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Inspection carried out on 7 June 2019

During a routine inspection

About the service

Floshfield is a care home situated in Cleator. It is operated by West House, a charitable organisation that provides care and support to people living in Cumbria with a learning disability or autism. Floshfield is registered to provide personal care to six adults. Accommodation is in single rooms in this dormer bungalow set in it's own grounds.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service

People told us they felt safe and, where they found it difficult to express themselves, they were relaxed in their own home and interacted well with staff. Staff had received suitable training about protecting vulnerable adults. Accidents, incidents, complaints and concerns were responded to appropriately. People told us they had good support from staff. The registered manager kept staffing rosters under review as people's needs changed. People or their relatives were involved in recruitment. New members of staff were specifically selected to work with individuals in the home and had been suitably vetted.

Staff were appropriately inducted, trained and developed to give the best support possible. We met team members who understood people's needs and who had suitable training and experience in their roles. Staff had extensive knowledge of different disorders people were living with and were skilled in working with people's needs.

People saw their GP and health specialists. People were supported to get involved with preparing healthy meals and looking after their health. Staff took the advice of nurses and consultants. The staff team completed assessments of need with health professionals and with the learning disability teams. People were happy with the arrangements for medicines support. Medicines were suitably managed with people having reviews of their medicines on a regular basis.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005. 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 told us the staff were caring. We observed kind and patient support being provided. Staff supported people in a respectful way. They made sure confidentiality, privacy and dignity were maintained.

Risk assessments and care plans provided detailed guidance for staff in the home. People in the service, their social workers and relatives, where appropriate, had influenced the content. The registered manager had ensured the plans reflected the person-centred care that was being delivered. People indicated that they enjoyed the activities and outings on offer. Staff could access specialists if people needed communication tools like Makaton or other sign languages. Staff worked with psychologists and psychiatrists when necessary.

The service had a registered manager who dealt with all aspects of the service. He was suitably skilled and experienced to manage the home. He consulted people and their representatives in a number of different ways.

The provider was in the process of analysing quality monitoring reports for all services to complete the new business plan, 'Transforming West House'. There was an action plan for Floshfield to ensure that quality care and services continued to be provided.

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

Rati

Inspection carried out on 1 December 2016

During a routine inspection

This was an unannounced inspection that took place on 1 December 2016 and was completed by an adult social care inspector. When we last visited the service on 20 February 2015 we judged that the staffing did not meet people's needs and the service was in breach of Regulation 18. Nutritional needs were not being met and the service was in breach of Regulation 14. The service was also in breach of Regulation 12 because assessment, care planning and delivery did not always meet individuals needs. The provider sent us a detailed action plan that assured us they were working on these breaches. At this visit we judged that these three breaches had been met.

Floshfield is a dormer bungalow situated in a residential part of the village of Cleator. It can accommodate up to six people living with a learning disability. Accommodation is in single rooms with shared facilities. The service is operated by West House, a charitable organisation that runs other services in Cumbria for people with a learning disability

The home 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 2008 and associated Regulations about how the service is run.

The service ensured that staff were suitably trained to identify and deal with any issues of abuse or harm. Suitable safeguarding arrangements were in place.

Risk management plans were in place for all aspects of the service. The provider had an emergency plan to deal with any potential problems. This had been put into action during the floods of 2015.

Recruitment and disciplinary matters were managed well. West House had detailed policies and procedures in place about these matters

When we last visited the service was in breach of Regulation 18, staffing, because we judged that the staffing levels did not meet peoples' needs. At this visit we saw that staffing levels were kept under constant review to reduce risk and give suitable levels of care. Staffing levels were suitable to meet needs.

Medicines were appropriately managed with staff receiving training and checks on competence. People had their medicines reviewed on a regular basis.

The home was clean and orderly when we visited. Staff were aware of the need to prevent any cross infection and took suitable action. There had been some improvements made to the environment with redecoration and new floor coverings being planned.

Staff received good levels of training, supervision and appraisal. The staff we spoke with were happy with the support they received.

The staff understood their responsibilities under the Mental Capacity Act 2005. We saw that appropriate action was taken if the registered manager thought anyone was being deprived of their liberty. Restraint had not been used in the service but staff were trained in how to manage behaviours that might challenge.

At our last visit we judged that the service did not meet Regulation 14, meeting nutrition and hydration needs. We saw at this visit that the staff team had worked on the problems and we found that people now received a balanced and wholesome diet. Suitable support was sought if anyone was underweight. People had good support from their GP, community nurses and health care specialists.

