We carried out a review of the data available to us about Fourways on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Fourways, you can give feedback on this service.
Fourways is a residential home providing accommodation and personal care to 40 older people at the time of the inspection. Some of these people were living with dementia or a cognitive impairment. The service can support up to 47 people.
People's experience of using this service and what we found
At our last inspection, we found people’s risks and environmental risks were not always managed. Medicines were not always managed and kept safely, and the quality of audits and checks were ineffective. At this inspection, we found improvements had been made.
Environmental risk management was improved since our last inspection. Fire checks were completed, but we found some outstanding actions needed to be completed. Following the inspection, the provider confirmed this work would be completed by 30 June 2021.
Medicines management had improved following our last visit. Medicines were managed safely by trained and competent staff.
People’s individual risks related to their health and wellbeing had improved and plans were in place to manage those identified risks. People's changing needs were responded to promptly by staff and other healthcare professionals were contacted when needed. People were treated with respect by staff. Where complaints had been made the provider had investigated and responded.
There were enough staff on duty to meet people’s needs and to respond to people’s requests for assistance.
Staff understood their responsibility to safeguard people from harm and report any concerns they had to the management team.
People were involved in pursuing their own interests and hobbies. Staff helped encourage people to share some of their interests with other people in the home. The pandemic and government restrictions had limited external and internal visits over the last 12 months, however staff continued to keep people occupied and stimulated.
Audits and checks were completed. People and staff provided their feedback which helped ensure the quality of service continued to improve. People and staff were complimentary of the management and staff felt the care provided at the home had improved since our last inspection. Relatives we spoke with confirmed the quality of care was much better and communication had also improved. Relatives we spoke with felt well informed and engaged in how their family members were supported. The provider’s care record system had a facility for family members to review what care had been provided each day which helped them to keep in touch.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 12 September 2019).
Why we inspected
The inspection was prompted in part to follow up concerns from the previous rated inspection in July 2019. As part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control (IPC) practice was safe and the service was compliant with IPC measures. We looked at the IPC practices the provider has in place.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
We reviewed the information we held about the service. No immediate areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Fourways on our website at www.cqc.org.uk.
Follow up
We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
We found the following examples of good practice.
¿A person told us they had been anxious about accessing the community after a period of isolation. Staff had supported them to regain their confidence to leave the home.
¿The provider had installed a purpose-built garden pod and sourced individual Christmas meals, so people could enjoy the festivities with family safely within the pod.
¿Staff were observed socially distancing and wearing personal protective equipment (PPE) in line with guidance. Staff wore PPE at all times to minimise the risk of infection to people who were unable to socially distance.
¿The home used plastic units to store PPE throughout the building. This supported cleaning of the area and ensured PPE was easily accessible to staff.
¿Laminated signs to monitor cleaning schedules were displayed throughout the home and updated when cleaning had taken place.
¿The home offered a sanitiser spray for clothing to staff and visitors as an additional measure to support infection prevention and control.
Further information is in the detailed findings below.
Fourways is registered to provide accommodation and personal care for up to 44 older people, including people who living with dementia. At the time of our inspection visit there were 42 people living at the home. Care is provided across three floors and communal lounge and dining areas were located on the ground floor. People’s bedrooms were not all ensuite so people used communal bathroom facilities located on each floor.
People’s experience of using this service and what we found
Since the last inspection visit, the provider sent us an action plan telling us how they would drive improvements within the service. We found some positive examples where people were more engaged and included in day to day events at the service. However, limited oversight and actions meant some quality improvements were not made and we found some issues we found last time continued. For example, the quality and accuracy of record keeping had not improved and, in some cases, was inaccurate and not timely. We still found examples of call alarm bells that were not in place or alarm mats that were not effective, which we found at our last visit.
Staff and managers did not consistently ensure people's medicines or prescribed items were administered safely due to excessive temperatures in people’s rooms during a period of hot weather. This had been identified by the provider in June 2019, but appropriate measures to retain the efficacy and manage this risk of those medicines, had not been taken. During this visit we continued to find medicines stored above recommended limits. There was no risk assessment to determine if people’s medicines remained fit for use.
Infection control checks were not always completed and we found examples where risks for cross infection could cause potential risk. Cleaning schedules implemented by the provider to drive improvements had not been completed or checked.
The service was not always responsive. People enjoyed the food; however, the food choices given to people during our visits were not seasonal. There was a continuing hot spell of weather, yet set planned meals continued to be provided without consideration of lighter options. Drinks were sometimes out of reach for people and staff offered some people their favourite drinks, rather than seeing if they wanted cold drinks or other options which would encourage them to keep hydrated.
Improvements to the wider organisational governance were being rolled out in July 2019. The director of quality and compliance felt these improvements would make sure day to day staff practice and good care outcomes would be identified and improved more quickly.
Overall, people’s comments were positive and people felt comfortable and relaxed at the home. People complimented staff’s attitude and approach and that staff were supportive. The provider used agency staff to support their own staff whilst recruitment continued. The provider used the same agency staff for consistency although some people said agency staff were not always as knowledgeable about their care needs as permanent staff.
