Inspection on 30/10/08 for Firtree House Nursing Home

This inspection was carried out on 30th October 2008.

CSCI found this care home to be providing an Good service.

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 01/10/07

Firtree House Nursing Home 23/01/06

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 16/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Firtree House Nursing Home 30 St James` Road Tunbridge Wells Kent TN1 2JZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kim Rogers     Date: 3 0 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Firtree House Nursing Home 30 St James` Road Tunbridge Wells Kent TN1 2JZ 01892523954 01892545241 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Firtree Care Ltd care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home 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 close by.. 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 Care Homes for Older People Page 4 of 26 Over 65 50 0 Brief description of the care home employs other staff for catering and domestic duties. Fees range from 695 to 895 pounds Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection of the service, which includes a site visit. The last key inspection was 01/10/07. We had a look around the home, spoke to the staff, service users and visitors and sampled records. Records sampled included medication administration records, care plans and staff files. We looked at the information in the Annual Quality Assurance Assessment that the manager completed. This tells us what the home does well, what has improved and how they intend to improve. The AQAA was well completed and gives us the information we need. Care Homes for Older People Page 6 of 26 The fee for this home ranges from 675 to 895 pounds per week. What the care home does well: What has improved since the last inspection? What they could do better: Staff feel that redecorating parts of the original building will enhance the environment for service users. The AQAA says they have plans to improve including developing better community links to give service users more opportunities to be part of the community. They plan to offer more outings and upgrade some bathrooms. Care Homes for Older People Page 8 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their needs will be assessed before they move in. There is good information to help people make a decision about the home. Evidence: We found that complete and detailed assessments are carried out before a person moves into the home. We found that service users and their relatives are fully involved in this process. We found that assessments by care managers and health professionals are obtained. This ensures that the staff have a complete picture of the person and their preferences and needs. Prospective service users come and have a look around before they decide about moving in. There is very detailed information about the home that is given to each resident and prospective residents. There is a glossy brochure, Statement of Purpose and Service user guide. This is produced in large print and on a CD format. This means that people have the information they need to help them make a decision about Care Homes for Older People Page 11 of 26 Evidence: moving in. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed person centred care plans ensure that people are supported in the way they prefer. People know their health needs will be supported and medication practice is safe, protecting service users. Evidence: People have a service user plan or care plan that is developed with them from the initial assessment. We found service user plans are clear and detailed showing the persons personal care, health and social needs and what staff should do to support the needs. We found regular review of plans ensures that any change in need is identified quickly. This means that service users are kept safe and well. Plans contain information about the persons life history and significant life events. This helps staff know about the whole person enabling them to offer the right support. Plans are person centred giving detail of how people prefer to be supported. This means that people are treated as individuals and get the support they need in a way they prefer. We found that potential risks are assessed and then strategies recorded and followed to ensure risks are minimised. Health needs are recorded in good detail and regular Care Homes for Older People Page 13 of 26 Evidence: review and monitoring ensures that people are kept healthy and well. Action is taken promptly when a change in need is identified and the proper support given. Staff said they have good relationships with external health professionals and people can see their G.P. in private. Aspects of the homes medication systems were inspected and administration by staff observed. We found storage and records are in order. Administration is person lead and safe. People told us that staff are kind and talk respectfully to them and always knock on the door before entering. People who use the service said that staff respect their dignity. We found that staff speak kindly to service users and observed staff informing a person that they were about to be moved. Another staff asked a person what they would like to drink and what biscuits they would like. We observed staff supporting service users with their meal discreetly. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity to take part in a range of activities and say the pace of life at the home suits them. The food is wholesome and nutritious. Evidence: We found that people have access to a range of activities facilitated by an activity coordinator. People are asked about their interests, hobbies and preferences at the assessment stage and as an ongoing process. People have the opportunity to take part in group activities or to have one to one sessions. Everyone is given a sheet of information about that months activities so can choose what they wish to take part in. People said they are happy with the activities on offer. In certain places around the home are displays to stimulate reminiscence and conversation. For example there is a display of wartime memorabilia. We found that there are links with the community, for example people go out to clubs and churches and groups are invited into the home. We found that people are offered choices, for example of meals and activities and also have a say about the way they are supported through the assessment and care planning processes. We observed service users making choices that are respected and supported by the home. We Care Homes for Older People Page 15 of 26 Evidence: spoke to some visitors who said they can visit at reasonable times, are made to feel welcome and are kept informed about their relatives. Service users spoken to said the food is good, it is always hot and there is enough of it. People said that their special diets are supported and that there is always a choice of meal. The home employs a cook and kitchen staff. Lunchtime was observed and we found staff supporting service users discreetly and respectfully. Food and drink preferences are recorded in service user plans and nutrition and weight is monitored if necessary. The home has two cats and fish and has visits from lap dogs giving people oppertunity to spend time with pets. