Firs Hall is a care home that provides 24-hour residential care for up to 31 people. At the time of our inspection there were 20 people living there. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Firs Hall is a large detached building located on the Oldham/Manchester border which provides accommodation over two floors. The home has 21 single rooms and five double rooms; 12 of the bedrooms have en-suite toilets. There are several large communal rooms and a small garden to the side of the building.

This was an unannounced inspection which took place on 6 and 7 December 2018. The CQC last inspected Firs Hall in May 2017, when the service was rated as ‘Requires Improvement’, overall. At that inspection we found the service was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Safe care and treatment. We identified concerns around infection prevention and control, cleanliness of equipment, administration of medicines and monitoring people's nutritional needs. At this inspection we found improvements had been made and the service was no longer in breach of any of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The building was secure, clean and well maintained. Communal rooms were attractively decorated and provided pleasant spaces for people to relax in. There were effective infection control and prevention measures within the service. Checks and servicing of equipment, such as for the gas, electricity and fire-fighting equipment were up-to-date.

There were enough staff to meet the needs of the people who currently lived at the home and appropriate recruitment checks had been made to ensure staff had the right character to work with vulnerable people. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

A safe system of medicine management was in place. Medicines were stored securely and records showed that staff received training and competency assessments before they were permitted to administer medicines. Risk assessments had been completed. These helped identify if people were at risk from everyday harms, such as falls. Where risks had been identified, there were plans in place to guide staff so that people were kept safe.

People were supported by a stable staff team, who knew the residents well. Training records showed that all staff had completed recent training in a range of topics. This helped them to maintain their knowledge and competence. Staff received regular supervision and an annual appraisal. This ensured the standard of their work was monitored and gave them the opportunity to raise any concerns or worries.

We observed that staff always considered people’s capacity and consent when supporting them with care tasks. People were given choices when making everyday decisions. When people were being deprived of their liberty the correct processes had been followed to ensure that this was done within the current legislation.

Care staff at Firs Hall monitored people’s health. Where specific healthcare needs were identified, the service liaised with health care professionals for specialist advice and support. People were supported to eat a well-balanced diet and were offered a choice and variety of good quality, home-cooked meals.

We saw that people were comfortable

This inspection was carried out on 10 and 11 May 2017. Our visit on 10 May 2017 was unannounced.

Firs Hall is a large detached residential care home located on the Oldham/Manchester border. The accommodation consists of 21 single rooms, 12 with en-suite toilets and five double rooms. The double rooms are only used to accommodate single persons, unless occupied by couples. None of these rooms were occupied by couples at the time of our inspection. Other facilities are a large communal lounge with adjacent small ‘music room’ and a dining room. At the time of our inspection there were 19 residents living at the home.

At the time of our inspection there was a registered manager in place. 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.

At our last inspection in January 2015 we rated the service as ‘Requires Improvement’ overall. At this inspection we have again rated the service as Requires Improvement. This is because we found a breach of Regulation 12 of the Health and Social Care 2008 (Regulated Activities) Regulation 2014. safe care and treatment. We identified concerns around infection control, cleanliness of equipment, managing medicines and monitoring people’s nutritional needs. You can see what action we asked the provider to take at the back of the full version of this report.

We have made one recommendation in relation to quality assurance processes.

Staff understood safeguarding procedures and what action they should take in order to protect vulnerable people in their care. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people.

Although the home was clean and attractively decorated, the outside environment was in need of maintenance and we found some equipment, such as wheelchairs were dirty. Positive efforts had been made to make parts of the home suitable for people with dementia. Checks and servicing of equipment, such as for the gas and electricity were up-to-date.

Medicines were stored correctly and staff who administered medicines had received the appropriate training. However, we found there were some omissions in the recording of medicines administration.

Risk assessments had been completed to show how people should be supported with everyday risks, such as risks to their mobility or nutrition. However, we found that where a risk had been identified and a plan put in place, this was not always followed fully. This was particularly in relation to risks to nutrition.

Staff had undertaken training to provide them with the skills and knowledge required for their roles and received regular supervision to talk about their training and support needs and to discuss any issues in relation to their work.

Staff encouraged people to make choices where they were able to and sought consent before undertaking care. The service was working within the legal framework of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards.

People were complimentary about the caring nature of the staff. Care plans were ‘person-centred’ and were reviewed regularly to ensure they reflected the current needs of individuals.

A range of activities were provided for people.

The service had a complaints policy although no recent complaints had been received. People spoke positively about the registered manager, the support they received from them and the management of the home.

