Firs Court is a purpose built home divided into three self-contained sections; accommodation and personal care for up to nine people, supported living services and personal care for six people, and four adjacent houses for independent living for five people who may require personal care. All the people who live at Firs Court have a learning and/or physical disability. Firs Court can accommodate a total of 25 people and 23 people were living at Firs Court on the days we visited.

All rooms were en-suite, individually decorated and furnished. The rooms were bright and airy and people told us they could choose what they wanted in their room. Each room has a telephone so people can make and receive calls. There were lounges, dining areas and kitchens in each area and a central courtyard garden. It was close to local amenities including shops, cafes, a library, and churches and had good transport links to the local towns and London.

At the last Care Quality Commission (CQC) inspection in July 2015, the rating for Caring was Outstanding and the overall rating for this service was Good. At this inspection we found the service remained overall Good and Caring remained Outstanding. The service demonstrated they continued to meet the regulations and fundamental standards.

Firs Court provided outstanding care to people. People were supported by caring staff at all times but especially when their physical and mental health needs were changing. Staff worked with multi-disciplinary healthcare professionals to ensure people were cared for in an outstanding way. We saw clear evidence of a person-centred, innovative and creative approach that was taken towards people’s individual rehabilitation so they were able to regain their strength, independence and understand their changing health conditions.

Comments from healthcare professionals to the provider included “The level of care given to this person was like that of a good nursing home, including the use of monitoring charts for sleep patterns and food and fluid intake” and “All the people I discuss with staff are approached as individuals and all the staff team demonstrate flexibility in administering care.”

We could see that support records were comprehensive and staff said that after they had read them, they were aware of people’s background, their skills and their challenges. This meant people were relaxed with staff who knew and cared for them.

Staff treated everyone as an individual and actively promoted the opportunity for people to express their individuality either in gender, religion or sexual orientation.

People remained safe at the home. Staff could explain to us how to keep people safe from abuse and neglect. People had suitable risk assessments in place. The provider managed risks associated with the premises and equipment well. There were enough staff at the home to meet people’s needs. Recruitment practices remained safe. Medicines continued to be administered safely. The checks we made confirmed that people were receiving their medicines as prescribed by staff qualified to administer medicines.

People continued to be supported by staff who received appropriate training and support. Staff had the skills, experience and a good understanding of how to meet people’s needs. We saw that staff encouraged people to make their own decisions and gave them the encouragement, time and support to do so. Staff were providing support in line with the Mental Capacity Act 2005. People were supported to eat and drink sufficient amounts to meet their needs. People had access to a range of healthcare professionals.

People’s needs were assessed before they stayed at the home and support was planned and delivered in response to their needs. People could choose the activities they liked to do. The provider had arrangements in place to respond appropriately to people’s concerns and complaints.

Staff we spoke with described the management as very positive. We observed during our visit that

We spoke with four people who lived at or received a service at Firs Court. Not everyone was able to tell us about their experiences because some people had complex needs which meant that it was difficult for them to explain their accounts. We spoke with relatives of two people at Firs Court and four staff.

As part of our inspection we spoke with several staff; they gave us some examples of how they sought consent from people. The relatives of two people told us they had confidence in the care and support provided by staff. One relative said "Continuity of care is important and I'm confident that the support provided is very good".

People were provided with a choice of suitable and nutritious food and drink. We looked at a menu choice covering one week and saw that people were provided with food from a variety of cultures.

Medicines were kept safely. Medication was stored in people's rooms in locked medication cabinets. We spoke with one person who gave us verbal consent to look at their medication.

The service had a registered manager and a deputy who worked full time and covered day shifts. The registered manager and deputy shared on-call responsibilities for the home.

We spoke with relatives of two people who commented on their satisfaction with the home and the service offered. One relative said "We cannot fault the staff". Staff records and other records relevant to the management of the services were accurate and fit for purpose.

The people who used the service at Firs Court were not always able to talk to us in a conventional manner. Some people indicated that they enjoyed living at the home by responding to direct questions. Others were able to tell us more directly that they found the home to be good and how they enjoyed activities such as attending day centres or going out shopping. One person told us that the staff "were very kind".

We found that the home offered a supportive and homely environment to people, with adequate numbers of suitably qualified staff.

We found that the care practice at the home was person-centred and that this was supported through policies and procedures, supervision of staff and communication with other agencies.

This inspection took place on 29 June and 2 July 2015. The first day of the inspection was unannounced and we told staff we were returning on the second day. At the last inspection on 16 December 2013 we found the service was meeting the regulations we looked at.

All the people who live at Firs Court have a learning and/or physical disability. Firs Court is a purpose built home divided into three self-contained sections; accommodation and personal care for up to eight people, supported living services and personal care for six people, and four adjacent houses for independent living for five people who may require personal care.

