Furzehatt Residential and Nursing Home

Furzehatt accommodated people across two separate wings, each of which had separate adapted facilities. “The Lodge” was accommodating 28 people on a residential basis with nursing care provided by the community nursing team. “The Court” was providing nursing and residential care to 30 people.

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

People spoke to us about staff who they felt were caring. Some said they felt staff did not have the time to spend with them socially. The nights and mornings were the times mentioned. Some staff and relatives also shared a similar view. During this inspection, we did not find any staffing concerns. We have shared the feedback with the registered manager who is seeking further feedback from people and staff to clarify the exact concerns and where improvements can be made.

Feedback from relatives and professionals was positive. Both spoke of good communication from staff and management who were responsive to questions and issues raised.

People had their health, dietary and welfare needs met. Their medicines were given and looked after safely. People’s care arrangements were personalised and regularly reviewed. Risk assessments were in place to support people to have their care safely managed by staff. These were in place on moving into the service and quickly reviewed. Support from a range of health and social care professionals was sought as needed.

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.

There was a clear system of leadership and governance in place led by the registered manager with the support of a deputy, other senior staff and the provider. This meant there was good oversight of the quality of the service with action taken as required to address any issues.

Rating at last inspection

The last rating for this service was Good (published 10 July 2019).

Why we inspected

We received concerns in relation to the management of people’s continence, skin care and diabetes. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

We found no evidence during this inspection that people were at risk of harm from the concerns.

On having the initial concerns raised with them, the registered manager and provider took action to ensure any issues were addressed.

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.

We reviewed the information we held about the service. No 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.

The overall rating for the service has remained as Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Furzehatt Residential and Nursing Home on our website at www.cqc.org.uk.

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.

About the service: Furzehatt Residential and Nursing Home provides accommodation and support for a maximum of 62 older people. At the time of the inspection 53 people were being supported by the service. The residential and nursing unit are situated within the same building and divided by a reception area at the main entrance. The nursing unit provided nursing care for a maximum of 32 people and the residential unit supported 29 people. At the time of the inspection 28 people were being supported in the nursing unit and 24 people within the residential part of the service. One person was in hospital.

People’s experience of using this service:

Since the last inspection, the provider has made improvements to the quality and safety of people’s care. This has included improvements in the way risk is assessed and managed, and in the management of accidents, incidents and people’s medicines. People’s health needs were better understood and managed more consistently and there was improved leadership and oversight of the service.

People told us they felt safe living at Furzehatt Nursing and Residential Home. There was a relaxed atmosphere between people and staff. Staff knew people well and were kind, caring and attentive.

People and relatives told us they felt listened to and their care was personalised.

People were protected from the risk of harm. People’s risks associated with their health, care and lifestyle were understood by staff and managed well. People’s rights and independence were respected and promoted. Management and staff understood their role with regards to the Mental Capacity Act (2005). People’s consent was sought before care was provided. When people were unable to consent and make decisions for themselves appropriate processes were followed. People were protected from discrimination and abuse because staff understood how to safeguard people.

People’s health needs were met, and medicines were managed safely. Improvements were required in relation to the food provided by the service. People were not all satisfied with the quality of food provided. People’s meals were not always provided to them at an appropriate temperature. The manager was aware of people’s concerns in relation to food and steps were being taken to address the issue. We have made a recommendation that the provider keeps the quality and temperature of food under review and ensures people know what actions are being taken to address any issues.

The provider had taken action to improve staffing levels and to ensure staff had the support and training to fulfil their role and meet people’s needs. People said staff understood how they needed and wanted to be supported. Some people and other agencies felt staff often looked rushed and were not always available to provide information when needed. This was raised with the manager at the time of the inspection and we were assured they would look at this issue and the organisation of staff.

The service had carried out a number of improvements to the environment in the past year. Some areas of the service still required some decoration and improvement. The manager and maintenance staff told us plans were in place for ongoing maintenance and improvement.

Quality assurance processes had improved and further ensured people received high quality care. Additional checks had been put in place and senior staff from within the organisation had regular oversight of the service. A manager had been appointed to oversee the running of the service and had applied to register with CQC. The manager demonstrated a commitment to improve the service and was well respected by people and the staff team.

The service met the characteristics for a rating of Good in 4 of the key questions we inspected. Therefore, an overall rating for the service after this inspection was Good.

Rating at last inspection: The service was rated as Requires Improvement at the last inspection (published 9th June 2018) with breaches of the regulations. 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 the regulations.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the service to ensure people receive safe, compassionate, high quality care. Further inspections will be based on the rating. If we receive concerns, we may bring the inspection forward.

