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
- Inspectors found better risk assessments, safe recruitment checks, enough staff and good cleanliness. They still found some unclear risk information and recommended improvements to medicines management.
- Effective?
- Good
- This question was not assessed during this focused inspection. Its previous rating was carried forward into the overall rating.
- Caring?
- Good
- This question was not assessed during this focused inspection. Its previous rating was carried forward into the overall rating.
- Responsive?
- Good
- This question was not assessed during this focused inspection. Its previous rating was carried forward into the overall rating.
- Well-led?
- Good
- Inspectors found more effective audits, a clearer improvement plan and a more positive staff culture. Some relatives were concerned about changes in leadership and how these had been communicated.
What inspectors found, July 2022
Rated Good; inspectors found safer care and stronger leadership, but medicines and mental-capacity records still needed work.
This was an unannounced focused inspection on 21 June 2022. Inspectors checked whether earlier problems with safety and management had been fixed. They spoke with people, staff, relatives and health and social care professionals, and checked care records, medicines records, staff files, audits and the home.
The home had improved since its previous inspection. Risk assessments were generally better, recruitment checks had improved, staffing levels were considered sufficient, and the home was clean. People and relatives said they felt safe and that staff were kind and supportive.
Some work was still needed. Inspectors recommended improvements to medicines processes. A small number of risk assessments were unclear, and two mental-capacity assessments had not been recorded before applications for restrictions on people's care were made. Activities had also reduced after the activities worker left.
Improved safety checks
Risk assessments and safety monitoring had improved since the earlier inspection. Staff were using care plans and equipment to help manage risks such as falls, dehydration and seizures.
“Peoples care files contained a range of risk assessments that identified and mitigated risks associated with their care and well-being.” from the report
Enough staff
People, relatives and staff generally felt staffing levels were suitable. Staffing was adjusted when people's needs changed.
“There were sufficient staff deployed to meet people's needs.” from the report
Clean home
Cleaning records had improved and inspectors found high standards of cleanliness and hygiene throughout the home.
“The home continued to looked visibly clean with high standards of cleanliness and hygiene throughout.” from the report
Stronger management
The leadership team had improved its audits, worked with outside organisations and created a more positive culture for staff.
“The leadership team had been working effectively with a range of external organisations to drive improvements within the service.” from the report
Medicines records and storage
needs fixingOne medicine was five months out of date, although it had not been used and was disposed of. Inspectors also found problems with records for controlled medicines and with the storage of medicines awaiting disposal.
“We recommend that the provider review their processes for the management of medicines that they treat as CDs.” from the report
Mental-capacity paperwork
needs fixingIn two cases, mental-capacity assessments had not been recorded before applications for restrictions on people's care were submitted. The manager said they would take responsibility for these assessments while the system was embedded.
“However, we found two examples, where a mental capacity assessments had not been completed before an application for a DoLs was submitted.” from the report
Reduced activities
needs fixingPeople had less access to regular activities for about a month after the activities worker left. The home was recruiting again and staff were providing some one-to-one time in the meantime.
“for the last month, people had had less access to regular activities and some people expressed a concern about this.” from the report
- 01What checks now make sure medicines are in date, controlled-medicine records are complete and medicines awaiting disposal are stored securely?
- 02How do you make sure a mental-capacity assessment is completed and recorded before any application for a DoLS authorisation?
- 03What regular activities are currently available, including for people who spend time in their rooms?
- 04How will you keep relatives informed about management changes and the home's improvement plan?
- 05How are unclear or conflicting risk assessments identified and corrected?
This was a focused inspection of Safe and Well-led only; the other key-question ratings were carried forward from the previous inspection. This explanation was written from the published report of 7 July 2022 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, January 2022
The Firs is rated Requires Improvement; inspectors found gaps in risk assessments, records, staffing checks and infection control, although people generally felt safe and cared for.
This was an unannounced focused inspection on 16 November 2021. The inspection looked at Safe and Well-led. Inspectors spoke with people, staff, relatives and health professionals. They also observed care, checked the home and reviewed medicines, care and staff records.
The home was not always safe. Some risks, including seizures, falls, dehydration, nutrition and skin damage, were not recorded or planned for properly. One recruitment check had not been risk assessed. Staff, relatives and people gave different views about staffing levels, with some staff reporting delays at busy times.