There were sufficient numbers of care staff on duty to meet people’s needs. The provider used a staff dependency tool to ensure staffing levels continued to meet people’s needs. The interim manager and deputy manager could support staff on the floor if emergencies happened. High agency staff use supported staff rotas, however plans to recruit more staff were in place.
Staff understood their roles and responsibilities, such as safeguarding people from poor practice. Staff told us they were confident to record poor care and if no action was taken, staff were more confident to refer onwards to safeguarding teams and to us. However, we found numerous examples of unexplained bruising and a lack of body mapping which meant we could not be assured, people always received safe care and treatment. The provider had not notified us of one safeguarding incident but they sent us a retrospective notification following our visit.
Staff training was completed but plans were in progress to ensure staff’s levels of training met the provider’s own targets. Further staff training sessions were planned for.
People’s dietary needs, preferences and nutritional needs were assessed and known by staff and when needed, people were referred to other professionals to support their healthcare needs. Some people had their food and fluid intake monitored and further improvements were needed to ensure those records were of value to determine next steps.
People were supported to have control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Where people’s freedoms were restricted, processes and authorisations had been followed.
A programme of audits included health and safety, environmental checks, water quality and fire safety were completed. People and relatives’ feedback was sought at planned meetings and events.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
Following our last Inspection in June 2018 where the provider had a breach of the Health and Social Care Act, the provider completed an action plan after the last inspection to show what they would do and by when to improve.
During this inspection the provider demonstrated that some improvements had been made and provider wide quality assurance systems had been developed and were due for rollout in July 2019. However, during our inspection visits we found some issues we identified at the last inspection remained. Further examples relating to people’s care delivery were not identified through audits and checks and some records failed to show what actions had been taken. We found a breach of Regulation 12 of the Health and Social Care Act 2014 (Regulated activities). We found the service continued to be requires improvement overall and there was a repeated breach of Regulation 17 of the Health and Social Care Act 2014 (Regulated activities). Further improvement and embedding of new quality assurance oversight is required to ensure positive changes are embedded into daily practice.
The last rating for this service was Requires Improvement (published 27 July 2018).
Why we inspected
This inspection was based on the rating at the last inspection. We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the Key Questions Safe, Effective, Caring, Responsive and Well Led.
Follow up
We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Fourways is a care home registered to provide personal care and accommodation for a maximum of 47 people. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is located in a residential part of Lillington with access to shops and local amenities. There were 45 people living at the home at the time of our visit, some of who were living with dementia.
The service had a registered manager. This is a requirement of the provider’s registration. 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. However, the registered manager was no longer working at the service, and a new manager had been appointed. The provider told us the registered manager was still providing support to the new manager, but acknowledged they needed to notify us of the changes in the day to day management of the home.
We last inspected Fourways in September 2015 when we rated the service as 'Good’ overall. However, the key question of safe was rated ‘Requires Improvement’ because people did not always receive their medicines as prescribed.
At this inspection we found further improvements were required because staff were not consistently demonstrating the provider’s values and ethos of care in their everyday practice. Improvements were required in staff’s understanding of people’s individual needs for support. People did not always receive support that was responsive to their social and emotional needs.
There were enough staff to keep people safe and people told us they felt confident with the staff who supported them. However, the deployment of staff meant they were not always responsive to people’s needs.
People’s individual risks were assessed and their care plans explained the actions staff should take to support people safely. However, staff did not always act consistently to mitigate people’s assessed risks or follow the provider’s guidance for managing medicines safely.
Staff went through a series of recruitment checks to ensure their suitability to work at Fourways. The induction, training and support given to staff ensured they had the skills, knowledge and confidence to carry out their duties and responsibilities effectively and understand their responsibilities to report any abuse or discrimination.
People were encouraged and supported to eat and drink enough to maintain their health. People told us they received good healthcare and were supported to access healthcare services when needed. The provider encouraged good working relationships between their own staff and community health professionals so information could be shared effectively.
The provider had made appropriate applications to the local authority in accordance with the Deprivation of Liberty Safeguards and ensured staff worked within the principles of the Mental Capacity Act 2005.
People felt cared for by staff who were kind and respectful of their wishes. Staff had training in equality and diversity and understood people were entitled to privacy and to express their views and opinions. Staff were respectful of people’s relationships with their family and friends.
The provider used a recognised activity programme to ensure people received mental and physical stimulation every day of the week. However, people who were less able to express themselves verbally, or who did not want to join in the group activities, did not experience the same quality of engagement or interaction with staff.
People and relatives were encouraged to provide feedback and make suggestions to improve the quality of care provided. Complaints raised were responded to in line with the provider’s policy and procedures.
There was an open culture in the home where learning from mistakes and incidents was encouraged. Where issues were identified, the provider learnt from experience and took action to improve. The provider had links with other organisations and agencies to share learning and good practice and improve outcomes for people within a care environment.
We carried out this inspection on 15 September 2015. The inspection was unannounced.
