Alternative House Care Home

We found the following examples of good practice.

Staff had received training to help ensure their knowledge on infection prevention and control was up to date. Personal protective equipment (PPE) and infection control hand gel was available throughout the home for all staff and visitors. The registered manager and staff told us enough stocks of PPE were available and we confirmed this on the visit. One staff member told us, “We have plenty of PPE.”

The home was clean and hygienic. Cleaning schedules were in place with additional cleaning protocols to ensure all high touch points were regularly sanitised. One person told us, “Staff come into my bedroom cleaning and hoovering and changing my bedding.” A second person commented, “The home is absolutely spotless. I have no concerns about cleanliness.” One staff member told us, “We have plenty of cleaning products and there are no restrictions on what we use.”

People were supported to maintain contact with those who were important to them, in line with current government guidance. Face to face visits took place within designated areas within the home or people were supported by family to maintain activities outside of the home.

People living in the home and the staff were tested regularly for COVID-19. People told us they had isolated when they had moved into the home. One person said, “When we came, we had to isolate and test before you mixed with anybody.” There were no staff employed who had not been vaccinated as is currently required. The provider’s IPC policy was up to date and had been audited during the pandemic to reflect best practice and current guidance.

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

Why we inspected

We undertook this targeted inspection alongside the IPC Assurance Plus inspection to check on a specific concern we had about the provider not working consistently within the principles of the mental capacity act. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

Feng Shui House Care Home is a residential care home providing personal care to people aged 65 and over. The service is registered to support up to 20 people, at the time of the inspection there was one person who lived at the home. The home is in the seaside resort of Blackpool overlooking the south promenade. There are two communal lounges and all bedrooms have en-suite facilities.

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

The service was not always safe. We observed staff not following good practice guidance around infection prevention and control including the use of Personal Protective Equipment (PPE). Staff were trained to give medicines and staff told us they were confident giving people medicines. Staff were aware of how to identify and report safeguarding concerns. Staff were able to tell us about the risks to people and knew how to support people to minimise the risks.

The service was not always well-led. Records relating to care and the management of the service were either incomplete, inaccurate and/or not kept up to date. We found no impact to people however; this could have compromised the quality and safety of the service provided. We have made a recommendation about this.

The service was effective. We were assured 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. However, we found documentation was at times conflicting, we have made a recommendation about this.

People were involved in their care planning. Staff told us that they received training and felt supported in their role. People told us they enjoyed the food and they were offered choice. The service was caring. Staff were aware of how to protect people’s privacy and dignity and people told us the staff did this well.

The service was responsive. Staff had received training in end of life care. Staff were aware of people's communication needs and how best to support them. People told us the service is flexible and responsive to their needs.

The provider worked with us in a positive manner and provided all the information we requested. Additionally, they responded promptly to our concerns during and after the inspection

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 inadequate (21 May 2021). At this inspection we found improvements had been made and the provider was no longer in breach of regulations around consent to care and good governance. However not enough improvement had been made with regards to safe care and treatment and the provider remains in breach for this regulation.

This service has been in Special Measures since 28 April 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the 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.

We have found evidence that the provider needs to make improvement. Please see the safe and well led section of this full report.

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 infection control, 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.

Feng Shui House Care Home is a residential care home providing personal care to 15 people aged 65 and over at the time of the inspection. The service is registered to support up to 20 people. The home is in the seaside resort of Blackpool overlooking the south promenade. There are two communal lounges and all bedrooms have en-suite facilities.

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

The provider did not have effective systems in place to ensure all risks were identified and medicines were managed safely. We found failings regarding the management of medicines and risks related to people’s health and the environment.

We found no evidence people had been harmed but they were at risk of avoidable harm due to the ineffective governance arrangements in place. Records were not always accurate and completed in line with people’s assessed needs. Audit systems failed to highlight the concerns we found around, medicines management, care planning, risk management, infection prevention and fire safety.

People were not always supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. The provider failed to document when decisions were made in people’s best interests. Mental capacity assessments had not been documented for some key decisions when people lacked capacity.

Employment processes were not always followed. We have made a recommendation about recruitment. Care plans did not always reflect people’s needs. We have made a recommendation about care planning. One person did not receive timely health care support. We have made a recommendation about supporting people to live healthier lives.

People told us they felt safe living at Feng Shui House. Staff were able to explain how to raise a concern to safeguard people. People and staff spoke positively about the food and the choice of food they had. People and staff felt the provider was approachable and supportive. One person told us, “[Provider], she’s very approachable for a chat.” During the inspection the provider worked to address concerns raised and minimise the risks identified during our visits.

