Fort Horsted Care Home Ltd

Fort Horsted Care Home is a residential care home providing personal and nursing care to up to 30 people. The service provides support to older people. At the time of our inspection there were 24 people using the service.

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

People’s medicines were not always well managed. Some medicines administration charts had not been completed fully to evidence people had received their medicines as prescribed. One person’s emergency medicine was out of date.

Risks to people were not always well managed. One person was at risk of harm because staff had not followed the risk assessment in place to prevent them from injury. We reported this during the inspection and immediate action was taken to ensure the person was safe.

Most staff had been recruited safely to ensure they were suitable to work with people. One staff member did not have a full employment history recorded on their employment records. People had regular staff who they knew well. Staff were well supported by the management team.

The service was not always well-led. The management team carried out the appropriate checks to ensure that the quality of the service was continuously reviewed, improved and evolved to meet people’s changing needs. However, some of the checks had not been robust enough to identify areas of concern found at the inspection. The provider and registered manager took immediate action to address this.

The registered manager promoted an open culture. If people or their relatives wanted to complain they knew how to do so. People told us they were happy living at the service. Comments included, “I feel happy and I am comfortable at Fort Horsted”; “They are supporting me to get better and stronger” and “Staff are friendly enough. They met with me to talk about my care needs.”

People were protected from abuse and avoidable harm. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was good (published 18 April 2020).

Why we inspected

We undertook this focused inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.

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.

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

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 and will take further action if needed.

We have identified breaches in relation to managing medicines safely at this inspection. 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, which will help inform when we next inspect.

Fort Horsted Care Home Ltd is a single storey ‘care home’ providing personal and nursing care to 23 people aged 65 and over at the time of the inspection. A number of people received their care in bed. Some people lived with dementia. The service can support up to 30 people.

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

Staff had been recruited safely to ensure they were suitable to work with people. People had regular staff who they knew well. People were well supported by competent, knowledgeable and well-trained staff. Staff were well supported by the management team.

The service was well-led. The management team carried out the appropriate checks to ensure that the quality of the service was continuously reviewed, improved and evolved to meet people’s changing needs. The registered manager promoted an open culture and was a visible presence in the service, staff felt listened to and valued.

People were protected from abuse and avoidable harm and risks to people were managed. People’s medicines were well managed. If people or their relatives wanted to complain they knew how to do so.

People were treated with dignity and respect. People’s views about how they preferred to receive their care were listened to and respected. People and relatives told us staff were kind and caring. Comments included, “The staff are always friendly” and “Staff are very laid back but in a good way, very happy with the care.”

People had access to a range of different activities throughout the week. People told us that they took part in these and that they were enjoyable. Activities were also provided for people who received their care and treatment in bed.

People received good quality care, support and treatment including when they reached the end of their lives. People had been involved in planning and discussions about their wishes and preferences in relation to their end of life care.

When people needed medical attention, this was quickly identified, and appropriate action was taken. For example, if people were losing weight referrals were made to dieticians, or if people fell regularly, they were referred to a fall’s clinic. Nursing staff worked closely with the GP who visited the service regularly.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 March 2019) and there were two 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, enough improvement had been made and sustained and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Fort Horsted Care Home Ltd 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. People received nursing and personal care.

Fort Horsted Care Home Ltd accommodates up to 30 people in one single storey building. There were 26 people living at the service when we inspected. A number of people received their care in bed. Some people lived with dementia.

At the last inspection on 09 November 2017 we rated the service Requires Improvement overall. The provider had failed to adequately assess and mitigate risks to people and staff. The provider had also failed to manage medicines safely. The provider also failed to plan care and treatment to meet people’s needs and follow the principles of the Mental Capacity Act 2005. The provider had failed to operate effective quality monitoring systems and failure to make accurate, complete and contemporaneous records.

At the last inspection on 09 November 2017 we also made a number of recommendations relating to: reviewing systems and processes to evidence that staffing levels met people's assessed needs, reviewing and amending safeguarding policies, reviewing and amending people's care plans with them as their needs change. We also recommended that registered persons reviewed the catering arrangements for people with different diet needs and training requirements for staff to ensure that staff had the right skills and knowledge to work with people who had specialist health conditions and arrangements for clinical supervision. We also recommended that the provider reviewed their policy and procedures to ensure people and their relatives had clear information about how to raise and escalate complaints should they need to and seeking advice and following good practice guidance to support people with dementia to orientate themselves in the service to enable them to live well.

The provider submitted an action plan on 05 March 2018. This showed that all breaches had been complied with and they planned to monitor this on an ongoing basis.

At this inspection we found the provider had met some of their actions. However, there continued to be three breaches. The service has been rated Requires Improvement overall. This is the second consecutive time the service has been rated Requires Improvement.

There was a registered manager in place. 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.

Improvements had been made to medicines management. However, further improvements were required. People were prescribed a variety of pain relieving tablets as and when required (PRN). PRN protocols were not always in place to detail how they communicated pain, why they needed the medicine and what the maximum dosages were.