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

Furzehatt is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Furzehatt Residential and Nursing Home is divided into two units. The residential and nursing unit are situated within the same building and divided by a reception area at the main entrance. The nursing unit provides nursing care for a maximum of 32 people and the residential unit supports a maximum of 29 people. At the time of the inspection 28 people were being supported on the nursing unit and 18 people within the residential part of the service.

There was a management structure in place. The service had a registered manager. 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.

At the last inspection on the 14 and 15 April 2016, we rated the service as Good overall. At this inspection we rated the service as Requires Improvement. This is because systems were not always in place to keep people safe, this included, medicines, risk management, and incident reporting. Staff were not always provided with sufficient information to meet people’s needs consistently and safely. Quality Audits had not been effective in identifying concerns we found at this inspection. The quality of care across the service was not always consistent.

Prior to the inspection we had received concerns from the local authority safeguarding team, regarding people’s care at the service. A safeguarding meeting had taken place with the local authority prior to the inspection and we were told a number of safeguarding investigations in relation to these areas of concern were on-going and therefore not concluded at the time of the inspection. We did not look at these specific investigations as part of the inspection, however, we did use this information to inform us about how we needed to conduct the inspection and areas of care we needed to consider and review.

The local authority had also informed us prior to the inspection, that due to the high number of concerns received, they had met with the provider and requested an improvement plan and assurances about people’s safety. Due to the concerns the local authority had agreed a suspension on all residential and nursing placements, whilst investigations were ongoing and improvements made. At the inspection the registered manager confirmed these suspension arrangements, and that they also would not admit any privately funded people during this time.

The Care Quality Commission had also spoken to the registered manager and written to the registered provider on two occasions since the last inspection about concerns raised by relatives about people’s care and medicine issues in the home. The registered manager and registered provider had responded to requests for information about these concerns at the time and had provided us with assurances about people’s safety. However, despite these assurances issues relating to people’s safety were found during this inspection.

During this inspection we found inconsistencies in systems and the quality of care provided across the service. When concerns we found related to a particular part of the service, we have reported on this by referring to either the nursing or residential unit. This information can be found within the full version of the report.

At this inspection we found people were not always safe. People did not always receive medicines in a way they were prescribed and staff did not always have guidance to follow to help them decide when certain medicines needed to be given. Systems were in place to report medicines incidents, however, staff were not in all cases clear about the type of medicines incident they should report. Some incidents relating to medicines such as a missed dose, or refusal by a person to take medicines had not been documented as an incident. This meant the service did not in all cases have an oversight of medicines incidents to enable them to review if appropriate action had been taken and to consider patterns and lessons learned. The medicines related concerns found during the inspection had not in all cases been picked up as part of the homes medicines audits and other quality assurance

We saw a number of good examples of risks to people being identified, reported and well managed. However, the quality of information relating to risks associated with people’s care was not consistent across the service. For example, when risks had been identified staff did not always have the information they needed to help ensure the risk was managed consistently and in a way the person needed and preferred.

Systems were in place for staff to report and escalate incidents. However, these had not in all cases been followed by staff to ensure people’s health and well-being was protected. For example, during the inspection one person’s health had deteriorated and medicines prescribed to the person had failed to be delivered by the pharmacist. The person’s health deteriorated significantly over a twenty four hour period resulting in the need for an emergency hospital admission. Staff had failed to effectively escalate this incident and to ensure the person’s health needs were met in a timely manner. This incident was reported to the registered manager at the time of the inspection.

People did have access to a range of healthcare services. However, care plans did not in all cases provide staff with sufficient information about how people’s specific healthcare needs should be met. This meant there was a risk of people’s healthcare needs not being met consistently by the service. Systems were in place to monitor people’s health, such as food and fluid charts, skin monitoring and repositioning charts and weight monitoring forms.

A programme of audits was in place. These checks were undertaken by the registered manager, staff and the registered provider, and included audits of medicines, records and the environment. However, these checks had not identified concerns found during our inspection, particularly in relation to medicines, risk management, incidents and care planning. For example, checks and audits were in place to review medicines and although the registered manager and provider had assured us improvements had been made to the medicine management systems, medicines errors and inconsistencies were still found.

