The Firs Nursing Home is registered to provide accommodation and nursing care to up to 40 people. The home specialises in the care of older people. At the time of this inspection there were 34 people living at the home.

At the last inspection, the service was rated Good

At this inspection we found some minor improvements could be made to make sure people received effective care but the overall rating for the service remained Good.

Why the service is rated Good.

People received safe care because the provider made sure there were enough staff available to meet people’s needs and ensure their safety. People’s medicines were safely administered by registered nurses and staff knew how to report any concerns or suspicions of abuse.

People were at risk of not being supported to have maximum choice and control of their lives because staff did not all have a clear understanding of people’s legal rights in relation to the Mental Capacity Act 2005. People’s health and well-being was monitored and staff sought appropriate advice and support to meet people’s healthcare needs.

People were cared for by kind and compassionate staff. One person said “I don’t think you would find better or more caring staff anywhere.” Care was provided to people in a way that respected their privacy and dignity.

People received care that was responsive to their needs and took account of their wishes and preferences. Staff made sure people received the right level of care and support when their needs changed. People said they would be comfortable to make a complaint if they were unhappy.

People lived in a home that was well led by the registered manager and provider. The provider was committed to continually improving the service and facilities for people. People were kept informed of changes and there were opportunities to share their views.

Further information is in the detailed findings below

This inspection was unannounced and took place on 10 March 2015.

There is a registered manager in post. 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.

The Firs Nursing Home is registered to provide nursing care and accommodation to up to 40 people. The home specialises in the care of older people. At the time of the inspection there were 36 people living at the home.

The home had a team of skilled and experienced staff who were well supported and received on-going training. People had confidence in the staff who supported them and felt well looked after. Comments included; “Staff are very good. We are well looked after there is no doubt about that,” “I need to be hoisted to move and the staff who help are really good at that” and “You can always talk with a nurse if you want advice or you aren’t feeling too good. They are all very good.”

Staff were kind and caring and people said they responded to all requests for help promptly and politely. People received care and support in a relaxed unhurried manner.

There was a varied activity programme which took account of people’s interests. People were able to take part in group and one to one activities. People told us staff spent time chatting and socialising with them. Staff had a good knowledge of the people they cared for and helped them to celebrate special occasions such as birthdays and wedding anniversaries.

People’s nutritional needs were assessed to make sure they received a diet in line with their needs and wishes. One person told us “The cook comes to speak with me to make sure I get what I like and what suits me.” People were very complimentary about the food at the home and said they always got a choice. Comments included; “Food here is good,” “There’s plenty to eat and drink” and “You couldn’t get better food.”

There were good relationships between people and staff which led to a happy and relaxed atmosphere. More than one person said they thought the home had a family type atmosphere and they felt part of a group. One person said “The staff are like friends.” A member of staff said “It’s a lovely place to work. The staff and residents are wonderful. We treat everyone as if they are part of our family.”

Care was personalised to people’s individual needs and wishes. People continued to make choices about all aspects of their life. One person told us “I’m certainly still in charge of things.” People said they were free to decide what time they got up, when they went to bed and how they spent their day. Some people enjoyed their own company and others socialised in the communal lounges. People said they were able to make choices on a day to day basis.

There were systems in place to minimise risks to people. Staff were thoroughly checked before they began work and knew how to recognise and report any suspicions of abuse. Medicines were administered by trained nurses who had received specific training and risk assessments were in place to promote people’s health and well-being.

The registered manager and provider carried out audits and checks to make sure standards were maintained and to gauge people’s satisfaction with the service and facilities.

We carried out this inspection to check whether the provider had taken appropriate action to address two areas of non-compliance found at our last inspection on 20 May 2013. In addition to these two outcomes, we also looked at how the home ensured the health and welfare of the people who lived at the home.

When we visited 35 people were using the service. We met with 16 people who lived at the home, three members of staff and the manager. We also spent time observing how staff interacted with the people who lived at the home.

People were positive about the care and support they received. Comments included “I am very happy with everything. The staff are lovely. I have no complaints” and “I feel well looked after here. If I need anything, I only have to ask.” Staff interactions were kind and respectful and people appeared to enjoy the company of staff.

We met with four people who were being nursed in bed. All appeared clean and comfortable and records showed that staff checked people at least hourly. We saw that people had access to a call bell. People told us that staff responded promptly to any requests for assistance.

Improvements in how people’s care plans and assessments were audited meant that risks were identified and managed in a timely manner.

