This inspection took place on 4 September 2018 and was unannounced.

Firs Residential Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 33 older people and older people living with dementia in one purpose-built building. Currently there are 29 people living at the home. Accommodation is provided over one level.

At the last inspection November 2017, the home was rated good. This is the first time the service has been rated Requires Improvement.

A registered manager was not 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. A new manager had been in post since October 2017 and was going through the application process to be registered with the Commission.

People told us they felt safe and staff knew how to recognise and report any concerns about people's safety and welfare.

Not all the required checks were completed before new staff started work to help to protect people. Staff told us the training was good and relevant to their role. However, records did not reflect training had taken place. Staff were supported by the manager and were receiving formal supervision where they could discuss their ongoing development needs.

Overall, there were enough staff deployed. However, we recommended the provider reviews staff levels at busy times of the day and during the night.

People who used the service and their relatives told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion.

Care plans were not all up to date. This meant care plans did not always detail what care and support people wanted and needed.

Individual risks to people's health and welfare were not always identified and managed. Their care plans were not always detailed enough, and this created a risk they would not consistently receive appropriate care which met their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s healthcare needs were being met. Medicines were being stored safely; however, they were not always managed safely.

Staff knew about people’s dietary needs and preferences. People told us the food was very good. There were drinks and snacks available for people in between meals. Improvements were required to the service’s monitoring of nutrition and people’s weight.

Activities were on offer to keep people occupied. Visitors were made to feel welcome and could have a meal at the home if they wished.

The home was spacious but required decoration. Also, two bathrooms and one toilet were out of use, and the sluice room was being used as a store room.

The complaints procedure was displayed. The home had not received any complaints.

Everyone spoke highly of the manager who said they were approachable and supportive. The provider had systems in place to monitor the quality of care provided. However, these were not always effective. Where issues were identified they acted to make improvements; however, the outcome was not documented.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and made one recommendation. We are considering the appropriate regulatory response to our findings.

Further information is in the detailed findings below.

Firs Residential Home provides residential support and care for up to 33 older people. At the time of our inspection there were 27 people living at the home. At the last inspection, in September 2015, The service was overall rated as ‘Good’ however we found that not all staff training was up to date. We issued one requirement action. At this inspection we found improvements had been made.

People remained safe at the home. People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. There were policies and procedures in place which minimised the risks of abuse to people. The risks to people had been assessed, recorded and plans were in place to manage these risks and keep people safe. People received their medicines safely and as prescribed from trained staff.

Staff undertook training and received regular supervision to help support them to provide effective care. Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is legislation protecting people who are unable to make decisions for themselves or whom the state has decided need to be deprived of their liberty in their own best interests. We saw people had a choice of food and drinks with snacks also available throughout the day.

People were treated with dignity and respect. People were asked their preferences about how they wanted to be supported and cared for. These details were recorded in people's care plans including their end of life wishes. People were supported to see other health and social care professionals when they required additional support.

Staff adopted a kind and compassionate approach to their work. People's involvement in decision-making was encouraged. People's rights to privacy and dignity were understood and promoted by staff. People's choices were respected.

Person centred plans were in place and people and their relatives were involved in planning the care and support they received. Care plans were regularly reviewed.

People, staff and professionals spoke highly about the registered manager and staff. The registered manager and registered provider continually monitored the quality of the service and made improvements in accordance with people's changing needs. When concerns were raised during the inspection the management were proactive in responding to them. The registered manager promoted an open culture which put people at the centre of the service.

We carried out this inspection on 01 September 2015 and it was an unannounced inspection. This means the provider did not know we were going to carry out the inspection. At the last full inspection carried out in February 2015, we found the home to be non-compliant with the following regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010; 10; Assessing and monitoring the quality of service provision, 13; Management of medicines, 18; Consent to care and treatment and 23; Supporting workers. Compliance actions were given for all these breaches. We followed up on these breaches during this inspection.

Firs Residential is a care home providing personal care and accommodation for 33 older people. The home is on one level and has 25 single and four double bedrooms. There are three lounge areas. On the day of our inspection, there were 32 people living at the home, some living with dementia.

It is a condition of registration with the Care Quality Commission that the home has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The registered manager was present on the day of our inspection.

People and their relatives told us they felt the home was safe, effective, caring, responsive and well led. Comments made included; “I definitely feel [the home] is safe. I don’t think there’s anything to worry about really”, “[Staff] are a lovely bunch. I’m completely surrounded by such nice people”, “I can’t find any fault at all, other than that we could do with more things to do”, “I see the GP when I need to. I had a water infection and [staff at the home] called a doctor out”, “I have no worries or responsibilities here, I’m free as a bird” and “It’s fantastic food here. I choose what I want to eat and when I get up. I choose what I want to wear. I’m asked about everything and anything really.”

