The provider of The Firs Rest Home provides accommodation and care for up to 15 people, some of whom were living with dementia. At the time of our inspection 15 people were living at the home.

At the last inspection in April 2015, the service was rated Good overall. However, in the safe question the provider was in breach of breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014 with the safe question rated as Requires Improvement. This was because we found people were not always kept safe by staff and or the registered manager as they did not recognise different types of abuse and report incidents of abuse appropriately for investigation.

At our focused inspection on the 7 October 2015, we found the provider had followed their plan and made the required improvements and had met their legal requirements.

At this inspection the provider had sustained the required improvements. Staff had received training in protecting people from abuse and showed a clear understanding about the types of potential abuse and how to report this.

Risks were assessed and managed and people were supported by sufficient staff to make sure they received care and support when they needed it.

People’s medicines were always made available in sufficient quantities with quality checks in place to make sure any discrepancies were identified in a timely manner and remedied.

Staff had the knowledge and skills to provide people with appropriate care and support. Staff enjoyed their work and felt they worked as a team for the benefit of people who lived at the home.

People were supported to maintain their nutrition and staff responded to people’s health needs. Staff monitored people’s health and shared information effectively to make sure people received advice from external professionals, according to their needs.

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

Staff were seen to be kind and caring, and thoughtful towards people and treated them with respect when meeting their needs. People’s privacy was respected and they were supported to maintain their independence and to live their life the way they wished including receiving their visitors who were welcomed.

People were satisfied staff were supportive and responded to their needs in the way they wanted. People’s care plans described their needs and abilities. Staff assisted people to have fun and interesting things to do so that the risks of social isolation were reduced.

People continued to be happy with the opportunities they had to share their views about their care and knew how to raise complaints if they had any concerns about the service.

There was clear and visible leadership in place and there was a culture of keeping people at the heart of their care.

There were arrangements in place to monitor and assess the quality of the service so continual improvements were made so that people received a good quality service at all times.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of this service on 14 April 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to safeguarding service users from abuse and improper treatment, regulation 13 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.

We undertook this focused inspection on 7 October 2015 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Firs Rest Home on our website at www.cqc.org.uk

The Firs Rest Home provides accommodation and personal care to a maximum of 15 people. There were 15 people who lived at the home at the time of our inspection.

At the time of our inspection there was 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.

At our focused inspection on the 7 October 2015, we found that the provider had followed their plan which they had told us would be completed by the 31 July 2015 and legal requirements had been met.

People told us they felt safe in the home and that they had no concerns. Staff we spoke with knew how to protect people from harm. Staff told us about different types of abuse and knew how to report this where necessary. When an incident had happened the appropriate external agencies had been contacted.

While we found there had been positive improvements in people’s experience of care. We could not improve the rating for safe from requires improvement to good. This is because to do so, the provider is required to demonstrate consistent good practice over time. We will check this during our next planned comprehensive inspection.

The provider of The Firs Rest Home provides accommodation and care for up to 15 people, some of whom were living with dementia. At the time of our inspection 15 people were living at the home.

At the last inspection in April 2015, the service was rated Good overall. However, in the safe question the provider was in breach of breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014 with the safe question rated as Requires Improvement. This was because we found people were not always kept safe by staff and or the registered manager as they did not recognise different types of abuse and report incidents of abuse appropriately for investigation.

At our focused inspection on the 7 October 2015, we found the provider had followed their plan and made the required improvements and had met their legal requirements.

At this inspection the provider had sustained the required improvements. Staff had received training in protecting people from abuse and showed a clear understanding about the types of potential abuse and how to report this.

Risks were assessed and managed and people were supported by sufficient staff to make sure they received care and support when they needed it.

People’s medicines were always made available in sufficient quantities with quality checks in place to make sure any discrepancies were identified in a timely manner and remedied.

Staff had the knowledge and skills to provide people with appropriate care and support. Staff enjoyed their work and felt they worked as a team for the benefit of people who lived at the home.

People were supported to maintain their nutrition and staff responded to people’s health needs. Staff monitored people’s health and shared information effectively to make sure people received advice from external professionals, according to their needs.

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

Staff were seen to be kind and caring, and thoughtful towards people and treated them with respect when meeting their needs. People’s privacy was respected and they were supported to maintain their independence and to live their life the way they wished including receiving their visitors who were welcomed.

People were satisfied staff were supportive and responded to their needs in the way they wanted. People’s care plans described their needs and abilities. Staff assisted people to have fun and interesting things to do so that the risks of social isolation were reduced.

People continued to be happy with the opportunities they had to share their views about their care and knew how to raise complaints if they had any concerns about the service.

There was clear and visible leadership in place and there was a culture of keeping people at the heart of their care.

There were arrangements in place to monitor and assess the quality of the service so continual improvements were made so that people received a good quality service at all times.

