Furze Hill Lodge

Furze Hill Lodge is a residential care home providing accommodation and personal care for up to 29 people. The service provides support to people who are living with dementia, or people requiring support with their physical health conditions. Everyone lives in one adapted building, set over 3 floors. There was a communal dining area, lounge and conservatory for people’s use, as well as a large level garden. At the time of our inspection there were 16 people using the service.

People’s experience of using this service and what we found

People and their relatives told us they felt Furze Hill Lodge was safe place to live. Staff demonstrated a good understanding of safeguarding procedures. Records confirmed that concerns raised were appropriately reported and investigated. Risks to people’s safety and well-being were managed well and accidents and incidents were reviewed to minimise the risk of them happening again. People were supported by sufficient staff who received the training they required to support them in their roles.

People were supported with their health care needs and staff were aware of the need to report any changes or concerns. Positive relationships had been developed with health and social care professionals. Robust medicines systems were in place which ensured people received their medicines in line with their prescriptions.

People and their relatives were involved in developing their care plans and felt their views and opinions were listened to. 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. Choices were provided to people wherever possible, and people’s preferences were known and respected.

Staff had developed positive relationships with people and were caring in their approach. Staff enjoyed spending time with people socially and there was a good range of personalised activities available. People were encouraged to maintain their independence and felt their dignity and privacy was respected.

A positive culture had developed in the home and people and staff felt respected and valued. There was an open and transparent approach to any concerns from the management team which was also reflected in the way staff members approached their roles. The registered manager was committed to continuous improvement of the service and quality assurance systems were used to monitor progress.

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 (report published 16 August 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider explore ways for people to be fully in involved in the reviews of their care. At this inspection we found the provider had acted on our recommendations.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up on the shortfalls we found at our last inspection.

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 COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Furze Hill Lodge is a care home and accommodates up to 29 people in an adapted building. The service supports adults requiring care and support due to their physical health conditions, mental health needs and those living with dementia. At the time of our inspection there were 17 people living at Furze Hill Lodge.

People’s experience of using this service and what we found

There was a lack of managerial oversight of the service. Quality assurance systems were not effective in ensuring continuous improvement. Relatives were not able to effectively contribute to how the service was run and records of people’s care lacked person centred detail.

Risks to people’s safety and wellbeing were not always monitored and reviewed to help keep them safe. Accident and incident records lacked detail and robust action to minimise risks was not consistently taken. Safeguarding concerns had not always been reported to the local authority in line with requirements.

Records of people’s healthcare needs contained contradictory information. Support from healthcare professionals was not consistently tracked to ensure people received the support they required. People’s care was not always personalised, and staff were not aware of people’s life histories. Activities provided had improved since our inspection in August 2019 although further development was required to ensure these were personalised to people’s interests.

People were not always supported to have maximum choice and control of their lives as people were not always fully involved in reviewing their care. Staff supported them in the least restrictive way and in their best interests; the policies and systems in the service supported this practice.

Individual interactions between people and staff were caring and people appeared comfortable with staff. People told us they enjoyed the food and people’s dietary needs were catered for. Provision had been made to ensure people were able to maintain contact with those important to them throughout the COVID-19 pandemic. Staff were seen to be wearing the correct PPE and safe infection control practices were in place.

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 23 October 2019) and there were multiple breaches of regulation. We completed a further targeted inspection on 23 July 2020 (published 26 August 2020) to look at concerns reported to us in relation to people’s safe care. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. We identified one breach of regulation. The provider completed an action plan following both of these inspections to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part by notification regarding a person’s unexpected death. As this incident is subject to an ongoing safeguarding investigation, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of health concerns and the emergency protocols in place in relation to these. This inspection examined those risks. During the inspection we found concerns regarding the way in people’s health care needs were monitored and how risks to their safety and well-being were managed. We have found evidence that the provider needs to make improvements.

