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Archived: Fauld House Nursing Home Good

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Reports


Inspection carried out on 7 August 2019

During a routine inspection

About the service:

Fauld House Nursing Home is a residential care home that was providing personal and nursing care to 45 people aged 60 and over at the time of the inspection. The service can support up to 48 people. The home accommodates people across two separate floors, each of which has separate adapted facilities and lift. Some of the people living in the home had a diagnosis of early stage dementia. The home is situated in the village of Tutbury near to Burton-Upon-Trent in Staffordshire.

People's experience of using this service and what we found:

Although people were supported to be safe, there were recording issues with some aspects of the care and support including the application of creams. We established that no one had come to harm but this could cause confusion to staff and visiting healthcare professionals. We have made a recommendation about this that can be seen in the 'Safe' section of this report.

People said that they felt safe. Staff received safeguarding training and had a good understanding of the principals involved in acting when abuse was suspected.

Save for some issues with the recording of the administering of creams, medicines were managed safely and this meant that people received their medicines as prescribed by healthcare professionals.

Staff told us they received good support from senior staff, including nurses and the registered manager. We did note that most of the checks and audits at the home were completed by the registered manager. There was an absence of documented input by others including nursing staff and provider. We also noted that whilst the registered manager was unavailable during the early part of 2019, insufficient support and oversight had been provided. This had led to insufficient progress around improvements that were required after an inspection by the quality assurance team of the local authority in March 2019. We have made a recommendation about this that can be seen in the 'Well-led' section of this report.

People's needs were met through assessments and support planning. The service worked with healthcare and social professionals to achieve positive outcomes for people. Staff had good knowledge and skills and this ensured people's needs were well met.

The provider had a recruitment process but some checks had not always been completed before staff started work. This was resolved after the inspection. Any issues with staff were dealt with promptly using a fair and thorough disciplinary process.

People's needs were met through robust assessments and support planning. The service worked with healthcare and social professionals to achieve positive outcomes for people. Staff and carers had good knowledge and skills and this ensured people's needs were well met. We saw good examples of when people had been supported to maintain a healthy and balanced diet.

People told us carers and staff were compassionate and kind and during the inspection, we observed this to be the case. Management and staff knew people well. 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.

People received care and support that was person-centred. We saw examples of how the care and support people received enriched their lives through meaningful activities. The service had a robust complaints policy.

The values and culture embedded in the service ensured people were safe and at the heart of the care and support they received. The registered manager and nursing staff planned and promoted holistic, person-centred, high-quality care resulting in good outcomes for people. People knew how to feedback their experiences and this was considered and acted upon by the registered manager.

There was an end of life policy in place that could be used if appropriate. Staff members had been trained around this and were able to ensure best practice was

Inspection carried out on 24 January 2017

During a routine inspection

This inspection took place on 24 January 2017 and was unannounced.

At our last inspection in February 2016, we rated the home as Requires Improvement overall. Improvements were needed to ensure the provider was following the legal requirements when supporting people to make decisions about their care required. Action was also needed to ensure the quality and safety checks carried out by the manager were effective in maintaining and improving the care people received. At this inspection, we found the required improvements had been made.

Fauld House provides accommodation, personal and nursing care for up to 48 people. At the time of the inspection, 45 people were using the service. There was a registered manager at the service. 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 their relatives were confident they were well cared for. If they had any concerns, they felt able to raise them with the staff and management team. Risks to people’s health and wellbeing were assessed and managed and staff understood their responsibilities to protect people from the risk of abuse. People’s care was regularly reviewed to ensure it continued to meet their needs. There were sufficient, suitably recruited staff to keep people safe and promote their wellbeing. Staff were received training and support to ensure they had the skills and knowledge to provide the support people needed.

Staff gained people’s consent before providing care and understood their responsibilities to support people to make their own decisions. Where people needed to be restricted of their liberty in their best interests, the registered manager had made the necessary applications for approval.

Staff had caring relationships with people and promoted people’s privacy and dignity and encouraged them to maintain their independence. Staff knew people’s preferences and supported them to have choice over how they spent their day. People were supported to eat and drink enough to maintain a healthy diet. People were able to access the support of other health professionals to maintain their day to day health needs.

