About the service: The Firs Residential Care Home is a residential care home that was providing personal and nursing care to 26 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

Risks to people were not managed safely. People were at risk of choking due to swallowing difficulties and this was increased because staff did not always follow guidance about food and drink preparation. People had lost weight but not enough action was taken to reduce the risk of this continuing. Staff did not know how to support people with their health conditions, such as diabetes, which put them at risk if these worsened. People were at risk from a lack of staff understanding about moving and handling equipment.

Fire evacuation information was incorrect and had not been updated to include all of the people living at the home. The safety and effectiveness of giving medicines covertly had not always been considered as advice or alternative medicines had not been sought. Safeguarding referrals were not made to the local authority safeguarding team and the manager did not recognise when this was required.

There was a lack of managerial oversight at the home, which lead to low staff morale and a high turnover of staff. The provider’s monitoring process did not look effectively at systems throughout the home. Where issues were identified, there was a lack of action to address them and these continued. There were not enough staff available to make sure people received care in a timely way. People had to wait for care, meals and to go to the toilet. Staff recruitment checks were not always fully obtained before new staff started working at the home.

Lessons were not learned about accidents and incidents and it took time to implement actions to reduce these. Medicines were stored safely, and records were completed correctly. Regular cleaning made sure that infection control was maintained and action was taken to address issues.

People were cared for by staff who had received some training but did not have all the skills or support to carry out their roles. People received a choice of meals, which they liked, and staff supported them to eat and drink. People were referred to health care professionals as needed although staff did not always follow the advice professionals gave them. Adaptations to the environment were made to ensure people were safe and able to move around their home as independently as possible. Staff members understood and complied with the principles of the Mental Capacity Act 2005 (MCA). People were supported to have choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were caring, kind and treated people with respect. People were listened to and were involved in their care and what they did on a day to day basis. People’s right to privacy was maintained by the actions and care given by staff members.

People’s personal and health care needs were met and people were happy with the care they received. Some care plans were written in detail to provide guidance to staff Other care plans were not available and staff did not always have appropriate guidance to care for people. There were activities for people to do and take part in and they enjoyed these when they were available. However, people told us they had little to do when the staff member responsible for these was not working. A complaints system was in place but complaints had not been investigated and responded to when they were first made. Staff had some guidance and support about people’s end of life wishes, although information in care records was limited.

We found several breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, a breach of Regulation 18 of th