Improvements had been made to management of risks. However, further improvements were required. Risks to people's individual health and wellbeing had been assessed. Risk assessments did not provide staff with clear guidance and information about the size and type of equipment required to support the person to move safely.

The management team had a good oversight of the quality and safety of the service. They had undertaken quality audits but these had not been robust enough to capture the action required to improve the service. Further improvements were required to ensure records were accurate and complete. Registered persons had not notified CQC of incidents such as serious injuries or Deprivation of Liberty Safeguards (DoLS) authorisations that had occurred.

People’s needs and rights to equality had been assessed and care plans had been kept up to date when people’s needs changed. People and health and social care professionals involved in their care and support told us how their general health and wellbeing had improved since living at the service. Staff had the right induction, training and on-going support to do their job. People were supported to eat and drink enough to maintain a balanced diet and were given choice with their meals. People accessed the healthcare they needed, and staff worked closely with other organisations to meet their individual needs. People’s needs were met by the facilities.

People were kept safe from avoidable harm and could raise any concerns with the registered manager. There was enough suitably trained and safely recruited staff to meet people’s needs. People were protected from any environmental risks in a clean and well-maintained home. Lessons were learnt from accidents and incidents.

People told us that staff were caring and the management team ensured there was a culture which promoted treating people with kindness, respect and compassion. Staff were attentive to people. The service had received positive feedback and people were involved in their care as much as possible. Staff protected people’s privacy and dignity and people were encouraged to be as independent as possible. Visitors were made welcome.

People received personalised care which met their needs and care plans were person centred and up to date. Where known, people’s wishes around their end of life care were recorded. People were encouraged to take part in activities they liked. There had not been any complaints, but people could raise any concerns they had with the registered manager. The provider sought feedback from people and their relatives which was recorded and reviewed.

People were happy with the management of the service and staff understood the vision and values of the service promoted by the owners and management team. There was a positive, person centred and professional culture. The management team communicated well with staff and worked in partnership with other health professionals. The management team promoted continuous learning by reviewing audits, feedback and incidents and making changes as a result.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

Further information is in the detailed findings below.

Fort Horsted Care Home Ltd 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. People received nursing and personal care

Fort Horsted Care Home Ltd accommodates up to 30 people in one single storey building. There were 29 people living at the service when we inspected, one of whom was in hospital. A number of people received their care in bed. Some people lived with dementia.

There was a registered manager in place. 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.

At this inspection people told us they enjoyed living at the service. They got on well with staff and we saw that people were comfortable and relaxed.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Records were not always complete, accurate or securely stored.

People's care plans detailed most of their care and support needs. However, care plans did not all reflect each person's current needs or specific healthcare needs.

The provider followed effective recruitment procedures to check that potential staff employed were of good character and had the skills and experience needed to carry out their roles. Appropriate numbers of staff had been deployed to meet people's needs. It was not clear how staffing levels had been determined as people’s dependency information was not used to calculate the staffing required. We made a recommendation about this.

People’s care records and assessments did not follow the principles of the Mental Capacity Act 2005. Staff supported people to make everyday choices about their care.

Staff had attended basic training but had not always attended training relevant to people's needs.

Staff had received effective supervision from the registered manager. There was no formal process in place for the registered manager (as a trained nurse) to receive planned and regular clinical supervision. We made a recommendation about this.

Risk assessments were in place to mitigate the risk of harm to people and staff. These had not always been updated when people’s needs had changed.

Medicines had not always been well-managed or stored securely. Prescribed thickening powder which was a choking risk was found unattended in the dining room and in some people’s bedrooms.

People and their relatives gave us mixed feedback about the activities. Activities took place during the inspection. Some people were enabled to access their local community both with their relatives and with the staff. We made a recommendation about this.

People had choices of food at each meal time which met their likes, needs and expectations. Food was not always prepared to meet people’s dietary requirements. People with diabetes were provided with the same meals as others. We made a recommendation about this.

There was a lack of signage around the home to direct people to communal areas such as the lounge and dining room. We made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had systems in place to track and monitor applications and authorisations.

Staff knew and understood how to protect people from abuse and harm and keep them safe. The service did not have a copy of the local authorities safeguarding adults policy and procedure. We made a recommendation about this.

People were supported and helped to maintain their health and to access health services when they needed them.

Maintenance of the premises had been routinely undertaken and records about it were complete. Fire safety tests had been carried out and fire equipment safety-checked.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the service was calm and relaxed. Staff treated people with dignity and respect.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time.

People and their relatives had opportunities to provide feedback about the service they received. Compliments had been received from relatives.

People and their relatives knew who to talk to if they were unhappy about the service. Complaints had been effectively managed. The complaints procedure required some updating. We made a recommendation about this.

Relatives and staff told us that the service was well run. Staff were positive about the support they received from the management team. They felt they could raise concerns and they would be listened to.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.