The Firefly Club Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

There were sufficient numbers of staff in place to meet people’s needs. We observed varying quality in relation to staff interactions with people. Some staff appeared skilled and motivated in their role, whilst others were not as pro-active in their approach. The provider needed to make improvements to ensure all staff had received training to promote a consistent and person-centred approach when supporting people. The provider had recognised where improvements could be made in their medicines management systems. They had taken action to improve the number of staff who were trained in medicines administration, which helped ensure staff were always available to provide this support. The provider had robust systems in place to safeguard people from suffering abuse or coming to avoidable harm. Risks in relation to people’s health and medical conditions were managed effectively. People were supported to access healthcare services where required and their health needs were regularly reviewed. However, the provider needed to continue work to improve how risks related fire safety and legionella were managed. They had taken actions in line with external professionals’ advice, but further time was required to ensure all recommendations were completed. The provider also needed to make improvements to ensure the service was always clean and hygienic.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were unable to give us verbal feedback about their care. Therefore, where appropriate, we spoke to relatives about their family member’s experiences of receiving support and care. The majority of relatives were positive about how incidents related to their family members had been managed by staff. 4 relatives told us they were confident that staff had the right skills to support their family members if they became distressed. However, 2 relatives felt that improvements could be made around staff’s abilities in managing incidents related to anxiety and behaviour. One felt communication could be improved when incidents took place, to ensure the family was made aware of the follow up actions taken to reduce the risk of recurrence.

Staff told us that they felt comfortable reporting safety concerns to senior staff and that they would be listened to, with incidents investigated appropriately. The registered manager told us there were systems in place to analyse incidents. They gave an example of how this had a positive effect for 1 person as they had recognised how they required personal space when they became anxious. In response to our feedback about some incident forms we reviewed being incomplete, the registered manager told us they were reviewing their incident analysis processes to help ensure all relevant actions were documented.

Incident forms were not always fully completed with some sections around steps taken to prevent future incidents left blank. The provider’s positive behaviour support lead had logged a record of incidents involving people’s behaviours over time, but there was no evidence of any analysis into why incidents had occurred. From the incident forms we reviewed as part of the assessment, there were clear themes, which could have been used to help develop strategies for staff to use to reduce the risk of recurrence.

People were unable to give us verbal feedback about their care. Therefore, where appropriate, we spoke to relatives about their family member’s experiences of receiving support and care. The majority of relatives told us that staff made efforts to help ensure their family members attended routine health appointments. They said staff had worked to help overcome barriers to accessing services, such as people’s anxiety around these situations.

The registered manager told us about how they supported a person to effectively transition into a different care setting. The registered manager worked with the incoming provider to help ensure the transition was managed at a pace where the person felt comfortable. This work helped to minimise the impact of this move by helping the person prepare and acclimatise to the change. The registered manager told us these measures had contributed to a successful transition to a new home.

We could not collect the evidence to score this evidence category. During our assessment we received and found no concerns in relation to safe systems, pathways and transitions. Partners we contacted had no specific feedback on this area.

There were appropriate policies and procedures in place to help ensure people had access to external medical and health services. This included documents that summarised people’s communication needs, which would accompany them to hospital or medical appointments, so external professionals would have an understanding of people’s needs. Staff had worked with people to overcome any anxieties people had over attending health appointments. This improved their access to healthcare and medical services.

People were unable to give us verbal feedback about their care. Therefore, where appropriate, we spoke to relatives about their family member’s experiences of receiving support and care. The majority of the relatives we spoke to were positive about steps taken to safeguard people from the risk of suffering abuse or coming to harm. Two relatives told us improvements were needed around how staff managed incidents between people. However, they felt issues were mainly related with agency staff and the quality of support had improved since more permanent staff had been employed.

Staff told us that they had received safeguarding training. Staff were able to describe different types of abuse, when to report any concerns to the senior staff and the importance of accurate record keeping in relation to safeguarding incidents. The registered manager had a good knowledge of local safeguarding procedures. They discussed safeguarding issues and scenarios in staff supervision and team meetings. This helped to ensure that staff had a shared understanding of their safeguarding responsibilities.

We made assessment site visits to the service on 3 separate occasions during different times of the day. We observed a range of staff providing support to people in communal areas of the home. We did not observe any restrictive practice and the support people received raised no safeguarding concerns.

There were appropriate safeguarding and whistleblowing policies in place to help protect people from suffering abuse or coming to avoidable harm. The registered manager had reported safeguarding concerns to relevant local safeguarding teams as required. This helped to ensure that concerns around people’s safety and wellbeing were investigated and concerns were addressed.