Fourways is registered to provide accommodation and personal care for a maximum of 44 people. Some people have a diagnosis of dementia. At the time of our inspection there were 40 people living at the home with accommodation over three floors. The service also offers a respite and day centre facility.
A requirement of the service’s registration is that they have 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was in post.
People told us they felt safe living at the home and could raise any concerns they had with staff. Staff were trained in safeguarding people and understood how to protect people from abuse. There were processes to minimise risks to people’s safety.
People received their medicines from staff trained to administer them, however this was not always given in a timely way and as prescribed. Medicine audits had not identified these issues. Overall there were enough staff to support people, however people did not always receive support at times they preferred, especially at the start of the day.
Checks were carried out prior to staff starting work to ensure their suitability to work with people who lived in the home. Staff received training which gave them the skills and understanding to support people with their health and social care needs.
People who were considered to lack capacity did not have formal capacity assessments, however, staff had some knowledge and understanding about this and further training was being arranged by the provider. Staff obtained consent from people before supporting them, and records reflected this.
People told us staff were kind and respectful and had the right skills to provide the care and support they required. Staff treated people with dignity and respect. People told us they enjoyed the food at the home and had a choice of meals and drinks which they could have at times to suit them. Different dietary needs were catered for.
People were referred to other health professionals when required and care records contained relevant information to help staff provide people with personalised care. People were involved in their care and were asked for their views and opinions about the support they received. People told us they enjoyed the activities on offer at the home.
People told us they could raise any concerns with the registered manager, and these would be listened to and acted upon. People, relatives and staff told us the management team were approachable and responsive. There were processes to monitor the quality of the care provided and understand the experiences of people who lived within the home. This was through regular communication with people and staff and a programme of other checks and audits.
In the care plans we looked at, we saw that the manager assessed people's needs and abilities before they moved into the home. People's care plans identified risks to their health and well-being. Instructions for staff minimised risks and promoted people's independence. Care staff we spoke with told us they regularly reviewed people's plans and made changes when they were needed.
The home was clean and well-organised because the provider followed the Department of Health guidance for infection prevention and control.
The manager checked staff's suitability to work with vulnerable people before they started working at the home. Staff told us about their induction and training programme when they started working at the home. Staff told us the manager was approachable and they could talk to her about anything. In the staff files we looked at, we saw that the manager kept a record of their regular one-to-one meetings with staff.
We saw that records of care and staff records were detailed and were kept securely in lockable cabinets. Staff could access the information they needed to deliver care safely and effectively.
We spent time observing staff interaction and talking with staff about how they meet the needs of the people they support. Staff demonstrated a clear understanding of people's needs and engaged with people in a positive manner.
People using the service told us they liked living at Fourways and felt well cared for.
One person told us, "staff are nice, good and caring" and another person told us 'staff are very good and excellent.'
We received positive comments about the staff from the health care professional we spoke with and the visiting relative. We were told 'staff are good with people' and 'care was excellent.'
People who lived in the home told us they felt safe and would be able to talk with staff if they felt concerned about their care. Some people were not able to tell us about their care, so we observed staff interaction and the people appeared relaxed and happy in the company of the staff.
We asked people about the food being served to them and they told us they enjoyed their meals and there was always a choice. One person told us, "food was excellent." However, some people were not as happy with the choice of food available to them.
We saw people's bedrooms were clean, warm and well furnished. People had brought in some personal items with them into the care home and this made their rooms "homely."
The majority of the communal rooms in the home were also clean and tidy and during our visit we saw a timetable for activities were displayed in the corridors.
We saw that people's needs had been assessed before they moved in to the home. Care plans had been devised to describe how people liked and needed to be supported. Risks to people's health and well being had been identified and measures had been put in place to protect people.
We saw there were quality assurance systems in place which measured people's satisfaction with the service provided by the home.
We spoke with 17 people using these services and eight relatives who were visiting at the time. People told us they liked living at the care home and felt well cared for. One person told us 'we like it because staff 'speak nicely' and said staff were 'friendly' towards them. People told us they were happy with the care they received and encouraged by staff to maintain as much independence as possible. We saw people making their own drinks when they wanted to and helping with the washing up after lunch. People told us they liked doing this. Each person we spoke with told us they felt safe and would be able to talk to staff if they felt concerned about their care. Some people were not able to talk to us about their care because of their dementia, however when we asked them if they were comfortable they smiled and nodded.
We asked people about the food being served to them and they told us they enjoyed their meals and there was always a choice.
Relatives told us they had no concerns about how their family member was being cared for. They told us that care given was 'respectful' and 'nothing was to much trouble'.
Relatives we spoke with at each care home told us that staff had 'time for everybody' and the managers were very approachable. Relatives liked the way that they could be involved with the care of their family member and join in with activities if they wanted to. Relatives made particular comments about how well the staff kept them informed about their family member's care needs.
Relatives told us the food looked good and people always had sufficient to eat and drink. They told us that snacks and drinks were always 'available' and they could make a cup of tea for their family member whenever they visited.