Following the inspection we took immediate action to ensure people were safe. We told the provider to provide assurances that people were safe in relation to medicines, management of risk and the escalation of incidents. The provider sent us assurances within the timescale requested, this included a plan to review care plans and risk assessments, to provide updated medicines training for staff on the residential unit and to provide training on incidents and the escalation of concerns. This action satisfied us that immediate concerns relating to people’s safety had been addressed.

People’s care plans were not in all cases personalised, and did not always provide staff with sufficient information about people’s routines and how they chose and preferred to be supported. Although people’s plans of care were reviewed at regular intervals or if needs changed, information was not in all cases updated to reflect these reviews and changes. This meant staff did not always have access to clear and accurate information about people’s needs.

Staff undertook a range of training and said they felt supported by their colleagues and management. However, some staff on the residential unit said some training was not in-depth enough to reflect the complexity of people’s needs, such as supporting people living with dementia. Following the inspection the provider sent an action plan to address immediate concerns we had found relating to people’s safety and management of risk. The plan included an action to provide staff with additional training in relation to caring for people with dementia and associated behaviours.

People, relatives and staff spoke positively about the registered manager. Comments included; “The manager is approachable, they always stop and say hello”, and “If I have any concerns I speak to the manager and they would usually sort it”. However, some staff and visiting healthcare professionals said the management and quality of care was at times inconsistent across the service. Comments included, “Roles and responsibilities are not always clear at weekends and evenings”, and “Systems and processes between the residential and nursing unit are so different, which isn’t helpful if you have to work between the two”. Two visiting health care professionals said staff worked hard and wanted to meet people’s needs effectively. However, they said care was sometimes inconsistent, “Some people received good care, and other aspects of care could be neglectful, I think this is about the management of the home”.

We received mixed views from people and staff about staffing levels and how staff were organised. Some said staff were available in sufficient numbers to meet people’s needs and to keep them safe, comments included, “ There are always staff around and they are always quick to help me if needed” whilst others said they did not always feel there were enough staff particularly when people wandered and needed close supervision. One person said, “I don’t want to stay in the lounge sometimes as I feel vulnerable and I get worried about others when staff are not around”.

People were supported by staff who cared and respected their privacy and dignity. We saw staff responding promptly and with compassion when people were distressed or felt unwell. Staff wer

Furzehatt Residential and Nursing Home provides care and accommodation for up to 62 people. On the day of the inspection 59 people lived in the home. The service provides care for people with physical and mental health conditions, which includes people living with Dementia.

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.

Support plans did not in all cases provide consistent or up to date information for staff. Guidelines in place to check people when they were in alone in their bedrooms and to monitor weight were not in all cases being followed or documented as agreed.

On the days of our inspection there was a calm, friendly and homely atmosphere. People appeared relaxed a happy. People and their relatives all spoke highly of the care and support Furzehatt Residential and Nursing Home provided. One person said, “I am happy here, we get the best of everything, I am 100% satisfied”. Staff interacted with people in a caring and compassionate way. For example, staff spent time sitting with people and checked they were comfortable and happy. One staff member kneeled down next a person and said how lovely their nails were, which had just been manicured by staff.

The design and décor of the building had been carefully thought out and took account of people’s needs. People were able to move safely around the building and had sufficient space to enjoy time on their own or in the company of others.

People told us the staff were caring and they felt they mattered. They said staff listened to them and respected their wishes. Staff we spoke with were clear about the importance of respecting people. They consistently spoke about people being individuals and treating people as they would like to be treated. Comments from staff included, “When supporting people with personal care, I put myself in their position and think how I would feel and treat them with the upmost respect”, “I’m here for people’s best interests. I’m here to care and that’s what I do. I make sure everyone is happy and well looked after”.

A range of activities were available to meet people’s needs and particular interests. Staff had considered innovative ideas to evoke memories and trigger reminiscent thoughts and conversation. For example, memory boxes and personalised activity baskets had been put together and provided in each person’s bedroom.

The service had an open door policy, relatives and friends were welcomed and people were supported to maintain relationships with those who mattered to them. Staff were well supported through induction, supervision and on-going training. Staff were encouraged to enhance their skills and professional development was promoted.

Staff told us they were supported and encouraged to question practice. Staff said they were aware of the values of the service and these were regularly discussed and promoted. Staff were inspired and motivated to provide a good quality service and had a clear understanding of their role and what was expected of them.

People had their medicines managed safely. People received their medicines on time and in a way they preferred. Care and support focussed on each person’s individual needs, their likes, dislikes and routines important to them. When people were unable to consent to their care or support discussions took place to ensure decisions were made in their best interests. When people’s needs changed staff reacted promptly involving other social and healthcare professionals if needed. The food in the home was of a good quality and catered for people’s specific dietary needs and preferences.