People were unable to give us verbal feedback about their care. Therefore, where appropriate, we spoke to relatives about their family member’s experiences of receiving support and care. The majority of the relatives we spoke to were positive about the support their family members received in managing risks. They told us that staff were effective in supporting their relatives to manage risks related to their health and medical conditions. However, 2 relatives told us some staff, were not confident in managing risks in relation to their family members behaviour, as a result, incidents were not always managed effectively.

Staff had a good understanding of what constituted restrictive practice and how they could work to minimise any restrictions in people’s lives whilst still managing assessed risks. They told us that people’s care plans contained suitable guidance about how to support people to manage risks and they felt confident in doing so. The registered manager had a good oversight of risks related to people’s care and effective strategies for staff to adopt when providing support.

We observed that the majority of staff had a good understanding of people’s communication needs and were able to support them effectively if they became anxious or distressed. We observed some examples where staff were not always pro-active or fully engaged when supporting people. Although we did not see people come to harm as result of this, staff were not adopting strategies identified in people’s care plan to help keep them engaged and calm. We brought this to the attention of the registered manager who told us they would address this feedback with staff.

People’s care and support plans contained guidance for staff about how to manage risks related to health, behaviour and wellbeing. Care plans reflected a positive behaviour support approach. Positive Behaviour Support aims to understand what behaviours that challenge tell us so that the person’s needs are met in better ways. This helped to reduce instances where people put themselves or others at risk through escalating anxiety. The provider also had plans in place to ensure people were safe in the event of an emergency or extreme situation, such as the care home not being habitable. There was a business continuity plan in place, which details the actions staff would take to keep people safe in such circumstances.

People were unable to give us verbal feedback about their care. Therefore, where appropriate, we spoke to relatives about their family member’s experiences of receiving support and care. 4 relatives we spoke to raised concerns about the care home environment. Concerns ranged from, lack of sensory stimulation at the service to accessibility issues which made it difficult for people to move freely around the home. Comments included, “I don’t think it meets [my relatives] needs, [there is]no sensory room” and, “I think the building design does not lend itself to [my relative], on steps he can get stuck.” The provider had also collected feedback from relatives where only 50% of respondents felt the care home environment was safe and met their family members needs.

Staff had a good understanding of fire safety procedures and told us they had received fire safety training. Feedback from staff collected by the provider via surveys reflected that 100% of staff felt the service was safe and well organised. The registered manager completed regular environmental audits, which helped to monitor the safety of the environment. They had recognised where some staff needed additional support to effectively carry out fire evacuations. They had organised more regular fire drills, which helped to ensure staff were confident in evacuation procedures.

We made assessment site visits to the service on 3 separate occasions during different times of the day. We did not observe any concerns about the safety of the care home environment during our assessment site visits. We made observations of arrangements around, fire safety, water safety and risks related to the physical care home environment, such as stairs. We observed that the service appeared tidy, with fire exits clear of clutter and appropriately identified through signage. We observed that fire safety equipment was in place and in good working order.

The provider commissioned an external company to complete a fire risk assessment of the service in February 2024. This highlighted actions with a recommended completion date within 30 days. The provider had completed the majority of the highlighted actions. However, at the time of our assessment, some actions were still outstanding. This put people at increased risk. We brought this to the attention of the provider, who gave us evidence and assurances that actions would be promptly completed. The provider commissioned an external company to complete a legionella risk assessment in July 2023. Although the provider had implemented most recommendations, there were still some incomplete actions outstanding. This included making procedures around monitoring hot water temperatures more frequent and robust. The provider had mitigated some risks around legionella through frequent flushing of outlets and water quality checks, but more work was needed to strengthen their risk management processes. There were effective operational risk assessments in place. For example, the business continuity plan detailed how people would be kept safe in the event of extreme circumstances, such as loss of electricity.

People were unable to give us verbal feedback about their care. Therefore, where appropriate, we spoke to relatives about their family member’s experiences of receiving support and care. 4 relatives told us there were improvements needed around staffing. The themes they reported were, lack of training around managing behaviour, inconsistency in approach (mainly new and agency staff), lack of training around medicines with medicines trained staff not always being available. Comments included, “[Staff turnover] changeover is high there” and, “No I don’t think so [that staff are appropriately trained). It is difficult, but staff should be trained to deal with [my relatives] behaviour.” We received positive comments from 2 relatives about staff’s engagement with their relative and the relationship they had formed. Comments included, “It’s taken a while but now they only employ [permanent staff]. We are seeing better improvements with consistency of people around [my relative]."

Staff told us they received good support from the registered manager in their role. They said that they had received training and ongoing support through supervision and staff meetings, where issues and feedback was discussed. The registered manager was working to improve the support staff received in their role. Actions included increasing the frequency of staff supervision, training staff to enable them to deliver training and ensuring more staff were trained in medicines administration. This helped to ensure more suitably trained and qualified staff were available. The provider had also adopted a new approach to managing challenging behaviour. The registered manager told us the new approach would be beneficial as it included practical strategies for staff to apply to real life scenarios when working with people.

