Archived: The Firs

Updated 1 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, looked at the overall quality of the service, and provided a rating for the service under the Care Act 2014. A service provider is the legal organisation responsible for carrying on the adult social care services we regulate.

This unannounced inspection took place on 19 and 23 July 2018 and was completed by one adult social care inspector.

The provider was not requested to complete a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We obtained this information during our inspection.

We reviewed other information held in relation to the service, including statutory notifications. A notification is information about important events which the provider is required to tell us about by law. We also reviewed information contained within the provider’s website.

We also reviewed quarterly reports sent to us by the provider which detailed the length of time each person was accommodated at The Firs; and the number of emergency readmissions to hospital of people who had been accommodated at The Firs.

During our inspection visit we spoke with seven people using the service, some of whom had limited verbal communication, and five relatives. We used a range of different methods to help us understand the experiences of people using the service who were not always able to tell us about their experience. These included observations and pathway tracking. Pathway tracking is a process which enables us to look in detail at the care received by an individual in the home. We pathway tracked the care of four people.

Throughout the inspection we observed how staff interacted and cared for people across the course of the day, including mealtimes, during activities and when medicines were administered. We spoke with the management team, including the operational manager, the registered manager, and the nominated individual, who was also the assistant director of Hampshire Adult Health and Care. We spoke with 19 members of staff covering the day and night shifts, including a senior case worker, two team leaders, an occupational therapist, two therapy practitioners, a senior care coordinator, seven health care assistants, four housekeeping staff and an office administrator.

We reviewed each person’s care records, which included their daily notes, care plans and medicine administration records (MARs). We looked at 11 staff recruitment and supervision files. We examined the provider’s records which demonstrated how people’s care reviews, staff supervisions, appraisals and required training were arranged.

We also looked at the provider’s policies and procedures and other records relating to the management of the service, such as staff rotas covering June and July 2018, health and safety audits, medicine management audits, infection control audits, emergency contingency plans and minutes of staff meetings. We considered how people’s, relatives’ and staff comments were used to drive improvements in the service.

Following the visit we spoke with the four people who had used the service, three relatives and three health and social care professionals. These health and social care professionals were involved in the support of people living at the home. We also spoke with the commissioners of people’s care.

This was the first inspection of this service since it opened on 24 July 2017.

Updated 1 September 2018

The Firs was established in July 2017 to provide short-term re-enablement in a dedicated facility based at North Hampshire Hospital, managed by Hampshire County Council (HCC). The Firs provides short term rehabilitation and enablement to support up to people 17 people with identified medical needs, that require ongoing support with personal care and accommodation, and have the potential to benefit from rehabilitation and therapy following a discharge from acute hospital care. The service supported people to recover, regain independence, and facilitated a safe discharge back to their own homes. At the time of inspection, staff were supporting nine people with their rehabilitation and reablement.

The service had a registered manager. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run. At the time of our inspection the day to day running of the The Firs was managed by the operational manager, supported when required by the registered manager, who was also managing another service nearby. The operational manager had almost completed the process to become the registered manager.

This comprehensive inspection took place on 19 and 23 July 2018. The inspection was unannounced, which meant the staff and provider did not know we would be visiting.

People experienced care that met their needs and helped them feel safe. Staff had completed the required training and understood their role and responsibility to protect people from avoidable harm and abuse. Staff were aware of people who were at risk of choking, developing pressure areas or falling and knew how to support them safely to prevent and mitigate these risks.

There was an open culture in the service where reflective practice encouraged learning from mistakes, incidents and accidents. The provider thoroughly reviewed all incidents and acted quickly to reduce the risk of a future recurrence.

The provider completed relevant pre-employment checks to ensure staff were safe to support people to rebuild their confidence and re-enable them to return home. The operational manager analysed staffing needs to ensure sufficient staff were deployed with the right mix of skills to meet people's needs safely.

Medicines were managed safely and administered as prescribed, by staff who had been assessed as being competent to do so.

Staff understood their roles and responsibilities in relation to infection control and hygiene and followed current relevant national guidance if there was an outbreak of disease. High standards of cleanliness and hygiene were maintained within the service.

Staff understood the importance of food safety and prepared and handled food in accordance with required standards.

The provider enabled staff to develop and maintain the required skills and training to meet people’s needs. People were supported to have enough to eat and drink to protect them from the risks associated with malnutrition. Where required people were supported to eat and drink safely to avoid the risk of choking.

The multi-disciplinary approach adopted by the provider, ensured that people were referred promptly to appropriate healthcare professionals whenever their needs changed.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were involved in making every day decisions and choices about how they wanted to live their lives and were supported by staff in the least restrictive way possible.

Staff supported people with kindness, and respect, whilst empowering them and promoting their independence. The provider enabled staff to have time to listen to people, answer their questions, provide information, and involved them in decisions about their care. Staff responded promptly, with compassion and kindness when people experienced physical discomfort or emotional distress.

People were involved in developing their support plans, which were detailed and personalised to ensure their individual preferences were known. People were supported to take part in stimulating activities of their choice.

The service re-enabled and rehabilitated people in a way which ensured flexibility, choice and good continuity of care. The provider complied with the Accessible Information Standard and was meeting the information and communication needs of people with a disability or sensory loss. The service had received no formal complaints. However, people felt confident that if they did complain, they would be taken seriously, and their complaint or concern would be explored thoroughly. People were offered the opportunity to make decisions about their preferences in relation to their end of life care.

The service was well managed and well-led by the operational manager who provided clear and direct leadership, which inspired staff to provide good quality care. The provider had a clear vision and credible strategy to deliver high-quality care and support to re-enable and rehabilitate people, which staff had embraced. The safety and quality of support people received was effectively monitored and identified shortfalls were acted upon to drive continuous improvement of the service. The service had clear and effective governance, management and accountability arrangements, which were well-embedded into the running of the service. The service worked effectively with partner agencies, to ensure that people’s needs were effectively assessed before they moved into the service.