Firtree House Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

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

This meant people were safe and protected from avoidable harm.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Management and staff had a proactive and positive culture of safety, based on openness and honesty. Lessons were learnt to help identify and embed good practice. A staff member said, “We do discuss in our handover what happened. What should be done in future as well. We are allowed to share our opinions.” A healthcare professional told us, “They are an open team sharing information and have a learning culture.”

Accidents and incidents were recorded and reviewed by management for the actions taken. Referrals were made if necessary to external healthcare professionals or changes made to people’s care. Lessons learnt were shared with staff through meetings and supervisions.

Quarterly reviews were carried out on accidents and incidents to look for themes and trends and changes made when appropriate. This included introducing body maps to record any previous injuries to a person so if they were admitted to hospital, it helped prevent confusion between old and new injuries.

Management worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. A staff member said, “If [person’s name] is going to the hospital (for an appointment) I would go with them. We have to take their paperwork and of course we have to have read it.”

People were visited and discussions took place internally with the clinical team to ensure the person’s needs could be met prior to them moving in. This helped prevent people coming to live at Firtree House Nursing Home and finding it was unsuitable for them. A relative told us, “I chose this home because it was a happy place and [person’s name] settled in really well.”

Where people were of very high dependency a request for 1 to 1 staffing was made in the first instance to help monitor the person and support them to settle in. This was reviewed over time and removed when appropriate.

Families were encouraged to visit a day or two prior to their family member moving in to personalise their room to help ensure the transition into the service was as smooth as possible for the person.

Management and staff worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. A relative told us, “I have never had any worries about [person’s name] safety. I have seen the carers demonstrate skills in calming residents.”

Management shared concerns quickly and appropriately with the relevant authorities and assisted them with providing information so investigations into allegations of abuse could take place. They also completed internal investigations alongside the safeguarding authority.

Staff underwent safeguarding adults training and put this training into practice by raising or reporting concerns. They had a good awareness of abuse indicators and reporting procedures. Staff told us, “Physical abuse – like someone is physically hitting or punching or grabbing. Of course I would report it to my nurse and my manager or CQC or the safeguarding team. I have heard of whistleblowing. I know what it is” and, “Verbal abuse, physical abuse. If somebody hits someone then it will be physical abuse. Bruising, scared. I will go to my manager, if they don’t take any action then we will have to call the safeguarding.”

Management and staff worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. People told us they felt safe living at the service and that staff looked after them, “Well.”

Where people were at risk of their skin breaking down, air mattresses were provided. We found 5 of these were set incorrectly according to the person’s most recent weight. For example, 1 person’s was set at 110kg and yet they only weighed 69.7kg and another person’s was set at 90kg despite weighing 62.6kg. Although the impact of this was low, as no one in the service was experiencing a wound or sore as a result. We did however highlight this to management to ensure that air mattresses were checked regularly for their settings.

Furthermore, we found a pot of thickening powder on 1 person’s bedside table. Although

people did not appear to be at risk of picking it up and inadvertently ingesting it, the thickening powder was not being stored in line with an NHS England safety alert in 2015 that recommended that thickening powders should be stored securely, out of reach of people. We reported this to management who took immediate action following our inspection.

Despite finding these shortfalls, we identified people’s needs were assessed in relation to their individual risks and action taken to help keep them safe. This included the use of bed rails where people were at risk of falling or rolling out of bed, using full body hoists where people’s mobility had reduced and supporting people on 1 to 1 basis to enable them to continue living a fulfilling life. We also found where people required a hoist, special slings had been purchased which people could sit in for long periods of time. This helped to reduce the number of times staff had to reposition a person to put a sling on to hoist them. The slings contained pads so people were not at increased risk of sores or wounds.

Staff were knowledgeable and told us how they would respond to people’s individual risks to help keep them safe. One person, for example, became anxious at times and they were at risk of becoming agitated towards staff or people. Staff told us they diverted the person and suggesting moving to another room, or going out to the local shop to calm them. We observed this happen during our visit.

Management detected and controlled potential risks in the care environment.

A recent fire service safety inspection found a good level of fire safety in the service and equipment such as hoists were checked for their safety. Regular fire drills took place with staff, both day and night, to check staff knew what to do in the event of an emergency. We observed carbon monoxide detectors in the kitchen and laundry room.