People received personalised care and were offered opportunities to join in social activities and follow their interests. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes.

There was an open and inclusive atmosphere at the home. People and their relatives were asked for their views on the service and this was acted on where possible. People knew how to raise complaints and were confident their concerns would be taken seriously. Staff felt supported by the registered manager. The registered manager and provider carried out checks and audits to continuously monitor and improve the service.

Inspection carried out on 24 February 2016

During a routine inspection

This inspection took place on 24 February 2016 and was unannounced. Our last inspection took place on 21 January 2015 and we found the service was not meeting the legal requirements where people were being restricted in their best interests and did not have systems in place to ensure that medicines were managed safely. The provider sent us an action plan and told us the legal requirements would be met by March 2015. We found that some improvements had been made, but identified that other improvements were needed.

Fauld House provides accommodation, personal and nursing care for up to 48 people. At the time of the inspection, 47 people were using the service. There was a registered manager at the service. 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 received their medicines when they needed them but some improvements were required to ensure medicines were recorded accurately in order that administration could be monitored effectively. Further improvements were needed to ensure the quality monitoring checks carried out by the registered manager were effective in maintaining and improving the care people received. The provider had taken action to ensure that where people were restricted of their liberty in their best interests, this was authorised in accordance with the legal requirements. However, although staff understood they should support people to make their own decisions, they did not fully understand how to apply the Mental Capacity Act 2005.

People felt safe living at the home and if they had any concerns, they were confident these would be addressed by the staff and management team. Risks to people’s health and wellbeing were assessed and managed and safeguarding procedures were in place to protect people from abuse. People’s care was regularly reviewed to ensure it continued to meet their needs. There were enough staff to keep people safe and promote their wellbeing. Staff had been recruited using clear guidance and staff received training so they had the skills and knowledge to provide the support people needed.

People received personalised care and were offered opportunities to join in social and leisure activities. Activities coordinators tailored or adapted the activities to meet people’s individual needs and abilities. Staff knew people well and encouraged them to have choice over how they spent their day. Staff were kind and caring and promoted people’s privacy and dignity and supported them to maintain important relationships. People told us the food was good at the home and they were supported and encouraged to eat and drink enough to maintain a healthy diet. People accessed the support of other health professionals to maintain their day to day health needs.

People and their relatives felt comfortable approaching the registered manager and staff with any concerns and were confident action would be taken. The registered manager investigated and monitored complaints and made improvements to the service where needed. People and their relatives were asked for their views on the service and were satisfied this was acted on where possible.

Inspection carried out on 21 January 2015

During a routine inspection

We inspected this service on 21 January 2015. This was an unannounced inspection. Our last inspection took place in November 2013 and at that time we found the home was meeting the regulations we looked at.

The service was registered to provide accommodation, personal and nursing care for up to 48 people. People who use the service have physical health and/or mental health needs, such as dementia.

At the time of our inspection 42 people were using the service.

The service had 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 and associated Regulations about how the service is run.

We identified that improvements were required to ensure people received their medicines safely. You can see what action we told the provider to take at the back of the full version of the report.

Some people were unable to make certain decisions about their care. The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) set out requirements to ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. We found that the staff did not have an up to date understanding of the DoLS to manage the restrictions they placed on people. We recommended that the provider ensures staff have the knowledge and skills required to meet the requirements of the DoLS.

We also made a recommendation that the provider reviewed the effectiveness of the tools they used to monitor and improve quality as these were not always effective.

Significant incidents were not always reported to us by the registered manager. This meant the registered manager was not meeting the requirements of their registration with us.

There were sufficient numbers of staff to promote people’s safety and the staff had received training to enable them to meet people’s needs. Staff understood how to keep people safe and reported safety concerns to the registered manager when required. The registered manager monitored safety incidents and took action to reduce any further incidents from occurring.

Care was provided with kindness and compassion and people’s independence and dignity were promoted.

People’s dietary needs were met. People chose the food they ate and specialist diets, such as; diabetic diets were catered for.