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 COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to how risks to people’s care and support were managed, the reporting of safeguarding concerns, the monitoring of people’s healthcare needs, staff training, how people were involved in planning their care and the management oversight of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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.

Furze Hill Lodge is a care home with nursing and accommodates up to 29 people in an adapted building. The service supports adults requiring care and support due to their physical health conditions, mental health needs and those living with dementia. At the time of our inspection there were 21 people living at Furze Hill Lodge.

People’s experience of using this service and what we found

Risks to people’s safety were not always accurately recorded and monitored. Where accidents and incidents occurred, records were not always completed in detail to ensure lessons were learnt. This meant investigating concerns and providing safeguarding information was not always consistent.

The providers duty of candour policy had not been consistently followed to ensure people and their representatives felt they had received open and transparent information relating to safety incidents. The provider had recognised these concerns and had worked with the registered manager and staff to ensure they were aware of their responsibilities going forward. We have made a recommendation in relation to this.

Improvements had been made to the overall culture of the service. Staff were attentive to people’s needs and there was a relaxed atmosphere throughout the service. The registered manager had supported staff to develop their skills and understanding and staff felt they were able to raise any concerns. Staff were aware of their responsibilities in safeguarding people from harm and understood reporting processes.

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 23 October 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. This targeted inspection was completed to address specific concerns regarding risks to people’s safety and aspects of the management of the service. A full update on breaches of regulations found during our last inspection will be provided following our next fully comprehensive inspection.

We undertook this targeted inspection to check on a specific concern we had about the way risks to people’s safety were monitored, how safety incidents were recorded and reported and the management systems in place around this. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to how risks to people’s safety is monitored and recorded at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Furze Hill Lodge is a care home with nursing and accommodates up to 29 people in an adapted building. The service supports adults requiring care and support due to their physical health conditions, mental health needs and those living with dementia. At the time of our inspection there were 24 people living at Furze Hill Lodge.

People’s experience of using this service and what we found

Staff had not always identified and reported safeguarding concerns which had led to overly restrictive practices concerning one person. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The care people received was not always person-centred. People’s care was provided in line with set routines rather than people’s preferences such as people receiving their care from the night staff in order for them to be ready for breakfast when the day staff arrived. People did not always receive the care they required to maintain good oral hygiene.

Sufficient staff were not deployed which meant staff did not have time to spend with people. Staff were not always aware of people’s past lives and activities were not always relevant to people’s interests. Although staff received training, this was not always effective in ensuring staff understood their responsibilities. People’s needs were assessed prior to them moving into Furze Hill Lodge although consideration was not always given to people’s compatibility with others. We have made a recommendation regarding this.

There was a lack of effective managerial oversight of the service which meant the above concerns had not been identified by the provider or registered manager. Records were not always clear and legible and the CQC had not been notified of all significant events in line with the providers responsibilities.

People told us staff treated them with kindness and we observed individual interactions with people were caring. Staff were aware of people’s care needs and risks to their well-being. People had access to healthcare professionals and received support with their medicines as required. Staff were recruited safely.

People told us they enjoyed the food provided and had a good choice. Some people told us they were able to maintain their independence in areas which were important to them. Visitors were made welcome and there were no restrictions on visiting time.

Previous Inspection

The last rating for this service was Good (report published 9 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the management of safeguarding concerns, staffing levels and training, person-centred care, the protection of people’s legal rights and the management oversight of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

The service 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.

Prior to this inspection we received a monitoring report by a local authority contract monitoring team. This had identified a few areas which required some improvements. At this inspection, we noted that improvements had been made.

Staff knew how to recognise abuse and how to respond to concerns. Risks in relation to people's care were assessed and planned for to minimise the risk of harm. Concerns regarding people's safety had been appropriately managed and staff displayed a good knowledge of safeguarding principles.

There were sufficient numbers of staff on duty to meet the needs of people who used the service. Staff underwent pre-employment checks including enhanced Disclosure and Barring Service (DBS) checks.