Rating at last inspection

The last rating for this service was good (published 01 November 2019).

Why we inspected

We received concerns in relation to risk management, infection prevention, consent to care and governance. As a result, we carried out a focused inspection to review the key questions of safe, effective and well-led only. Some of these issues are subject to further review and enquiry by CQC and additional information on any further action may be reported after this 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.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider has completed multiple actions since we visited, and this has reduced the risks for people living at Feng Shui House Care Home.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Feng Shui House 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 have identified breaches in relation to the management of risk, medicines, consent and infection control. There are breaches related to consent and good governance.

We identified breaches related to, Need for consent, Safe care and treatment and Good governance.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

People were cared for in a clean and homely environment. Infection control systems and audits ensured a clean environment people. Visiting at Feng Shui House Care Home was restricted. Visitors were required to follow best practice guidance and wear appropriate PPE. Their visiting policy and restrictions had been discussed with people, their families and friends.

We observed all staff had access to and wore personal protective equipment (PPE). They were able to share best practice on the putting on and taking off PPE. We observed PPE was available at the entrance and on all floors of the home. The home was registered to regularly test staff and people for the COVID-19 infection. Staff deployment was structured to ensure people were safe. The registered manager reviewed staff levels as people’s needs and occupancy levels changed.

Further information is in the detailed findings below.

Feng Shui House Care Home is a residential care home providing personal care to 18 people aged 65 and over at the time of the inspection. The service is registered to support up to 20 people.

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

Medicines were administered safely; however good practice guidelines were not always followed. We have made a recommendation about the management of some medicines.

All other risks people faced were assessed and safely managed. People and relatives felt the care and support kept people safe. Staff showed good knowledge of safeguarding procedures. Infection prevention was ongoing, and the home was clean and well maintained.

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 did not always support this practice. We have made a recommendation the service work within the principles of the Mental Capacity Act 2005 (MCA).

The provider had links with health professionals. This promoted timely support and positive outcomes for people. People had access to food and drinks, 24 hours a day if requested. Staff told us the training ensured they had the skills to carry out their roles effectively and the management team were supportive.

Care plans did not always contain comprehensive information on people’s unique support needs. We have made a recommendation about this.

The management team audited the service to ensure people received effective support and the service was well-led. We have made a recommendation about audits.

The provider representative used a variety of methods to assess and monitor the quality of the service. They were aware of their regulatory responsibilities associated with their role.

People took part in valued activities within the home. The provider representative would deliver end of life care to ensure people stayed in a familiar environment with people they knew. People’s communication needs were identified, and appropriate support offered. There was a complaints procedure which was made available to people and their families.

Staff were knowledgeable about people’s backgrounds and preferences. They were caring, patient and took time to ensure people felt valued. They worked in partnership with people, offered choices and promoted people’s independence. Due to the stability of the staff team there was a rapport between people, visitors and staff.

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 October 2018). 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.

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.

Feng Shui House Care Home 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. Feng Shui House Care Home is registered to provide personal care for up to 20 older people who require support with personal care. At the time of the inspection there were 16 people receiving support.

The home is located in the seaside resort of Blackpool overlooking the south promenade.

At our last inspection in April 2016 the service was rated ‘Good.’ At this inspection we found notifications that are required to be sent to the Care Quality Commission when certain events occur, were not always provided to us. This was a breach of Regulation 18 of the Care Quality Commission (Registration Regulations) 2009.

The registered provider was an individual who also managed the home on a day to day basis. Registered providers 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.

You can see the action we told the provider to take in the full version of the report.

We observed medicines being administered and saw this was carried out in a safe way. Access to medicines was restricted to staff who had received training to ensure medicines were administered and managed safely. We noted a recording error within the services ‘Controlled drugs’ book. Prior to the inspection being concluded we saw the error had been rectified. We have made a recommendation about the safe management of medicines.

Recruitment checks were carried out to ensure suitable people were employed to work at the service and staff told us they were supported to attend training to maintain and increase their skills. We saw one staff record where no reason had been recorded for a gap in employment. We have made a recommendation regarding the recording of prospective staff information.

We found some information was recorded regarding people’s end of life wishes and the deputy manager told us they were planning to review this area of people’s care. We have made a recommendation regarding end of life care planning.

The registered provider told us there were two deputy managers in place and they completed checks to identify if improvements were required in the service provided. We saw documentation which showed checks were carried out and staff told us they were informed if improvements were required.