People’s health and wellbeing were monitored and staff worked with other professionals to ensure people received medical, health and social care support when required.

Systems were in place to enable people to receive end of life care in accordance with their care preferences and needs.

People were involved in an assessment of their needs and care was planned and delivered to meet people’s individual care preferences. People were also encouraged and enabled to participate in activities that were important to them.

The registered manager regularly sought and acted upon people’s views of the care. This led to improvements in care. Complaints about care were managed in accordance with the provider’s complaints policy.

There was a positive and inclusive culture within the home and a management structure was in place to support the staff and improve the quality of care. There had been a recent change in the management team and people and staff told us this change had led to some recent improvements in care.

Inspection carried out on 4 November 2013

During an inspection looking at part of the service

This inspection was unannounced which meant the provider and the staff did not know we were coming. We spoke with five people using the service, four visitors and three staff. At our last inspection in June 2013 we made three compliance actions in relation to staffing, quality assurance and the management of medicines. This meant the provider needed to make improvements in these areas to demonstrate they were fully protecting people using their service.

During this inspection 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 provider could demonstrate people�s medication was handled safely, there were sufficient staff to support people, and there were systems in place to assess the quality of the service provided.

People we spoke with were happy with the care and support they received, one person using the service said, �The staff are great. They help you; they don't see you stuck for anything.�

On this inspection we also checked to make sure people were suitably fed and hydrated. We looked at records to make sure these were stored securely and held the information required. People liked the meals offered and we saw suitable records were in place.

Inspection carried out on 24 May 2013

During a routine inspection

During our inspection we spoke with six people who used the service, five relatives, four members of staff and the manager. People told us they were happy with the care they received. One person told us, �I am okay here, I think they look after me well.� A visitor said, �It has got potential, the care is good.� We found that people were treated with dignity and respect. Their individuality was recognised and they were supported to make their own choices.

We saw that people�s care records contained up to date information. This meant that information was recorded accurately to guide staff on how to support people.

During our last inspection in August 2012 we found medication management needed improvement. On this inspection we saw that suitable systems were still not in place. This meant the required improvements had not been made.

We saw that staff engaged with people in a friendly manner and people told us suitable care and support were provided. Some people including visitors and staff considered there were not always sufficient staff on duty to meet the needs of people using the service.

The home does not have a registered manager in place as required in The Care Quality Commission (Registration) Regulations 2009. We will be contacting the provider about this.

Inspection carried out on 8 August 2012

During a routine inspection

We carried out this inspection to check on the care and welfare of people using this service. We visited Fauld House Nursing Home in order to up date the information we hold and to establish that the needs of people using the service were being met. We also needed to check that the provider had met the compliance action we made in January 2012 regarding the lack of staff available to people using the service during the night.

The visit was unannounced which meant the provider and the staff did not know we were coming. We spoke with nine people using the service, five staff on duty and three visitors whilst we were there, and other staff afterwards on the telephone.

We found that people�s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The home was warm, clean and well maintained with no malodours. We saw people had the necessary equipment in place to provide a safe environment. Bedrooms were personalised and suitably furnished, and shared rooms offered screening. This meant people�s privacy, dignity and independence were respected.

People spoke well of the home, one person told us, �The staff are polite and ask me what I would like, I don�t feel on my own which is nice.� �Another person using the service said, �The staff are so willing; there is nothing here to worry about.�

Everyone we spoke with told us that staff were helpful and kind. We heard staff speak respectfully and it was clear from our observations that people reacted positively when the staff engaged with them. We observed staff providing support and saw people were treated with respect. Personal care issues were discussed sensitively and discreetly. We saw the staff listened to people and did not rush them.

We looked at the recruitment procedures for staff and found that suitable systems were in place to protect people using the service.

When we last visited the home in January 2012 we found that the provider did not offer enough staff at night. We checked the rotas and spoke with the staff who confirmed there were now always three staff on duty during the night. They told us this had been a significant improvement, one person told us, �I don�t have to wait as long as I used to during the night for the staff to answer my bell.� A staff member said, �It has had an impact on the morning shift because we are now not as rushed.�

We looked at medication management and found that medication was not always recorded in a suitable manner. This meant people using the service could be placed at risk because the management of medicines was not as safe as it needed to be.