Staff understood their role with regards to the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Applications were made and advice was sought to help safeguard people and protect their human rights. All staff had undertaken training on safeguarding adults from abuse, and felt confident any incidents or allegations would be fully investigated. People told us they felt safe living at the home.

The registered manager took an active role within the running of the home and had good knowledge of the staff and the people who used the service. There were clear lines of accountability within the management structure. People, friends and family and staff described the management of the home to be approachable, open and supportive. People told us, “The manager is always around, she will come into my room to say hello and check I am ok with everything”.

There were effective quality assurance systems in place. Incidents were appropriately recorded and analysed. Learning from incidents and concerns raised had been used to help drive continuous improvement across the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We spoke to ten people who used the service and they said they were all happy with the care provided. They said they were treated with respect and dignity by the staff. There were enough staff on duty to meet the needs of the people who received care at the home and people were able to say they felt safe living at Furzehatt. For example when a bell was used by one person staff responded immediately to ensure they were safe.

We found care and treatment was planned and delivered in a way that ensured people's safety and welfare. We found that there were clear risk assessments and links to care planning. People's care was in line with the care plans. People, who were able to communicate with us, told us they felt their care was safe. One person said, 'The staff are very good and always help me'.

People had the correct equipment in place to meet their assessed needs. One person who had moved from the residential side of the home to receive nursing care had appropriate pressure relieving equipment in place. One person for whom a hoist and slide sheet was used to move and reposition them had this equipment in their rooms. Staff were fully trained on their use to ensure people felt safe when this was being carried out.

Staff had received medication training to ensure they were suitably qualified to administer medicines.

Is the service effective?

We discussed people's care needs with staff and they told us about people's needs and how they liked their care to be delivered. Staff we spoke with were able to tell us in detail what they did to support people and knew what to do for them if they needed any additional support. For example, staff told us about one person whose health had deteriorated recently. They went onto say how they now needed to be supported to maintain their health, for example assisting them with their food and fluids.

Is the service caring?

People we spoke with who lived at the home told us that staff were caring and looked after them well. One person told us, 'The staff are very kind to me'. A relative we spoke with said "The care mum receives is great -I am so pleased she lives here".

We observed people being supported to take part in an activity in the residential side of the home. We saw people were treated with respect and affection. As an example, we saw one person became confused about the activity they were taking part in. We saw a member of staff approached them, assisted this person and encouraged them to continue. We saw the person responded well to the member of staff who was patient and supported them at their own pace.

This demonstrated to us that the staff were patient and caring towards the people who lived at the home.

Is the service responsive?

We saw that the home responded quickly to changes in people's needs. We saw for example that care plans and assessments were reviewed regularly to identify changes in people's condition. We saw that for one person admitted with a pressure sore the home had provided suitable pressure relieving equipment.

The staff spoken with confirmed that the home covers any vacant shifts with either agency staff or their own staff completing additional hours, to ensure sufficient staff were available to meet people's needs. On the day we visited we saw sufficient staff on duty to meet the needs of people living in the home.

Is the service well-led?

The Registered Manager and many of the staff had worked at the home for some time. Staff were aware of the needs of the people living at the home and were able to meet them. We saw the Registered Manager of the home was experienced and knowledgeable.

Staff we spoke with told us they enjoyed working at the home, and felt they were well supported. They understood who was in charge and their individual roles. Staff told us 'We always support each other'. Another staff member said 'I am fairly new to the home but know that I can always ask someone for help'.

Staff told us they were clear about their roles and responsibilities. All the people spoken with were happy with the staff working in the home. One visitor said, 'I am very happy with the care mum receives and I am always kept informed on what is happening to her'.

We found staffing levels in the residential unit had improved and a further registered nurse was due to start working imminently in the nursing unit which would improve the staffing levels on that unit. Medicines management in the residential unit had improved considerably with staff having undertaken training and audits in place. Improvements were still required in relation to records and ensuring people's confidential information was kept secure, care plans reviewed as people's needs changed and ensuring observation record charts were completed promptly by staff.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found. The summary is based on our observations during the inspection, speaking with thirteen people using the service, the staff supporting them, speaking with a visiting healthcare professional and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We spoke to 13 people during our inspection, nine on the nursing side and four on the residential side of the home. People told us 'It's very nice here, the girls are lovely'; 'Good food and you get second helpings, plenty of tea too'; 'There's bingo, usually something on every day' and 'They are helping me regain my independence'.

