The Firs Care Home

The last comprehensive inspection of this service took place on 2 and 8 February 2016. The service was rated good overall but care plans did not clearly inform staff of each person's needs, personal preferences and the support they required. This increased the risk of inappropriate or unsafe care. We issued a requirement notice to ensure the provider made improvements. After the inspection in February 2016, the provider sent us an action plan, detailing how the identified shortfalls were to be addressed. During a focused inspection on 13 February 2017, the provider had followed their action plan and improvements had been made. During this inspection we saw the improvements made had been sustained by the provider and that the service had improved to Good in the Responsive domain.

The service was exceptionally caring. The service worked to create a homely, comfortable environment where people were supported to develop strong relationships with each other and care staff. People were treated with kindness, compassion and empathy. Staff explained how they respected people’s privacy and dignity. The service celebrated people’s achievements. People were supported to remain as independent as they wanted to be.

People and their relative’s spoke extremely highly of the care and support received. They felt that the management team and staff often went ‘the extra mile’ for people. We observed, and people told us, that staff worked with them in a caring and person centred way. We observed people were comfortable in the presence of staff.

Staff spoke passionately about wanting to provide people with a high standard of care and support. Their comments included “I love working with the residents and want to give them the best care possible. We treat people as individuals and ask all the time about how they want their care to be” and “We see people as an individual, not their illness or diagnosis. You have to be passionate about this job and we all are, wanting to give everyone the best care.”

The service was very well-led. The registered manager was available on both days of our inspection with one of the providers attending on the second day. 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.

The registered manager was passionate about providing a high standard of care to people. People were supported by staff who shared the registered manager’s commitment to providing an excellent service. Staff, relatives and health professionals spoke highly about the management team and staff and the service being delivered to people.

There was an effective quality assurance system in place to ensure any improvements needed within the service were identified and the necessary action was taken to implement change.

People received a personalised service which was responsive to their individual needs. Care plans contained essential information on people’s preferences and life experiences to help ensure people received person centred care in their preferred way.

There were safe administration systems in place and people received their medicines when required. Medicines were stored securely and disposed of safely. People’s care records showed relevant health professionals were involved with people’s care. People’s changing needs were monitored to make sure their health needs were responded to promptly.

People were supported to eat and drink sufficient amounts. Staff were aware of people’s dietary requirements. Where required, people had access to specialist diets and guidance was in place to ensure staff met these needs accordingly.

People were protected from the risk of harm and abuse. Staff had received training in safeguarding adults from the risk of harm or abuse and were aware of their responsibility to report any concerns. Policies and procedures were in place to advise staff on what they should do if they had concerns. Risks were assessed and reviewed regularly and control measures were put in place to minimise the risks to people. There were effective pre-employment checks for the safe recruitment of staff, including criminal records checks and obtaining character references.

There were sufficient staff on duty to ensure people’s needs were met. We observed throughout the inspection that staff were unhurried and spent time engaging with people. People received care from staff who had the skills, knowledge and understanding needed to carry out their roles. New staff members received a comprehensive induction. Training records confirmed staff received training in a range of core subjects required by the provider.

Further information is in the detailed findings below.

The last inspection of this service took place on 2 and 8 February 2016. The service was rated good overall but care plans did not clearly inform staff of each person's needs, personal preferences and the support they required. This increased the risk of inappropriate or unsafe care. We issued a requirement notice to ensure the provider made improvements. After the inspection in February 2016, the provider sent us an action plan, detailing how the identified shortfalls were to be addressed. At this inspection, we saw the provider had followed their action plan and improvements had been made.

The Firs Care Home provides accommodation and care for up to 32 older people, some of whom may be living with varying degrees and types of dementia.

There were two registered managers in post. One registered manager had undertaken the role previously but had transferred to another location, run by the same organisation. They told us they had chosen to maintain their registration, as they were still very much involved in the home. The second registered manager gained their position at the time of the last 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. Registered managers are responsible for the day to day management of the home. One registered manager was available throughout the inspection. The second registered manager was present towards the latter part. Both were involved in receiving feedback about the inspection and our findings.