We looked at ways in which the home assessed its own quality and safety and saw suitable systems were in place except for the above.

Inspection carried out on 22 December 2011

During an inspection looking at part of the service

We have visited this service in January and September 2011 and compliance actions were made. This meant the home needed to improve outcomes for people using the service in some areas. We saw there were gaps in the home's arrangements to promote and sustain good standards of cleanliness and infection control and the environment did not meet people�s needs safely. We saw people did not have suitable or sufficient equipment to keep them safe and the provider needed to produce an up to date statement of purpose that offered all the necessary information.

During this visit in December 2011 we checked to make sure improvements in these areas had been made. The home had sent us an action plan as required. We visited the home to ensure the plan provided to us was an accurate reflection and demonstrated compliance.

Before we visited the service we spoke to other people who had an interest in the service to determine if they had any concerns or observations they wanted to make about the quality of service provided. No one had raised any concerns with the CQC since our last visit.

People spoken with told us they felt the staff treated them well and respected them. They also commented that they received support from regular staff, which promoted consistency. They told us they were assisted with the necessary equipment and their home was clean and well maintained.

We saw that Fauld House was warm, homely and comfortable, there was no malodour. It was evident redecoration and refurbishment had taken place and new equipment had been purchased. Chairs and furniture were organised to offer cosy seating areas that gave a less formal appearance. We saw people choosing to sit in a number of different areas and some people chose to go to their bedrooms throughout the day. People were encouraged to freely move around the home as they wished.

The staff we spoke with confirmed there had been improvements and they felt settled and supported, they told us the new manager had made a positive impact.

During our visit when looking at the number of staff on duty we were informed that only two staff were on duty at night to support 30 people. This was not sufficient and we have informed the provider of this.

Inspection carried out on 31 August 2011

During an inspection in response to concerns

We carried out this review in response to an overall multi agency safe guarding strategy which was being coordinated by the local authority. The investigation is presently ongoing. The alerts raised identify potential concerns around specific aspects of care provided to people which included how pressure area care was managed. We were not looking at the investigation of these alerts because these were being looked at under separate safe guarding procedures. The purpose of this review was to check compliance in key outcome areas.

Due to the needs of some of the people living at the home not everyone was able to share their experiences of what it was like to live at Fauld Nursing Home. We spent time observing people being supported by the staff on duty during our visit.

People told us the staff were very good, comments included; "They are thoughtful, I can take my time." �I like it here the staff are nice." �I am well looked after." "They are kind and helpful." One person told us, "You sometimes have to wait a bit (for help or care) and that can be difficult."

Comments made by visiting relatives were positive they included; "I am very happy with the staff, I have never seen anything untoward." �I�m not worried about anything." "I can't fault it at all it is lovely."

Staff told us they felt well supported by the new manager who had been in post for six weeks they said, �She is improving it a lot, and she is on the ball." "We can do our job safely now." �We have a manager that listens, it is a 100% better."

We saw people were dressed in their own style and if they needed support, staff helped them to continue to take a pride in their appearance. The staff provided support where required and people in the home were well presented.

People using the service required more equipment to keep them safe and the environment needed to be improved upon to ensure people were comfortable and looked after appropriately. For example there was no facility for people to have a bath at the time of our visit and equipment to protect people when they were in bed was not always in place.

The home needed to improve the systems they had in place for infection control management to minimise healthcare associated infections.

Inspection carried out on 11, 14 January 2011

During a routine inspection

People living at the home, relatives and visitors offered positive comments overall. They were happy with the care and support they received and felt safe living at Fauld House.

People told us they were involved in decisions about their care and support and that their privacy and dignity was respected. Some plans of care have been developed with individuals to inform staff how people wished to be supported, although there was some further work to do on these.

For people who do not have the capacity to tell staff about choices, there is little evidence of the involvement of the person or their representatives in their plan of care to ensure that their preferences are being managed.

Those who were able to talk to us were complimentary about the choice and standard of food. People confirmed sufficient staff were on duty they told us staff were kind and caring.