The home had an electronic care record system. Care records contained information regarding risks and guidance for staff on how risks were to be managed. We found one care record required updating as further information was required regarding how a person’s change in needs could be met. Prior to the inspection concluding we were informed this had been done.

Staff we spoke with knew the needs and wishes of people who lived at the home. Staff spoke fondly of the people they supported and said they cared about them and their wellbeing. Staff were gentle and patient with people who lived at the home and people told us they felt respected and valued.

Relatives told us they were consulted and involved in their family members care. People we spoke with confirmed they were involved in their care planning if they wished to be and staff treated them kindly and with respect.

Staff we spoke with were able to describe the help and support people required to maintain their safety and people who lived at the home told us they felt safe.

People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate. People and relatives told us they were happy with the care at support provided at Feng Shui House Care Home.

People told us they could raise their views with staff and they felt involved in the running of the home. We saw minutes of meetings where people at the home were informed of changes and were asked their opinion on the service provided.

People told us they had a choice of meals to choose from and they enjoyed the meals provided. People also told us they were offered more if they wanted this. We observed the lunchtime meal. We saw people were given the meal of their choice and were offered more if they requested it. Staff were available to help people if they needed support.

We found the environment was clean and we observed staff wearing protective clothing when required. This minimised the risk and spread of infection.

Staff told us they were committed to protecting people at the home from abuse and would raise any concerns with the registered provider or the Blackpool Safeguarding Authorities so people were protected.

There was a complaints procedure which was displayed at the home. People we spoke with told us they had no complaints, but they if they did these would be raised to the registered provider or staff. During the inspection process the registered provider told us a complaint had been raised with them. They explained they were currently responding to this.

People and relatives we spoke with told us they were happy with the staffing arrangements at the home. We observed staff spending time with people and the atmosphere was relaxed and unhurried. Staff we spoke with told us they had the time to support people in a calm and relaxed way.

People told us there were a range of activities provided to take part in if they wished to do so. People told us they were asked if they wanted to take part in activities and if they declined, their wishes were respected. staff told us they reminded people of the activities available.

The registered provider demonstrated their understanding of the Mental Capacity Act 2005. People told us they were enabled to make decisions and staff told us they would help people with decision making if this was required. People are supported to have maximum choice and control in their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff told us they felt supported by the registered provider and the management team. Relatives we spoke with told us they were could speak with the registered provider if they wished to do so and they found the registered provider approachable.

This is the first time the service has been rated Requires Improvement

Further information is in the detailed findings below.

During our inspection undertaken on 08 March 2016 we found no breaches of legal requirements.

Feng Shui House Care Home is registered for the regulated activity accommodation for persons who require nursing or personal care for 20 people. The home is located in the seaside resort of Blackpool overlooking the south promenade. All bedrooms have en suite facilities. A hairdressing salon and therapy room is also in place for the use of people staying at the home. Off street parking is available for visitors. At the time of our inspection visit there were 19 people who lived at the home.

The registered provider was an individual who also managed the home on a day to day basis. Registered providers 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.

We found recruitment procedures were safe with appropriate checks undertaken before new staff members commenced their employment. Staff spoken with and records seen confirmed they had received induction training when they commenced working at the home. One staff member said, “I had to wait for my references and Disclosure and Barring Service checks (DBS) to be completed before I could start working at the home. I understand these checks are required to ensure I do not have a criminal record.”

Staff had received training and were knowledgeable about their roles and responsibilities. They had skills, knowledge and experience required to support people with their care and social needs.

We found sufficient staffing levels were in place to provide support people required. We saw staff could undertake tasks supporting people without feeling rushed. People told us when they requested assistance this was responded to in a timely manner. One person said, “I have my alarm with me at all times and know staff will come running if I press it. This makes me feel safe.”

We found the registered provider had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices. People we spoke with told us they felt safe and their rights and dignity were respected.

The registered provider understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

We looked around the home and found it was clean, tidy and well-maintained. No offensive odours were observed by the inspection team. We observed staff making appropriate use of personal protective equipment such as disposable gloves and aprons. This meant staff were protected from potential infection when delivering personal care and undertaking cleaning duties. People who lived at the home told us they were happy with the standard of hygiene in place.

Equipment used by staff to support people had been maintained and serviced to ensure they were safe for use.