We made assessment site visits to the service on 3 separate occasions during different times of the day. We observed a range of staff providing support to people in communal areas of the home. We observed a mixed quality of interaction and support between staff and people. Some staff were knowledgeable about people’s communication needs, and preferences. We observed some good practice with staff offering people choice, promoting independence and effectively using communication aids. However, this was not consistent with all staff. Although we did not see any unsafe practice, communication and engagement with people could have been more pro-active as some staff did not always appear motivated or confident in supporting people. For example, some staff did not utilise communication strategies identified in people’s care plans, which meant it was difficult to motivate people through different transitions between activities during the day.

The provider had systems in place to monitor staff’s ongoing training needs. However, the planned schedule of training updates was not in line with best practice guidance. For example, in areas such as basic life support and fire safety training, the timeframe between planned training dates was significantly longer than recommended. Not all staff had received training or training updates in the providers chosen specialist approach in managing challenging behaviour. This meant there were some staff who had not received training in line with the agreed approach in people’s care plans. The provider had safe staff recruitment processes in place, which helped them determine staff’s skills, experience and suitability to work with people. There were enough staff in place to meet people’s needs. The provider had recently made efforts to recruit more permanent staff to reduce the need for agency staff. They told us this would help promote a consistent approach as permanent staff would have have a greater depth of knowledge about people’s needs.

People were unable to give us verbal feedback about their care. Therefore, where appropriate, we spoke to relatives about their family member’s experiences of receiving support and care. We received mixed feedback from relatives about the cleanliness and hygiene at the service. 3 relatives felt the home environment was clean and well maintained. However, 3 further relatives told us improvements were needed in the following areas, cleanliness and condition of carpets, cleaning regimes in areas where people ate their meals, cleanliness of people’s private areas and communal spaces.

Staff told us they had adequate supplies of personal protective equipment (PPE) in place. They were able to explain appropriate use of PPE and the importance of hand hygiene. The registered manager told us they were addressing issues where they had observed some complacency around staff using PPE appropriately. This work was ongoing at the time of our assessment.

We made assessment site visits to the service on 3 separate occasions during different times of the day. We made observations of the cleanliness and effectiveness of the infection control practices at the service. Staff did not always follow best practice guidance. For example, food was found in the refrigerator opened without a label and not properly sealed. The registered manager was made aware of this and the visit the following day showed this had been acted upon as items in the refrigerator were appropriately labelled. On the 1st day of our assessment site visit, the inside of the microwave needed cleaning, as did the cooker hood and fan in the kitchen. This was brought to the attention of the registered manager. However, we observed during subsequent assessment site visits that the fan had still not been cleaned. We observed that one member of staff did not wear appropriate PPE, such as gloves or use hand hygiene when handling bags containing clinical waste. This increased the risk of infections spreading. The registered manager told us they would address this issue with staff.

The provider had an up-to-date infection prevention and control (IPC) policy in place. Staff had received training in infection prevention and control, which outlined how to reduce the risk of infections spreading, though adhering to good hygiene practices. There were appropriate levels of PPE available for staff to use. The registered manager monitored stock levels to help ensure there was an adequate supply. The provider had cleaning schedules to monitor how the service would be kept clean. However, these were not always completed, so there was not always and accurate record as to whether required cleaning had taken place.

People were unable to give us verbal feedback about their care. Therefore, where appropriate, we spoke to relatives about their family member’s experiences of receiving support and care. We received mixed feedback from relatives about the support their family members received around their medicines management. 3 relatives told us their family member’s received effective support in receiving their medicines as prescribed. 2 relatives told there were not enough staff in place who were trained in medicines administration. However, they told us that although there were on occasion short delays in receiving medicines, their family members did not come to harm as a result.

Staff who carried out medicines administration told us they had training and had their competency annually assessed. Staff who we observed were clear about their responsibilities and followed good practice. The registered manager had recognised where they could make medicines management systems more robust by ensuring more staff received training in medicines administration. The registered manager told us that now 80% of staff had completed this training, which helped to ensure there was always a trained member of staff available.

The provider had medicines management policies in place, which were developed in line with best practice. The registered manager completed regular audits of medicines management systems to monitor that people were receiving their medicines as prescribed. Some ‘when required’ (PRN) protocols were duplicated or out of date. We addressed this with the registered manager, who took action to remove all records which were no longer relevant. The provider had commissioned an external company to complete a review of the medicines management systems at the service. The review highlighted actions which would improve the safety of the medicines management systems. The registered manager was working to implement changes in line with these recommendations.