Care plans had been rewritten and contained detailed information about people’s needs, preferences and the support required. People and their relatives had been fully involved in the development of the plans and staff had been asked to contribute their knowledge. Care plans were being regularly updated, as people’s needs changed.

There were assessments which identified potential risks to people’s safety. Whilst these were up to date, not all had been completed accurately. This presented a risk that certain areas of people’s care, such as malnutrition and pressure ulcer prevention, were not managed in accordance with their needs. The registered manager told us they would review this information to ensure all was accurate.

Staff knew people well and were responsive to their needs. There were many positive interactions although on one occasion, staff spoke over a person and not to them. At lunch time, one member of staff stood up to assist a person to eat. This did not promote their dignity or ensure their safety. However, all other staff assisted people to eat in an appropriate manner. They undertook any requests and answered call bells in a timely manner.

Those people, who wanted to go out, were supported to do so. This included staff accompanying people with a walk or to the local shop. Other people enjoyed singing to the music that was playing and spending time with their visitors The registered manager told us the home was very much part of the local community. They said they were hoping this would be further developed, as a staff member with specific responsibilities for activity provision, was being recruited.

People and their relatives were aware of how to raise a concern, if they were not happy with the service. They were confident any issue would be properly addressed. The registered manager told us they regularly spoke to people and their relatives. This enabled any complaints to be raised informally and dealt with quickly, without escalation.

The Firs Care Home provides accommodation and care for up to 32 older people, some of whom may be living with varying degrees and types of dementia.

A registered manager was employed by the service although they were in the process of leaving due to promotion within the organisation. The home’s care manager had successfully been appointed, as the new manager. They were in the process of registering with us to become the registered manager. 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. The registered manager and the newly promoted care manager were present throughout the inspection.

Whilst people had a care plan, not all were detailed and fully reflected their needs or the support required. Potential risks to people’s safety such as the risk of malnutrition and the development of pressure ulceration had been identified. However, some assessments lacked detail. Any accident was appropriately investigated and measures were put in place to minimise further occurrences.

People and their relatives were happy with the service they received. There were many positive comments about staff and the overall care provided. People told us they felt safe and were able to follow their preferred routines, without restrictions. They said they enjoyed the food provided and had enough to eat and drink. People were offered a range of meal choices and snacks, based on their preferences.

People received good support and intervention to meet their health care needs. They were supported to maintain links with the local community and received regular visitors. An activity organiser was deployed to provide ‘in house’ social activity. People and their relatives were encouraged to give their views about the service. They knew how to raise concerns and were confident any issues would be satisfactorily addressed. Records showed any suggestions for improvements were implemented.

People were supported by staff who knew them well and were responsive to their needs. There were sufficient staff to support people effectively. Staff received training to ensure they had the knowledge and skills to do their job. Staff felt valued and well supported. They received regular time with their manager to discuss their work and any challenges they were facing.

Systems were in place to monitor and assess the quality and safety of the service. The care manager regularly worked shifts, as part of the working roster. This enabled them to keep up to date with people’s needs and to monitor staff’s practice. Any issues identified were addressed appropriately through support, additional training or more formal procedures.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with four people using the service, their relatives, three staff, the manager and the provider. We reviewed seven care plans, three recruitment files and other relevant records. Additionally we used the Short Observational Framework for Inspection (SOFI) observation for a sixty minute period. SOFI is a specific way of observing care to help us to understand the experience of people who could not,clearly, tell us about it.

Is the service safe?

Care plans instructed staff how to meet people’s needs in a way which minimised risk for the individual. They were detailed and ensured staff cared for people in a safe way.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the home liaised effectively with the local authority DoLS team and had made applications as appropriate. The home had made one DoLS referral in 2014.

We found that medication was administered and recorded in a way which kept people as safe as possible. Staff were properly trained and their competence to administer medicines was checked regularly.

