Firtree House Nursing Home

Firtree House Nursing Home is a care home providing accommodation with nursing and personal care for up to 50 people across two adjoining wings. People had varying needs, including people with nursing needs and people living with dementia. At the time of our inspection there were 31 people using the service.

People’s experience of using this service and what we found

Risks to people’s health and welfare had been assessed but some risk assessments lacked detail. Checks and audits had been completed on all aspects of the service, but they had not identified some of the shortfalls found during the inspection.

People were supported by staff who knew them very well. Staff understood risks and how to manage these safely. Staff were described by people and relatives as kind, caring and friendly. One relative said, “The staff are amazing, so caring and cheerful, they do a wonderful job. I am confident [relative] has the best care. They are so kind to me too.”

People told us they were happy and felt safe living in Firtree House and relatives agreed. One relative said, “Oh yes, they are definitely safe. They are well looked after, and they deal with issues very quickly.” Staff had been trained in safeguarding and knew how to report any signs of abuse.

Staff were recruited safely and there were enough staff to meet people’s needs. Staff had training appropriate to their role and regular supervision. Checks had been made on the environment in line with health and safety requirements. Medicines were managed safely, and staff followed appropriate infection control guidance.

People’s needs were assessed before they moved into the home to ensure the service could meet their needs and preferences. People were supported to maintain good health and had access to doctors and other healthcare professionals when they needed them.

People had been asked their opinion about the care and service they received, and their suggestions had been acted upon.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 16 October 2020).

Why we inspected

We received concerns in relation to the management of people’s nursing care needs and the escalation of concerns to healthcare professionals. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the effective section of this full report. We have found evidence that the provider needs to make improvements in other areas. Please see the safe section of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Firtree House Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Firtree House Nursing Home is registered to provide nursing and residential care for 50 older people.

At this inspection there were 24 people living in the service.

People’s experience of using this service and what we found

People told us they were safe at the service and well supported by staff. A person said, "The staff are good to me and I like them." In a thank-you card a relative said, “All the staff who cared for mum were kind and compassionate and we are grateful for the care and attention she received.”

People were safeguarded from the risk of abuse. Risks to health and safety had been managed and people received safe care and treatment. Medicines were managed safely in line with national guidance. Sufficient staff were deployed and safe recruitment practices were in place. Infection was prevented and controlled. Lessons were learned when things went wrong.

Quality checks monitored and evaluated the service, regulatory requirements were met and good team-working was promoted.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 25 June 2019).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 28 March 2019. Breaches of legal requirements were found. The registered provider completed an action plan after the last inspection to show what they would do and by when to improve the delivery of safe care and treatment and to monitor the operation of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Firtree House Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Firtree House Nursing Home is a nursing home providing nursing and personal care to up to 50 people aged 65 and over. People had varying care needs, including, living with dementia and diabetes. At the time of our inspection, there were 31 people receiving a regulated activity.

For more details, see the full report which is on the CQC website at www.cqc.org.uk

Although the service met the characteristics of Good in Effective and Caring, there were three areas, Safe, Responsive and Well Led that Required Improvement.

People’s experience of using this service:

The medicines people were prescribed to take were not always recorded and managed in a safe way.

Risks within the premises and environment had not always been identified to make sure management plans were in place to reduce the risks to people.

People's best interests were not always documented properly. We made a recommendation about this.

People were not always provided with activities to meet their interests and avoid social isolation. We made a recommendation about this.

Opportunities were missed through the provider’s monitoring and auditing systems to identify the areas of quality and safety that needed improvement, so that action could be taken in a timely manner.

Complaints were not always recorded with outcomes reached. We spoke to the registered manager about this.

Care plans had improved and provided individual guidance and a person-centred approach to people’s care.

People were supported to make their own decisions on a day to day basis.

Staff knew people well and many staff had worked at the service for a number of years.

Staff told us they were happy in their work and felt well supported.

People were supported to maintain their independence and staff were careful to respect people’s privacy.

People were encouraged and supported to express their views.

The provider had enough staff to make sure people received the care and support they needed.

People were happy with their meals and were able to eat in a large comfortable dining room.

Rating at last inspection:

Requires Improvement (Report published 5 June 2018). This service has been rated Requires Improvement at the last two inspections but had previously rated as Good.

Why we inspected:

This was a responsive inspection based on information received by CQC.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of this report.

Follow up:

We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated Requires Improvement.

This inspection site visit took place on 13 and 15 March 2018 and was unannounced.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the 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.

At the last inspection on 06 October 2015, the service was rated ‘Good.’ At this inspection we found the service to be ‘Requires Improvement.’

Not all risks had been managed safely. Falls had not been assessed and monitoring tools had not been scored correctly. Other risks around the environment had been managed safely and the possibility of harm reduced through effective risk assessment.

Medicines were not consistently being managed in a safe way. Audits had not been effective in counting correct stocks of medicines and some ‘as required’ medicines were not being recorded correctly.

