The Firs Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This assessment was undertaken as a response to concerns received about staffing numbers and concerns about environmental safety. We reviewed 5 quality statements in this key question. We found a breach of the legal regulation in relation to safe care and treatment. This was because staff had propped open doors which should have been closed and taken windows off window restrictors. We also found people did not have sufficient and consistent guidance available for staff to know how to support distressed reactions. Staffing numbers were not always sufficient to meet people’s needs at night. We found incident forms had not always been completed following all incidents and accidents. Reviews of incidents to identify any learning were not effective and had not considered all factors. The management were responsive to our feedback about this shortfall. Staff told us they had the training they needed and regular supervisions.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People did not share any concerns about this quality statement.

The care manager told us there was a learning culture at the service and staff reflected on learning during handovers and staff meetings. However, the care manager also told us evidence to demonstrate this learning was not always available as records were not completed consistently. For example, some incidents had taken place, but staff had not completed incident forms. This meant there was no evidence to demonstrate action taken to mitigate risks and learning identified to prevent recurrence.

The provider did not have effective systems to make sure all incidents had been reviewed by management to prevent recurrence. Analysis of incidents was not thorough and had not considered all factors and potential causes. For example, falls analysis had not included a review of times of falls to consider if there were any periods of the day which could be problematic. The registered manager told us they would review their incident reporting process to make sure any lessons learned were identified and recorded.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Whilst people told us they felt safe at the service we found 1 safeguarding incident which had not been reported to the local authority. The care manager told us they would take action to address this shortfall.

Staff told us they had received safeguarding training and told us they would report any concern about safeguarding to the care manager. Staff told us they thought the management would take the action needed to keep people safe.

We observed people were not always being supported safely due to shortfalls in the environment. For example, we observed a person had a tub of thickening agent on a table in their room. This thickening agent, if ingested, incorrectly could cause choking. The door to their room was open and the tub was visible to anyone walking past. People with dementia lived in this area of the service and may not understand the risks. The care manager removed the tub once we made them aware of it.

The provider had systems to report safeguarding concerns to the local authority. However, these systems were not consistently effective and we found 1 incident involving people which had not been reported. Management recognised this shortfall and told us they would take action immediately. Other safeguarding incidents had been reported in a timely way and action taken to keep people safe. Where appropriate management had applied for Deprivation of Liberty Safeguards (DoLS) authorisations. For those that had been approved with conditions, action was being taken to meet them.

People did not share any concerns about this quality statement.

The care manager was not aware that there was specific health and safety guidance available for management of bed rails. They took action during this assessment to make themselves aware of and act on this guidance. Staff told us they were able to read care management plans in place for identified risks.

We observed people were not being supported safely at all times due to shortfalls in the environment and using some equipment. We have reported on these shortfalls in other areas of this key question.

Common risks to people’s safety such as falls and skin damage had been identified and guidance was available for staff to follow. However, risks around people experiencing distress had not been recorded and there was no guidance for staff to follow. For example, staff told us 1 person was regularly experiencing distress when having personal care. Staff were often experiencing the person pinching them and causing scratches. There was no guidance available for staff to know how to support the person in a safe and consistent manner. The care manager told us they would make sure guidance was put in place immediately.

People were not always kept safe as staff had taken action to override safety measures. For example, we saw 2 windows that were wide open. Whilst there were restrictors in place, staff had removed the restrictors to open the windows wider. We were told that in the past a person had climbed out of one of the windows we saw wide open. Both these windows were on the ground level and the person had not been harmed, however, taking windows off the fitted restrictors increased risks to people’s safety.

Staff told us hot water at the service was not consistently available. At times they had to get hot water from nearby bathrooms as people did not have hot water in their rooms. The care manager sent us a report following our site visit to tell us what action they were taking to address this concern.

We observed some doors which should have been locked were open throughout both days of our site visits. For example, the laundry room door was unlocked, and a sluice room door was also unlocked. This meant there was a risk of people having access to chemicals being stored in these rooms. We observed doors to people’s rooms were being held open by various objects such as chairs, cabinets and door wedges. This meant in the event of a fire these doors would not automatically close to help manage the spread of fire and help to prevent smoke inhalation.

Systems were not effective to make sure staff understood risks of overriding safety measures. During our assessment we found management were in the building, but staff continued to use objects to hold doors open and keep doors unlocked that should be locked. Regular checks for utilities such as gas had been carried out. Prior to this inspection a fire officer had visited the premises and identified actions for safety with regards to the environment. The provider had carried out all the improvements needed to address the shortfalls.

People told us they thought there were enough staff during the day, however, 2 people told us they did have to sometimes wait for staff at busy times. People were not able to tell us how long they had to wait, and they did not share any impact with us for having to wait. We shared this feedback with the provider.

Staff told us they thought there were enough staff during the day, however, not all staff were assured about the numbers of staff on duty at night. We discussed this concern with the care manager during our site visit. Following on from this discussion the care manager informed us a review had been completed and night staff numbers would increase. Staff told us they had been provided with an induction when they started work and they felt this was enough to give them the skills and knowledge they needed.

We observed there were 2 members of staff working at night. There were a number of people living at the service who required 2 members of staff to help them with personal care and mobility. This meant whilst staff were in a person’s room supporting them with the door closed, there were no staff available to monitor or respond to other people.

The provider used a dependency tool to calculate staffing numbers. Whilst staffing numbers appeared to be sufficient for days, there were not enough staff available during the night. The provider had not considered the risks to people's safety when the 2 night staff were busy supporting people with personal care with doors closed. In response to our feedback, the provider told us they had reviewed their staffing provision, and they would increase staffing numbers at night. The provider had carried out checks on staff prior to offering employment. However, we found the provider had not always checked for a full employment history for all staff. The registered manager told us they would review this without delay. New staff were given an induction when they started work and regular training updates. Staff had supervision and an annual appraisal to identify any training and development needs.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.