An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?The Firs is one of a group of residential homes providing care and support to people within a village environment known as Ravenswood Village. It was run primarily for those of Jewish faith, but people and staff did not have to be Jewish to live or work there. People were supported to practice their faith, and the village celebrated Jewish rituals and festivals. People had the choice of whether they wished to attend the synagogue or follow Jewish rituals.
The location did not have a registered manager at the time of our inspection. This is a requirement for registration with the Care Quality Commission (CQC). We spoke with the person managing the service on the day of our inspection. They told us they had submitted their application for the role of registered manager to CQC. Our records confirmed this.
As part of this inspection we spoke with three of the ten people who use the service, four people's relatives, the manager, two deputy managers, three care workers and one volunteer. We also reviewed records relating to the management of the home, including five care plans and daily care records.
Below is a summary of what we found.
Is the service caring?
One person told us 'I like the staff'. We observed staff were patient and caring, and people sought their company. People and staff dined and chatted together. This indicated to us that people felt relaxed with and enjoyed the company of staff. All the relatives we talked with spoke positively about the care that staff provided.
One relative told us the service was a 'family unit', as the people had lived together for a long time. They said 'Those needing extra care get it. Care workers treat people respectfully. When X visits us they always ask when they can go back home. X is happy to be there'. Another relative said care was 'Very client led. They work carefully with people to ensure their wishes are considered'. They told us when they visited they saw that staff were attentive and respectful when interacting with people.
Is the service responsive?
We saw staff were responsive to people's needs and wishes. One relative told us staff were 'Committed to addressing X's [health problem]'. One care worker told us 'We work with rather than for the residents'. They understood people's anxieties, and took actions to promote people's wellbeing.
Care plans recorded people's support needs, and we saw this information was reviewed on a quarterly basis, and updated when it had been identified that people's needs changed. Care workers spent quality time with people, and were able to identify slight changes in people's facial features or gestures if people were unable to verbally communicate. This meant care workers were able to respond promptly to indicators of ill health, discomfort or dissatisfaction.
When people required health interventions, we saw records documented that staff ensured they attended health appointments and followed guidance from health professionals. This demonstrated that the service was responsive to people's needs.
Is the service safe?
We found the service followed safe practices. For example, assistive technology, such as sensors to detect seizures at night, had been used to promote people's safety when asleep. Risk assessments had been completed and reviewed to protect people and others from identified hazards. Accidents and incidents had been reviewed to reduce the risk of repetition.
The provider ensured essential checks and services had been completed in accordance with health and safety and manufacturers' guidance to maintain the safety of the service. For example, we saw gas safety certification, and noted the lift had been regularly serviced. Safety checks and regular maintenance protected people from potential harm.
We found there were sufficient staff to support people safely. People's needs were assessed, and the number of staff on duty was directed by this needs analysis. The manager ensured staffing levels were sufficient to support people with their planned activities.
Records were stored securely. This meant information about people and staff could only be accessed by those authorised to do so.
Is the service effective?
At our last inspection in September 2013 we did not find systems to monitor and assess the quality of the service had been effective. At this inspection we found actions had been implemented to provide assurance of an effective service delivery.
One relative told us 'Overall I am very happy X is there. Any problems are minor. X is safe, secure and well cared for'. All the relatives we spoke with told us that their loved ones were effectively cared for in accordance with their care plans.
Records demonstrated that information was documented, reviewed and analysed to ensure people were cared for appropriately. This showed us that the service monitored and assessed the care people received to ensure they were cared for effectively.
Is the service well led?
We found the service was well led. Relatives we spoke with told us the manager had implemented changes for the better. One relative told us 'We can see a big improvement since the manager's arrival'.
We saw evidence that feedback was sought from people, their families and staff, and issues identified were acted on. For example, we saw changes had been made to the menu to provide healthier options, and people chose where they wished to holiday.
We saw checks and audits ensured care worker's allocated roles and responsibilities had been completed. Where information required updating, we saw entries in the communication book, or discussion in team meetings, to remind staff to address identified issues. This meant that staff understood the procedures required to ensure people were appropriately care for.