Firbank Residential Care Home 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. The home is registered to provide accommodation for 26 people. There were 21 people living at the home at the time of the inspection.

The home was based on three floors, connected by a passenger lift and stairwells. Two bedrooms had en-suite facilities and there were toilets and bathrooms available on each floor. There was a choice of communal spaces comprising of two communal lounges and one dining room where people were able to socialise.

The inspection was conducted on 13 and 17 November 2017 and was unannounced. There was a registered manager in place. 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 last inspection, on 18 and 22 August 2016, we identified breaches of Regulations 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to maintain a clean, hygienic environment; had failed to manage individual risks to people effectively; had failed to protect people from the risk of being deprived of their liberty without lawful authority; and had failed to operate effective quality assurance systems.

The provider wrote to us, detailing the action they would take to address the concerns. At this inspection, we found action had been taken to address all areas of concern and there were no longer any breaches of the regulations.

People felt safe living at the home. Staff knew how to identify, prevent and report abuse. They assessed and managed risks to people and risks posed by the environment effectively.

Arrangements were in place for the safe management of medicines. People received their medicines as prescribed. The home was clean and hygienic and staff followed best practice guidance to control the risk and spread of infection.

There were enough staff to meet people’s needs in a timely way. Appropriate recruitment procedures were in place and pre-employment checks were completed before staff started working with people.

People’s needs were met by staff who were competent, trained and supported in their role. Staff acted in the best interests of people and followed legislation designed to protect people’s rights and freedom.

People’s dietary needs were met and they received appropriate support to eat and drink enough. Adaptations had been made to the home to make it supportive of people living with dementia.

People were supported to access healthcare services when needed. Staff made information available to other healthcare providers to help ensure continuity of care.

People were cared for with kindness and compassion. Staff knew people well and supported people to maintain relationships that were important to them.

Staff protected people’s privacy and dignity. They encouraged people to remain as independent as possible and involved them in planning the care and support they received.

People’s needs were met in a personalised way. Each person had a care plan that was centred on their needs and reviewed regularly. Staff empowered people to make choices and responded promptly when people’s needs changed.

People had access to a meaningful activities based on their individual interests, including regular access to the community. They knew how to make a complaint and a complaints procedure was in place.

Staff took account of people’s end of life wishes and preferences. They supported people to remain comfortable and pain free.

People and their relatives felt the service was run well. Staff we

This comprehensive inspection took place on the 18 and 22 August 2016 and was unannounced. The home provides accommodation with personal care, including people living with dementia for up to 22 people. At the time of the inspection there were 21people living at the home, all of whom were older people with physical frailties and some with dementia.

The home was based on three floors, connected by a passenger lift and stairwells. Not all bedrooms had en-suite facilities but there were toilets and bathrooms available on each floor. People had level access to the front garden, but did not have full access to the rear garden due to uneven ground. There was a choice of communal spaces comprising of two communal lounges and one dining room where people were able to socialise.

There was a registered manager at the home. A registered manager is a person who had 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.

Some of the environmental risks had not been assessed by the provider, including visitor access and internal stairs placing the people at risk. Other environmental risks had been identified in an audit completed by the home, however not all risks highlighted had been addressed or rectified.

This included floor covering in bathrooms and toilets and some beds and furniture being in a poor state of repair, resulting in them being difficult to clean effectively and therefore an infection control risk. Individual risks to people, such as the risk of falling or developing pressure sores were not always managed effectively and care plans in place to support staff to manage risks were not always followed. Environmental risks and risks to people were raised with the registered manager at the time of the inspection who agreed that appropriate action would be taken to reduce these risks.

People’s privacy was not always repected by all the staff. Staff were seen entering people’s rooms without knocking or requesting admission and staff were heard talking about the people where they could be over heard.

Staff sought verbal consent before providing care and treatment, however the service did not always follow the principles of the Mental Capacity Act, 2005 (MCA). Where people lacked the capacity to make specific decisions, staff had made decisions on their behalf. Assessments of people’s capacity to make these decisions did not follow the standard two-stage test and family members had not always been consulted. Therefore, the provider was unable to confirm that the decisions had been made in the best interests of people. We have recommended that the provider seek advice and guidance on adopting the latest best practice in respect of recording assessments and decisions under the Mental Capacity Act.

