Inspection on 23/08/05 for Firtree House Nursing Home

This inspection was carried out on 23rd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Firtree House Nursing Home 30/10/08

Firtree House Nursing Home 01/10/07

Firtree House Nursing Home 23/01/06

Firtree House Nursing Home 07/10/04

Firtree House Nursing Home 04/05/04

Firtree House Nursing Home 31/10/03

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Firtree House Nursing Home 30 St James Road Tunbridge Wells Kent TN1 2JZ Lead Inspector Gary Bartlett Unannounced 23 August 2005 13:45 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Firtree House Nursing Home Address 30 St James Road Tunbridge Wells Kent TN1 2JZ 01892 523954 01892 545241 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Firtree Care Limited Mrs Catherine Ellen Brewster CRH Care Home 50 Category(ies) of OP Old Age (50) registration, with number PD Physical Disability (5) of places TI Terminally Ill (5) Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Of the 50 beds available 50 are registered for Nursing and 5 are registered for Residential Care. Date of last inspection 7 October 2004 Brief Description of the Service: Firtree House Nursing Home provides nursing care and accommodation for 50 older people.Firtree Care Limited owns and operates the Home. Firtree House is located in a residential area of Tunbridge Wells with shops, public transport and other usual town amenities being approximately ½ mile away. Firtree House Nursing Home consists of a detached property and garden with car parking facilities at the front of the building. There is accommodation on 3 floors in the newer part of the building and on 2 floors in the older part of the Home. The Home has two shaft lifts. There is a staff call system with various television and telephone points throughout the Home. The Home employs care and nursing staff, working a roster, which gives 24-hour cover. The Home also employs other staff for catering and domestic duties. Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission was represented by Gary Bartlett, Regulatory Inspector, who was in Firtree House Nursing Home from 1.45 p.m. until 5.00 pm. During that time the Inspector spoke with some residents, visitors and staff. Parts of the Home and some records were inspected. The inspection was conducted four days after there had been a fire at the Home and the focus of the inspection was to assess residents’ immediate safety, comfort and well-being. The Regional Manager and Manager were present. They and all staff were helpful during the inspection What the service does well: What has improved since the last inspection? The Home had improved protection of residents by purchasing a new medicines refrigerator, obtaining the latest guidelines from the Royal Pharmaceutical Society and guidance for the administration of PRN medicines Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 6 The recently provided decked area in the garden was very popular with residents. Records of staff training had been updated. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These Standards were not inspected EVIDENCE: Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 Residents’ welfare would be better promoted through the Home contacting health care professionals for specialist advice where necessary. Residents’ privacy and dignity were maintained within the Home. EVIDENCE: Two care plans were inspected in detail. The Manager described how the format had been updated and it was evident the plans were regularly reviewed. One review in February 2005 recorded that the Home was to contact a Consultant for clarification of an aspect of the resident’s care. It was Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 10 not evident this had been done. There was some discussion about the need to expand risk assessments where it was possible that a resident’s behaviour could impact on other residents, staff or visitors. Records seen and discussion with staff and residents indicated that residents were able to have access to Doctors, Dentists, Chiropodists etc as and when required. From observation and discussion with residents and visitors it was clear that staff treated residents with respect and promoted their privacy and dignity. The storage and administration of medicines was not inspected in enough detail to make judgement, but the Manager did mention that new medicines refrigerator and the latest guidelines from the Royal Pharmaceutical Society had been obtained to further protect residents. The Manager also said guidance had been obtained for the administration of PRN medicines. Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with asssistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 14 Residents had some choices about their daily lives, were able to have visitors at any reasonable time and enjoyed continued links with the local community where this was their preference. EVIDENCE: Residents said they were able to satisfy their individual preferences as far as was practicable in the routines of daily living. One resident said they got up at time that suited them and another said of staff “if you ask them for anything, they’ll help you as best they can.” Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 12 During the inspection a number of visitors were seen in the Home and the visitor’s book recorded regular visits by families, friends and others. Visitors mentioned they were always made welcome at the Home at any reasonable time. Standard 15 was not specifically inspected, but several residents mentioned how they enjoyed the meals and always had plenty to eat. Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Residents felt safe in that if they could complain if they had need to and any complaint would be treated seriously. The Home had systems to safeguard residents from abuse, discrimination and neglect. EVIDENCE: The complaints procedure was seen to be available to residents and their families. Residents spoken with said they knew they could make a complaint when necessary but “I’ve never had anything to complain about here” and “little problems have always been sorted out quickly”. Records of complaints were not inspected. There were Adult Protection procedures at the Home and records seen indicated staff received training in abuse awareness. Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21 and 23 The standard of the environment within the Home was generally good providing residents with a comfortable place to live. EVIDENCE: Residents said they were comfortable and liked their bedrooms and communal areas. There had been some adjustments to lounge areas because of the recent fire, which residents said they found perfectly satisfactory. The parts of the Home seen by the Inspector were commendably clean and a visitor said Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 15 they had always found the Home pleasant. Some residents spoke of having enjoyed using the recently provided decked area in the garden during recent warm weather. Residents and staff considered the bathing and toilet facilities to be adequate. Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These Standards were not inspected EVIDENCE: Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s polies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 33, 35 and 38 (Older People) and Standards 23, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Residents were potentially at risk through some poor staff practices. EVIDENCE: Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 18 Subsequent to the recent fire, the Home had identified that residents’ safety would be better protected by all senior staff undertaking crisis management training. Records seen indicated that staff had fire training or participated in fire drills at the frequency recommended by the Fire Safety Officer. It was not unreasonable to expect staff to demonstrate a heightened awareness of fire precautions. It was particularly disturbing therefore to see that a lounge door fitted with an automatic closing device had been obstructed by an armchair. On being made aware of this, the Manager immediately removed the chair and undertook to ensure staff were reminded of their responsibilities to promote residents’ safety. The fire had necessitated the closure of parts of the Home. The Regional Manager gave assurances that all parts being used had been assessed as being safe. One of the consequences of the fire was that there was restricted area for storing wheelchairs and lifting hoists. Staff were seen to be diligent in minimising risks to residents by carefully placing equipment to avoid obstruction. Records of maintenance and safety checks were not inspected. Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 x 3 x 4 x 5 x 6 x HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 3 3 3 x 3 x x x Score Standard No 7 8 9 10 11 Score 2 2 x 3 x Standard No 27 28 29 30 x x x x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 x 32 x 33 x 34 x 35 x 36 x 37 x 38 2 Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 20 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 13(1)(b) Timescale for action “The registered person shall Action plan make arrangements for service to be users to receive where received by necessary, treatment, advice and CSCI by other services from any health 19/09/05 care professional in that review decisions to contact health care professionals must be undertaken “The registered person shall With ensure that unnecessary risks to immediate the health or safety of service effect from users are identified and so far as 24/08/05 possible eliminated” in that doors fitted with automatic closing devices for use in emergencies must not be obstructed Requirement 2. 38 13(4) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations It is strongly recommended the scope of risk assessments on care plans be more comprehensive Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone, Kent ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Firtree House Nursing Home H56-H06 S26166 Firtree House V245600 230805 Stage 4.doc Version 1.40 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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