We inspected the service on 26 March 2018. The inspection was unannounced.

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 Firs Residential Care Home accommodates up to 12 people over two floors. On the day of our inspection, 11 people were using the service and one person was in hospital.

The Firs Residential Care Home is also a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection, two people were receiving a care package where personal care was provided.

At the last inspection in March 2016, the service was rated ‘Good’, in the key questions and at this inspection; we found the service remained ‘Good’ again in all areas.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks associated with people’s needs including the environment, had been assessed and planned for and these were monitored for any changes. People did not have any undue restrictions placed upon them. There were sufficient staff to meet people’s needs and safe staff recruitment procedures were in place and used. People received their prescribed medicines safely and these were managed in line with best practice guidance. Accidents and incidents were analysed for lessons learnt to reduce further reoccurrence.

People continued to receive an effective service. Staff used nationally recognised assessment tools to effectively support people’s needs. Staff received an induction, ongoing training and support. People were supported with their nutritional needs; food and drink choices were offered and provided. The staff worked well with external health care professionals, people were supported with their needs and accessed health services when required. 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. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Advocacy information was available should people have required this support.

People continued to receive a responsive service. People’s needs were assessed and planned for with the involvement of the person and or their relative where required. People received opportunities to pursue their interests and hobbies, and social activities were offered. People were also supported to participate in community activities and interests. The provider had made available the complaint procedure.

The service continued to be well-led. There was an open and transparent culture and good leadership, oversight and accountability. People received opportunities to share their feedback about the service and staff felt valued. The provider had quality assurance checks in place on quality and safety. The registered manager had implemented innovative ways of supporting people with their wishes.

Further information is in the detailed findings below.

This announced inspection was carried out on 2 March 2016. The Firs Residential Care Home is registered to provider accommodation and care for 12 older people. On the day of the inspection there were 12 people using the service.

The service had a registered manager in place 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.

People’s safety was promoted because systems were in place to keep people safe from harm. Staff knew how to report any concerns to the authorities where they suspected someone was at risk of harm or abuse.

People were supported by a sufficient number of staff who had the time to meet their care and social needs. People had the assistance they required to take their medicines as prescribed.

People were provided with care and support by staff who were trained and supported to deliver care safely and appropriately. People’s human rights to make decisions for themselves were respected and they provided consent for their care when needed.

People received the assistance they required to have enough to eat and drink. People received support from staff who understood their health conditions and arranged for them to see healthcare professionals when needed.

People were able to try the home to see if it was to their liking before making a decision to move there. They were actively involved in preparing and reviewing their care and support so this was exactly how they wished it to be. People were given the encouragement and practical support they needed so they could follow their hobbies and interests and maintain links and friendships with their own local community.

People were asked how their service could be improved any action needed could be taken without them needing to make a complaint. People felt comfortable to raise any issues that they wished to and were confident these were listened to and addressed.

People had opportunities to express their views on what it was like to live in the service and how they felt this was run. People knew the registered manager well and trusted them to look after their welfare. There were systems in place to monitor the quality of the service and make improvements when needed.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with eight people who used the service and asked them for their views. We spoke with two care staff, the cook, the registered manager and one of the directors, who was the nominated individual. We also looked at some of the records held in the service including the care files for four people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found where people were able to they gave consent to their care and support. A person who used the service told us, “I decide what I want to do. My routine is what I want it to be.”

We found people were provided with a varied and nutritional diet. A person who used the service told us, “The meals suit me and I am a fussy eater. I don’t know how they manage to feed me, there are so many things I do not like.”

We found that suitable arrangements were in place to manage people’s medication and ensure they received any medication they needed. A staff member told us how one person liked to take their medication in a particular way and this was recorded in the person’s care plan for medication.

We found there were sufficient staff to meet people’s needs and the provider maintained records that were accurate and fit for purpose. A person who used the service told us, “There are always plenty of staff if you want any assistance. There are no problems there.”

One of the people we spoke to said they were able to decide what they wanted to do or have for themselves. They told us, “I wanted a cup of tea at six o’clock the other morning and they brought it.” Another person told us they were very independent and looked after their own care.

We had a discussion about the home with three people around the dining table. They made a number of complimentary statements about their experience within the home. These included, “The staff do everything they can to make it right for you”, “The food is wonderful”, “We have great activities” and how welcoming everyone was to their friends and family. One person told us, “The Queen could not be looked after better. If we can’t look after our selves at our homes we couldn’t be in a better place.” Another person who was listening nearby to our discussion came over and said, “Every word they said is true.”

People told us they felt safe in the home. One person said, “It is very safe here, it looks safe.” Someone else said, “If you say you need something they are there. I feel very safe.”

One of the people who lived in the home said, “They are fully trained, I know it is good training because the results are good. If the training wasn’t good the results wouldn’t be good.” We were told by someone else, “You see bad reports about care homes in the press, there is nothing like that here.”