The Firs Residential Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Improvements had been made since the last inspection and people now received person-centred care that supported their social inclusion needs, and interests. Activities now took place to help people spend their time meaningfully. Staff now understood the importance of in-depth consideration of people’s wishes when they were entering their end-of-life care. This information was now recorded to guide staff. This meant that the service was no longer in breach of any regulations. However, the management team were still trying to recruit an activities co-ordinator. In the meantime, staff had improved the number of activities undertaken at the service to help ensure people had social interactions. In the main, people were supported with person-centred care and support, although 1 person was served a food option, they told us they did not like. Most people's individuality and preferences were considered and promoted within their care. Protected characteristics such as disability, sensory needs, and religion were considered in the assessment process. People told us they were treated and respected as individuals and that staff listened to their wishes. People were encouraged to feedback on the service provided. Information was available in different formats to help aid people’s understanding. People and their relatives felt listened to when raising a concern or suggestion and these were resolved where possible.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most people’s personal preferences and support by staff was carried out in a person-centred way. This included staff knowing and respecting people’s likes and dislikes. However, 1 person said they did not like a certain food type, and we saw staff gave this person this food type already plated up during lunch. This demonstrated to us that not all personal preferences were communicated to the staff team. A person told us about their wishes that staff respected. They said, “I am perfectly happy sat on my bed and I can see my TV, I like my curtains open, I don’t want an armchair.” People were now asked their preference of the gender of staff supporting them with personal care. A person when asked told us, “It does not matter if they are male or female, they are alright.”

The registered manager told us that, “Person-centred care,” was now being delivered by staff. A staff member when asked to describe person-centred care responded, “It has to be specific to the person you are caring for.” Another staff member said, “Before going in [persons] room I knock, ask their permission to clean the room and if they refuse, I inform the manager and never ever go in if they have personal care.” However, during our site visit staff were not always fully aware of people’s individual likes and dislikes.

We saw specific technology was in place to assist people with their individualised needs. One person who was at risk of falls had a falls sensor mat, and a motion sensor in place. This alerted staff that the person was moving around. A member of the management team explained the importance of the motion sensor verses the falls mat. Without the person having direct contact with the mat, the alert would not be activated to signal staff. So, the technology we saw in place helped to further reduce the risk of falls, before a fall occurred.

People were supported by a consistent staff team who knew them well. This helped ensure continuity of care and support. Whilst there had been staff turnover since the last inspection, good rapport and professional relationships had been built. This meant staff knew people well and could be responsive to their specific needs. A staff member told us how they got to know people they supported. They said, “I implemented resident of the day. [We] review risk assessments, [mental capacity assessments] MCAs, care plans, ask cook to speak with them and do a deep cleaning of [their] room.”

The management and staff team used consistent local services for people, and this consistency also provided continuity of care. This included the same team of district nurses visiting, and regular and flexible support from the local GP service.

A relative told us of the communication improvements at the service. They said, “Communication and feedback is brilliant now. They listen and respond”, and “I have met both the registered manager and the deputy manager, and I had a meeting with them... They have my email address now so they can contact me.”

The registered manager gave examples of how the service was able to use the Accessible Information Standard (AIS) to communicate with people and help aid people’s understanding. They confirmed they could provide information in large print and or in pictorial form if preferred. They also said that the, ‘you said, we did’ feedback form for people to use, was in large text. Information in pictorial forms to remind people that food was available to them 24/7 should they wish.

Processes were in place to help make sure people’s digital records documented where people required assistance with communication aids. This included the need to wear glasses, use an eye glass, hearing aids or dentures (to assist with speech). This information guided staff about people’s sensory needs. Records also documented where these aids were not used by the person through choice, despite sensory loss, and how best they could still be supported by staff.

A relative told us that the management team, “Listen and respond.” However, they also told us they were not aware of any relatives’ meetings that had been held. Nor were they aware of any surveys to complete to give feedback on the service provided. They said, “[I’m] not aware of any recent relatives’ meetings but they have said they are organising some. I have had phone calls from the service to give feedback. Not aware of any surveys.”

The registered manager told us how relatives were able to raise individual suggestions and or concerns. They said, “[We] try to give feedback opportunity to [relatives] when they visit. Give a relative the [computer] tablet to give feedback on.” When asked if they felt there were missed opportunities of free text for people to explain their answers or raise specific concerns or suggestions. The registered manager told us, “The surveys were previously sent to residents’ family. They didn't get returned or they thought the survey was too long to complete.” They went on to give examples of a relative’s concern and how it was resolved.

Processes were in place for people and their relatives or representatives to feedback on the service and make any suggestions or raise concerns. There was a ‘you said, we did’ suggestion board and a complaints box in reception for people to raise complaints. However, during our first site visit there were no pens and paper available to raise concerns should anyone wish to. Whilst this was resolved quickly when pointed out. This increased the risk of feedback not being freely captured in the moment. We saw minutes of a resident’s family meeting held 29 June 2024. Five relatives attended. The services owner, registered manager and deputy manager were present. At the meeting, discussions were held about the commitment to ongoing improvement to address the last CQC inspection findings. Those present were also updated following a local authority visit and talked about the Environmental Health Officer (EHO) visit. Residents had a meeting held on 30 June 2024. Minutes from the meeting included discussions around, knowing the owner, food and meal choices. Actions to follow up from the meeting included people’s’ meal preferences. The services complaints process was also discussed. People were reminded that the management teams office door was always open for discussions.

People had access to care, support and treatment they needed. This included in the event of an emergency. Pathways in communal external areas of the service had improved since the last inspection to make access more accessible and safer for people. This included people at risk of poor mobility.

Staff acted to ensure people had access to specific health professionals when needed such as GPs, district nurses, and dentists. For example, the registered manager talked us through the contact they had with a person’s GP around whether the person needed a specialised diet or not.

Processes were followed by staff to help make sure people had access to specific health professionals when required. For example, twice daily telephone calls took place to the service, from the virtual ward. During these calls health professionals sought information about the person which included clinical observations (blood pressure, pulse, oxygen saturation's), medical device reviews and medicine compliance. In addition to the virtual ward support the person also had GP and district nurse reviews.

A person who was cared for in bed, confirmed to us that staff knew their wishes. They said, “They all know that is what I want.” A relative said about conversations they had with the management team about their family members care and support wishes, “They listen and respond.”

The registered manager was not able to give any specific examples currently in the service but described previous care services worked in and how they promoted people from communities whose voices were seldom heard. This was to demonstrate their understanding of the importance of this.

Processes were in place and records documented that people, when needed, had access to specific health professionals.

The registered manager told us, staff had end-of-life care training. They then said that they had [number of] years of end-of-life care experience and collaborated with staff on how to do this. Two people at the service had recently received end-of-life care. The registered manager said the families were happy with care provided by staff.

During this assessment no person was receiving end-of-life care. Improvements had been made around the recording of people’s wishes should their health deteriorate quickly. People were now asked to make advanced decisions regarding what they would like to happen at the end of their life. This included placement of their care. Records also showed staff had death, dying and bereavement training.