All rooms are en-suite, individually decorated and furnished. The rooms were bright and airy and people told us they could choose what they wanted in their room. Each room has a telephone so people can make and receive calls. There are lounges, dining areas and kitchens in each area and a central courtyard garden. It is close to local amenities including shops, cafes, a library, and churches and had good transport links to the local towns and London.

Firs Court can accommodate 23 people and 19 people were living at Firs Court on the days we visited.

The service had a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Firs Court provided outstanding care to people. People were supported by caring staff at all times but especially at the end of their lives and staff respected people’s final wishes. Staff worked with multi-disciplinary healthcare professionals to ensure people were cared for in an outstanding way.

Comments from healthcare professional to the provider included “You and your team have endeavoured and succeeded in ensuring people’s care was excellent and a person’s quality of life was maintained during the last months of life.” “Your care was so good that it prolonged people’s length of life and you have supported people to die with care and dignity.” Staff helped people and relatives through bereavement and ensured that if they needed additional help to express themselves, this was given.

We saw clear evidence of a person-centred, innovative and creative approach that was taken towards a person’s individual rehabilitation so they were able to regain their strength and walk again. Staff with support from the physiotherapy team had encouraged the person to exercise and had compiled a video diary to help them see the progress they had made. The person's family commented “We believe this is happiest they have ever been.”

We could see that support records were comprehensive and staff said that after they had read them, they were aware of people’s background, their skills and their challenges. This meant people were relaxed with staff who knew and cared for them.

Staff treated everyone as an individual and actively promoted the opportunity for people to express their individuality either in gender, religion or sexual orientation.

People used various communication methods and staff enabled people to make their own decisions. This meant people had the opportunity to develop and learn in a caring environment.

Firs Court held monthly house meetings and advocacy services were available at the day centre or workplaces that people attended. This gave people the opportunity to speak about any aspect of their life that they wanted to discuss.

Personal care was provided in the privacy of people’s rooms and we observed that staff knocked on people’s door and waited to be invited in.

People were safe at the home. We saw that the office door was open and people could speak to the manager or deputy at any time. The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received training in safeguarding adults at risk of harm. Staff knew and explained to us what constituted abuse and the action they would take to protect people if they had a concern. Information about safeguarding and the phone numbers to ring for help were available in the service users’ handbook, which was available in an easy read format.

Care plans showed that staff assessed the risks to people's health, safety and welfare. Records showed that these assessments included all aspects of a person’s daily life. Where risks were identified, management plans were in place.

Records showed that incidents or accidents were thoroughly investigated and actions put in place to help avoid further occurrences. We saw that regular checks of maintenance and service records were conducted. Staff had received training in fire awareness and safety. This helped to prevent an emergency occurring and to keep people safe when an emergency did occur.

We observed that there were sufficient numbers of qualified staff to care for and support people and to meet their needs. We saw that the provider’s staff recruitment process helped to ensure that staff were suitable to work with people using the service.

People were supported by staff to take their medicines when they needed them and records were kept of medicines taken. Medicines were stored in locked cupboards and weekly checks were made of the medicines storage and administration. Staff received annual medicines training as well as yearly observation checks of them administering medicines to ensure that medicines were managed safely.

People with the help of staff were encouraged to keep their own rooms clean and we saw the home was clean and free of malodours.

Staff had the skills, experiences and a good understanding of how to meet people’s needs.

Staff spoke about the training they had received and how it had helped them to understand the needs of people they cared for. The home had a team of 21 staff and those we spoke with spoke positively about the support they received from the manager and deputy manager and through training.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS are in place to protect people where they do not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way, to protect themselves or others.

We saw and heard staff encouraging people to make their own decisions and giving them the time and support to do so. People were supported to eat and drink sufficient amounts to meet their needs. On the first day of our visit it was very hot and people were choosing to take their meal into the garden and eat outside and staff assisted them to do this.

Detailed records of the care and support people received were kept. Each person had an annual healthcare check and had a comprehensively completed ‘Hospital Passport.’ People had access to healthcare professionals when they needed them.

People’s needs were assessed and information from these assessments had been used to plan the care and support they received. Support plans were in an easy read format, written in the first person and comprehensive.

People had the opportunity to do what they wanted to and to choose the activities or events they would like to attend.

The provider had arrangements in place to respond appropriately to people’s concerns and complaints. People told us they felt happy to speak up when necessary.

From our discussions with the manager and deputy, it was clear they had an understanding of their management role and responsibilities and the provider’s legal obligations with regard to CQC.

The home had policies and procedures in place and these were readily available for staff to refer to when necessary. Many of the policies were in an easy read format and this helped people to understand the policies and how they could affect their lives.

The provider had systems in place to assess and monitor the quality of the service. Weekly, monthly and annual health and safety and quality assurance audits were conducted by the home.