Firgrove Nursing Home provides accommodation, care and support for up to 35 people. The service provides support to older people, those living with dementia or mental health conditions, or people with long term health needs such as Parkinson’s Disease. At the time of our inspection 18 people were living at the home.

Firgrove Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Firgrove Nursing Home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. At the time of our inspection the registered manager was also the nominated individual for the service.

We undertook a comprehensive inspection took place on 10 and 11 September 2018 which was unannounced. Following that inspection, we received information of concern in relation to staff recruitment. We undertook a further visit to look into those concerns on 13 December 2018. We announced this visit and we looked at the key questions of Safe and Well Led. This report covers our findings at both visits.

This is the first time Firgrove Nursing Home had been rated Inadequate and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the last comprehensive inspection of the service in September 2017, the overall rating for the service was Requires Improvement with three breaches of regulation. People’s social needs were not being met and people were at risk of social isolation; consent to care and treatment was not always sought and documented in line with legislation; and there was a failure in some systems for monitoring standards and quality. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least Good. At this inspection, although some improvements had been made, there remained areas of significant concern. We did not find these inconsistencies had impacted on the safety of people, but these demonstrated shortfalls in quality monitoring and management oversight

This inspection took place on the 21 September 2017 and was unannounced. Firgrove Nursing Home is a privately owned care home that provides nursing care and support for up to 35 people. At the time of our inspection, there were 22 people living at the home. Firgrove Nursing Home supports people with a range of needs such as physical frailty, Parkinson’s disease, stroke and people living with dementia. The home is situated in a residential area of Burgess Hill and is a large two storey building, with accessible gardens to the rear of the premises.

The home had a registered manager in post. 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. Both the registered manager and the provider were present during the inspection.

At the last inspection undertaken on the 24 and 26 March 2015 we had no concerns and rated the service as 'Good' overall. At this inspection we found three breaches of regulations and further areas of practice that needed to improve.

Staff did not demonstrate a clear understanding of the requirements of the Mental Capacity Act 2005 and their responsibility to seek consent for care and treatment. Some people lacked capacity to make specific decisions, including consent for the use of certain equipment that restricted their movement. Decisions that had been made in their best interest had not been documented and reviewed in line with legislation and guidance. This was a breach of the regulations.

People’s social needs were not being met and this meant that some people were at risk of social isolation. Some organised events were arranged with external performers but these were on an occasional basis. People did not have things to do throughout the day that were suitable for their needs, and relevant to their personal interests. This was a breach of the regulations.

Some management systems had not been effective in providing oversight of shortfalls in practice. This was identified as a breach of the regulations.

People were receiving their medicines safely. However during the administration process medicines were not always stored safely and this was identified as an area of practice that needed to improve.

Some people needed help to move around and staff were using equipment to support them. However, staff were not always using equipment in line with current good practice. This is an area of practice that needs to improve.

People told us they were happy with the food provided at the home. They received the support they needed to have enough to eat and drink and any nutritional needs were assessed and monitored. One person told us, “The food is good here.” People were given a choice at supper time but not for the main meal at lunchtime. Staff said that people were offered alternatives if they did not like the main meal. One person was asleep when their lunchtime meal was brought to them but staff did not offer to reheat the food even though half an hour had passed. This was identified as an area of practice that needs to improve.

People and their relatives told us they felt safe and happy living at Firgrove Nursing Home. One person said, “I feel safe, if not I would tell my family.” A relative said, “The care is very good.” There were enough staff on duty and people did not usually have to wait to have their care needs met. Risks to people had been identified and assessed and care plans were in place detailing how care should be provided. Staff had a clear understanding of their responsibilities to keep people safe and knew how to recognise abuse and what actions to take.

People and their relatives had confidence in the skills of the staff. One person said, “I am very happy with them and trust them completely.” A re

We spoke with five people, two visitors, the manager and five members of staff. People told us that they were happy living at the home and satisfied with the care and support they received. One person told us 'I am happy here, the staff know what I like and they treat me well'.

