Archived: Firwood House

There is a registered manager at the service. 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.

This was an unannounced inspection, which meant the provider, and staff did not know we were coming. It took place on 14 and 15 August 2017.

We previously inspected Firwood House in June 2016 where we rated the service ‘requires improvement’ however; there were no breaches of regulations. This was because we found some areas of practice that needed to improve. At this inspection, we found that improvements had been made and improvements were now fully embedded into practice.

People were supported by staff who had taken the time to get to know people as individuals. They had a good understanding of their needs and the support they required to enable them to return to independent living. Staff cared about people, they treated them with compassion and respect. The service was a happy place and we observed relaxed conversations and humour between people and staff.

People were involved in decisions about their own care. They were supported to identify their own goals and what they needed to achieve to return home safely. People’s support plans contained information staff needed to support people appropriately.

There were enough support staff, nurses and therapists on each shift to safely meet people’s needs. Recruitment systems were established and only suitable staff were employed to work at Firwood House.

There were systems in place to ensure medicines were safely managed and people received their medicines as prescribed. Staff had a good understanding of safeguarding and knew what steps to take if they believed someone was at risk of abuse or harm.

Risks were managed safely. Risks to people had been identified and guidance provided for staff about keeping people safe but helping them to maintain their independence.

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 were supported to eat and drink a variety of foods and maintain a healthy diet. Nutritional assessments were in place to identify people who may be at risk of malnutrition.

There was an effective training and supervision system in place. Staff competencies were regularly assessed. This meant people were cared for by staff that had received training and skills to meet their needs.

People had access to health care services to maintain their health and well-being.

There was clear leadership and staff understood their roles and responsibilities. The registered manager was well thought of by people and staff. There was an open and positive culture which was focussed on ensuring people received good person-centred support and achieving their individual goals. Good communication and teamwork was evident. Staff described an open culture where their views were valued.

People’s feedback was actively sought and used to improve and develop the service. Any concerns or complaint raised were addressed and acted upon promptly.

A quality assurance system was in place to monitor the service and the quality of support people received. This meant areas for improvement were promptly identified and addressed. Systems and processes for monitoring quality were effective in driving improvements.

There is a registered manager at the service. 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.

This was an unannounced inspection which meant the provider and staff did not know we were coming. It took place on 20, 21 and 22 June 2016.

People were supported by staff who knew them well and had a good understanding of their individual needs, choices and preferences. Staff were committed to supporting people to achieve their goals and return to independent living. They treated them with kindness and respect whilst encouraging them to do things for themselves. We found people’s records did not always accurately reflect the support people required. These shortfalls had not been identified by the audit system. We have made a recommendation about this.

There were systems in place to ensure the management and storage of medicines was safe. However, there were no PRN protocols in place to ensure people who needed ‘as required’ medicines received them consistently. We have made a recommendation about this.

Risks assessments were in place, staff had a good understanding of the risks associated with people they were supporting. However, risks associated with pressure area care were not always well managed.

Staff were able to recognise different types of abuse and told us what actions they would take if they believed someone was at risk.

There were enough support staff, nurses and therapists on duty who had been appropriately recruited to safely meet people’s needs. Staff sought and obtained people’s consent before they supported them. They understood the requirements of the Mental Capacity Act (MCA) 2005 when helping people to make decisions. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered.

People were provided meals that were in sufficient quantity and met their needs and choices. People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences and support they required at mealtimes.

Staff were knowledgeable and competent to meet people’s needs. They received ongoing training and support to help them meet the needs of people who used the service. Staff told us they received regular supervision and felt supported by their line manager and the registered manager.

There was an open positive culture at the service, where management and staff were committed to treating everyone as an individual and providing a good level of support to people who used the service.

Records viewed showed that staff were provided with detailed information about each person. Staff confirmed this was enough to inform their support of people. Records showed evidence of progress towards independence and the involvement of therapists to achieve this.

We looked at nutrition and saw that people were given opportunities to state their preferences and to request alternatives to the menus provided. People who were seen to be at risk from poor nutrition were monitored.

The service worked closely with a range of other professionals to ensure people had a smooth transition from the service to their own home or to another placement.

We found that there were enough staff. Managers were aware of some issues around the skill mix and were able to demonstrate what actions they were taking to remedy this.

We saw from our review of records that these were kept updated, well maintained and kept secure. Systems were in place for the archiving and destruction of records after suitable timescales.

At this inspection we looked at what progress had been made towards compliance with this area of the essential standard for staff support. People using the service were not asked to comment as they would not have had access to relevant information. We spoke with seven staff in total who were a mix of health and social services staff. We reviewed documentation relevant to the whole staff team in addition to ten individual staff training, appraisal and supervision records.

We were satisfied that the provider had made the improvements necessary to ensure all staff were in receipt of regular training, supervision, and appraisal of their work practice.

The relatives we spoke with commented positively about the service their family member was receiving, comments included:"We can't fault it". "We have no complaints at all".

People who received support from the service said that they found staff to be kind and helpful. They thought they were kept informed about their care and support, and all felt they had made good progress in the time they had spent in the service.

Two relatives we spoke with were complimentary about the service. One gave examples of where they thought the service had been very proactive and had "gone the extra mile" to ensure the safety of their family member.

People admitted to the service who met the criteria of having the potential and commitment for rehabilitation experienced positive outcomes. They achieved a return to, if not full independence, a level of independence they may not have achieved without access to this intensive and specialised programme of support.