The inspection visit took place on 27 February 2018 which was an unannounced comprehensive inspection. We returned announced on 7 March 2018 so we could review the provider’s quality assurance systems, talk with more staff and to see how the provider supported those people who smoked, to be kept safe.

The Firs is a mental health nursing home, which provides care for up to 25 people over two floors. At the time of our inspection there were 23 people living at The Firs.

People in care homes receive accommodation and nursing and/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.

A requirement of the service’s registration is that they have 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 legal responsibility for meeting the requirements in the Health and Social Care Act and the associated Regulations about how the service is run. At the time of our inspection visit there was a registered manager in post who had been registered at this location since July 2016.

At our last comprehensive inspection in September 2016, we rated the service Requires Improvement overall. We found a breach of the regulations because risks were not managed safely. We found further improvements were needed to ensure learning was taken to identify patterns and trends when accidents and accidents occurred. Staff did not always support people in line with the mental capacity act and the provider’s quality assurance systems needed to be improved.

We completed a focused, follow up inspection to look only at ‘Safe’ in July 2017, to check whether improvements had been made. We found sufficient improvements had been made so the service was no longer in breach, but further improvements were still needed to show how they analysed accidents and incidents. Medicines management had improved but further improvements were needed around medicine protocols, for 'as and when required' medicines. This was because there was no information for staff about when to administer this type of medicine.

At this inspection we found improvements had been made since our last inspection visit but further improvements were still required in their quality monitoring systems. Analysis of incidents and accidents had been undertaken although the system required more simplification so it provided a clear picture of what had happened. The registered manager was confident any accidents and incidents were brought to their attention and any action needed, was taken. Medicines protocols for ‘as and when’ medicines were in place and being followed. Staff supported and offered people choice, even if they lacked capacity but improvements were still needed in the recording of best interest decisions.

People were pleased and satisfied with the quality of care provided. People were encouraged to make their own decisions about how they lived their lives.

People received care and support in line with their expressed wishes and goals that promoted and improved people’s social skills. Staff encouraged people and supported them to remain as independent as possible so they did not de-skill people. People maintained important relationships with those closest to them and people were happy with living in a shared home.

For people assessed as being at risk, care records included information so staff knew how to minimise risks to those in their care. Staff knew how to support people to minimise identified risks to the person and others.

Care plans contained information for staff to help them to provide the individual care people required, but more detail was needed to support the provider’s vision of person centred care. Staff knowledge of people was comprehensive, but these details were not always included

We carried out an unannounced comprehensive inspection of this service on 28 and 29 September 2016 and found that the provider had breached regulation in relation to the safety of people living at the home. The provider had not ensured people’s known risks were managed well and had not made sure systems were in place to mitigate risks. Following this inspection the provider sent us an action plan stating what they intended to do to meet the breach of regulation.

We carried out this unannounced focussed inspection on 5 July 2017 to see if the registered provider had followed their plan and to determine if they were now meeting legal requirements. This report only covers our findings in relation to this focussed inspection which looked at whether the service was safe. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Firs Nursing Home on our website at www.cqc.org.uk.

The Firs Nursing Home provides nursing care and accommodation for up to 25 people who are predominantly living with mental health needs. There was a registered manager at the service who was present throughout 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.

At this inspection we found that there had been some improvements made and the provider was no longer in breach of regulation.

People told us they were supported safely by staff. People received safe support when mobilising around the home and when being supported with their medicines.

Improvements had been made in the assessment of people’s risks and new systems had been introduced to ensure the risks associated with people’s individual needs were now better managed. Although these improvements had been made we found further work was needed to ensure these were carried out consistently and to ensure people were protected from the risk of reoccurring accidents or incidents.

Whilst most medicines practice was safe we found that further improvements were needed in some records and in ensuring information was always available around ‘as required’ medicines.

There were sufficient staff available to support people. We found that many aspects of safe staff recruitment were in place although further improvements were needed to ensure all checks carried out were robust.

We carried out this unannounced inspection on the 28 and 29 September 2016. The Firs Nursing Home Limited provides care and support for a maximum of 25 people who are living with mental health conditions. There were 22 people living at the home at the time of the inspection. The Firs Nursing Home Limited is an established nursing home, however, since our last inspection the operation of the home had been taken over by a new company (legal entity).This change meant we treated this as the first inspection of a new service. It was however positive that the new provider had taken into account the last inspection of this service and the improvements we identified were required.

The home has a registered manager who was present throughout 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.

People told us they felt safe living at the home. Staff had knowledge of possible signs of abuse and could describe action they would take in reporting any concerns. There were enough staff available to meet people’s requests for support.

The provider had identified risks to people. Where risks had been identified appropriate action had not always been taken to reduce or monitor the risk for the person. You can see what action we told the provider to take at the back of the full version of the report.

People received their medicines safely and there were systems in place to monitor medicines administration.

Staff told us they had received sufficient training although we noted that some staff training had not been kept up to date.

Staff had some knowledge of the Mental Capacity Act (MCA)(2005) and described how they supported people with making choices. The service had not always fully considered the principles of the MCA when determining people’s capacity to make decisions.

People had access to regular healthcare and specialist advice was sought when needed.

People were happy with the provision of meals and drinks at the service. Some people had not been supported safely with their specific dietary needs.

People were happy with the care provided and told us that staff were kind and caring. People were involved in planning their care to meet their individual needs and care was reviewed with people to ensure people were still happy with the care they were receiving. Staff enjoyed working at the home and knew the people they supported well.

People were treated with dignity and respect and were encouraged to remain independent.

People had the opportunity to join in activities in the home and out in the community which were based on their interests.

People were happy with the way the service was managed and there were opportunities for people to feedback their experience of living at the home. The systems in place to monitor the quality and safety of the service were not complete or robust and had failed to effectively monitor all aspects of the service.