We found care records up to date and well maintained. This improvement reduced the risks of people receiving unsafe or inappropriate care.

We visited The Firs Nursing Home to carry out a planned inspection. We also used this time to follow up two compliance actions that had been set from the last inspection in July 2012.

At the time of the inspection there were 33 people living in the home. We spoke with five people who lived in the home, two of their relatives and observed how people were cared for and treated. People living in the home and their relatives told us they were very happy with the care and treatment that was received. They also said they would recommend the home to others. One person said “staff are very kind and helpful, the home is lovely, no concerns or areas for improvement”. We found that when observing staff their interactions with people were sensitive and respectful.

We looked at four individual care records which showed people’s needs had been assessed. Although some care records did not reflect people’s current needs.

We found the home was well maintained and action was taken to address any maintenance that was necessary to keep people safe. We found the manager carried out appropriate checks on its staff to ensure they were of good character and skilled to carry out the role.

This review was carried out to follow up on concerns raised at the previous inspection in February 2012. We also carried out a full review of all outcomes detailed in this report.

During our visit we found that overall people’s views of the service were good. We spoke with six people who lived in the home. Some of their comments were; “staff are very good here”, “some of the staff are not as competent but the majority are great” and “I can’t fault any of it”.

One person we spoke with told us they had some concerns about how their care was provided. We raised these concerns with the manager who arranged for appropriate action to take place to ensure the home was meeting the person’s needs. We were informed that improvements were to be put in place for this person and possibly implement some staff training.

People who had the capacity to consent told us they were always asked for their consent before a member of the care team undertook any care, support or treatment. They told us that if they did not want staff to do something then they could say no and that was respected by the member of staff.

Staff spoken with told us that they would not push someone into a decision about any aspect of their care. For example, a member of the care team told us that the home schedules baths for people on particular days. If someone did not want a bath on the day they were scheduled then they would be offered a choice for another day.

During our visit we found there were some concerns regarding how the home gains consent from people who lack the capacity to make an informed decision about their care and treatment. There were also concerns in relation to an unsecure shower room which was under renovation that may put people at risk.

People who lived at the home told us that they were satisfied with the care they received. They also told us that they were able to make choices about how they spent their day. Comments included “I feel the staff know me well enough to know how I like to be helped”, “I decide when I get up and what time I go to bed, sometimes I like to watch my television until late”. Some people spoken with told us that they preferred to remain in their bedroom. They said “the staff know that I don’t want to sit with others, they bring me my meals and drinks and check that I am alright”, “it’s my decision and the staff respect that”.

People confirmed that staff were aware of their preferences for food and drink. They said “they know what I like and what I don’t like and they will always check with me”. The cook and care staff spoken with told us that they met with people when they moved into the home to discuss their preferences for food and drink. They told us that a record of people’s preferences was kept in the kitchen.

During our visit we observed that people moved freely around the home. Some people were unable to mobilise without staff assistance and we saw that staff offered these people a choice of where they would like to sit. One person said “you can come to your room when ever you like and if you need help you just ring the bell”.

Some people spoken with were aware that they had a care plan. One person said “the staff know me well and they know how much help I need”. Another person told us “I am always treated with respect by the staff and I have no complaints”.

People appeared very comfortable in the presence of staff and it was evident that staff knew people well. Staff interactions were noted to be kind and respectful. The atmosphere in the home was relaxed and people were offered assistance with personal care in a dignified and discreet manner. Staff were observed to knock on people’s bedroom doors before they entered.

People’s contact with health and social care professionals had been recorded in the care plan which demonstrated that people had access to appropriate professionals in line with their individual needs.

Staff observed and spoken with, demonstrated a good knowledge of the needs and preferences of people living at the home.

No concerns were raised with us during our visit and people told us that they would feel comfortable in raising concerns if they had any. One person said “I wouldn’t hesitate in telling somebody if I had any concerns”.

Everyone asked said that they felt there were enough staff on duty to meet their needs. One person said “the staff are very good and they come if you ring your bell”. Another said “there always seems to be someone about to help you”.

We observed that staff responded in a timely manner to any requests for assistance. Although staff were busy we saw that they had time to chat with people as well as undertake tasks.

Some people spoken with told us that they had the opportunity to attend meetings where they discussed a range of topics. People’s relatives/representatives had also been invited to attend these meetings.

We saw the minutes of the most recent meeting which demonstrated that people had expressed their views on the menu and activities offered. Following suggestions made by people using the service a suggestion box and activity notice board had been displayed in the reception area of the home.