supported to have choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were caring, kind and treated people with respect. People were listened to and were involved in their care and what they did on a day to day basis. People’s right to privacy was maintained by the actions and care given by staff members.

People’s personal and health care needs were met and people were happy with the care they received. Some care plans were written in detail to provide guidance to staff Other care plans were not available and staff did not always have appropriate guidance to care for people. There were activities for people to do and take part in and they enjoyed these when they were available. However, people told us they had little to do when the staff member responsible for these was not working. A complaints system was in place but complaints had not been investigated and responded to when they were first made. Staff had some guidance and support about people’s end of life wishes, although information in care records was limited.

We found several breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

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.

The service met the characteristics of Inadequate in two areas and Requires Improvement in three areas; more information is in the full report.

Rating at last inspection: This was the first inspection for this service.

Why we inspected: We brought this inspection forward due to information of risk and concern received from the local authority.

Enforcement: Action we told provider to take (refer to end of full report)

Follow up: The service has been placed into Special Measures. Services in special measures will be kept under review and will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures which may lead to begin the process of preventing the provider from operating this service. We will continue to monitor all information we receive about the service and schedule the next inspection within six months of publication of this report.