CQC report explained · a residential care home
What the CQC found at The Firs
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Staff understood safeguarding procedures and risks to people were assessed and managed. Medicines were given safely, although the records showed three staff as overdue for refresher training and this was being checked.
- Effective?
- Good
- Staff received induction, regular training and supervision. The home worked with health professionals and supported people's nutrition, healthcare and legal rights.
- Caring?
- Good
- Staff knew people well and were described as kind, respectful and attentive. Care plans supported people's communication, dignity, choices and independence.
- Responsive?
- Good
- Support was personalised and care plans were reviewed at least yearly and when needs changed. Activities reflected people's abilities and preferences, although one relative wanted more work opportunities.
- Well-led?
- Good
- Inspectors found strong improvement under the registered manager. Audits, improvement plans, staff meetings and feedback systems were being used to monitor and improve the home.
What inspectors found, June 2018
Rated Good; inspectors found safe, kind and well-managed care, with a small medicines training record issue.
The home provides care without nursing for up to 10 people with learning disabilities and some physical disabilities. Nine people lived there during the visit.
The inspection was unannounced on 23 April 2018 and was carried out by one inspector. Inspectors reviewed care records, medicines records, staff and training records, health and safety information, and records about how the home was run. They observed care and spoke with people, staff, relatives and visiting professionals.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found considerable improvement in management since earlier inspections, which had led to improvements across the service.
Enough familiar staff
Inspectors found enough staff to meet people's individual needs safely. The home tried to use staff who already knew the people living there when covering gaps.
“There were enough staff on duty at all times to meet people's diverse, individual needs safely.” from the report
Skilled support
Staff received general and specialist training, including training about epilepsy and autism. The home also sought help from health and other professionals when needed.
“The service sought advice from and worked with health and other professionals to ensure they met people's needs.” from the report
Kind and respectful care
Staff knew people well and supported their communication, dignity, choices and independence. Relatives and inspectors described interactions as caring and respectful.
“People were supported by a dedicated and caring staff team who knew them well.” from the report
Improved management
Inspectors found that management had made considerable improvements since earlier inspections. The home used audits and improvement plans to keep track of progress.
“The service had benefited from the appointment of a new manager who had embedded good practice in line with the provider's policies and procedures.” from the report
Medicines refresher records
minorThree staff were recorded as overdue for medicines refresher training. The manager said the electronic records might not be accurate and agreed to check whether the training was actually overdue.
“There were three staff who were overdue for medicine e.learning refresher training, two of whom were waking night staff.” from the report
More work opportunities
minorOne relative said they would like to see more work opportunities for a person living at the home. The report also says the home recognised that activities needed to reflect that some people were getting older.
“I would like to see some increased 'work' opportunities so that they can experience greater satisfaction in accomplishments.” from the report
- 01Were the three staff shown as overdue for medicines refresher training actually overdue, and has this been corrected?
- 02How are staffing levels covered when regular staff are absent, and how often are agency staff used?
- 03How are activities adapted as people's abilities, preferences and ages change?
- 04How are people and their families involved in reviewing care plans and decisions?
- 05What further improvements have been made since the inspection's management improvement work?
This was an unannounced inspection of the overall quality of the home and all five CQC areas, including care records, medicines, staffing, training, safety records and feedback from people, families and professionals. This explanation was written from the published report of 1 June 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, March 2017
The Firs was rated Good overall, but inspectors found that the home was not yet consistently well-led.
This was an unannounced, focused inspection on 2 February 2017. It followed an earlier finding that the provider did not have effective systems for checking the quality of the service. Inspectors looked only at whether the home was well-led.
Inspectors found that the provider had improved its oversight. There were more regular checks, a mentor supported the interim manager, and some issues found through surveys and audits had been acted on. People and staff said the interim manager was approachable.
However, some improvements were still overdue. These included staff meetings, training, care records, staff appraisals and medicine recording. The overall rating remained Good, while the well-led rating was Requires Improvement. The earlier breach of Regulation 17 had been addressed and was no longer in place.
Improved oversight
The provider had introduced more regular checks of the home and had made some improvements after the previous inspection.
“We found that improvements had been made with the provider oversight of the service and that there was no longer a breach of the regulations.” from the report
Support for management
The interim manager had support from senior management and an experienced mentor.
“A mentor had been provided to support the interim manager.” from the report
Approachable manager
Staff said the interim manager was approachable and supportive. People and staff were confident that concerns would be acted on.
“Support staff told us that the manager was approachable and supportive.” from the report
Regular safety checks
The home carried out regular checks covering equipment, the building and the environment.
“There were regular health and safety checks which covered equipment, the building and the environment.” from the report
Outstanding actions
needs fixingSome matters identified by audits and monitoring visits had not been completed within the agreed timescales.
“There were still outstanding matters which had been identified by a range of audits and monitoring visits which had not been addressed within agreed timescales.” from the report
Training and meetings
needs fixingSome new staff had not completed required training on time, and there had not been enough team meetings.
“Not all new staff had completed appropriate training units within required timescales.” from the report
Records and appraisals
needs fixingThe latest audit found further work was needed on care records, monitoring and staff appraisals.
“The range of areas included, internal care related record keeping and monitoring, staff training requirements and staff annual appraisals which were significantly overdue.” from the report
Medicine records and key access
seriousInspectors found a discrepancy in medicine recording. They also found that arrangements for keeping medicine cabinet keys affected access security.
“There was also a discrepancy in medicines recording and access to medicine cabinet keys was compromised by arrangements for their safekeeping in the home office.” from the report
- 01Have all outstanding audit actions, including the care file actions from 2016, now been completed?
- 02Have all new staff completed the required training, and are staff appraisals up to date?
- 03How are medicine records checked now, and how are medicine cabinet keys kept securely?
- 04Has a permanent registered manager been appointed, and how is the home being supported during the change?
This was an unannounced focused inspection of well-led only; the overall Good rating and the other areas were not reassessed in this visit. This explanation was written from the published report of 9 March 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of The Firs
3 rated inspections over 2 years: the service has held its Good rating throughout.
- June 2018Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2017Goodstayed GoodWell-led: Requires improvement
- March 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- August 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 20 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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