The Firs Care Centre

On this page

• 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

People received safe care. Some improvements were needed to make sure people always received care in accordance with their risk assessments and personal preferences.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider took action to address incidents and accidents which occurred at the home to make sure improvements were made. For example, records showed 1 person had a high number of falls. In response to this specialist equipment was sourced and no further falls for this person were recorded.

Staff spoken with thought there had been lots of improvements at the home. One member of staff said, “The support now is so much better. The manager is listening now.”

The provider analysed all incidents and accidents which occurred. They took action to address issues and minimise further incidents.

People had their needs assessed before they moved into the home. This helped to make sure the service was able to meet their needs and expectations.

Staff told us they worked with other agencies to make sure people received care and support to meet their needs. The provider told us in their Provider Information Return (PIR) submitted to CQC in March 2024, “We foster effective communication with specialised services, including speech and language therapists, dementia specialists, nutritionists, tissue viability teams, and reablement services. This fosters a smooth flow of information between our care home and these specialised services.” (The PIR is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.)

One visiting professional told us they thought the staff worked well with other services to make sure people received the care and support they required.

Pre-admission assessments were carried out to make sure people’s needs could be adequately met. However, we noted that for 1 person receiving respite care, all the information in their assessment had not been included in their care plan.

People and their relatives told us they felt safe at the home. One person showed us their call bell alarm and said, “Yes I feel safe.” One visiting relative told us, “She’s safe here, when she’s in her room she always has a smile on her face.”

Staff told us, and records confirmed, they had received training in recognising and reporting abuse. Staff said they would be confident to report any issues. One member of staff told us, “Anything reported would be investigated.”

People appeared comfortable and relaxed with staff supporting them.

The provider had systems to make sure all safeguarding concerns were shared with relevant authorities and fully investigated. The provider made applications for people to be legally deprived of their liberty where they needed this level of protection to keep them safe.

People had care plans and risk assessments which highlighted risks and action to be taken to minimise them. People were not always receiving care and support to minimise these risks.

Staff were able to tell us about the risks to people’s physical health and the action they took to minimise these risks. Staff told us they had a handover meeting each day where any new risks were shared so that staff could adapt their practice accordingly.

People did not always receive care in accordance with their risk assessments and care plans. For example, 1 person’s care plan said they were able to eat a normal diet but at lunch time we noted they were given a pureed meal.

Processes in place did not always evidence that appropriate action was being taken to minimise risks to people. For example, 1 person had been assessed as being at very high risk of pressure damage to their skin. To minimise this risk, it was recommended in the care plan that the person should be helped to change position every 4 hours. Records did not show this had always been carried out, placing the person at risk. At our first visit we found 2 pressure relieving mattresses were incorrectly set. This meant they did not provide the people with maximum protection against pressure damage to their skin. This had been corrected by our second visit.

People lived in an environment where the new provider was carrying out refurbishment and maintenance to ensure all areas were safe. Visiting relatives praised the work that had been undertaken. One visitor commented, “This environment is much better than most I’ve seen”. The home was a large older style building which had been extended over the years. People’s ability to move safely and independently around the home was not supported by clear signage.

Staff were happy with the changes being made to the environment. Staff told us they were carrying out regular tests and checks to make sure the building and equipment were safe for people who lived and worked there.

Some doors including the front door, had key codes to enable doors to be opened. Some visitors had the key code which enabled them to freely visit people. On our first visit, we saw 1 person was wanting to leave the building via the front door. As no staff were with the person, they relied on visitors to ensure their safety. On our second day the key code had been changed so that visitors needed to be let in by staff. This helped to make sure staff were aware of anyone who wanted to leave and could offer support to them.

A series of checks were carried out to maintain safety for people. This included checks on fire detecting equipment, water temperatures and all lifting equipment. Records were kept of checks.

People were mainly happy with the staff who supported them. People said staff were kind and respectful. One person said, “Most staff are kind. They are pretty good.” Visitors felt staff were well trained. One visitor said, “The training is spot on.” They also informed us about the improvements their relative had had since moving in. They commented about their relative, “He is improved and is more engaged now.” Some people and visitors said they felt that language barriers sometimes meant staff did not fully understand their wishes. One person told us, “The one fault is they [staff] don’t always listen to you”. Another person said, “They ask how you want to be helped but then they seem to ignore you. I think sometimes they simply don’t understand me.”

Staff felt that staffing levels were appropriate to the needs of the people who lived at the home. Staff said there had recently been a lot of new staff, many of whom had not previously worked in care. We were told that although new staff had received induction training, they did not always have the experience to provide good quality person-centred care. One member of staff commented, “Carers are ok, people have their needs met but we need to make sure they have continual teaching about how to do things and why.” We were told that in response to these issues new staff now had a buddy when they started work. This was to enable them to work alongside more experienced staff and enhance their learning. Staff told us they received training appropriate to their role.

During our visits we observed staff were task focussed and, in many cases, there was limited interaction with people when carrying out their roles. For example, we saw staff serving meals and supporting people to mobilise without speaking with them. One relative commented, “There needs to be more interaction with him when he’s being hoisted. You can’t just move him and not explain what you're doing.” There were adequate numbers of staff to meet people’s needs, but staff were not always well deployed. On our first visit, we saw 1 floor was staffed entirely with male care staff. This meant if people preferred to be supported by female staff, they had to wait for a female member of the team to come from the other floor. One person told us, “This morning I had 2 males to wash and dress me, I’d prefer females.”

Staff were safely recruited. Recruitment records showed appropriate checks were carried out before new staff began working at the home. The provider used a dependency tool to assess the number of staff hours required per day to safely support people. There was a training programme in place. The training included some face-to-face training and online courses.

People felt that hygiene at the home had improved since the new owners had taken over. One person said, “Well it’s [the home] a lot cleaner now, since they took over”. One person praised the housekeeping staff. They told us, “The sheets get changed regularly, they [staff] do all the washing.”

Staff told us they received training in infection prevention and control.

Most areas of the home appeared clean and hygienic. We saw there were adequate supplies of personal protective equipment, such as disposable gloves and aprons, and staff wore them appropriately.

There was a dedicated housekeeping team who followed cleaning schedules to make sure all areas of the home were kept clean. Minutes of a meeting with nurses showed that infection prevention and control policies and practices were discussed. This helped to make sure staff were up to date with guidance.

People received their medicines safely from staff who had received appropriate training to carry out the task. People had their medicines at the right time and in a safe way. Records of medicines administered were accurately recorded, including time sensitive medicines for people with complex health conditions. Staff were observed taking time supporting people with their medicines, in a kind and calm way.

Staff told us they liaised with health professionals for advice. The clinical lead in the staff team told us they had a good working relationship with the local pharmacy and told us things had improved since changing pharmacy provider.

People received their medicines as prescribed. People's medicines administration records were generally well completed. Medicines were stored, ordered and disposed of safely. The treatment room and drug trolleys were clean and tidy. Temperature monitoring of the treatment rooms and fridge was carried out daily to make sure medicines were stored safely. Where people were prescribed 'as required' medicines they had a protocol in place to guide staff when and how to use these medicines. This included medicine to support people with anxiety, pain, and constipation. Appropriate policies and procedures were in place for staff to follow to ensure the safe administration of medicines to people. Staff training in medicines administration was not always recorded on the training records. However, we saw in staff files that appropriate staff had received this training and had their competency assessed.