This inspection took place on 4 September 2018 and was unannounced. Firs Residential Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 33 older people and older people living with dementia in one purpose-built building. Currently there are 29 people living at the home. Accommodation is provided over one level.
At the last inspection November 2017, the home was rated good. This is the first time the service has been rated Requires Improvement.
A registered manager was not in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager had been in post since October 2017 and was going through the application process to be registered with the Commission.
People told us they felt safe and staff knew how to recognise and report any concerns about people's safety and welfare.
Not all the required checks were completed before new staff started work to help to protect people. Staff told us the training was good and relevant to their role. However, records did not reflect training had taken place. Staff were supported by the manager and were receiving formal supervision where they could discuss their ongoing development needs.
Overall, there were enough staff deployed. However, we recommended the provider reviews staff levels at busy times of the day and during the night.
People who used the service and their relatives told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion.
Care plans were not all up to date. This meant care plans did not always detail what care and support people wanted and needed.
Individual risks to people's health and welfare were not always identified and managed. Their care plans were not always detailed enough, and this created a risk they would not consistently receive appropriate care which met their needs.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People’s healthcare needs were being met. Medicines were being stored safely; however, they were not always managed safely.
Staff knew about people’s dietary needs and preferences. People told us the food was very good. There were drinks and snacks available for people in between meals. Improvements were required to the service’s monitoring of nutrition and people’s weight.
Activities were on offer to keep people occupied. Visitors were made to feel welcome and could have a meal at the home if they wished.
The home was spacious but required decoration. Also, two bathrooms and one toilet were out of use, and the sluice room was being used as a store room.
The complaints procedure was displayed. The home had not received any complaints.
Everyone spoke highly of the manager who said they were approachable and supportive. The provider had systems in place to monitor the quality of care provided. However, these were not always effective. Where issues were identified they acted to make improvements; however, the outcome was not documented.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and made one recommendation. We are considering the appropriate regulatory response to our findings.
Further information is in the detailed findings below.