Not all people had been supported to eat and drink enough to maintain a balanced diet. Some people had lost weight but not received a reassessment of their care plan or alternate strategies such as fortified foods. Other people told us that they liked the food and we observed staff supporting people to drink regularly.

The principles of the Mental Capacity Act 2005 (MCA) were not being adhered to. Three MCA assessments had not been completed correctly and some people who required an application to deprive them of their liberty had not been referred to the local authority.

Care plans were not as person centred as required giving personalised details such as how a person prefers to receive their personal care. Activities were being reviewed and we observed a range of activities being provided to people but there were some gaps in recording. We have made a recommendation about this in our report.

A programme of quality audits were in place but had not been effective in highlighting the issues we found at this inspection. The service had a friendly and homely culture and people told us they liked living at Firtree House.

People and families were engaged in the running of the service. The registered manager was a visible presence in the service and ensured that feedback led to learning and improvement. The service was working effectively with other key partner organisations such as local health teams.

Staff had received training in a range of courses relevant to their role. However, competency checks were not consistently effective. We have made a recommendation about this in our report.

People were protected from the risk of abuse by staff that understood their role in reporting any concerns. There was sufficient staff deployed to keep people safe and meet their needs. The service was clean and the risk of infection was reduced through effective infection control procedures. Lessons had been learned when things went wrong and incidents and accidents were tracked by the registered manager.

People had effective assessments prior to admission. This meant that care outcomes were planned for, and staff understood what support each person required. The service worked with other professionals such as people’s GPs and social workers to ensure care was effectively delivered. People maintained good health and had access to health and social care professionals.

Staff worked effectively to provide support when people moved to or from the service. The premises and environment met peoples’ needs and were being refurbished with people’s input.

Staff treated people with kindness and compassion. Staff knew people’s needs well and people told us they liked and valued their staff. People and their relatives were consulted around their care and support and their views were acted upon. People’s dignity and privacy was respected and upheld and staff encouraged people to be as independent as safely possible.

There was a complaints policy and form, including an accessible format available to people. Staff were open to any complaints and understood that responding to people’s concerns was a part of good care. People on end of life care had a pain free, comfortable and dignified death.

During this inspection we found five breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.

We visited to undertake a responsive inspection following receipt of concerning information through our whistleblowing process and other safeguarding concerns reported by the Local Authority. The report is based on our observations during the inspection, talking with people who lived at the home, their relatives and also staff. We also reviewed records.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Although there were systems in place to protect people from the risks associated with infection, these were not always effective in identifying and addressing concerns. Health and safety audits were carried out but did not address issues such as the security of the home. We found that there were insufficient numbers of staff to ensure that people's needs were met.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While we were told no applications have been submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service caring?

People were supported by kind staff. We saw that staff showed patience and sensitivity when supporting people. Four families we spoke with said that staff were good at keeping them informed when their relative was not well or if it had been necessary to call the doctor out. One said the staff are excellent, and another relative told us "I could not ask for better care, the care workers and nurses are really kind and help me a great deal". However, we spoke with some people who lived at the home and their relatives who were concerned about the care they receive. .

Is the service responsive?

Some people and relatives we spoke with said that they had been involved however we were also told by a person who lived at the home and their relative that they had not been involved in the formation of the care plan. This meant that although most of the people who lived in the home and/or their families had been involved and had agreed the care and the way they wanted care provided, not all people felt that they were not involved in the planning of care for their relatives.

Is the service effective?

In the care files we viewed people's care needs were assessed with them or their relatives and they were involved in discussions about their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Some people and relatives we spoke with said that they had been involved however we were also told by a person who lived at the home and their relative that they had not been involved in the formation of the care plan. This meant that although most of the people who lived in the home and/or their families had been involved and had agreed the care and the way they wanted care provided, some people felt that they were not involved in the planning of care for their relatives.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service well-led?

Staff told us that the head of care was approachable and they were able to raise any concerns they had with them. We saw that many aspects of the operation of the home were monitored through regular audits and reviewed. However, these were not always effective in identifying and addressing concerns in a timely manner.

Some relatives we spoke with were positive about the support provided by managers at the home. Other relatives were less positive and felt that improvements needed to be made at the home. We saw that appropriate processes were in place for ensuring that people were able to make their views known through surveys sent to people who lived at the home and their representatives. People also had a forum for voicing their opinions through regular service user meetings.

Care plans gave staff guidance about how to support each person with their personal, social and health care needs.

The manager was knowledgeable about how to refer to and work with the safeguarding authority about concerns or allegations of abuse.

People benefitted from safe and comfortable accommodation, which was suitably designed and maintained to meet their needs.

People who used the service were supported by enough skilled staff who knew how to meet people's needs. People told us 'The staff and the care is good.'

People who used the service and their relatives and/or representatives were asked for their views about the service provided. We saw that people were able to communicate their wishes to staff, who listened and took action. People who used the service told us 'They're very nice. I've got no complaints.'