We found care plans were organised and had identified the care and support people required. We saw people or a family member had been involved in the assessment and had consented to support provided. We found care plans were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs. People we spoke with said they were happy with their care and they liked living at the home.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. We observed the lunch time meal which was well organised. People who required support to eat their meals were supported by staff who were caring and patient. The cook had information about people’s dietary needs and these were being met.

We found people had access to healthcare professionals and their healthcare needs were met. On the day of our inspection visit we saw one person was supported by a staff member to attend a hospital appointment. This ensured the service had up to date information about the outcome of the person’s appointment.

People told us they were happy with activities arranged to keep them entertained. On the day of our inspection visit a party had been arranged to celebrate the birthday of one person who lived at the home.

We found medication procedures in place at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept and appropriate arrangements for storing were in place.

The service had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they knew how to make a complaint if they had any concerns.

The registered provider used a variety of methods to assess and monitor the quality of the service. These included staff, resident meetings and care reviews. We found people were satisfied with the service they received.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. We also spoke with Blackpool council's contracts monitoring team and Healthwatch Blackpool who are an independent consumer champion for health and social care.

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

Is the service safe?

People told us they felt safe and their rights and dignity was respected. They told us they were receiving safe and appropriate care which was meeting their needs. Safeguarding procedures were in place and staff understood how to safeguard people they supported.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff understood when an application should be made and in how to submit one. We saw best interest meetings had been held when necessary and these were clearly recorded. The records confirmed safeguarding procedures had been followed and the people had received appropriate support and representation during the meetings. This meant people's rights were safely protected.

The service was safe, clean and hygienic. Equipment had been maintained and serviced regularly ensuring people were not put at unnecessary risk. People living at the home told us they were happy and well looked after.

We looked at the recruitment of new staff. This showed that some required recruitment checks had not been undertaken. We found gaps in employment history were not being explored at interview. This meant the home did not have a full employment history of the people employed.

People did not always receive their medicines at the times they needed them and in a safe way. Medicines were not always administered and recorded properly. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to recruiting new staff and administration of medicines.

Is the service effective?

People's health and care needs had been assessed with them, and they were involved in writing their plans of care. Specialist dietary needs had been identified where required. Care plans had risk assessments completed to identify the potential risk of accidents and harm. Staff members we spoke with confirmed guidance was provided to ensure they provided safe and appropriate care. We found care plans were flexible, regularly reviewed for their effectiveness and changed in recognition of the changing needs of the person. People spoken with said their care plans were up to date and reflected their current needs.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. The people we spoke with were happy with the care being provided. One person said, 'I love it here. The girls really look after us. They are so pleasant and caring. Nothing is too much trouble for them. The food is wonderful and we have lots of activities to keep us entertained.' Two people visiting their relatives told us they were happy with the home and had no concerns about the care provided. One person said, 'I cannot believe the difference in my mum since she moved into the home. She is always clean and well presented. How they manage it I don't know. The staff really care. I cannot praise them high enough.' Care plans had been maintained recording the care and support people were receiving. Good care practices were observed and people told us they were happy with the support they were receiving.

Is the service responsive?

Records showed admissions to the home were well planned. Information about people's care and dietary needs had been recorded. We also saw potential risks to people's health and welfare had been identified. Guidance had been provided for staff to ensure they provided safe and appropriate care. We found people completed a range of activities. On the day of our inspection we saw people playing dominoes and bingo in the afternoon. People we spoke with said they enjoyed the activities organised by the home. We found people had access to healthcare professionals. People received regular health checks with their General Practitioner and the outcome of these visits were recorded on their care records.

Is the service well-led?

The service had quality assurance systems in place. Records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving. Staff had a good understanding of their roles and responsibilities. People we spoke with said they received a good quality service at all times.

The people we spoke with said they were receiving safe and appropriate care. They told us the staff were polite, caring and professional when undertaking their work. One person said, 'The staff have been very caring and attentive during my stay. I would recommend this home to anyone'. A visiting relative told us they were very happy with the care being provided. They said, 'I looked around a number of homes before choosing this one. I picked it because I felt I could stay here myself. The care has been outstanding and my mum tells me she is very happy. I always feel very welcome whenever I visit. I have no concerns about her care'.

During our inspection we contacted the Blackpool contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

We found the people living at the home did not have appropriate recorded information in relation to their care, support and treatment. This meant staff may not know how to look after people properly or be able to provide the care and support people needed and wanted.

We observed staff interacting with people in a pleasant and friendly manner and being respectful of people's choices and opinions. One person living at the home said, "The staff are very nice'.