Firgrove House

Updated 23 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

The inspection was carried out by one inspector for adult social care. Prior to the inspection we looked at information we had about the service. This information included the statutory notifications the provider had sent to CQC. A notification is information about important events, which the service is required to send us by law.

Before the inspection, we had asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they planned to make. We reviewed the information included in the PIR and used it to assist in our planning for the inspection.

During our visit, we observed people living in the home and we spoke individually with seven. We also joined them for their Halloween party and an activity session. Relatives were happy to speak with us and share their thoughts about the home and we spoke with a volunteer who regularly visits the home. We spent time with the provider, registered manager and office manager. We spoke individually with seven staff.

We looked at four people's care records, together with other records relating to their care and the running of the service. This included four staff employment records, policies and procedures, audits and quality assurance reports. At the end of the inspection the provider, registered manager and office manager sent us a written reflective piece of work they had completed to look back and celebrate their achievements. We have referred to exerts of this in the report.

Updated 23 January 2019

This inspection took place on 30 October and 2 November and was unannounced. On the 6 November we returned to provide feedback to the provider, registered manager and office manager. There were no concerns at the last inspection of May 2016. Firgrove House provides accommodation and personal care for up to 20 people, offering 2 rooms for couples if required, and Day Care facilities. At the time of our visit there were 17 people living at the service.

At our last inspection, the service received an overall rating of Good. They had received an outstanding rating in Well Led. At this inspection, we found evidence continued to support the outstanding rating in Well Led and in addition, in Caring and Responsive. This meant the overall rating for the service had improved to Outstanding.

A new manager had been in post since April 2018 and registered with CQC in June 2018. 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 provider told us, “Our new manager brings to Firgrove House years of management experience, passion and fresh vision. Having previously managed an Outstanding service we know that she has already brought an incredibly positive outcome to many clients at Firgrove and our team who support them. We strive to add additional areas to our current Outstanding in Well led and know she is the right manager to make this possible”.

We were introduced to people throughout our visits and they welcomed us. People were relaxed, comfortable and confident in their home. The feedback we received from people was extremely positive throughout. Those people who used the service expressed great satisfaction and spoke highly of all staff and services provided.

Staff involved in this inspection demonstrated a genuine passion for the roles they performed and their individual responsibilities. Visions and plans for the future were understood and shared across the staff team. They embraced new initiatives with the support of the provider, registered manager and colleagues. They continued to look at the needs of people who used the service and ways to improve these so people felt able to make positive changes.

People experienced a lifestyle that met their individual expectations, capacity and preferences. There was a strong sense of empowering people wherever possible and providing facilities where independence would be encouraged and celebrated. People’s health, well-being and safety were paramount.

Staff had the knowledge and skills they needed to carry out their roles effectively. They enjoyed attending training sessions and sharing what they had learnt with colleagues. There was an emphasis on teamwork and unison amongst the staff at all levels. People were supported to enjoy a healthy, nutritious, balanced diet whilst promoting and respecting choice. The ‘residents’ annual surveys consistently reflected how much they enjoyed the quality of food, the variety and the constant access to beverages and snacks through the day.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). For people who were assessed as not having capacity, records showed that their advocates or families and healthcare professionals were involved in making decisions.

Staff had an excellent awareness of individuals' needs and treated people in a warm, loving and respectful manner. They were knowledgeable about people's lives before they started using the service. Every effort was made to enhance this knowledge so that their life experiences remained meaningful.

People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. People were involved throughout these processes. This ensured their needs were clearly identified and the support they received was meaningful and personalised.

Staff were proud and felt privileged when supporting people during the end of their life. They did this with empathy, love and respected people’s wishes to the very end in order to ensure a peaceful, dignified death.

Regular monitoring and reviews meant that referrals had been made to appropriate health and social care professionals and where necessary care and support had been changed to accurately reflect people's needs. People lived meaningful lives and that suited their personal interests and hobbies. The service had developed a creative and active community life at the home.

People and relative feedback was a vital part of the quality assurance system either through annual surveys, ‘residents’ meetings, complaints or reviews. People, relatives and staff were listened to and action was taken to make improvements where required. The registered manager monitored and audited the quality of care provided, striving to meet the ever-changing needs of people living in the home.