The home had robust recruitment procedures and checked, as far as possible, that candidates were safe and suitable to work with vulnerable people. People told us they had never experienced any poor treatment and felt safe in the home. The home referred staff to the appropriate bodies if they were not fit to work with vulnerable people.

Systems were in place to make sure that the manager and staff continually monitored the quality and safety of care offered to people.

Health and safety was taken seriously by the home and all the appropriate safety checks had been completed. This reduced the risks to the people who lived in the home, staff and visitors.

Effective?

One person, who reflected the views of others said: ‘‘I can’t fault them, they’re all very, very kind’’. The four people we spoke with told us they were happy living in the home and felt all their needs were met. A relative told us that the home met their relative’s needs extremely well.

People’s health and care needs were assessed with them, and/or their relatives, as appropriate. Care plans were detailed and clearly identified people’s needs and how they should be met. They were reviewed regularly and changes were made to meet people’s changing needs. We saw that staff gave support as described in individual’s care plans.

Caring?

People were supported by kind, caring and patient staff. We saw that care staff were attentive, encouraging and positive. They responded appropriately to people’s needs. Staff communicated with people at all times and encouraged interactions between people using the service.

People's diversity, values and human rights were respected. Care plans were individualised and person –centred. We saw that people were treated with respect and dignity by the staff.

Responsive?

We saw that health care was sought in a timely way and special plans of care were put in place to ensure people received any necessary short term additional care.

The home had made changes and improvements as a result of ideas and discussions with people who lived in the home and their relatives.

The home had received one complaint in the previous eight months. This was dealt with appropriately and actions taken, as necessary. A relative told us that any concern raised, however small, gets an immediate response.

Well led?

Staff members told us that they were supported to do their job well. They said that they felt valued and their views were listened to. People who lived in the home and their relatives told us that staff and the manager were very approachable, as was the provider who visited regularly.

The service had a comprehensive quality assurance system. We saw records which showed that identified shortfalls and ideas people put forward were addressed. Several examples of changes made as a result of the regular satisfaction surveys were provided by relatives and the manager. As a result the quality of the service was being maintained or improved.

Overall, we found that the provider had taken sufficient action to improve the home's medication administration and training for staff, so that people using the service were looked after safely.

The manager showed us how the care plans were reviewed every six months to monitor care and keep it up to date and effective. These reviews included the person and if appropriate a relative. We saw the care plans were reviewed monthly by the person's key worker. In all the records we looked at these reviews had been undertaken and changes referenced. One relative we spoke with told us 'they always tell me about any changes that have happened to mum, and keep me up to date with any issues'.

We found the administration of medicines was not safe and not in line with the provider's medicines policy. We judged this to be a minor risk to the people who use the service.

We spoke with two relatives visiting the home and both told us they were happy with the numbers of staff in the home and thought the training and experience were sufficient to meet the needs of their parents. One person told us "the staff here care and this is the best home mum has been in'. We also spoke with a visiting healthcare professional who told us 'the staff here are good and the new manager has got to grips with the home very quickly. I think the care is good, especially the prevention of pressure ulcers. I have every confidence in the staff'.

We saw the manager maintained a training matrix for all staff members to identify which training was current and when updates were planned. We looked at individual staff training records and saw staff had completed a variety of courses to promote the wellbeing of people who used the service.

A person was staying short term at the home for a period of re-ablement under a local authority/NHS scheme. They told us staff helped them to feel increasingly confident about returning home. They said: 'Nobody tells me what to do, I choose.'

There was liaison with external health professionals as needs arose. Arrangements were made for people to receive optical, dental and chiropody visits.

We spoke with four care and senior care staff. They understood what would constitute abuse and how to report concerns. They told us they felt well supported by training and supervision and they felt involved and valued by the service.

The provider told us they visited the home every week. We saw they were well known to the staff and people in the home. They could show how they and the manager monitored the quality of the service and acted on any shortfalls they identified.