Far Fillimore Rest Home

People’s experience of the service and what we found:

People were not always safeguarded from the risk of abuse and action was not always taken to mitigate the risk of harm to people following incidents and accidents. Systems in place did not support continuous learning. People’s risk assessments were not always followed, and this put them at risk.

The environment was not always safe for people. Window restrictors did not meet health and safety guidance and safety checks were not always undertaken on a regular basis. Although the home was clean, there was a malodour in the ground floor bedroom corridor.

Quality monitoring systems had not ensured that the service was safe. The registered manager undertook monthly audits, however these were not effective in analysing trends and identifying improvements.

People were supported to have maximum choice and 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was Good and the report published on 23 April 2018.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

You can see what action we have asked the provider to take at the end of this full report

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Far Fillimore on our website at www.cqc.org.uk.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

• The visiting policy in place was complied with. Visits were permitted in exceptional circumstances such as if someone was at the end of their life. Visitors were required to wipe their feet on a mat which sanitised the bottom of their shoes prior to entry.

• Visitors were required to have temperature checks undertaken and undergo lateral flow tests prior to entry. • Allocated parking bays had been created for visitors to reduce their movement and to ensure an efficient testing process could be undertaken to mitigate risk of transmission of infection.

• People were supported by staff who were trained in infection prevention and control (IPC) and who wore Personal Protective Equipment (PPE) in line with current guidance. PPE competency checks were completed during supervision to ensure staff understood and complied with current guidance.

• A whole home COVID-19 testing programme was in place and people and staff were tested in line with current guidance.

• When people tested positive for COVID-19, they were required to self-isolate in line with current guidance.

• When people did not understand the need to self-isolate due to a cognitive impairment, mental capacity assessments were undertaken and least restrictive best interests decisions were made to mitigate risks to people. One person lacked insight into the need to self-isolate so a sensor beam was used to alert staff if the person was approaching their bedroom door.

Far Fillimore Rest Home is a ‘care home’, registered to provide support for up to 26 people. People in care homes receive accommodation and nursing or 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. At the time of our inspection 24 people were using the service. This unannounced inspection visit took place on 23 April 2018. The service did not provide nursing care.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained Good.

People were protected from the risk of avoidable harm by staff who understood their responsibilities to identify and report any signs of potential abuse. We saw that concerns were taken seriously and investigated thoroughly to ensure lessons were learnt. People received their medicines safely. Risks associated with people’s care and support were managed safely and visitors were confident their relatives were safe and well cared for. Sufficient staff were available to support people, and safe recruitment processes were followed.

People received support from staff who had received training to provide effective care. The manager had recognised that further training for staff in supporting people living with dementia would enhance staff’s understanding.

Staff supported people to maintain their physical health and wellbeing and people received meals which met their requirements and preferences. The home environment was adapted to meet people’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were caring, and people were treated with kindness and respect. Staff knew people well and understood how to communicate with them. People’s privacy was respected, and their dignity and independence promoted. Visitors were encouraged and people were able to maintain relationships that were important to them.

People’s preferences and wishes were taken into account and opportunities for people to take part in activities at home and in the community were provided to reduce the risk of social isolation. People and their relatives contributed to the assessment and development of their care plans and felt able to report any concerns they had.

Systems were in place to monitor the quality of the service, and these were used to drive improvements. People and their representatives were consulted and involved in the running of the service. The provider and registered manager understood their responsibilities and regulatory requirements and had resources available to them; including partnership working with other agencies that ensured people’s needs were met.

Further information is in the detailed findings below

Far Fillimore Rest Home provides accommodation and residential care for up to 26 people who may be living with dementia. On the day of our inspection 20 people were using the service.

A registered manager was in post at the time of this inspection. 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 we spoke with told us they felt safe living in the home. Staff demonstrated a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise identified risks. Plans were in place to respond to emergencies to ensure people were supported in accordance with their needs. Care staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

Recruitment checks were carried out prior to staff starting work to ensure their suitability to work with people and the staffing levels in place met people’s needs. People were supported to take their medicine as and when needed. Staff received training and support to enable them support people effectively.

People received food and drink that met their nutritional needs and preferences and were referred to healthcare professionals to maintain their health and wellbeing. Capacity assessments had been completed where people lacked capacity to show how people were supported to make decisions. When people were being unlawfully restricted this had been considered and Deprivation of Liberty Safeguards (DoLS) applications had been made to ensure people’s rights were protected. Staff gained people’s verbal consent before supporting them with any care tasks and helped people to make their own decisions.

People were supported to socialise and take part in activities to promote their wellbeing. People told us that they liked the staff and we saw that people’s dignity and privacy was respected by the staff team. Visitors told us the staff made them feel welcome and were approachable and friendly.

Staff listened to people’s views and people knew how to make a complaint or raise concerns. There were processes in place for people and their relatives to express their views and opinions about the service provided. People felt the service was well managed and they were asked to express their views and be involved in decisions related to the planning of their care. There were systems in place to monitor the quality of the service to enable the manager and provider to drive improvement.

At our last inspection on 3 September 2013, we made two compliance actions. This meant the provider had to make improvements to demonstrate they were fully protecting people using their service in these areas.

We found that suitable and sufficient improvements had been made where we had identified concerns. We saw the provider had put right what was required. This meant the home could demonstrate outcomes for people using the service had improved.

We found people using the service were safe because the staff were given clear instructions, support and guidance. People told us they were treated with care and compassion and the staff responded well to their needs or concerns.

We saw information regarding capacity and consent was not always in place. This meant the home could not always demonstrate how arrangements to seek people's consent to care or treatment had been agreed in the person's best interests.

We found that medication was administered safely but the recording and storage of medications required some improvements.

We found people using the service received appropriate nutrition. People told us they enjoyed the meals provided.

We looked at the cleanliness and suitability of the environment and saw the home was clean, safe and well maintained.

The provider had systems in place to check on the quality of the care people received. The service was well led because the registered manager supported the staff team, had quality monitoring systems in place and managed risks effectively.

People told us they could express their views and were involved in decision making about their care. They said they were treated with respect and dignity. One person told us, 'I am very happy with them all, I never feel embarrassed, they are patient and understanding.'

We were told by people using the service the staff team provided sensitive and flexible personal care support and they felt well cared for. The people we spoke with said they felt safe. They said they were happy with their care and the staff were responsive to their needs.

Staff had a good knowledge of the care needed and what people wanted. One person told us, 'The girls let me do what I can, they don't rush me and they understand my ways.'

We saw that all the necessary checks were made to ensure they were fit to do their job.

The provider had systems in place to ensure people could raise concerns and improve the quality of the care received. We saw information which confirmed complaints were responded to and people were able to voice their opinions.