The Firs Care Home

The Firs Care Home is a residential care home providing accommodation and personal care to up to 26 people. The service provides support to older people some who may be living with dementia. At the time of our inspection there were 20 people using the service.

People’s experience of using this service and what we found

Medicines administration was not carried out safely or in line with the provider’s policy. Medicines open dates were not always recorded and protocols for ‘as and when required’ medicines were not always reviewed in a timely manner. Medicine trolleys were not stored securely. Risk assessments were not always sufficient to mitigate identified risks to people.

The provider could not always be assured robust recruitment checks had been carried out. Incidents and accidents were recorded though analysis of these to identify patterns and trends was not in place. Infection control practices were followed, and a new decorating programme had begun to address environmental areas needing a refresh.

The provider and registered manager did not have sufficient oversight of service delivery; audits of the service delivery were not effective or robust. The registered manager and staff worked with other professionals and families.

Staff had not all received sufficient and suitable training. Assessments of people’s needs were not always sufficiently detailed or addressed in their care plans. Staff supported people to eat and drink, though records of this did not reflect the practice of staff. People were asked for their consent when being supported by staff and had access to health care services when needed.

Care plans were not always person-centred. While no-one was receiving end of life care, there were end of life care plans in place. Complaints about the service were recorded and investigated where required.

The staff and registered manager were caring. They considered people’s equality, dignity and respect in every aspect necessary. People’s views were actively sought by the service and these were listened to and actioned.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 03 April 2019).

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment of people, records not being person-centred and oversight of service delivery at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ On arrival at the home visitors were screened for symptoms of COVID-19. There were PPE packs available to ensure their visit could take place safely in line with current guidance.

¿ People were supported to maintain contact with relatives. For example through phone calls, video calls and regular newsletters. There was a designated visiting space in place which visitors could access via a separate entrance. This space was divided by a perspex screen which meant people were able to see and talk to their visitors in a safe and comfortable environment. The provider noted that the perspex screen restricted people’s ability to be able to hear each other clearly. Therefore, the room was fitted with a microphone and speaker to improve sound.

¿ Specific training around infection prevention and control for Covid-19 had been given to staff to promote awareness and good practice.

¿ There is a designated domestic staff team to maintain housekeeping and ensure frequent cleaning of the home including all touch points.

The Firs is registered to provide accommodation and personal care for up to a maximum of 26 people some of who may be living with dementia. At the time of our inspection there were 26 people living at the home.

People’s experience of using this service:

People received safe care and support as the staff team had been trained to recognise signs of abuse or risk and understood what to do to safely support people. People received safe support with their medicines by staff who had received training and who had been assessed as competent. The provider had systems in place to respond to any medicine errors. The provider completed regular checks to ensure that people were receiving the right medicine at the right time. Staff members followed effective infection prevention and control procedures. When risks to people’s health and welfare were identified, the provider acted to minimise the likelihood of occurrence. The provider had systems in place to identify any maintenance issues and acted to replace furniture and equipment when it was needed.

The provider supported staff in providing effective care for people through person-centred care planning, training and supervision. People were promptly referred to additional healthcare services when required. People were supported to maintain a healthy diet and had choice regarding the food and drinks they consumed.

People received help and support from a kind and compassionate staff team with whom they had positive relationships. People were supported by staff members who were aware of their individual protected characteristics like age, gender and disability. People were supported to maintain their independence.

People participated in a range of activities that met their individual choices and preferences which they found interesting and stimulating. People were provided with information in a way that they could understand. Policies and guidelines important to people were provided in an easy to read format with pictures to aid their understanding.

The provider had systems in place to encourage and respond to any complaints or compliments from people or visitors.

The provider understood the requirements of their registration with the Care Quality Commission and was meeting the legal requirements. The provider had effective systems to monitor the quality of the service they provided and to drive improvements where needed. The provider had good links with the local community which people benefited from.

More information in Detailed Findings below.

Rating at last inspection:

Good (13 May 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection, ‘Good.’

Follow up:

We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

A registered manager was in post at the time of our inspection. 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.

Staff obtained advice from health professionals and took action so people’s health needs were met. Staff arranged for people to see their GPs and other health professionals when they needed to. Staff supported people to take their medicines so they remained well.

People benefited from living in a home where staff understood their individual needs and preferences. Staff recognised when people’s needs changed and took action so people continued to receive care in the best way for them. Staff knew about the things which were important to people and what things they liked to. Staff strived to assist people to keep their independence.

People’s right to make decisions and their freedom was protected. Staff knew what actions to take, if they had any concerns for people’s safety or well-being and was able to obtain advice from the registered manager, provider or external organisations if required. Staff were supported through regular supervision, training and meetings.

People had enough to eat and drink. Other people were supported to enjoy a range of food, drinks and snacks by staff so people would remain well.

People enjoyed being with the staff who cared for them. We saw people got on well with the registered manager and caring relationships had been built with the staff. Staff supported people to keep in touch with their families and to do the things they enjoyed doing. Relatives were welcomed into the home and encouraged to participate in the home’s social activities. People were given encouragement and reassurance by staff when people when they wanted this.

People were involved in deciding what care they received and staff encouraged people and their relatives to be involved in their care reviews so they received the care which was right for them. People and their relatives knew how to raise any complaints they had and were confident staff would take action if this happened.

The registered manager and senior staff team supported care staff to provide safe and compassionate care. There was clear and open communication between the registered manager and staff, so staff knew what was expected of them. Checks were undertaken on the quality of the care provided by the registered manager and provider and actions were taken where developments had been highlighted. The registered manager and provider made sure there was a focus on continuous development of the home.

We found that people were supported to make choices and decisions about the care that they received. Where people were unable to make decisions for themselves the provider had involved the people that knew them best to make decisions about the care they received. One relative told us: "They (staff) involve me in all aspects of his care'.

We saw that people appeared relaxed and comfortable. They were cared for in a way that they preferred. The relatives we spoke with were positive about their experiences of the care that had been provided. One person told us it was: "Homely and caring". Another person told us that: 'The care is good'.

We found that medicines were appropriately stored and administered.

There was a complaints policy in place and people were supported to raise any concerns.

The two relatives of people who used the service gave us positive feedback about the standards of care and support that the staff provided. One person said that they had, "Confidence in the staff skills". Another said that they had, "Never seen any ill treatment".

Staff employed at the service had access to further training and told us that they felt supported by their peers and the registered manager. One staff member said they had, "good access to training". Another said, "I feel completely supported in my role". This meant that staff had the support and knowledge to meet the care and welfare needs of the people living there.

There were regular meetings for people who used the service, their families and staff. This meant that the provider was able to review the quality of the service and to ensure appropriate care was being provided.