19 July 2018
During a routine inspection
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.