Archived: Firtree House Nursing Home

Updated 15 February 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 9 January 2017 and was unannounced. The inspection team consisted of three inspectors, one of whom had a nursing background.

Before the inspection we had received information of concern in relation to the care and treatment of people living at the service which meant we brought forward our planned inspection. We reviewed information that we had on the service which included any notifications that had been submitted. A notification is information about important events which the provider is required to tell us about by law.

During the inspection we observed how care and support was delivered. We spoke to three people who used the service, five relatives, three members of staff and the registered manager. We reviewed five care plans, two staff recruitment files and other records relating to the running of the service such as audits, policies and procedures.

After the inspection we spoke to two healthcare professionals to obtain their view on the quality of the service being provided to people. We also asked the registered manager to send us further information which they did.

Updated 15 February 2017

This was an unannounced inspection which took place on 9 January 2017.

Firtree Nursing Home is registered to provide accommodation for elderly people who require nursing or personal care. The home provides care for up to 35 older people, some of whom are living with dementia and some of whom have specific nursing needs. Accommodation is arranged over two floors. At the time of our visit there were 26 people living at the home.

During our inspection the registered manager was present. A registered manager is a person who has registered with the Care Quality Commission 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.

We found that there were not always enough staff employed to safely meet people’s needs. Whilst on the day of inspection we found that there were sufficient numbers of staff that attended to people promptly our analysis of the staff rota showed that the required number of staff was not always maintained. Feedback from relatives was that this was an issue, particularly at weekends. Agency staff were used regularly to help maintain staffing levels. Not all staff were recruited safely and recruitment checks had not been fully completed.

There were assessments made of risks to people’s health and safety. Whist these identified risks action to reduce the likelihood of harm occurring was not always taken. One person was at risk of developing a pressure sore and had asked to stop using a special mattress that would have helped to reduce one developing.

Not all staff had received relevant training or supervision to help themto do their job well. Training records detailed that most staff had not completed mandatory training despite this needing to be done every year. This resulted in staff not always having the skills and competencies to do their job well. Feedback from healthcare professionals was that staff were not always aware of people’s needs or how to treat specific conditions they may have.

The application of the Mental Capacity Act was not consistently followed and applications that were needed to authorise a deprivation of liberty had been made that were not appropriate. Best interest decisions were not always made with professionals involved in people’s care.

There were mixed views on the quality of food in the home. Whilst people nutritional needs were met there was an inconsistent approach to mealtimes and the types of food that people could safely eat. Where people had specific dietary requirements such as allergies or for those with diabetes these were catered for.

People and relatives told us that staff were kind and caring however these comments were not consistent. Some relatives felt that some staff appeared not to treat people with dignity and respect. We saw that, whilst staff spoke kindly to people, there were occasions when staff missed the opportunity to sit and talk to people.

People were not supported to engage in meaningful activities and spent most of the time sitting watching television. Staff did not spend time sitting and talking with them when they had the chance to.

The care plans we viewed were not always accurate and did not provide staff with detailed information about people’s most up to date needs. People and relatives had made complaints but these had not been responded to or investigated in line with the providers’ complaint policy.

There was a lack of oversight from the provider about the quality of the care people received. Where quality assurance systems had been used they had not been effective as they had not identified the shortfalls we had found. Important notifications about incidents in the home were not submitted to CQC in a timely manner.

Medicines were administered safely. There was safe storage and disposal of medicines by qualified nursing staff who had been trained to give medicines to people. Medicines records were clear and had been completed appropriately. People were protected from harm and safeguarding incidents were reported appropriately to the local authority by the registered manager. Staff knew what to do if they suspected that abuse was occurring.

People had access to other healthcare professionals to help maintain their wellbeing. There were regular visits from the local GP to help ensure that people were treated in a timely manner.

Staff told us that they felt supported by the registered manager and relatives told us that the manager had made improvements in the home.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014.