The Firs Residential Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Staff knew the people they supported well. This included people’s individual preferences and wishes on how they wanted staff to care for them. Improvements had been made. We saw documented evidence that people and / or their relatives had been involved in the assessment and reviews of their family member’s needs. Care records were now written in a person-centred way. Staff sought consent from people before carrying out care tasks. Effective systems and processes ensured that where people had DoLS authorisations in place, these were effectively managed. Advocacy services were available for people where required, and records evidenced where legal representatives had been appointed. People seemed to enjoy their meals and were offered menu choices. This included plated up choices to stimulate people's sensory needs enabling them to make decisions. The management team and staff made referrals to and worked with other teams such as the local hospital, GP, community nurses to ensure a continuity of care. Since the last inspection, improvements were noted in staff awareness of current guidance and legislation to provide effective care and support. Staff signed to say they had read company policies, procedures and government legislation. However, on our review, we found staff had not always dated when they had read policies and procedures. This meant we could not be assured of exactly when they were read and signed as understood by staff (especially important where policies may be updated).

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

A relative told us how staff had discussed with them to agree the best way to support their family member’s needs. They said, “[Family member] has a [health condition], so [staff] have put [them] to bed. I have queried this before as staff before always put [family member] to bed, and I was not comfortable with this [social isolation]. This time they explained to me the reason why and asked my permission. I have met both the registered manager and the deputy manager, and I had a meeting with them.” A person when asked about the care and support staff gave them, and whether it met their assessed needs confirmed, “[I’ve] got no concerns.”

The registered manager told us how they ensured staff could meet people’s assessed needs using a person-centred approach. They said, “We check staff skills and people’s needs. If we feel we cannot meet people’s needs we would contact the local authority, or if privately funded, a family member to inform them the persons needs had outgrown the service. [The management] don’t just think about the money, it is whether staff can meet their needs.”

Effective risk management took place to monitor people's risks included people being at risk of weight loss or gain. Improvements had been made to evidence outcomes for people through robust staff monitoring and responses to people’s known risks. For example, to help people maintain weight we saw recorded evidence of interim measures such as enriching foods at the service. Staff also contacted the persons’ GP and referrals were made to specialist health professionals such as a dietitian. People’s care records were reviewed and updated in line with advice received. Where people were at risk of skin damage, staff took responsive action with provisions of air alternating mattresses. Staff also assisted people with positional changes and skin monitoring.

People and a relative told us about the improvement in the food. A relative said, “Food has improved with the new chef… [people] do have food choices. [Staff] put the covered two plates [of food choices) in clingfilm on a tray and go round to all in the dining room.” Another relative told us, “One person told me the food is good, I didn't ask but they volunteered this.” A person confirmed, “Food is very nice, I get choice, I come to the dining room for my meals.” Both visit days were warm in external temperature and staff encouraged people to take on fluids in varying forms to remain hydrated. People were observed to be regularly provided with drinks and ice lollies of choice by staff.

The registered manager explained to us how guidance and legislation including updates were communicated to staff. The registered manager said, “[It’s] communicated via group staff meetings, each month. [We have an] 11am meeting [flash meeting] and handovers, senior team leaders [are also] instructed. As a registered manager and the deputy manager walk the floor and ask staff questions re knowledge and check staff are following guidance.” The registered manager went onto say that staff were asked to read, sign and date to confirm they have read the guidance or legislation. It was also printed out for staff to read. They confirmed, “[Named digital record system] is a computerised system used at the service, so guidance is on this system and staff have a log in.”