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their complaints will be listened to and acted on. People are safeguarded from harm and abuse. Evidence: We found that there is a clear complaints procedure that is displayed and a copy given to each person. This is produced in large print and is included in the homes information pack. The head of care said the home welcomes complaints and comments so they can take action to improve. The head of care said they take complaints seriously and try to address any issues at an early stage. We spoke to relatives and service users and found that people know who to speak to if they are not happy about something. People who use the service said they are confident that they will be listened to and action taken to address their complaints. We have received no complaints about the home since the last inspection. We found that there are clear policies and procedure to safeguard vulnerable adults. Staff attend training in how to recognise and respond to abuse and attend regular refreshers. We found that staff know what to do if they suspect abuse protecting service users. We found that clear guidelines in service user plans enable staff to support people who may at times challenge the service. Care Homes for Older People Page 17 of 26 Care Homes for Older People Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, bright and well maintained making it a nice place to live. Evidence: We found that the home is clean, bright and well maintained. People said they are happy with their rooms and that the home is always clean. There are singe and double rooms and some rooms have en suite facilities. There are spacious comfortable communal areas like lounges and a conservatory. There is also access to the garden and a large decked area. This means that people have the choice of different areas to spend time alone or with visitors. The home employs domestic staff, kitchen staff and laundry staff. We had a look around the home, which was clean and suitably fragranced. We found that furniture and fittings are good quality enhancing the environment for service users. Bathrooms and toilets are close to bedrooms and have adaptations to meet service users needs. This maximises peoples independence and keeps people safe. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough trained staff to meet service users needs. Recruitment checks are robust, which protects service users. Evidence: We found that there are enough staff to meet service users needs. Service users said staff respond when they use the call bell system. We observed staff responding to requests from service users in a timely manner. This means that people do not have to wait too long for support. There are usually two trained nurses on duty with a team of care staff. Staff are supported by a Head of Care and Registered manager. Service users said staff are kind and respectful and this was observed. Staff are supported by a training department and training manager. Staff said the training offered is good. We found the induction of new staff is in line with the Minimum standard. We sampled training records and found staff are trained in mandatory areas like health and safety and safe moving and handling. Staff also attend training related to service users needs. This means staff have an understanding and awareness of the needs of people they are supporting. We found that recruitment checks are carried out before a person starts work at the home, this protects service users. Service users meet prospective staff when they come to look around the home as part of their interview. The head of care said that Care Homes for Older People Page 20 of 26 Evidence: the home is now fully staffed and only use agency staff occasionally. This means that there is continuity of care for people who use the service. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in service users best interests. People know that their finances and health and safety will be safeguarded by staff. Evidence: The Registered Manager was not at the home during the visit as she was on leave so the Head of Care and two senior nurses on duty assisted us. All spoke with knowledge and understanding of service users needs. The manager is a registered nurse and has managed the home for a number of years. The manager completed the AQAA, which was well completed and gives detail of what the home does well, how it has improved and how they intend to improve. Records are to hand, well organised and up to date. Records are held securely protecting service users confidentiality. We found that there are good quality assurance systems in place. Service users views are sought and acted on, for example there has been more detailed consultation about activities since the last inspection. Regular in depth company audits are carried out. Care Homes for Older People Page 22 of 26 Evidence: Recommendations are made if necessary then checks made to ensure the recommendations have been met. We found that service users finances are protected by safe systems. Receipts are obtained and individual records kept of income and expenditure. We found that regular checks are carried out of the building and equipment, which protects service users. Regular checks of the rooms are made and repairs carried out when necessary. Staff attend training in areas relating to health and safety including safe moving and handling, first aid, fire awareness and infection control. The fire logbook shows that regular checks of fire equipment are carried out as well as regular fire drills. We found that accidents and incidents are recorded and reported as required protecting service users. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!