The inspection took place on 15 August 2018 and was unannounced. The last inspection took place on 4 and 5 April 2017 when the service was rated good in all domains and good overall. This inspection was undertaken as a response to concerns raised following a death at the home. This matter is currently under investigation. At this inspection we identified two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regard to safety and good governance.

Firbank House is owned by Partnership Caring Limited, which is a private company. Firbank House 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.

Firbank House consists of two buildings and can accommodate up to 42 people. One building is known as the Windsor Unit and can accommodate up to 22 people. The other building is the Balmoral Unit and provides facilities for up to 20 people. The home is registered to provide residential care and accommodation only. At the time of this inspection there were a total of 27 people using the service.

There was a manager in place who was currently in the process of registering with the Care Quality Commission. 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.

Care staff were knowledgeable about how to recognise and report safeguarding issues they may encounter and said they would not hesitate to report any poor practice they may witness.

Staff recruitment required some improvements to ensure it was satisfactory. There were sufficient staff to meet the needs of the people who used the service.

There was a key code in place to help ensure safety, however, an outside area presented a potential risk. This was addressed immediately following the inspection.

There were some issues relating to infection prevention and control. The sluice rooms and laundry areas were cluttered and there was no clear system in the laundry to prevent the risk of cross infection. We also found that some cleaning equipment was stored unsafely, which presented a potential risk to people who used the service.

Individual risk assessments, relating to issues such as mobility, falls, mental capacity and nutrition were not presented in an acceptable format. The manager had commenced changing the care files but as yet appropriate risk assessments were not in place for people who used the service. This meant that risks to people’s health and well-being had not been addressed appropriately.

¿Accidents, falls and incidents were recorded and actions to address any issues had been put in place. Learning was taken from these issues to help ensure improvement to service delivery. Medication systems were robust and staff competency checks were undertaken regularly.

The on-going service improvement plan had identified issues relating to staff training and support, which was now in hand. Staff supervisions had not been in place, but had now been re-commenced.

Amendments were being made to the format of care files, but they contained essential information about people’s health and well-being. Care charts relating to areas such as pressure care and nutrition were completed appropriately and referrals to other agencies were made as required.

We observed one meal time and saw that people enjoyed their food and staff provided support and prompting for people as required. We looked around the premises and found that the décor was tired and worn in places. For example, we saw some peeling wallpaper in one of the corridors.

People we spoke with were all positive about

We carried out the inspection on 4 and 5 April 2017 and the first day of the inspection was unannounced. We last inspected the service in October 2015 where we found the service required improvement.

Firbank House consists of two buildings. The building previously known as the ‘old’ building is now known as the Windsor Unit. This unit has bedroom and communal facilities for up to 22 people. The building previously known as the ‘annex’ building is now known as Balmoral Unit. This unit has bedroom and communal facilities for up to 20 people. The home is registered to provide residential care and accommodation only. At the time of this inspection there were a total of 27 people using the service. One person was in hospital and a total of five people were on respite stays.

At the time of our inspection the registered manager had left their employment with the service early in March 2017. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider of the service had recruited a new manager who was in post at the time of our inspection.

Prior to the registered manager leaving the service the provider had ensured they had received regular and on-going support from their line manager, who had been based at Firbank House for at least three months. This support continued when the new manager came into post, with additional support also being provided by the nominated individual (providers representative). In our conversation with both the line manager and nominated individual, it was confirmed that this support would continue whilst all pre-employment checks had been satisfactorily carried out for the new manager.

We found that that the breaches of regulations identified at the inspection conducted in October 2015 had been satisfactorily addressed.

People and their relatives told us they felt the care and support they received kept them safe and met their assessed needs.

Staff we spoke with were familiar with the safeguarding policy and knew the procedure to follow should they have any concerns. Staff spoken with confirmed they had undertaken mandatory safeguarding training.

We found that all individual care plans and risk assessments had been reviewed regularly and updated where required.

At the time of the inspection we found there to be sufficient staff to meet the assessed needs of the people living at Firbank House.

Medicines were managed safely and people were receiving their medicines in line with the prescriber’s instructions.

The recruitment processes which were in place were robust and required pre-employment checks were carried out to ensure staff working in the home were of good character and were suitable to work with vulnerable adults.

The service was working within the legal requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) applications were made appropriately.

People were encouraged to make decisions themselves and consent was sought prior to staff carrying out any interventions with the person.

