Archived: The Firs

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People were safe, care staff had a good understanding of the risks people faced at home and out in the community and knew how to report suspected abuse. Medicines were managed safely and the premises were adapted to meet the complex needs of people.

Care staff all fed back they were happy that the training provided gave them the skills they needed to effectively meet people’s needs. The registered manager was developing a process of recording how people were supported to meet key outcomes and goals. People were supported to access healthcare services appropriately and in a timely manner, and the food provided ensured people maintained a healthy balanced diet whilst still having their dietary preferences met.

Care staff were kind and caring in their interactions with people and spoke with affection about them. People were given choices around what activities they took part in and food they ate. Appropriate communication methods were used for conversations with people where required, such as objects of reference, single words or short sentences, and pictures and symbols. Where people had families, they were involved in creating support plans.

Peoples needs were responded to promptly. Care staff knew people very well and could describe people’s preferences for their care in detail. We saw preferences being met during the inspection that were described in people’s support plans. There was a complaints policy but no complaints had been made in the last 12 months.

Care staff said they felt supported by the registered manager who had made several improvements to the home and had further plans for developing staff and improving the facilities for people.

At this inspection The Firs met all relevant fundamental standards.

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 support this practice.

Further information is in the detailed findings below.

The area manager is the registered manager for this service and is directly overseeing the service. The area manager is registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC managed 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.

We met and spoke to all four people during our visit. People were not able to fully verbalise their views and used other methods of communication, for example pictures and symbols. We therefore spent time some time observing people.

People’s medicines were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate training and understood the importance of safe administration and management of medicines. People were supported to maintain good health through regular access to health and social care professionals, such as speech and language therapist.

People’s care records were very detailed and personalised to meet individual needs. Staff understood people’s needs and responded when needed. People were not able to be fully involved with their support plans, therefore family members or advocates supported staff to complete and review the support plans. People’s preferences were sought and respected.

People’s risks were documented, monitored and managed well to ensure they remained safe. People lived full and active lives and were supported to access local areas and activities. Activities reflected people’s interests and individual hobbies. People were given the choice of meals, snacks and drinks they enjoyed whilst maintaining a healthy diet. People, when possible were encouraged to help prepare meals and drinks.

Staff understood their role with regards to ensuring people’s human and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by the area manager. They knew how to make sure people who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest.

Staff had completed safeguarding training and had a good knowledge of what constituted abuse and how to report any concerns. Staff described what action they would take to protect people against harm and were confident any incidents or allegations of abuse would be fully investigated.

Staff described the area manager as being very approachable and supportive. Staff talked positively about their roles.

People mainly had one to one staffing, with two staff when they accessed the community. Staff did not feel the service had sufficient staff. However new staff had recently been employed. Staff had completed appropriate training and had the right skills and knowledge to meet people’s needs. However, some training was out of date. This meant staff may not be up to date with new practices. People were protected by safe recruitment procedures.

All significant events and incidents were documented and analysed. Evaluation of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback to assess the quality of the service provided was sought from people living in the home, professionals and staff.

We met the manager, area manager and senior manager and discussed the developments currently taking place and quality assurance.

We spoke with one person who said "I am very happy and have a lovely room". Observations made about other people showed that they were pursuing interests of their choosing with staff support. We observed staff being kind and supportive to people who used the service. The home was a small "family like" environment with people having their own flat which had it's own lounge, bedroom, and ensuite facility.

We spoke with four members of staff who were pleased to discuss how they delivered support to people who used the service and their own personal development. One member of staff said "I receive good support and training". Another member of staff said "I really enjoy working at the home".

We spoke with one parent and sent another parent an email asking them for their views on the service. One parent said that "I am very happy with the service".

The records we looked at were up to date and in sufficient detail. This helped and supported staff to deliver care and support that was required for each individual person.

People's accommodation was personalised, clean and tidy. From our observations staff treated people as individuals and included them in any decisions or changes which affected their daily lives. We observed staff treating the people they were supporting in a kind and respectful way.

We spoke with several staff during our visit and they appeared to have developed good relationships with people using the service. Staff received training and guidance which enabled them to tell us they what action they would take if they saw anything which might affect the well-being of the person using the service.

The records held by the service were complete and kept up to date. This helped and supported staff to maintain the comfort and wellbeing of people using the service.

Systems were in place for monitoring the service. External quality audits of the service were regularly carried out to help ensure people using the service lived in a safe, well run service.

Having assessed the available evidence, we considered the service demonstrated how it met the safety and welfare needs of the people using the service.