Further information is in the detailed findings below.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

During our inspection, we observed there were enough skilled staff on duty to meet the needs of people living at the home. The provider had an effective recruitment procedure. This included completing all security checks before anyone commenced work at the Firs Rest Home. This helped ensure the safety of all people at the rest home. We were informed that a senior member of staff was always on call in case of emergencies.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack capacity related to making informed decisions about their care and support. The provider told us an application had been made for a DoLS in January, 2014. We checked the application and all paperwork had been completed appropriately and recorded in the provider`s audit file.

The provider had policies in place to record any incidents or accidents. Any concerns that were expressed were discussed at the next staff meeting. This helped ensure that any identified incidents were learnt from and was aimed at improving the quality of service provided at the rest home.

Is the service effective?

During our inspection, people living at the care home told us they were happy with the care and support they received at Firs Rest Home. One person told us, "I really feel safe here - everybody gets very well looked after here." We observed and talked to staff members and it was clear they had a good understanding of the needs of all the people they cared for. This was confirmed by a doctor who was visiting the rest home who commented, "This is a very friendly home - staff have a good knowledge of the residents needs."

We observed good interaction between staff members and people living at the home. We were able to speak to several people and one said, "Everyone is brilliant here - there is always someone there for you." Another person commented, "The staff are lovely - they are really helpful to me." We saw evidence of a multi-agency approach to providing care. On the day of our inspection, a doctor and a community nurse attended appointments with people living at the home. We also noted the provider contacted other professionals, for example the pharmacist. This was related to a change of medication for one of the people living at the rest home which showed the provider acted in the person`s best interests and protected their welfare.

Is the service caring?

We looked at individual care plans during our inspection. We noted, that as far as possible, people living at Firs Rest Home or their families had been involved in writing up their care plans. People`s wishes and preferences had been recorded and their care and support had been provided in accordance with their wishes. This reflected a person centred approach to providing care.

People living at the rest home were supported by attentive and caring staff members who were patient when trying to understand people`s different support needs. We noted people were supported with their personal care needs and if necessary, at meal times they were assisted with eating their food. One family member who was visiting said, "The staff are great - I hope I end up here."

Is the service responsive?

Staff meetings were held regularly at the rest home which were aimed at improving the quality of care and support provided to people living there. The outcome from one meeting was a decision that staff completed a communication book during each shift detailing the care and support that had been provided. This helped ensure people received a continuity of care and so had their needs met appropriately.

We were told by the provider that the need for an improved complaints procedure had been identified. Consequently, a dedicated log book had been provided which helped ensure any complaints were listened to and responded to in an acceptable time frame. People could be assured that all complaints were investigated thoroughly and action taken if necessary.

Is the service well-led?

The provider told us, and we saw evidence, that Firs Rest Home worked well with other agencies. This meant people received the support they needed when they needed it. One family member said, "If there is ever a problem they get in touch with us straight away - they are very good like that."

We saw details of monthly audits that had been conducted related to the environment, infection control procedures and people`s nutritional needs. Weekly fire alarm checks were also held. Hoists and lifts were audited on a quarterly basis which helped people receive the support they needed. External audits were also observed. Worcester County Council (WCC) had recently completed an audit of all individual care plans. During 2012-13, WCC awarded the rest home with an award for, `Improving the Quality of Person Centred Dementia Care.` In March, 2013, a pharmacy audit was completed with no concerns recorded. Overall, the rest home had a quality assurance system in place that identified any concerns and addressed them immediately.

13 people were living at the home when we inspected. We talked with four of them as well as the registered manager, deputy manager and three members of staff. The staff we spoke with included care and catering staff.

We spoke with people who had recently arrived at the home and people who had lived there for some time. The people we spoke with told us they were happy living at the home. One person said: “It’s lovely. I couldn’t have a nicer place, it’s beautiful.” Another person said: “I like it – the staff are fine and everything is okay.”

The staff we spoke with knew about the needs of the people they provided care to. We looked at care records for two people and found that these contained guidance for staff on how to meet their needs. We saw that people’s needs were reviewed regularly.

We found that people were able to have a choice of suitable and nutritious food and drink in sufficient quantities to meet their needs.

People were cared for by sufficient numbers of appropriately skilled staff.

The provider had a system in place to monitor the quality of its service regularly.

There was a system in place for people to make complaints if they were not happy with any aspect of the service. We noted that the service had not received any formal complaints during the last 12 months.

15 people were living at the home when we visited. Many of the people who lived at the home were not able to talk directly with us because of their dementia so we used different methods to see whether they received the care and support they needed. We used the Short Observational Framework for Inspection (SOFI). We also spoke with the deputy manager and three staff.

Staff knew about the needs of the people they were caring for. We looked at care plans for four people and found that these contained guidance for staff on how to meet their needs.

Staff that we spoke with had varying levels of knowledge about safeguarding issues. This meant that some staff would be more able to recognise signs of abuse than others.

We saw that staff had recently received training in a number of areas including dementia, which meant they were able to meet the specific needs of people living at the home.

We saw looked at records which showed that the provider’s system for monitoring the quality of its service was not working effectively.