Within care plans seen, people identified as being at risk of malnutrition had nutrition and hydration assessments in place and were weighed and monitored on a weekly basis.

Complaints were recorded, investigated, resolved and responded to in line with the organisations policy.

Firbank House consisted of two buildings. There is one building known as the ‘old’ building and another building known as the ‘annexe’. The ‘old’ building has bedroom and communal facitilites for up to 22 people. The ‘annexe’ has bedroom and communal facilities for up to 20 people and is the only building currently used to provide accommodation for people living in Firbank House.

We carried out an unannounced scheduled inspection of the service in September 2014 and we had some concerns about the safety and suitability of some parts of the premises. At the time of this visit, the ‘old’ building was not in use and was found to be in a state of disrepair and the provider said that it was his intention to fully refurbish the building so that it could once again be used for residential purposes.

After the scheduled inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a follow up inspection on the 12 February 2015 to check that they had followed their plan and to confirm that they now met legal requirements. We found that the provider had failed to to meet the legal requirements in relation to the breach. A further visit was made to the service on the 9 March 2015 where it was found that the required work had still not been completed.

A Notice of Proposal to restrict admissions into the home was served on the provider. This was to ensure that all work was safely and satisfactorily completed to the ‘old’ building before it was used again for residential purposes.

This report only covers our findings in relation to this topic. You can read the reports from our previous inspections, by selecting the ‘all reports links for ‘Firbank House’ on our website at www.cqc.org.uk’

The registered manager of the service had recently left and a new manager had been in post for the past five weeks. They had yet to register with the Care Quality Commission. 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 associated Regulations about how the service is run.

At our focused inspection on the 4 August 2015, we found that the provider had followed their plan and all work had been completed to the areas of the ‘old’ building intended for use as residential accommodation. Works were still required to be completed to the top floor of the premises, such as plaster boarding a ceiling and removing old furnishings and other rubbish. This part of the premises would not be used for residential purposes and secured access would be fitted. We were told by the maintenance person, who was involved in the refurbishment of the premises, that a further two week’s should see the end of all the required work and that the premises should then be fit for use.

We confirmed that the premises would then need to be fully checked and passed by the local Fire Officer and by an approved electrical contractor to confirm that the premises were safe in relation to fire prevention and electrical safety. Copies of these reports would need to be provided to the Care Quality Commission.

The inspection team was made up of one inspector. We set out to answer the question is the service safe and is the service caring?

Below is a summary of what we found.

The summary is based on speaking with the registered manager of the service and touring relevant parts of the premises, including the ‘old’ building.

Is the service safe?

We found that some parts of the service were not safe.

During our tour of the ‘old’ building we had some concerns about the safety and suitability of the premises. Although the provider had carried out some work to some of the bedroom areas, most of the building still required re-furbishing to bring it up to a suitable and safe standard to again be used for residential purposes.

Is the service caring?

During this visit we found that appropriate action had been taken to address the concerns about maintaining the confidentiality and security of service user’s records and personal information.

Many of the people who used the service were unable to fully express their views due to their varying levels of dementia and limited abilities to communicate verbally. People who were able to speak with us told us: “I’m very happy with everything. The girls (staff) are smashing with me. The night girls (staff) are good, they bring me a drink when I need one”, “The staff here are really very good, they look after me very well. Two girls (staff) hoist me into bed. They put a sling behind me and make sure I’m safe before moving me” and “You couldn’t get better treatment in a hotel.”

Care plans and risk assessments had been reviewed and updated on a regular basis. We also saw evidence to indicate that other healthcare professionals such as General Practitioners (GPs), social workers and Speech and Language Therapist (SALT) had been involved in identifying, reviewing and supporting people's needs.

We found that there were sufficient numbers of staff on duty at the time of our visit.

Staff were receiving training that supported them to do the jobs they were employed to carry out.

Systems were in place to demonstrate that the quality of service was being monitored by the provider and registered manager.

We spoke with two people who were using the service. They told us that they were very happy with the care and support they received at the service. Comments included, “The staff cannot do enough for you, nothing is too much trouble”, “The manager is very good, she comes around every day to see you” and “The girls (staff) have to hoist me. There are always two of them and they know what they are doing. I always feel safe when they are hoisting me”.

Both staff and people living in the home were very positive about the management of the service. The manager had been in post since July 2012 and had previously managed another service belonging to the same provider.

We were limited to the number of people using the service we could speak to due to their level of confusion and communication difficulties.