We observed that staff were polite and respectful towards the people living there. People told us that they were listened to and were involved in making choices about their care. They said they were encouraged to be as independent as possible and could decide how and where to spend their time. One person told us 'the staff treat me with respect and address my choices'.

People told us they were well cared for and felt safe. We saw that people had individualised care records and risk assessments in place which helped staff to understand and meet peoples' needs. We noted that in a recent survey a relative had commented 'The home has a lovely atmosphere and it is always a pleasure to visit and my relative is very settled. Also I know that I do not need to worry about her as she is being cared for very well'.

We saw that medication was administered, recorded and stored accurately and safely.

We found that staff were trained and supported through supervision to provide an appropriate standard of care. They were knowledgeable about the people they supported.

All records were kept securely and the records describing peoples' care needs were well organised, detailed and regularly reviewed.

We did not speak to the people using the service during this visit.

People living at the home told us they felt safe living there and that staff were always available when they needed them. They felt the staff knew what support they needed and how they liked things done.

People we spoke with told us they were involved in making decisions about the way they spent their day. They felt the staff always respected their privacy and dignity. Staff knew the people living at the home well and had a good understanding of their needs.

People told us that liked living at Firgrove.

The inspection took place on 24 and 26 March 2015 and was unannounced.

Firgrove Nursing Home is a privately owned care home that provides nursing care for up to 35 people. At the time of our inspection, there were 26 people living at the home. Firgrove Nursing Home caters for people with a range of needs such as physical frailty, Parkinson’s disease, stroke and people living with dementia. The home is situated in a residential area of Burgess Hill and is a large two storey building, with accessible gardens to the rear of the premises. The main communal area is large and bright and some bedrooms have views that overlook this area, so that people can see what is going on. There is a large garden room and a smaller library area with a range of books that people can borrow. A co-ordinator arranges activities and events for people and a hairdresser visits weekly.

The home has a registered manager. 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.

People felt safe living at the home and staff members had been trained in safeguarding adults at risk. They knew what action to take if they suspected abuse was happening and who to contact. Risks to people were managed safely and care plans showed that risks had been assessed appropriately. Premises and equipment were managed safely. Staffing levels were sufficient to meet people’s needs safely and effectively and staff felt they had enough time to talk with people too. Safe recruitment practices were in place and necessary checks undertaken when new staff were employed. Medicines were managed safely and registered nurses were trained in the administration of medicines. Medicines were ordered, stored and disposed of in line with legal requirements.

Food was freshly cooked each day and people were supported to maintain a balanced diet. Special diets were catered for and people had a choice of food available to them. Where needed, specialist advice was sought from a dietician. People had access to a range of healthcare professionals and received care from staff who were trained to carry out their roles and responsibilities. Training was organised for staff in a range of areas and they received regular supervision from their line managers. Team meetings were held monthly for staff. Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and associated legislation and put this into practice.

The home had a warm, friendly atmosphere and positive caring relationships had been developed between people and staff. People’s choices and preferences were respected and staff knew people well. People were actively involved in all aspects of their care and they were treated with dignity and respect. Relatives and friends could visit without undue restriction. Ministers visited from two local churches and people could participate in hymn singing or receive Holy Communion.

Social activities were organised by an activities co-ordinator and people could choose whether they wanted to be involved. Some people went out into the community with support from relatives or friends. Care was personalised to meet people’s needs and care plans provided information about people’s personal preferences and choices. The provider was in the process of transferring care records onto a computerised system. Concerns and complaints were investigated and acted upon, although no complaints had been received recently. The provider had a complaints procedure policy in place.

The home was well led and residents’ meetings were held regularly. People and their relatives were asked for their views about the care provided and these were acted on. There were robust quality assurance systems in place and the registered manager audited various aspects of the service, measuring these against health and social care regulations. Staff were asked for their feedback about the service and understood what was expected of them.