We found people were treated with respect and dignity by the staff. During our inspection we spent time observing the care people received in both the residential unit and the nursing unit. We noted the interactions were good and showed staff respect towards people at the home. People told us they felt safe at the home.

There were systems in place to make sure managers and staff learned from events such as accidents and incidents, complaints and investigations. We saw the home had made significant changes since our previous inspection to make aspects of people's care safer, particularly concerning the management of medicines.

We spoke with staff and they had a good knowledge of people's care needs and consulted external health professionals promptly when people's needs changed. All staff had received an induction and some staff had received additional training to manage more complex health conditions.

Safeguarding procedures were robust and staff understood how to safeguard the people they supported. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us they had not needed to submit any applications. Policies and procedures were in place and the manager had liaised with the local DoLS team. The manager and senior staff had been trained to understand when an application should be made, and how to submit one. Recruitment practice was safe and thorough and during our inspection we found the levels of staff on duty were good.

Is the service effective?

People who lived in the home told us they were happy with the care they received. People's health and care needs were assessed. Specialist health care professionals were involved where appropriate and the equipment they needed as identified in their care plans.

Where people were not able to make certain choices and decisions we found evidence that relatives and representatives had been involved in the care planning process. Regular care plan reviews were carried out to ensure they reflected people's current needs. Weekly clinical meetings reviewed people whose health needs had changed.

Is the service caring?

People told us they were supported by kind and attentive staff. We observed that staff were patient and went at the person's pace when assisting them with their mobility, food, and medication. We observed staff patiently reassuring people who were worried and people told us that staff supported them to regain their independence where possible. Staff understood Furzehatt Care Centre was people's home and we saw good relationships had been built between staff and people.

Is the service responsive?

People's needs had been assessed before they moved into the home. The manager visited people and carried out an assessment to ensure the service was able to meet their needs. The service employed an activities person and people had access to activities that were important to them.

We saw the complaints procedure was available on the noticeboard in the corridor. Several people told us they felt able to speak to the manager or staff if they were unhappy about something. They felt confident that the service would deal with any matters to their satisfaction.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. We spoke with a visiting healthcare professional who told us the manager and staff at the home contacted them if they had concerns and followed their advice.

Staff told us they were clear about their roles and responsibilities and care staff told us they would report any concerns they had about people to the registered nurse. Staff told us they had regular meetings with the manager. This helped to ensure that people received a good quality service at all times.

People told us "I'm well looked after, no complaints"; "Marvellous place". We found people were involved in their care, treatment and support choices where possible. People were able to express their views about the running of the home and their care through resident's meetings and annual questionnaires.

We found people had their needs assessed and these reflected people's individual needs. However, we found people's changing needs were not always identified which put their welfare and safety at risk. The home was introducing a clinical indicators tool to monitor people's welfare.

We found the home was clean and there were procedures in place to minimise the risk of infection. Staff had been trained in infection control and the cleanliness of the home was monitored through regular audits.

We found that there were not always sufficient staff on duty to meet the care needs of people at the home, particularly on the residential side of the home. The home were actively recruiting to address the shortfalls. We found improvements were required to the management of medicines to ensure people received the medicines they were prescribed.

We did not speak to anyone using this service on this occasion. Instead the provider has sent information about infection control which we have reviewed. This included information about staff training, checks made of staff awareness about correct procedures in relation to hand washing and use and disposal of gloves and aprons. It also included audits of infection control and actions taken in response to findings.

We concluded from the evidence seen that people were protected from the risk of infection because appropriate guidance had been followed. The provider had effective systems in place to reduce the risk and spread of infection.

Most people and relatives we spoke with were very positive about the home. One person said "they will do anything you want them to do", another said "nothing is too much trouble" and a third said "they look after me very well". One relative they liked the fact that the careworkers had worked at the home for a long time, another relative said "all in all, I'm a very satisfied customer". One person said they found the home quite noisy at times. Four of 18 people and relatives we spoke thought the food could be improved.

We found that people's care needs were being met and risks were well managed. People and relatives we spoke with told us they felt people were safe at the home and they knew who to raise any concerns with. We looked at all areas of the home and found they were clean and well maintained. We observed that some staff were not following the homes infection control policies and procedures in relation to the use of aprons and gloves. This meant people could be at risk from infections and improvements were needed. The provider carried out a range of quality checks at the home and took corrective action when needed.