Inspection on 23/01/06 for Firtree House Nursing Home

This inspection was carried out on 23rd January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 23/08/05

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 HOMES FOR OLDER PEOPLE Firtree House Nursing Home 30 St James` Road Tunbridge Wells Kent TN1 2JZ Lead Inspector Gary Bartlett Announced Inspection 23rd January 2006 09:30 X10015.doc Version 1.40 Page 1 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 Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 2 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. 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 DS0000026166.V268137.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Firtree House Nursing Home Address 30 St James` Road Tunbridge Wells Kent TN1 2JZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01892 523954 01892 545241 Firtree Care Limited Mrs Catherine Ellen Brewster Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the 50 beds registered, 5 may be used for care without nursing. Date of last inspection 23rd August 2005 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 DS0000026166.V268137.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Firtree House from 9.30 a.m. until 5.00 pm. During that time the Inspector spoke with some residents, visitors, and some staff. Parts of the Home and some records were inspected. The owning organisation’s Regulation Manager was present for the inspection. A number of comment cards were received prior to the inspection. Residents and their relatives responded that they liked the home and staff. Responses from health professionals also indicated good standards of care. Statements on comment cards included: • “Excellent and well managed Home. We have a good working relationship due to the excellent care they provide.” • “Staff of all grades have a good understanding of the clients care needs.” • “I have always found the staff and care given- caring and of an excellent standard.” • A visitor stated: • “We have always been happy with the care given here.” The Manager and staff gave their full co-operation throughout the inspection. The organisation’s Regulation Manager was present for the inspection. What the service does well: Staff operated a good pre-admission assessment process and were helpful in assisting residents to settle in to the Home. Firtree House provided a comfortable environment for the residents. General health needs were well recognised and managed. Residents spoke favourably of the meals. Staff were friendly and they had a good relationship with the residents. Safe systems for the giving of medicines were in place to protect residents. Effective staff recruitment systems ensured only appropriate people worked at the Home. There was ongoing training for staff. The Home effectively maintained confidentiality. Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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 DS0000026166.V268137.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, and 6 The Home’s Statement of Purpose and Residents Guide provided service users and prospective service users the information they need to make a decision about moving into Firtree House. Good pre-admission assessments and the opportunity to visit the Home prior to admission ensured residents were appropriately placed and the Home could meet their needs. The Home did not provide intermediate care. EVIDENCE: The Manager said the Statement of Purpose was accurately descriptive of the aims, objectives, philosophy of care, services and facilities and terms and conditions of Firtree House and copies of the Service Users Guide were provided for each service users or their representative. The Manager described how a pre-admission assessment was made of each prospective resident using an aide-memoir which went on to inform the care Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 9 plan. Records seen indicated prospective residents, their families, advocates, and relevant health care professionals were involved in the assessment process. The Manager said prospective residents or their families were able to visit the Home before moving in. Some residents confirmed this and also said staff had been very helpful in assisting them to settle in. Records showed specialist training was provided for staff and specialist health care support was obtained where required to ensure residents’ needs could be met. Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. 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 feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 The care plans were not always comprehensive or directive enough to provide staff with the information needed to meet all the residents’ needs. Residents were protected by adherence to good practice guidelines in the storage and administration of medicines. Residents’ health needs were met with good liaison with relevant health care professionals. Staff treated residents with respect and maintained their privacy and dignity. EVIDENCE: Each resident had a care plan and three were inspected in detail. There continued to be an improvement in the plans. In some instances, they needed to be more comprehensively completed and directive as to how care needs were to be met. The Medicines Room was inspected and medications were seen to be stored in accordance with their instructions. Records were available to indicate that all Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 11 staff administering medications had been trained and signed off as being competent to do so. The Medication Record Administration Record (MAR) sheets that were inspected had been completed appropriately and there were systems to monitor this. Medicines were seen to be given in accordance with guidelines on good practice. The Home continued to have a good working relationship with the specialist and local health care professionals, supporting residents in their health care needs. A comment card received prior to the inspection stated “The Manager has demonstrated her willingness to partnership work with the PCT and Social Services.” From discussion with residents and observation it was clear that staff treated residents with respect and promoted their privacy and dignity. Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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 maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Residents enjoyed routines of daily living and activities that were flexible and varied to suit their preferences. Where practicable, residents could participate in local community activities and their autonomy and choice was promoted. Dietary needs of residents were catered for with a balanced and varied selection of food that met their tastes and choices. EVIDENCE: Staff spoken with were aware of the rights of residents to have choice in daily routines and activities. Residents described how their links with the local community were maintained according to their wishes and taking account of their needs. Residents said that they were able to receive visitors at any reasonable time and there was a comfortable room in which they could receive their visitors in private should they choose not to use their bedrooms. Visitors said they were always made welcome. Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 13 The Manager stated residents were supported to manage their own affairs for as long as they wished and were able. Residents spoke favourably of the meals, said they had plenty to eat and enjoyed the choices available to them. The meals were well presented and looked appealing. Lunch was taken in a relaxed atmosphere and staff were seen to offer assistance in a discreet and sensitive manner. The menus seen were varied and alternatives were offered. Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 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’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents and their relatives knew their complaints would be listened to and acted on. There were systems to ensure residents were protected from abuse. EVIDENCE: The complaints procedure was readily available to residents and their relatives and visitors. Residents said they knew of the complaints procedure. Records of complaints were kept and these included details of investigation and action taken. The Manager stated that complaints were used to improve practice where required. There were procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The Manager and other staff spoken with demonstrated a sound understanding of adult protection procedures and stated that any allegation of abuse would be referred to the concerned agencies without delay. Where a resident’s bed was equipped with bed-rails, although the form of consent was on file, it had not been completed. It was strongly recommended that where any form of restraint was used, the Manager obtain the written consent of the resident’s G.P. and Care Manager (if applicable) in addition to that of their relative and relevant risk assessments be made. Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 15 Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 23, 25 and 26 The standard of the environment within the Home was generally good providing residents with an attractive and homely place to live. Parts of the Home needed to be made good to promote infection control and residents’ health. EVIDENCE: The parts of the Home inspected were clean and free from unpleasant odours. Residents said they had access to all parts of the Home and facilities they needed. They were happy with their bedrooms and found the communal areas comfortable. The bedrooms seen had been personalised with the occupants’ personal effects and reflected their individual tastes and interests. There was an ongoing programme of redecoration and refurbishment. Sluice facilities seen were well maintained. Improvements were needed to the room with the incontinence waste disposer and a shower room to better Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 17 promote infection control. To this end, some commode frames that were rusted had to be replaced. A staff member said that bathing facilities were adequate. Equipment was generally well maintained although a lifting hoist was in need of replacement foam padding and a clean and some wheelchairs had worn handgrips. The Manager undertook to address these. It was noteworthy that some matters of notified concern were addressed very quickly during the inspection. Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Recruitment processes were robust and offered protection to people living at the Home. The arrangements for staff induction were good with the staff demonstrating a clear understanding of their roles. The Home provided ongoing training for staff so they had the skills to meet the needs of the residents. EVIDENCE: Residents spoke very highly of staff. A comment card received prior to the inspection said of one staff member, “extremely helpful and caring towards residents and families often praise her. She has an excellent understanding of clients needs.” Of staff in general, a comment card noted, “they are always patient and professional.” Residents benefited from a relatively low staff turn over. The recruitment processes were sufficiently robust to ensure only properly vetted people were employed at the Home. All new staff were required to undertake an induction programme and did not work unsupervised until deemed competent. A comprehensive training Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 19 programme was available to staff and NVQ training was encouraged. Some staff spoke of the support they had received in this. There was a training matrix for easy monitoring of staff members individual training/update requirements. Staff were seen to be attentive and demonstrated a commitment to meeting residents needs. Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. 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 the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 The Manager had a clear vision for the Home and was supported well by the senior staff in providing leadership. The Home regularly reviewed aspects of its performance through a programme of self-review and consultations, which included the opinions of residents and relatives. The Home protected residents’ financial interests. The Home ability to ensure residents’ safety was let down by the need for better food storage in the refrigerator. EVIDENCE: Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 21 The Manager was a registered nurse and had many years experience in the care of older people in a senior capacity. Throughout the inspection, the Manager and senior staff demonstrated a commendable commitment to a high quality service. Staff and residents said they considered the management team to be approachable, understanding and supportive. There were quality assurance systems to gather the views of residents, relatives and other stakeholders to further develop the service as required. The Home encouraged residents to manage their own financial affairs or to have assistance from their families / representatives and did not hold any cash on behalf of residents. The staff records seen complied with the Regulations and were well maintained. The Manager stated there was a staff member trained in first aid on every shift. Records of accidents seen had been appropriately completed and the Manager regularly monitored them. Records seen indicated that all staff had received recent fire training. There was some discussion about the advantages of having the fire risk assessment formally signed off by the Fire Safety Officer. Staff spoke of a staff supervision and appraisal system to ensure residents’ care needs were being met through good practice. The Manager described how staff worked together to maintain the standard of cleanliness in the kitchen. Refrigerator and freezer temperatures were being monitored. The storage of foods in the refrigerator did not comply with current food hygiene regulations, potentially placing residents at risk. Staff were seen to be diligent in carefully placing equipment to avoid obstruction and in ensuring COSHH requirements were adhered to. The Manager stated that records of maintenance and safety checks were in order. These were not inspected on this occasion nor were the Home’s policies, procedures or environmental risk assessments. Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 22 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 2 3 X 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 2 Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 24 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 OP7 Regulation 15(2) 17 Sch 3 & 4 Requirement Timescale for action 24/02/06 2 OP22 12(1)(a) 23(2)(c) 3 OP26 13(4) 4 OP38 13(3) 13(4)(c) Firtree House Nursing Home The registered person shall maintain records as specified in Schedules 3 and 4. The registered person shall keep the service users plan under review in that care plans must be accurately reflective of service users current needs and directive in how the needs are to be met. An action plan must be received by CSCI by the given timescale. “The registered person shall 24/02/06 having regard to the number and needs of the ensure that equipment provided at the care home for use by service users or persons who work at the Home is maintained in good working order” An action plan must be received by CSCI by the given timescale. “The registered person shall 24/02/06 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home”, in that: 1.The room with the incontinence waste disposer and the damaged wall in the shower room must be made good. 2. Worn/rusted commode frames must be replaced. An action plan must be received by CSCI by the given timescale. “The registered person shall 24/02/06 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home”, in DS0000026166.V268137.R01.S.doc Version 5.1 Page 25 that the storage of foods must comply with current food hygiene regulations. An action plan must be received 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 2 3 Refer to Standard OP7 OP7 OP18 Good Practice Recommendations It is recommended every care plan includes a current photograph of the resident to aid staff in identification It is recommended residents or their representatives sign off their clans to indicate they have been involved in the writing of the plan and agree its content. It is strongly recommended that when bed-rails or any other form of recognised restrain is used, the written authorisation of the resident’s General Practitioner and Care Manager (if applicable) is obtained It is strongly recommended staff do not work long consecutive shift patterns that may compromise their competency through fatigue. It is recommended a record is kept of questions asked and of answers given at staff recruitment interviews. It is recommended the Home has the fire risk assessment formally signed off by the Fire Safety Officer. 4 5 6 OP27 OP29 OP38 Firtree House Nursing Home DS0000026166.V268137.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone 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. 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