Fircroft Home provides residential care and accommodation for up to 18 disabled people. People are predominantly aged 60 and over and have a learning disability, and some people are living with dementia. Bedrooms and communal bathroom facilities are located on either the ground floor or the first floor and the premises are served by a passenger lift. At the time of this inspection there were 16 people living at the service.

This inspection took place on 31 August and 2 September 2016. The first day of the inspection was unannounced. At our last inspection on 2 May 2014 we found the provider was meeting regulations in relation to the outcomes we inspected.

There was a registered manager in post, who has managed the service for over a year. 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.

People told us they felt safe with staff. Risk assessments were in place to guide staff about how to minimise identified risks to people’s safety and protect them from the risk of possible harm. Safe systems were used to ensure people’s medicines were properly managed. The registered manager understood and complied with the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS). Staff had received relevant training and understood their responsibilities to protect people’s rights.

There were effective recruitment processes in place and sufficient staff were deployed to ensure people were safely cared for. Staff received suitable training, supervision and support to meet people’s needs. The quality of the food was good and people were supported to meet their nutritional needs.

Staff knew people well and provided their care and support in a kind and caring way. People’s dignity and confidentiality were respected. People’s needs had been assessed and their care and support plans addressed their health and social care needs in a detailed manner. Clear information was provided to people and relatives about how to make a complaint, and any complaints were investigated in an open and professional way.

People were supported to access the healthcare they needed and the provider liaised well with external healthcare professionals. There were effective measures in place to provide people with compassionate care at the end stage of their lives.

The service was well managed. The provider had clear systems in place to monitor the quality of the service and seek the views of people and their supporters, however we found that there was one incident reportable to the Care Quality Commission in accordance with legislation that the provider omitted to inform us about. We have issued one recommendation in relation to this finding.

During our inspection we set out to answer our five questions; Is the service safe?, Is the service effective?, Is the service caring?, Is the service responsive?, Is the service well led?.

Below is a summary of what we found. The summary is based on our observations during our visit, discussions with people who used the service, their relatives, the staff supporting them and looking at records.

Is the service safe?

People told us they felt safe. Relatives told us they felt assured and safe in the knowledge that the home was a place of safety for their family members to live. Safeguarding procedures were robust and staff understood their role in safeguarding the people they cared for.

The service was clean, hygienic and safe and provided people with safe access to all areas of the home.

Appropriate security checks were undertaken on staff to ensure people's welfare and safety were protected. We looked at staff training arrangements in place and saw that staff were provided with the appropriate training to ensure safe and appropriate care was provided for people who used the service.

Is the service effective?

People's health care needs were assessed with them whenever possible and included in individual care plans. Arrangements were in place for people who used the service to have support from other health care professionals. A GP commented the home provided excellent care.

We saw there was district nurse provided support to oversee clinical procedures, and for staff who were undertaking these procedures.

Is the service caring?

We saw people were supported by kind and caring staff who spoke to people in a polite and respectful manner. People told us that staff were caring and always treated them kindly. Relatives said the staff were very professional and always had time to reassure them. Comments included, "Its simply the best care ever", "No matter what time I come the staff are always cheerful and kind".

People's preferences, interests and aspirations were taken into account as to how their care was to be undertaken. Family links were maintained and a person told us that staff supported them to write letters and cards to relatives and this was very important to them.

Is the service responsive?

The service was responsive to the needs of people who used the service. When a risk had been identified for example frequent falls, the provider responded with the provision of a sensory mat, and reallocation of staff to monitor the frequency of falls and to minimise the risk. When a person who used the service required a soft diet the provider made provision for a speech and language assessment and a visit from the dietician to promote nutrition.

Is the service Well lead?

The home is very well managed by an experienced manager who had been in post for fourteen years. She had a sound knowledge of people's needs and the management requirements of the home.

The service had quality assurance systems in place. We saw surveys were sent to people who used the service, relatives, staff and health care professionals in March 2014 and the service had a good response to this. People said the home was caring and the staff very supportive and knowledgeable of peoples needs and expectations.

The manager had regular auditing systems in place for the monitoring of service provision. Health and safety was also monitored to promote the welfare of people who used the service and maintain a safe working environment.

As part of our inspection we spoke with four people who used the service, the Registered Manager, two support staff, one domestic staff and a visiting healthcare professional. We also used the Short Observational Framework for Inspection (SOFI) because some people living in the home had complex needs, which meant they were not able to tell us their experiences of using the service. SOFI is a specific way of observing care to help us understand the experiences of people who are not able to talk to us.

Our observations showed that some people used different methods of communication. For example, the use of body language or facial expressions. We observed that staff recognised these non verbal communication methods and responded appropriately. We saw that staff spoke to people before supporting with any care in order to gain their consent and to ensure they were happy to be supported.

People we spoke with told us they liked living in the home and felt safe. Comments included "It's nice here" and "I feel nice and safe". People said that staff are "Nice" and that they were looked after "Very well".

Staff told us that they "Liked" working at the home and felt supported by their manager.

We found that appropriate checks were in place to confirm the suitability of staff to work with vulnerable people.

People who use services at Fircroft are predominantly older adults who have multiple or complex needs. Those people who spoke with us were very happy and positive about the service they received at the home. We observed that people were relaxed and at ease in their surroundings and were involved in meaningful activities. They were supported by staff in a way that was mindful of their rights to respect, dignity and privacy.