Fulford Care & Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At our last inspection, this key question was rated requires improvement, improvements have been made and this key question is now rated good, the service was no longer in breach of regulations. Leadership was now stable and staff told us morale had greatly increased. Managers and staff created a culture to support the delivery of high-quality care. Effective systems to assess, monitor and improve the service and were in place, when shortfalls were identified by internal systems, these were addressed. There was a capable and compassionate management team who, with staff, fostered a culture that delivered good quality care for people in partnership with external professionals. Staff and managers worked in partnership with visiting health and social care professionals which provided good outcomes for people. People, family members and external health and social care professionals told us they felt the service was well led. People, their relatives and staff were able to feedback about the service through suggestion boxes, quality survey questionnaires and meetings. Feedback was listened to and addressed.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager had established a schedule for planned meetings amongst their teams and departments, as well as full staff meetings. Minutes of the meetings showed how the discussions were meaningful to the participants. For example, the housekeeping staff were able to freely speak about issues within the laundry and the activity staff discussed fetes and people’s involvement to the garden upgrade. Meeting minutes evidenced staff and people were able to give their suggestions and were listened to, for example, people had requested the activities schedule to be more accessible, this was reiterated during the staff meetings for awareness. People were encouraged to give feedback formally and informally. Bi-annual questionnaires were distributed by the provider, there was a suggestion box if people of their relatives wished to make suggestions. People were also able to speak with the staff whenever they wished or the registered manager during their daily walk around the service.

The registered manager had worked hard to instil a positive and inclusive culture within the service. Meetings, supervisions and mentoring had opened channels of communication to promote a shared vision for the staff and people using the service. Staff told us there had been improvements to culture since our last inspection. Comments included, “Now, I can’t complaint at all, I’m the happiest I have ever been. Lots of improvements, fantastic new manager. They listen to us and our opinions, if they can adapt things they will, they so what they say. Before we were just talking to the wall. There was always a divide between staff and managers but our opinions now count.”

The registered manager and their management team had right skills, experience and qualifications to ensure people received effective care. The registered manager was working towards a doctorate in dementia care and used their knowledge to make changes and improvements in the service. For example, they had implemented a recent change where staff worked a maximum of 6 hours in the dementia suite to ensure people were supported by staff who were not tired. They had received positive feedback about this initiative.

At our last 2 inspections, there had been a high turnover of management and there was some discord between staff and management. At this assessment improvements had been made; all staff we spoke with provided optimistic feedback about the impact the registered manager had made. A staff member said, “[Registered manager] is the best we have had so far. They are the only one who introduced themselves and acknowledges us. They are approachable and gets things done, for example, there was a resident on William (the residential suite) who needed to go as we were not right for them, [registered manager] worked hard with all the professionals for them to go home safely.”

Staff told us they would be comfortable to speak up and gave examples when they have. There were managers within the service including, a deputy care manager, clinical lead, office manager and head housekeeper. Staff were able to speak with their line managers but were encouraged to speak directly with the registered manager whenever they wished. A staff member told us they could contact the registered manager in the evenings and weekends if required. A staff member said, “[Registered manager] is nice and approachable, they always say hello. We see them walk round checking the residents are happy and us staff.”

Systems and processes were in place to ensure everyone had the freedom to speak up. Suggestion boxes were available so staff and people could leave feedback if they wished, this could also be done anonymously. The service has an open culture and there was a whistle-blowing policy should staff wish to refer to it.

The management team ensured everyone was treated fairly and were not discriminated against due to any protected characteristics, the registered manager showed us an example of where reasonable adjustments had been made to support a staff member. Some staff had changed roles within the service to suit their needs and personal life. The services equality, diversity and inclusion policy was detailed and was being followed by staff and management.