There were a range of up-to-date policies available for staff to refer to for guidance on best practice. There were quality assurance processes in place to monitor the quality of the service and ensure it was maintained and improved. However, these had not identified all t

We saw that some of the people staying at the home had complex health care needs such as dementia. This meant that they were unable to tell us about their experiences of receiving a service. However, we did speak with three people who lived at the home. They told us that it was “okay” living at the home. They described the staff as “helpful” and “very good”. We heard that the food was “excellent” and people said they were confident any complaints they had would be addressed.

We spoke with two visitors who told us they were satisfied with the service provided to their relative. Both had stayed and shared a meal with their relative. They said the food was “very good” and “plentiful”.

We saw that people lived in a clean and odour free environment and some areas had benefited from redecoration. People received respectful and supportive care from staff and their health and nutritional needs were monitored and supported.

Recruitment of staff was safe. We spoke with two care staff, both demonstrated a good understanding of providing individual support and safeguarding people.

We saw that regular checks on the different aspects of the service were undertaken.

At the time of this inspection visit, the Registered Manager was not available.

We inspected the home because our inspection visit of 1 May 2012 identified two areas where the service provided was not of a satisfactory standard.

In May 2012 people’s care records did not contain sufficient personal information to enable staff to provide individual care and support in accordance with people’s needs and wishes.

We looked at two people’s care records at this inspection visit. They provided clear evidence that people’s needs were assessed appropriately. In addition there was good evidence that people had been involved in agreeing how their care should be provided to them.

Our inspection visit in May 2012 identified that there were insufficient safe and hygienic hand washing equipment available for staff to use. This meant infection control practices were not as safe as they could be.

At this visit, we saw that paper towel and hand wash dispensers were fitted in all the toilets and bathrooms. Paper towels and hand wash soap were available. This meant staff could wash their hands in a safe manner and so minimise the potential risk of transmitting infection.

At the time of our visit, 21 people were accommodated at Firs Hall Care Home Limited. A number of people had dementia type illnesses, which made it difficult for them to tell us what their experiences were like of living at the home.

However, we spoke with four people living at the home and one visitor. People told us that they liked living at the home. They told us that the staff were helpful and respectful and that the food was good.

One person said that the staff “Look after me”. They said “The food is very good and if you don’t want something on the menu the cook will go out of his way to get you something you want”. They told us that they “Played skittles occasionally and did some baking last week”.

Another person told us they “Liked the food and people”. They said “Staff are respectful, I can’t complain”. They told us that there were occasional activities such as “Bingo and armchair exercises”.

We heard from other people that staff were helpful and that people’s choices at bedtime were respected.

One visitor told us that the staff always called out a doctor if there were any concerns about the health of their relative. They said they were satisfied that their relative was cared for.

We heard that there had recently been a ‘resident and relatives’ meeting at the home. People told us that they enjoyed this.

We saw that the manager had sent out ten questionnaires to local medical professionals such as doctor’s surgeries in January 2012. Four questionnaires had been returned. These all contained positive responses. One GP practice wrote “The residents seem content”.

This inspection of Firs Hall was carried out over two days on the 19 and 20 January 2015. Our visit on the 19 January 2015 was unannounced.

Firs Hall is a large detached care home accommodating up to 31 older people who require assistance and support with personal care needs.

Accommodation comprises of 21 single rooms, 12 with en-suite toilets, and five double bedrooms, one with an en-suite toilet. Other facilities include two lounge/dining areas. There were 22 people living at the home at the time of our inspection.

The home is located on the Oldham/Manchester border and is accessible for local amenities and bus routes.

We last inspected Firs Hall in May 2013. At that inspection we found the service was meeting all the essential standards and regulations that we assessed.

There was a registered manager in post at the time of our inspection. 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.

During the inspection we observed care and support in the communal areas of the home, spoke with staff, visitors, visiting healthcare professionals and people living at Firs Hall. We also looked at care and management records.

The care records we viewed demonstrated to us that people’s health was monitored and referrals were made to other health professionals as appropriate.

The experiences of people who lived at the home were positive. People told us they felt safe living at the home and were happy living there. People told us that the food was nice and there was always a choice.

In addition we saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered choice and if people required assistance to eat their meal, this was done in a dignified manner.

During the inspection we saw that although staff were busy they were kind to people when attending to their needs.

Staff told us that they had to undertake all the laundry duties for the home and some of the evening meal preparations. Due to these added responsibilities they told us they felt they did not have enough time to spend with people.

Although refurbishments had taken place since our last inspection visit we found that some areas of the home and furnishings and fittings were tired and worn in appearance and required updating.

We found that the provider’s quality assurance systems required improvement because the shortfalls we found with particular reference to the environment and medication recordings in relation to controlled drugs had not been identified through their audit processes. You can see what action we told the provider to take at the back of the full report.