Firtree House Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

Atour last assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Before people moved into the service an assessment of their needs was carried out to determine Firtree House Nursing Home was the most appropriate place for them to live. Once moving in a brief care plan and summary was written up on the care planning system and family were invited to meet with senior staff members to discuss individual likes and dislikes of their family member. All of this formed the basis of a person’s care plan which was completed and reviewed regularly for its accuracy and appropriateness. A relative told us, “On my initial visit to view the home I sensed a very homely, friendly and caring environment, which has never changed, and I have been very grateful that [person’s name] has been looked after there.”

Staff planned and delivered people’s care and treatment in line with legislation and current evidence-based good practice and standards.

People’s weights were checked monthly and their Body Mass Index (BMI) calculated. This helped staff screen people for potential weight-related health problems. In addition nationally recognised tools such as the Rockwood tool which enabled staff to evaluate people’s overall health, including mobility, cognition, and existing medical conditions as well as Waterlow assessments for skin integrity were completed.

Checks were repeated on a monthly basis so staff were aware of themes or trends, such as a person losing weight. In these instances, supplements were requested from the GP and weekly weighing was instigated. Where people were at risk of choking staff told us, “The nurse will contact the speech and language therapy team. We have to give the correct level (thickener).”

Management and staff worked well across teams and services to support people.

There were good relationships between the service and external professionals, such as the GP, occupational therapist (OT) and speech and language services. Following an OT assessment several people had been provided with in-situ slings. These are specifically designed to be left under a person for extended periods, and used for people who require frequent transfers with a hoist. Staff told us, “We have a very good relationship between us. We work together, we communicate” and, “We are very lucky. We have a great relationship with the community and we are very lucky to have our GP, [GP name].” A healthcare professional said, “I feel safe coming in (to the service) and have the support I need to be able to give 100% of my service to my client.”

In addition, the GP held a dedicated fortnightly on-line session with the service to discuss individuals. This helped ensure that anyone requiring the input of the GP or associated staff, received this in a timely manner. A healthcare professional told us, “[Staff name] has intelligence to observe, pick up on the cues when patient status is changing, ability to communicate the issue well to the Dr and always has the observations to hand.”

There was a good skill mix amongst the clinical staff at the service which helped ensure that referrals to other professionals were appropriate and included relevant detail. There was good information in people’s care plans. For example, there were clearly highlighted steps to take in relation to 1 person’s pre-diabetes diagnosis such as a chiropodist cutting their toenails and annual eye tests.

Staff supported people to manage their health and wellbeing to help them retain a healthier life and where possible, reduce their future needs for care and support. A staff member said, “We report to the nurse then we will monitor if it’s needed. The nurse would call the GP. The GP is good.”

As a result of the monthly checks undertaken with people, staff were able to act or seek external clinical input in a timely manner. For example, 1 person was recorded as not recognising food due to their dementia progression. Weekly weights were introduced and a referral to the Speech and Language therapy team made. This resulted in a change to the person’s diet and drink supplements being introduced. A further change was made to the person’s diet following further review a couple of months later and as a result of this the person was put on a modified diet, and their weight had stabilised.

Staff recognised the need for good oral health. One told us, “In the morning we help them with brushing their teeth and before they go to bed, we offer to brush the teeth. We just encourage them and reassure them and explain that brushing teeth is good but if they refuse they refuse. We don’t force them. We just try our best. They will see the dentist.”

Staff routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves. Staff placed strong importance not only on a person’s mental health, but also their physical health and they worked proactively, and compassionately with people. A healthcare professional told us, “Their medical record keeping is good; always asking for summary printouts of medical problems, results and updating ReSPECT forms.”

One person had previously struggled with poor controlled diabetes, reduced mobility and significant social isolation. They were unable to wear shoes due to swelling and discomfort which limited their independence and confidence. Staff collaborated with healthcare professionals to create a realistic and enjoyable tailored meal plan for this person which suited their preferences and medical needs and with ongoing encouragement and support staff helped the person make sustainable changes at their own pace. As a result, the person’s blood sugar levels improved, allowing for a reduction in diabetic medication and the decrease in swelling meant they could wear shoes again enabling them to participate more fully in daily activities.

A second person had a feeding tube in place upon admission into the service, but with staff support and regular dietician review their nutritional status had improved and this was no longer required as the person was now able to tolerate a pureed diet.

Management and staff did not always tell people about their rights around consent as there was mixed understanding on the principles of the Mental Capacity Act 2005 (MCA).

Although we found capacity assessments and best interests decisions had been carried out in most cases, this was not consistent across the service. In addition, despite people living in a service which had a locked front door, capacity assessments had not been completed for this. Upon speaking with the registered manager’s they explained they had made decisions on ‘providing nursing and care’ on the assumption this encompassed the locked environment. They also told us they made best interests decisions with clinical staff and the GP and then told family members of these, rather than including family members in the discussions.

Staff we spoke with did not have a good understanding of the MCA with 1 staff member telling us, “You can tell their capacity by their hands.” Although another said, “We get good guidance on mental capacity so we know how to support residents’ choices.”

Despite the shortfalls in some of the documentation and understanding of the principles of the Act, Deprivation of Liberty Safeguard applications had been made and approved and there were structures in place to reassess and apply for the DoLS upon its expiry.

Following discussion with the registered manager’s they took immediate action to work through people’s care plans to review the documentation in relation to the MCA as well as arrange staff refresher training.