People were having their liberty restricted without appropriate authorisation and applications to restrict people’s movements, where appropriate had not been made. Deprivation of Liberty Safeguards (DoLS) provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely. The service had not gained legal authorisation to deprive people of their liberty, yet the service was restricting people’s movements.

Meaningful activities were not organised to promote people’s welfare. A staff member had been assigned to arrange activities, but the registered manager acknowledged they had not been given sufficient time to do this. They had managed to speak with people about activities they would wish to take part in and these were recorded, but no action had been taken to arrange them. We have recommended that the provider seek advice and guidance on adopting the latest best practice

There were 19 people living at Firbank Residential Home at the time of our visit. We looked around the building which was clean and free of unpleasant odours. The registered manager advised us that the home was commencing a redecoration programme in February 2014 of communal areas and showed us two rooms that were in the process of being redecorated. All the rooms were single occupancy with hand basins and two of the rooms had ensuite toilets and hand basins. The rooms were personalised with photographs, TV's and pictures. There was a lift so that people could access the first and second floors floor.

During our visit we spoke with five people who used the service and four members of staff including the registered manager. We also spoke with two relatives who visit the home regularly. Due to the nature of people’s dementia we were able to obtain limited feedback. We observed how staff interacted and supported people. We saw staff treating people in a sensitive, respectful and professional manner.

All the people we saw looked happy living at Firbank Residential Home. One person told us that they were “very happy “and that the food was alright. A relative told us that the “staff couldn’t do enough” and that they were “very pleased” that their relative was in the home. Another relative told us that the staff were “pleasant” and that they had no complaints.

We spoke with six of the 19 people who were at the home. They said that they were “very happy” with their care and that staff “treated them with respect”. One person said they had been “apprehensive” before coming to the home but that it had been one of their “better decisions”. They and other people told us they were looked after very well. We spoke with six relatives of people living in the home. They said that staff “always told them about the care” their loved one was receiving including any changes in their health. They said that when visiting they had never observed or heard anything that caused them any concern. Visitors commented on the warm friendly atmosphere and that activities were provided. One visitor, who regularly stayed for lunch, was complimentary about the meals provided.

We spent time observing care in communal areas. We found that people had positive experiences. We observed that staff were courteous and respectful of people's views. Choices were offered and where necessary informal consent was obtained. The staff knew what care and support people needed and they respected their wishes. The support that we saw being given to people matched what their care plan said they needed.

We found that people received an appropriate diet, medication was correctly managed and adequate staffing levels were provided. Care plans were relevant to people and all other necessary records were maintained and stored securely.

Many of the people who live at Firbank Residential Care Home have age related memory loss and we were therefore unable to talk to them. We did speak to two people who confirmed that they felt their care needs were being met and that staff seemed to know how to care for them.

We also spoke with the Isle of Wight safeguarding team who confirmed that the investigation at Firbank Residential Care Home has now been concluded.

We spoke with some of the people living at Firbank Residential Care Home, it was not possible to speak with all people due to the level of their disability. People we were able to speak with were generally positive about the home and care they receive. They confirmed that food is good and that staff are polite and helpful, although staff are often rushed and don't have time to just sit and chat. People stated that there are few activities.

We spoke with some of the people who live at Firbank Residential Care Home, it was not possible to speak with all people due the level of their disability. People we were able to speak with were generally positive about the home and care they receive.

One person stated they were very happy living there, they were not concerned about anything and if they did have concerns they could talk to the staff. This person stated that although they do not know staff names they are friendly and helpful and support her with her needs. The person said that food is very good and they could have something different if they did not like what was offered. This person had no reason to complain and never had any concerns. The person stated that activities do now occur but that they choose not to get involved in them.

Another person stated that staff are friendly, they are treated with respect and they have a good rapport with staff. This person stated they were aware of risk assessments and care plans but not that interested in these and leaves it to the staff. They stated they are happy to talk to either the manager or the staff if they are concerned about anything. This person also stated that they have weekly meetings and if they were unhappy about something they could also bring it up then. The person stated they were happy with their room and that staff respect their privacy.

Other people we spoke with reflected these opinions.

We also spoke with some visitors including a health professional who had no concerns about the home.