There had been improvement in storing and managing medicines, but some medicine instructions and records were still incomplete. Infection control needed to be followed more consistently. Activities were not regular or meaningful enough for everyone, especially people cared for in their rooms.
The overall rating remains Requires Improvement, as do Safe and Well-led. The home had also been rated Requires Improvement at the previous inspection in February 2021. The other three question ratings were not assessed during this focused inspection and carried over from the earlier comprehensive inspection.
People generally felt safe
People and relatives told inspectors they felt safe. Recent safeguarding concerns had been reported appropriately, and action had been taken to reduce further risks.
“Outcomes showed that action had been taken to reduce further risks to people.” from the report
Kind, person-centred care
People and relatives were positive about the care. Relatives said staff listened, involved them and focused on each person's needs and preferences.
“Relatives told us the service had a clear person centred focus and praised the staff for their positive approach to people's needs.” from the report
Improved medicines safety
The home had improved medicine storage and monitoring enough to remove the previous breach relating to medicines safety, although some further improvements were still needed.
“At this inspection we found sufficient improvement had been made and the service was no longer in breach of this part of Regulation 12.” from the report
Partnership working
Staff worked with health professionals and other organisations to support people's health and wellbeing. A specialist care homes team was also helping improve care plans and staff training.
“The service worked in partnership with other organisations to help improve the health and well-being of people.” from the report
Incomplete risk planning
seriousCare plans did not always explain important risks or how staff should respond. This included seizures, falls, dehydration, nutrition, skin damage and distressed behaviour.
“Some of the risks to people's health and wellbeing had not been adequately assessed and planned for.” from the report
Weak records and checks
seriousCare records, risk assessments and medicine records were sometimes incomplete, inaccurate or conflicting. The provider's audits were not strong enough to identify all these problems or make sure actions were completed.
“The provider had not ensured the effectiveness of the governance arrangements in place or that records relating to people's care and support were accurate and complete.” from the report
Staffing and recruitment concerns
seriousOne recruitment record had not been properly risk assessed. Some staff also reported too few staff at certain times, with possible delays to medicines, meals, activities and some night-time medicines.
“This meant people were not fully protected from being cared for by staff who were unsuitable for the role.” from the report
Activities were not regular enough
needs fixingActivities often depended on whether care staff had time. Records gave limited assurance that everyone, particularly people in their rooms, received enough social and meaningful activity.
“More needed to be done to ensure that each person had sufficient opportunities to be part of regular and meaningful activities, particularly those cared for in their rooms.” from the report
Infection control was inconsistent
needs fixingThe home looked clean, but cleaning records were not kept. Inspectors also saw gaps in PPE and COVID-19 checks, which the manager said would be addressed.
“We found some areas where the measures in place for preventing and controlling infection, and more specifically COVID-19, needed to be implemented more effectively.” from the report
- 01What has been done to complete and check care plans for seizures, falls, dehydration, nutrition and skin damage?
- 02How are you making sure staffing levels are safe during afternoon, evening and night shifts?
- 03What changes have been made to recruitment checks, including risk assessments of DBS information?
- 04How are medicine instructions, allergy records and PRN medicine protocols now checked?
- 05What regular activities are available for people who spend time in their rooms, and how do you record their participation?
This was a focused inspection of Safe and Well-led only; the other three question ratings carried over from the previous comprehensive inspection. This explanation was written from the published report of 7 January 2022 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
8 rated inspections over 7 years: the service has improved, from Requires improvement to Good.
- July 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2022Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- February 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- November 2017Goodup from Requires improvementSafe: GoodWell-led: Good
- September 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 2015Requires improvementstayed Requires improvementSafe: Requires improvement
- June 2015Requires improvementstayed Requires improvementSafe: Requires improvement
- March 2015Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- October 2013
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- April 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 29 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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26 live-in carers within about an hour of Hampshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,260 a week. 23 can care for a couple. 14 years' experience on average.
“I cannot recommend Prisca highly enough, she is one in a million.”
“He stayed with her throughout the pandemic, refusing to visit his own family, who lived nearby, to reduce the risk of infection.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.