The Firs Residential Care Home

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Improvements had been made to the quality monitoring, governance systems and provider oversight of the service. This meant that the service was no longer in breach of regulation. However, more time is required to ensure, and evidence, the improvements made continue to be fully embedded and sustained. Most records had improved; however, some records required more details. This included safeguarding, and complaints logs to highlight and have oversight of any patterns and trends. Also, the majority of the out of hour monitoring reports did not record the time of the visit. A provider visit record evidenced also did not record the year the visit took place. Whilst improvements had been made to health and safety and infection control practices, health and safety audits and infection control audits had not identified improvements still needed. Staff training had improved although processes required further review. Where training was undertaken, it was important this be reviewed with all staff to ensure their full understanding and confidence in areas. For example, whistleblowing and fire safety. Furthermore, where actions are set as part of competency assessments, action dates should be clearly recorded, and completion reviewed and documented. People and their relatives, or representatives, could feed back on the service in various ways. However, feedback did not clearly document where free text suggestions were made. Also to promote openness and transparency surveys should record who, including the name of the staff member, helped people complete the survey.

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.

Most staff told us they felt supported by the new management team. Staff through improved engagement with the management team had a better understanding of the values of the service. The provider and staff team now understood their role was to also make the people who lived at the service feel cared for, respected and valued. The registered manager told us about the vision and organisational culture of the service. They said they thought the environment of the home was now, “Fantastic.” The registered manager went on to describe the shared direction of the service and its new values. They said, “There is a reason I came to this home, I don’t want what happened previously.” [Service’s previous failings].

Meetings were held to try to make sure that people, their relatives or representatives, and staff were briefed on improvements being made. This included improvements to organisational culture and the importance of embedding the services values. This included a staff meeting held after the first CQC site visit where staff were reminded that standards of care needed to remain high.

During the assessment process, the new management team demonstrated their understanding of past regulatory failures and told us they were committed to providing a safe and effective service. In the main staff felt supported by the new management team in place. A staff member talked through their experience of working at the service. They said, “[I have the] managers support, they always support us [staff] and sometimes a colleague or a manager will give advice. Any problem, any issue the manager says just come here [to the office] and I will solve it.” The registered manager talked through the changes the new management team had implemented to help ensure compassionate care was delivered by the staff team. They said, “More care of the residents, care given in a person-centred way. Environment is much better 110% better, staff are more skilled, and the home is getting good management team…The development never stops.” They confirmed that for any staff training developments identified, the provider was spoken with.

There was a service improvement plan in place dated 12 July 2024. These itemised areas requiring improvement and whether the actions to make these improvements were completed or ongoing. Ongoing improvements included, but were not limited to; ongoing refurbishment, recruit an activities co-ordinator, implement a robust induction, create staff champion roles, and improvements to quality monitoring analysis to ensure robust systems are in place. However, further time is needed for the provider to evidence these areas are actioned, embedded and sustained.

The registered manager told us that an improvement made since the last inspection was that the new management team were in place and available to people, their relatives or representatives. They said, “Management team always available to discuss anything.” Relatives confirmed this was happening and that communication with the management team and staff had improved. However, 1 staff member told us they were not aware of how to whistle-blow concerns.

The provider sought feedback from people. However, during our review of people's feedback from June 2024, it appeared people had been supported by either staff, or their representatives to complete this, some forms had answers such as "stayed quiet" or "hasn't answered". Who had assisted the person was not documented. This is important because people may not feel completely at ease when raising suggestions or concerns with a member of staff present and so chose not to say anything. There were few, if any, alternative ways to capture people’s views where there were unable to verbally or with the use of aids share their experiences. We reviewed the relatives survey evidence. The analysis did not clearly show that people’s relatives, or representatives, were also given the opportunity to feedback specific suggestions, good practice and concerns.

There was a diverse workforce at the service. Most staff felt supported by the provider and new management team. A staff member said, “We all work well as a team and get on.” However, 1 staff member gave examples to us of how they did not always feel supported by the management team.

There was a diverse workforce at the service. As they had recruited overseas staff. An overseas staff member told us, “[I am] being treated well.” Records, such as staff meetings minutes, demonstrated that staff were included in discussions surrounding the support provided at the location.

Staff talked through the improvements made at the service including the quality of care now provided to people and how this improved staff morale. A staff member said, “Staff morale [is] good, feel happy to report [concerns], team meetings once a month with managers, small flash meetings daily, everyone [working] on floor and seniors [in post].” Another staff member talked us through the systems now in place. They said, “Documentation, protocols, structures, models, framework implemented, compliance manager comes 2-3 weekly unannounced and checks all.” Although the registered manager told us they were aware of the need to continue to improve and embed good practice. They gave us examples of work currently being undertaken to improve the service. This included improving staffs’ documentation and notes.

Improvements had been made to the quality monitoring of the service. However, more time is needed to be assured the improvements made had been fully embedded and sustained. Audits were carried out to monitor the service provided and the quality of documentation. Some records, whilst improved, could benefit from further improvement to ensure they are fully robust. For example, 'out of hour monitoring reports' did not always document the time of the visit. The 2024 safeguarding log did not summarise the 'abuse' or 'neglect' recorded to highlight any trends. Furthermore, the 2024 complaints log could be more robust for monitoring themes with further detail included. We looked at the health and safety audits for April and May 2024. We also looked at the infection control audits for May and June 2024. These audits had not identified 3 window restrictors in place did not meet the necessary safety standards. Also, audits had not identified some damaged surfaces needed improvement as they did not promote good infection control in the current condition. We found on speaking to staff, staff training processes required review. Where training was undertaken, it is important it is reviewed with staff to help ensure their understanding and confidence in areas, such as whistleblowing and fire safety. Furthermore, where actions are set as part of staff competency assessments, action and completion dates reviewed and recorded. Whilst we found improvements in people’s records, some further specifics required oversight. For example, 1 care record stated a person was to receive a specific diet due to a health condition. On discussion with the chef, we identified this was not being provided. Through conversation, the registered manager told us an external health professional confirmed a specialist diet was not needed. We asked for this to be reviewed. A person’s mobility needs had started to change, and records held for the person were not consistent in recording this change.

A person was supported at the service via a ‘virtual ward’ set up. This helped ensure that where appropriate, the person received the care they needed. But experienced this in their home environment, such as the service, rather than in a hospital setting. Telephone calls were made by the registered manager to the ‘virtual ward’, and we also overheard the management team at the service liaise with external health professionals including the persons GP.

Since the last CQC inspection the management team and staff worked with an external agency of consultants, and the local authority, to make the improvements required at the service. The registered manager explained how following a persons fall they communicated with the persons GP, the local authority safeguarding team, and a district nurse. They went on to tell us how they had communicated with a person’s social worker to support the persons wish to have trips out in the community.

A local authority monitoring visit report rated the service as good – dated January 2024.

The registered manager talked through the learning and improvements made in their opinion since the last CQC inspection. They said, “Person-centred care, environment, maintenance [person] checking every day, chef and cook and good food, residents like the food. Things are quickly fixed. Provider understands now they need to react quickly and get things fixed fast.”

Improvements had been made to the governance systems, the processes in place, and the quality monitoring of the service provided. Daily handovers, flash meetings had also been introduced to help make the necessary improvements. However, there were still some minor issues found by the CQC that had not been identified by the governance monitoring systems in place.