Staff supervisions, appraisals and meetings all happened regularly. Staff spoke highly of the support they received from management and were confident they could raise any issues or concerns, knowing they would be listened to and acted upon.

People received their medicine safely. They received their medicines in a way they chose and preferred. The medicines administration records (MAR) were signed and up to date. Staff kept an on-going record of how much medicine was administered and how much was left, to make sure medicines were always available when people needed them.

People were cared for in a clean and safe environment. We saw infection prevention and control policies and procedures were in place.

New staff commenced an induction to ensure they developed the skills and knowledge needed to support people safely. The induction included the opportunity for new staff to shadow more experienced staff until they felt confident.

Staff were encouraged and supported to undertake training. We saw records which showed staff had received training in various aspects of care delivery. There was a comprehensive training programme that was delivered to staff as part of the mandatory induction.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. This ensured that people's right to be involved in decisions about their own care was consistently upheld and respected.

People had access to a range of health care professionals such as GPs, district nurses, speech and language therapist, dieticians and occupational therapists. Immediate referrals were made with appropriate follow up meetings when staff had any concerns about people's health.

People were supported to have food and drink of their choice. The home operated a ‘protected’ mealtime system. This ensured staff were available to serve food and assist people if necessary so they could enjoy their food in a more relaxed environment.

People were supported with care and compassion. People told us they were treated with dignity and respect. Staff understood the need to protect people's privacy and dignity.

People received a personalised service which was responsive to their individual needs. Care records were person centred and developed to meet people's individual needs and reviewed if there were any significant changes.

People were supported to lead a full and active lifestyle. Activities and people's daily routines were personalised and dependent on people's particular choices and interests.

Complaints were taken seriously, thoroughly investigated and lessons learnt from them. Any concerns raised were assessed by the management team to see if any changes needed to be made to the service to minimise the risk of similar concerns being raised and to improve the quality of the service.

The provider had a quality assurance system in place and gathered information about the quality of the service from a variety of sources including people who used the service and other agencies. We saw that these were used to encourage best practice.

During the visit we found the service had completed all the checks to ensure staff were of good character. We saw that records of qualifications, criminal record checks and reference checks were complete. The service had met the requirements of the regulations.

We spoke with seven people about their experience of life at the home. Also with a visitor, the registered manager and four staff. We looked around the home and grounds and spent time sitting with people in bedrooms and a lounge.

People were happy with the home and their care. They had access to health care services. Their comments included, "The home is well managed. Staff are kind'. 'Staff sit and talk with me about my care plan. They keep it up to date and check if I want it changed. We have entertainment and various activities. We go out to the library and enjoy tea at a garden centre'.

We found that people or others on their behalf had agreed their care plans. The provider had acted within legal requirements to promote the rights of people without capacity to make complex decisions. We observed staff to be friendly, skilled and professional in their interactions with people. The activities coordinator engaged people in stimulating activities.

Staff were suitably trained and supported, ensuring delivery of safe and appropriate care. Emergency procedures minimised risk of people's care needs not being met in the event of emergencies. Risk assessment, risk management and maintenance arrangements ensured the safety and security of the environment. Quality checking systems assured the safety, health and welfare of people.

People expressed high levels of satisfaction and we received a number of positive comments. One person told us that they 'Cant fault the care,' another person said that 'Care is extremely good'.

People told us that they were treated with dignity and respect and that they were involved in their care plan. We were told that people enjoyed the activities available, although one person wanted more exercise classes.

We asked people if they felt safe and each person we spoke with confirmed that they did. We were told that staff were 'Always kind and helpful.'

Staff had received recent safeguarding training and were aware of their role in safeguarding vulnerable adults.

People told us that staff seemed well trained and equipped in their role. We saw appropriate recruitment checks took place which meant that staff were suitably skilled.

People were made aware of the complaints system and we saw that complaints had been investigated and resolved to people's satisfaction.