We saw that people had freedom to move around the home and that approaches made by staff were positive, supportive and respected peoples rights.

People told us that they were supported and well cared for by all the staff working in the home. Comments included, “The staff are very good, kind and very polite and patient”, “The staff are marvellous” and “The ladies (staff) are really very kind”.

We saw that people appeared happy in their surroundings and those that could told us that they were happy with their daily lifestyles including the overall standard of service they received.

This was an unannounced inspection that took place on 7 and 8 October 2015. There were 19 people using the service at the time of the inspection.

Firbank House consisted of two buildings. One building known as the ‘old’ building and the other known as the ‘annex’. The ‘old’ building has bedroom and communal facilities for up to 22 people. The ‘annex’ has bedroom and communal facilities for up to 20 people and is the only building currently used to provide accommodation to people living in Firbank House.

Firbank House is owned by Partnership Caring Limited, which is a private company. The home provides residential care only and is registered to accommodate up to 42 persons. The service was previously inspected on 3 and 4 September 2014, when breaches of legal requirements were identified.

At our inspection in September 2014 we had some concerns about the safety and suitability of some parts of the premises, in the ‘old’ building. The building was found to be in a state of disrepair and the provider said that it was their intention to fully refurbish the building so that it could once again be used for residential purposes. Following that inspection, we produced a report and set the provider a compliance action to address the concerns raised. To ensure that service users and others having access to premises where a regulated activity is carried out are protected against the risks associated with unsafe or unsuitable premises. The provider sent us an action plan telling us how they intended to address the concerns we had raised and to ensure compliance with regulation was achieved.

We undertook a further follow up inspection on 4 August 2015 to check that the provider had completed all the work required to the ‘old’ building to meet legal requirements in relation to the outstanding breach. We found that although most of the work had been carried out, some further work still required finishing to make the building safe for residential use.

There was no registered manager at this location. A new manager had been in post since July 2015. They had yet to apply to be registered with the Care Quality Commission. 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 associated Regulations about how the service is run.

This was a breach of section 33 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Failure to comply with conditions. You can see what action we told the provider to take at the back of the full version of this report.

In parts of the home known as the ‘annex’ we identified areas where improvements were needed to ensure the safety of people using the service, staff and visitors.

The boiler room on the upstairs corridor was found to be unlocked and being used by staff to store their bags and coats as well as other items being stored in there. This room was very warm and people using the service were at risk of entrapment should they enter the room and become disorientated to where they are.

Where people required the use of a hoist, it was confirmed that people did not have use of their own, individual sling(s). Using the same slings to transfer different people increases the risk of cross contamination and infections.

This was a breach of Regulation 15 (1) (b) (d) (e) (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Premises and equipment. You can see what action we told the provider to take at the back of the full version of this report.

We looked around all areas of the ‘old’ building including every bedroom and communal facilities. We found that all bedroom areas had been fitted with, new beds and bedroom furniture and we saw that soft furnishings had been installed and, where required, new nurse call points fitted.

All the rooms with en-suites had all new tiling, flooring and sanitary ware fitted.

Work that was outstanding for completion at our last inspection of the ‘old’ building was found to have been completed.

We were provided with a copy of the electrician’s report for these premises that confirmed all electrical work and electrics had been fully checked and was compliant with electrical safety regulations.

We were provided with a copy of the report supplied by the fire contractor for the service, Bridge Fire Protection. They had carried out a full risk assessment of the premises. on 24 August 2015. The report identified the following areas had been assessed in accordance with the Regulatory Reform (Fire Safety) Order 2005 – Fire Risk Assessment. A list of those areas assessed can be found in the main body of this report.

Staff spoken with were able to demonstrate their knowledge around safeguarding vulnerable people and also around the whistleblowing procedures.

Inspection of the staffing rosters and discussions with staff and people who used the service confirmed that sufficient numbers of suitable experienced and competent staff were available at all times.

Care records seen showed that people using the service had access to other health and social care professionals, such as social workers, district nurses, general practitioners (GP) and community practitioners such as speech and language therapist and community psychiatric nurses.

We saw that people looked well groomed, well cared for and wore clean and appropriate clothing.

People using the service told us that they felt their needs were being met. People’s diet and fluid intake were closely monitored and action taken where concerns had been raised.

To make sure people using the service were receiving safe and effective care; auditing systems had been put in place to monitor the quality of the service being provided.