The workforce at Fulford Care and Nursing Home was diverse, staff had a wide range of backgrounds and experiences. Some oversees workers were being supported to work towards achieving their nursing qualifications and told us the management were supportive of this. The management team ensured all staff were included and involved in running the service. Feedback questionnaires were completed by staff, the results analysed by head office and a ‘you said, we did’ poster detailed how staff feedback was addressed. A staff member said, "[Registered manager] is phenomenal, the changes she has made and the confidence she has brought in is amazing."

Leadership and governance had improved since our last 2 inspections. The registered manager had introduced champion roles with staff which empowered them to take ownership on their departments. For example, the head housekeeper completed infection, prevention and control audits, these were seen to be thorough and their findings addressed promptly. Staff were kept up to date by attending meetings relevant to their roles. Management from the provider’s head office visited the service regularly and were building relationships with staff and people. One staff member told us, “The team is more stable for sure, everyone is a lot happier. We have met the operations manager; they saw the home first hand. [Operations manager] in at least once a month, they love to make sure we are all happy. We are doing well.”

Since the last inspection, improvements have been made and quality assurance processes were embedded. This resulted in improvements to the quality of the service. Service development plans identified concerns found at our previous inspections; the concerns had been addressed and the plans continually updated. Quality assurance processes were in place, including audits which covered all aspects of the service, such as, medicines, care records, safeguarding and accidents and incidents. Monthly meetings were held amongst the management team to discuss findings from all audits and establish what learning was required to be cascaded to the team. Policies were accessible to staff and a ‘policy of the month’ was discussed at monthly staff meetings.

Staff and management built positive links with health and social care professionals to ensure people received timely and appropriate support. Staff described strong working relationships with professionals. Comments included, “I mostly work with OTs (occupational therapists) and social workers. When residents receive new equipment it's great to see them (people) up and about, they say 'I can do it'.” The registered manager told us about some of the community links which have been made and said, “At Christmas, a local school came in and sang carols, we have a local drama group who did a pantomime for them (people). We are linked with the local primary school who sometimes do show and tell projects. The residents enjoy this.”

Visiting health and social care professionals provided positive about the staff and management team. Their comments included, “Communication with Fulford has in the past been a concern but under new management, [registered manager] and the team have been working with us to improve this. Management, under [registered manager] has been very open to suggestions and seem keen to improve. The management team have always been very approachable with any concerns and usually quick to respond to any emails or in person to resolve any issues or concerns.” And, “[Staff member] has demonstrated they are knowledgeable, compassionate and dedicated to provide excellent care to Fulford’s residents and training to Fulford staff.”

People were able to access local services, not only for health and social care but also socially. Local musicians, schools and nurseries visited people at the service and the local police force had raised funds for the garden project. There were open visiting times and staff arranged fetes and parties for people, their relatives and staff. People gave their opinions through meetings and feedback questionnaires, people said they felt they would be listened to if they made any complaints or suggestions.

Involvement from health and social care professionals was updated in people’s care records so staff could access the advice. Staff handovers provided an up to date picture of how people were responding to professional advice. Newsletters had recently been produced so people could look back on what activities they had participated in which included visiting entertainers and visits from the community. These newsletters were also distributed to relatives so they could see what their loved ones had been doing.

There were clear processes in place to enable learning and improvement. The registered manager attended the provider’s managers meetings where they could share lessons and best practice with the provider’s other registered managers. The service development plans were based on findings of audits, feedback, incidents and near misses. Where outside agencies had visited the service, their advice and findings were added to the service improvement plan. For example, West Sussex Fire and Rescue Service had identified areas of improvement, the remedial works were added to the service development plan and were being completed during our visit.

The provider had learned from the concerns found at our last 2 inspections. Staff told morale had increased and how the culture had improved as the service had benefited from a stable management team. Staff and management worked through action plans and addressed improvement actions as needed. Actions from incidents, safeguarding and audit findings were shared to embed a culture of learning and being open. Staff commented, “We have a lot of lessons learned. We have scenarios and we have discussions about what we would do. I go to the team meetings and find them helpful. We have discussed previous (CQC) reports and how things can be done differently. Everyone just seems at lot happier.”