We judged that the staff team were kind and caring towards the four people who lived in the home. We had evidence to show that the staff supported people to have as much privacy as they wanted. We observed staff ensuring that people could retain their dignity. Everyone in the home had access to independent advocacy services.

We also had evidence to show that the staff team tried to support people to be as independent as possible.

We had also identified a breach in Regulation 12 when we last visited because assessment and care delivery did not al

Inspection carried out on 20th February 2015

During a routine inspection

This was an unannounced inspection that took place on 20th February 2015. The last inspection was on 21st October 2013 and there were no requirements made.

Floshfields is a care home for six people who are living with a learning disability. Some of the people who live in the home are older people and some people have physical health needs. The home is an adapted dormer bungalow on the outskirts of Cleator.

West House, a local not for profit organisation, is the provider who runs the home.

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 and associated Regulations about how the service is run.

This service was not safe. We discovered that the arrangements for infection control were not adequate. The service needed to have arrangements in place for the use of systems and cleaning materials to ensure that people were protected from potential harm.

We judged that the staffing levels were unsafe. Two members of staff were expected to undertake all care and domestic tasks. We judged that 50% of the people in the home needed the support of two people at some times of the day. There was only one person in the home at night and this person was designated as the “sleep-in” member of staff. People in the home were at risk due to low staffing levels.

The service was not effective. People in the home who found it difficult to maintain a healthy weight did not have suitable nutritional plans in place. Healthy eating needed to be promoted in the home.

We learned that staff were trained in managing behaviours that challenge. The home had not reported potentially abusive behaviour to the local authority on two occasions. This meant that they were not accessing available support for this person.

The service was not well-led. The registered manager was not always available as she was managing community based services. Some problems in the home had not been identified or dealt with through the quality monitoring system.

You can see what action we told the provider to take at the back of the full version of the report.

The staff team were aware of their responsibilities in protecting people from harm and abuse.

Staff had received suitable training in the skills and knowledge required to support people properly. The manager had good arrangements in place to develop each member of the team through training, supervision and appraisal. People in the home had access to suitable health care and support. The premises were adequate for the needs of the people who lived there.

The home was caring. We saw examples during our visit of people being treated with dignity, respect and care. People in the home responded well to the caring approach of the staff. Staff were good advocates for people with learning disability. People were encouraged to be as independent as possible. Staff were developing new strategies to support people as their needs changed.

The service was responsive. Person centred planning was underway for the year with people being helped to look at their aims and objectives for the coming year. Care planning was of a good standard. The staff team took people out to activities and entertainments as much as possible. New activities were being introduced when people could not go out. There were no complaints from anyone during the inspection.

Inspection carried out on 14 November 2013

During a routine inspection

The home is registered to provide personal care and accommodation for six people who have a learning disability. On this visit there were five people living in the home. Some people in the home had limited verbal communication and we therefore spent time observing these people's behaviour and interactions with staff. Other people were quite vocal and told us they liked living in the home and enjoyed going out with staff to various local places and to attend events. For example one person chose to take part in Tai Chi classes and was part of a local walking group while another preferred to go to concerts and discos.

We observed lively and positive interactions between staff and people in the home which made for a relaxed and friendly atmosphere. We also observed staff responding sensitively to people and picking up cues from body language when they needed assistance or reassurance. We judged that people were leading interesting and meaningful lives and were being supported to stay healthy and well.

We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Inspection carried out on 23 November 2012

During a routine inspection

When we visited there were six people living in the home. We visited on a Friday afternoon when five of the people were at home. One had family visiting; one was spending time in their room and another person returned from having lunch out and going to the shops with staff support. The other people were relaxing watching television, doing things that interested them and making themselves cups of tea.

We observed lively and positive interactions between staff and people in the home which made for a relaxed and friendly atmosphere. We also observed staff responding sensitively to people with more limited communication and picking up cues from body language when they needed assistance or reassurance.

Staff were well trained and supported to offer care to people in a skilled and sensitive manner. A number of people had health issues related to old age and staff had received training to help them do this effectively.

People we spoke with said they liked living in the home and that the staff treated them well. One person said, "Yes I like it here, staff are very nice to me." Another said, "The staff help me go out to the places I like. I like shopping in Carlisle and we’re going to the panto.”

We judged that people were leading interesting lives and were being supported to stay healthy and well. The home was well designed and equipped to effectively and safely care for people with limited mobility and more complex healthcare needs.

Inspection carried out on 3 March 2012

During a routine inspection

People were very positive about their lives in this house.

"I go out to cookery class...I go out shopping and in the car".

"This is my house ....I like to spend time in my room".

"We go on holidays and I like it here".

"The food is nice and I help make it".