People were protected from abuse and the home followed adequate and effective safeguarding procedures. Care records contained personalised and relevant information for staff to assist in providing personalised care and support.

Staff told us they felt well supported and they had supervisions with the new manager. Training updates were not always provided when needed but plans were in place to address this.

We found good practice in relation to decision making processes at the home, in line with the Mental Capacity code of practice, the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

The registered manager carried out regular audits at the home and recorded any required actions on audits and on the ‘home action plan’. Actions that had been identified as a result of audits were verified and signed off by the registered manager when they had been addressed and completed. The registered manager had a plan in place to start additional regular audits to ensure all areas of the home were monitored.

We carried out this inspection on 10 February 2015 and it was unannounced.

Our last inspection of the service took place on 09 December 2013, when we found the service was not meeting the requirements of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010; Consent to care and treatment.

Firs Residential Home provides personal care and accommodation for up to 33 older people. The home is on one level and has 25 single and four double bedrooms. At the time of our inspection, there were 20 people living at the home.

It is a condition of registration with the Care Quality Commission that the service has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At the time of our inspection, the registered manager was not the person who was managing the service. We spoke with the manager about this, who told us the provider was looking to recruit a new manager, who would register with CQC as the registered manager.

We found the service ensured people were protected from abuse and followed adequate and effective safeguarding procedures. We found care records were personalised and contained relevant information for staff to provide person-centred care and support.

We found some concerns about the decision making process regarding the use of restraint at the home, where the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had not been followed.

The management of medicines was unsafe and there was no auditing of medication systems and processes.

We found the culture at the service was not monitored, through supervision of staff values and behaviour, although staff told us they felt confident in speaking with the manager and provider, should they see any instances of bad practice.

There was no monitoring system in place to identify staff had received training relevant to their role. Staff had not received supervision on an individual basis nor had their performance appraised.

During our inspection, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

You can see what action we told the provider to take at the back of the full version of the report.

People told us that they were happy living at the home and that they were satisfied with the care they received. Peoples comments included, "Staff are kindly”,” it’s very nice, the staff are a lovely lot”,” staff are very good, very kind” and “it’s a really good home, staff are always pleasant.”

We spoke with two relatives who were visiting the home and they confirmed that they were very satisfied with the care provided. One told us, “The care and the staff here are brilliant.” Another relative said "I’m extremely happy with the care and home in general.”

We used periods of observation to see how members of staff interacted with people who used services. We saw staff treated people with dignity and respect by using a positive, friendly and kind approach. We found people looked clean, tidy and had their personal care and welfare needs met.

We carried out this inspection to check out the progress made with the compliance actions made at the last inspection. The outcomes checked were about the safety, availably and suitability of equipment and quality assurance. We did not speak to people living in the home about these outcomes. However from our observations, we found that people were generally happy living in the home and had friendly relationships with the staff. We saw people sitting comfortably in communal lounges. The building was warm and homely.

We spoke to three staff who told us that the manager was working very hard to ensure that the service met all of the outcome areas.

We spoke with Barnsley Local Authority, Contracting, Commissioning and Safeguarding

and they told us that the new manager was "making a significant difference" at the home.

People living in the home told us they were generally “Very happy” with the service and told us that staff were “Fantastic” and “Spot on”.

People using the service told us staff “Look after me well” and one said they “Put the life into me”.

People living in the home said they were generally happy with the service and we observed staff were committed to promoting their welfare.

People using the service told us they were generally happy with the service but we saw evidence in the minutes of meetings with them they sometimes felt cold.

Comments from people that use the service were generally extremely positive about the staff and said they were “Wonderful” and “Kind”. People said they “Couldn’t ask for more – All very good”.

We visited the home on two separate occasions as on our first inspection visit, we did not have access to all of the information that we needed to see.

During our inspection visits we spoke with the provider, the manager, four care workers, the activities coordinator and the cook. We spoke with seven people who lived at the home and four relatives and friends of people who lived at the home.

Before people received any care or treatment they were not always asked for their consent to ensure the provider acted in accordance with their wishes.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People said, “I’m grateful for what the staff do, I would like to be at home but I appreciate the help I get, they’re are always around when you need them” and “It’s not bad, staff are not bad, I like to do my own thing, no complaints.”

People were protected from the risks of inadequate nutrition and dehydration. People told us, “Food is very good and varied, they always ask if we want more, there’s no need for people to bring you any extra in, we get plenty” and “I like the food.”

The home had an appropriate recruitment procedure in place.

There was an effective complaints system available. People told us, “I’ve no complaints but would tell someone if I had” and “Some [staff] listen, some don’t. I will open my mouth when I want to.”