Firtree House Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

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

This meant people’s needs were met through good organisation and delivery.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People’s care plans contained clear documentation and guidance for staff on how best to care for people. This included information about any risks, their mobility, nutrition and hydration needs as well as their communication and wellbeing. Staff demonstrated a strong knowledge of people’s preferences and routines and there was evidence of regular reviews and updates to individual care and risk management plans.

Where people had specific health conditions, such as epilepsy, diabetes or Huntingdon’s disease, individualised care plans were in place. These gave additional information and guidance to staff on the care that was needed. In one instance, staff showed a good understanding of how 1 person’s condition influenced the person’s perception and mental health, particularly in relation to their medicines.

Staff said, “Care plans are on [electronic care planning system]. We would read them (if there is a new person). I would tell the nurse if the care plan is wrong.”

Staff understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff worked closely with external professionals who were skilled in the specific health conditions of people living at the service. This helped to ensure that care was consistent and responsive to people’s individual needs.

The service worked with the Quality in Care Homes team as well as the Surrey Heartlands Integrated Care Board. Both offered support, training and advice to staff around people’s care needs. For example, there was a thread of involvement by healthcare professionals throughout the care plan of 1 person with contact details to ensure adequate provision and continuity. For example, their dementia diagnosis (related to alcohol) clearly outlined when they were more affected and how to support them and there was evidence of GP advice being sought frequently by staff.

Staff supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. In addition, staff supported people’s individual communication requirements.

One person had a whiteboard in their room that staff used to support communication. Although the person’s understanding was deteriorating, staff continued to engage meaningfully by writing friendly messages such as ‘Good morning’.

Within the staff team, including management, there was a range of languages spoken, which helped ensure that people whose first language was not English could communicate more easily and feel understood. Languages spoken among the team included French and Creole. This reduced communication barriers.

Relative’s felt communication was good with 1 telling us, “I have always been kept informed about all of [person’s name] medical issues and provided with general updates and am totally confident that I would be included in any major decisions. I can talk to the nurses directly whenever I have questions.”

Staff made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

People were encouraged to give their feedback about some aspects of care at the service as the activity lead obtained feedback around the food and this helped to develop the weekly menus.

The registered manager’s told us they did not carry out survey’s with people and families as, “We sit with people and chat with them and anything coming up we deal with there and then. A family member told us about the trees in the front which were overhanging and we had them cut back straightaway.”

Staff involved people. One person liked to paint and staff encouraged them to display their paintings as an exhibition for others to enjoy. They told us they appreciated the opportunity to be recognised and involved.

Staff made sure that people could access the care, support and treatment they needed when they needed it. A relative told us, “I have never seen any evidence of discrimination, with all residents being treated equally.”

One person told us how they liked to read and “books suddenly appear”. They said they liked a particular author and we saw that 1 of the books given to them was by that author. Another person said they had a sore on their hand and that staff had put ointment on it for them and advised the doctor would take a look at it. A third person said they enjoyed wildlife and we observed the activities lead sitting with them sharing pictures of animals and birds.

Management told us people were aware of their rights and staff undertook equality and diversity training to help develop strategies for promoting good practice and handling sensitive situations. The service had a wide range of people with different health or physical needs and people from different cultures. Staff had taken the time to learn some words in languages other than English as well as getting to know people’s cultural preferences. Staff told us, “(We have) large print and braille print bibles. If they would like the timetable then they can have it bigger for them. If they struggle to read, we can read it for them nice and slowly. If the relatives want them then they can have them.”

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

People said a choice of activities were arranged for them. One relative said they felt their family member’s brain was, “More stimulated here.” They went on to say, “[Activities lead] puts on lots of activities, such as flowering arranging, face painting and colouring displays. [Activities lead] is very good at teaching people how to do things and she has good ideas.”

We observed little movement within the service for people as we saw people sitting in the same place for the whole day. We discussed this with management as we felt more opportunity for outside activities would benefit people. Following our inspection, we were sent evidence of some people being escorted to the local shops or the hairdressers, but this was not consistent across the board.

A pastor visited the service in the morning to lead a religious session with people. They knew everyone well and greeted them individually on arrival. Management told us, “He will adjust his services depending on people’s faith.” People said they enjoyed his sessions.

A staff member said, “I make this (activities timetable) on a monthly basis. You can’t always stick to a plan. You can find out from family member or from them what their preferences are. We’ve got a group of people who really can’t do anything because of their high level of dementia so we do an aromatherapy session. We’ll take them into the second lounge we put on aromatherapy on the TV and then we do nice hand massages. We’ve got a gentleman whose hands turn in but his hands relax and open up (when he has aromatherapy).” This was confirmed by a relative who told us, “[Person’s name] has been included in all activities in spite of (their) advancing Alzheimer’s and reducing capacity e.g. activities …… the wonderful group aromatherapy sessions. With the latter a calming atmosphere is created with dimmed lights and soft music. I have seen hand massages being given tenderly and sensed the calmness in the residents present, including [person’s name].”

People were supported to plan for important life changes, including at the end of their life. People had advanced care plans in place where information was recorded on people’s specific wishes. This included who they wished to be involved in their care, whether they wanted to be resuscitated, and whether they preferred to remain at the service or be cared for elsewhere. This helped to ensure that people’s choices were respected and that care was delivered in line with their values and preferences. A staff member told us, “I’ll sit and hold their hand and talk to them. I might even read them a story. We had a lady who was poem orientated so I sat and read her lots of poems. Some residents don’t have family; they know that somebody is there and that they care. If somebody is religious then we make sure that happens as well.” A healthcare professional told us, “The have good experience and management of the EOLC (end of life care) pathway.”