The flooring in the service had been changed so it could be cleaned easily and it was safe for people who were independently mobile. Although corridors were narrow, they did enable people with wheelchairs or people who used walking aids space to move through them. Windows had appropriate restrictors on them and the lift, stairs and front door had keypad access only to ensure people could move around the home safely.

Recruitment process at the service were through, but not fully meeting Schedule 3 of the Health and Social Care Act. Schedule 3 lists checks that should be made when recruiting a new staff member. This included ‘a full employment history, together with a satisfactory written explanation of any gaps in employment’. We did not always find this was the case. Of the 7 recruitment files we reviewed all of them had unexplained gaps in employment. We spoke with management about this who immediately took steps to correct this. However, we found all other recruitment documentation in place and staff underwent a Disclosure and Barring Service (DBS) check prior to commencing work. DBS checks help ensure staff are suitable to work in this type of service.

Management made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. A relative told us, “I believe the carers have skills which cannot be taught and which come naturally to them.”

We observed a sufficient number of staff on duty during the day and staffing levels in line with what we had been told. Staff worked well together and busy periods, such as lunchtime. We observed mealtimes were smooth and uneventful. Where people were on 1 to 1 staffing, these staff were over and above the daily allocation and we saw these staff carrying out their duties as required. Staff felt there were enough of them and told us if they needed support management would step in.

Staff underwent an induction process and full training programme with refresher training provided on a routine basis. Staff said, “Training is great here and we get lots of chances to learn new things” and, “All the training helps me feel confident in my job.” In addition, staff were supported to meet with their line manager on a 1 to 1 basis to discuss their role, training requirements or any concerns. Staff said, “My clinical lead like [staff name] will do my supervision. We have different people doing our supervisions. Sometimes our manager does. We talk about everything. What I have done so far, what is my progress. What do I want to do in the future? We talk about the residents. Opportunities for training of course. I am doing NVQ level 3 at the moment.”

Although management assessed and managed the risk of infection there were areas of the service that may be difficult to clean as some parts of the service were tired and in need to refurbishment. This was particularly in the older part of the service where alterations had been made to doors, for example, and there was exposed woodwork. Some people’s rooms were cluttered with equipment and furniture that was not made of cleanable materials, such as 1 person who had a fabric settee in their room. Another person’s room had an open packet of incontinence pads on the floor, exposed to the air, with a folder wheelchair on top of them. The wall of a further person’s bathroom had a badly stained wall beside the sink and we found that the upstairs sluice room (an area for cleaning soiled equipment, such as urine bottles) was unlocked.

However, we did not identify any malodours in the service and we saw personal protective equipment (PPE) stations placed around the service for staff. Management told us deep cleans took place every fortnight and in particular we found the newer wing of the service looked clean and well maintained. A relative told us, “The home is always very clean and I see regular cleaning taking place in the bedrooms and living areas when I visit. [Person’s name] room has always been clean and tidy whenever I have gone into it, with (their) clothes hanging up neatly in the wardrobe or placed in the drawers.”

A staff member said, “We do have enough PPE. If we need more, we will get it.”

The provider did not always make sure that medicines were stored appropriately or other items were checked for their expiry dates.

The clinical room where the medicines trolley was stored was small, although it was fairly well organised. However, although staff were storing medicines securely in locked cabinets and in medication trolleys, excess medicine was stored in an open shelf which is not in line with best practice. We spoke with management about this who took action prior to us leaving the service by fitting doors over the shelving. In addition, we found items in the 2 first aid boxes had expired. This included Microporous tape which expired in December 2019 and burn gel which expired in August 2025. We highlighted this to management who provided us with evidence of purchasing 2 new first aid boxes.

Other than these 2 areas, we had no concerns about the administration of medicines or medicines practices within the service. Medicines were administered by trained staff who had completed up to date medication competency assessments. Staff followed the home’s medication policy and received annual refresher training. Staff were observed checking people’s medication administration record (MAR) when doing the medicine round and ensuring people had swallowed their medicine before filling in the chart. People told us they received the medicines they needed and 1 person who had a headache told us staff had given them paracetamol.

A robust process was in place for ordering repeat prescriptions and liaising with local pharmacies and medicines no longer required were disposed of in line with current guidance. Staff also ensured antipsychotic medication was reviewed and reduced with the involvement of people, external health professionals and staff to avoid people receiving too many unnecessary medicines. A healthcare professional said, “They have good housekeeping around prescriptions.”