Since the last inspection, improvement was made in the monitoring of staffs’ awareness of current guidance and legislation. This would help staff provide effective care and support in line with current practice. Staff now signed to evidence having read company policies, procedures and government legislation. However, staff had not always dated when they had read these documents. This meant we could not be assured of exactly when new or updated guidance were read and signed as understood by staff. Evidence was available within the digital records system of people being supported with specific treatment, such as dentistry. Short-term care records were in place to guide staff, for example when people had an infection. This directed staff on the importance of specific short-term requirements, such as medicines, reviews, monitoring of fluid input and output and nutritional intake. Processes had been implemented to promote food intake. Staff used small plated up meals to help encourage people to make their choice of what they wanted to eat. This stimulated people using visual prompts, and smell to make informed choices. People were also offered additional helpings. Two people on specialist diets were seen to be served their food pureed to reduce the risk of choking and poor swallowing.

Staff supported people appropriately by making referrals to health professionals and accompanied people to appointments where necessary. Health professional services involved with people at the service included: visiting chiropody services, virtual ward, dietician, mental health team, DoLS assessors, district nurses, GPs and diabetic nurses. The virtual ward is a support service on discharge from hospital to allow medical review, input and oversight to continue in a person’s home environment. The registered manager explained how they had worked with the GP and a visiting district nurse when a person had a fall. The GP on request reviewed the persons medicines and stopped 1 of their tablets.

The local authority contract monitoring report dated January 2024 shared with the CQC prior to the assessment scored the service overall as good.

Staff had access to detailed individualised information about the people they cared for and supported. Digital records evidenced people’s background history, their health conditions, known risks, preferences and likes and dislikes. This information was seen being shared with visiting health professionals. This also helped inform the hospital information sent with people when hospitalisation or medical appointments took place.

To promote people’s well-being and to promote social inclusion, staff encouraged people to take part in activities. During our first site visit we saw armchair exercises were taking place to help people increase their level of physical activity. People also told us how staff enabled them to access external health professionals when needed. A person said, “[I’ve] seen the doctor…a chiropodist last year, I think I had a hospital appointment.”

A staff member explained how they and the staff team supported people to live healthier lives with external professional input where required. They gave an example of 1 person who had regular falls and the external health professionals and services they contacted for support and advice.

The management team and staff made referrals to and collaborated with other teams such as the local hospital, GP, dieticians and speech and language therapists to ensure continuity of care. All referrals, appointments and visits were clearly recorded within peoples’ records, including any advice given and outcomes. People’s digital records were reviewed following specific health professional involvement, and information for action was contained within these. Evidence provided by the management team showed people’s relatives or representatives being notified, where appropriate, following their family members appointments and or assessments including any outcomes.

Staff routinely monitored people’s care and treatment and completed this on a scheduled basis. The service operated a ‘resident of the day’ process. This meant each day of the month 1 person’s care record would be formally reviewed, with the person, or with their relative or representative, if appropriate. The registered manager was asked how they monitored that people got the care they needed, in line with people’s expectations. They told us they completed, “Regular checks and complete audits. And during walk arounds I will check what staff have written down [care tasks]. We are working with staff on how to write more detailed meaningful daily notes.”

Evidence was available which identified how people and their relatives were involved in the care planning process. Records identified regular reviews with people. Staff ensured reviews took place during the 'resident of the day' monthly process, and reviewed promptly should people’s needs change.

Staff asked for people’s permission before undertaking care and support tasks. People also told us that staff respected their choices and wishes. A person said, “It’s my choice when I get up and go to bed.” Another person told us, “I stay in my room, my choice.”

The registered manager confirmed to us, and we saw that advocacy services were available for people who needed additional support to make decisions on their care and support needs. Where people had a DoLs authorisation in place staff were aware this did not restrict the person’s ability to make all decisions. Staff understood the importance of offering and enabling everyone a day-to-day choice. This included how people wished to spend their time and what food and drink they would like to have. The management team told us they had received positive feedback from a visiting health professional regarding people’s care records and risk assessments. This, they said, led to the health professionals having confidence in the individualised care provided to the person.

Improvements had been made since the last inspection. Effective systems and processes in the form of a tracker were now in place to manage and have oversight of any DoLS authorisations in place for people. People were supported to make decisions, where they were able to do so. Family members and legal appointed representatives were involved as required. Care was provided in the persons best interests and in the least restrictive way possible.