Fordingbridge Care Home

Fordingbridge Care Home is a care home, with nursing, that provides care and support for up 60 people. At the time of the inspection, 58 people were using the service.

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

Improvements were required to ensure people consistently received a person centred and dignified service at all times.

Comments from relatives and staff suggested more activities could be in place to improve people's quality of life.

Staff were knowledgeable about safeguarding and told us the registered manager would act if required.

The provider had suitable arrangements in place for the management of infection control.

The provider had enough appropriately skilled, qualified, and experienced staff deployed at all times.

Staff were safely recruited.

Lessons learnt were shared with staff to improve the service.

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

Rating at last inspection

This last rating for this service was good (published 31 March 2021).

Why we inspected

We undertook this inspection because we received information of concern relating to the management of the service and the culture of care provided.

We have found evidence the provider needs to make improvements.

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 the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained the same.

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 from 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.

Fordingbridge Care Home is a residential care home providing personal and nursing care to 38 people aged 65 and over at the time of the inspection. The service can support up to 60 people. The care home is purpose built with accommodation across three floors.

When we inspected, the service was owned by the provider, Sentinel Health Care. We were informed on the second day of inspection that Sentinel Health Care had been sold to Allegra Care.

When compiling the report, the provider’s registration with Care Quality Commission had not been updated to reflect these changes.

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

Staff knew how to alert and record safeguarding concerns and were aware of their responsibility to do so. However, on one occasion, the registered manager had failed to alert serious safeguarding allegations raised with them to relevant agencies.

Risks were assessed and reviewed as required. People had individual risks assessed and generic assessments of equipment were also completed.

Staff were safely recruited, and enough staff deployed to meet people’s needs.

Medicines were safely managed. Staff administering medicines received training and regular updates, competence checks were completed annually.

The premises were clean and there were no malodours. We were assured that infection prevention and control was being safely managed.

Learning from accidents and incidents was shared with the staff team to minimise future risks.

Throughout 2020 there had been disruption to the mandatory training, delays happened due to the pandemic. Training records had not been accurately maintained. However, the nominated individual was able to evidence that most staff had attended their mandatory training, or an online alternative. One-to-one supervision of staff had been less frequent or had not happened in 2020. Staff, however, felt well supported as the registered manager had been available should they need to speak with them, and had worked alongside them during the COVID-19 outbreak in the service. Steps had been taken before our inspection to provide staff with regular supervision and a training schedule was planned for 2021.

The registered manager had not reported a significant safeguarding allegation, nor had they spoken with relatives of those people involved to inform them of the concerns. The registered manager is no longer employed at the location. The managing director and nominated individual had taken responsibility for investigating the incidents alongside the local authority and police and had acted promptly and appropriately since they became aware of the concerns.

People were very much at the centre of service provision and we saw caring interactions between people and staff members.

Quality assurance questionnaires and audits informed the provider how well the service was running and of any improvements required.

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 5 September 2019).

Why we inspected

The inspection was prompted due to concerns received about the reporting of, and action in response, to safeguarding concerns. A decision was made for us to inspect and examine those risks. We undertook an inspection of the safe, effective and well-led key questions only.

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

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.

Fordingbridge Care Home is a residential care home providing personal and nursing care to 46 people aged 65 and over at the time of our inspection. Fordingbridge Care Home is a purpose-built service providing nursing care to up to 60 people.

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

People were supported safely by suitably trained staff who would not hesitate to report poor practice by colleagues or concerns about people.

We found some incomplete employment histories; however, the provider had already changed their recruitment procedures to reflect changed requirements and more recent records had improved. The incomplete histories were updated following the inspection.

The provider had effective systems of monitoring safety aspects of the premises.

People had person-centred risk assessments which considered their abilities as well as assessing possible risks.

Medicines were safely managed however there had been two occasions when medicines had run out and were not administered as a result. There had been no negative impact on people as a result of missing their medicines on these occasions however reviewing the medicines ordering procedures would minimise future risks of this happening.

The premises were very clean, bright and airy and staff had a good understanding of how to minimise infection risks.

The provider reflected when things went wrong and learning was shared across their organisation.

Staff participated in an induction when commencing with the service and shadowed experienced colleagues before working independently.

Staff were regularly supervised and there were monthly staff meetings.

The provider followed the ‘Food First’ strategy and fortified foods for people at risk of malnutrition. Meals were prepared for people’s individual needs to current best practice guidelines.

The service was purpose built with large reminiscence areas on each floor.

People were supported to maintain and improve their health and well-being and the provider utilised good practice tools such as NEWS2.

The provider was compliant with the principles of the MCA.

People and their relatives told us staff were caring and kind and we saw positive interactions between staff and people using the home. Staff supported people respectfully and promoted their independence while maintaining their dignity

People were involved in planning and reviewing their care if able and if not, relatives contributed, or decisions were made in their best interests.

The provider had a person-centred approach to providing care and support. People were approached in the most appropriate way to enable them to fully understand and participate.

The provider treated people as individuals and approached communication in the same way providing resources to facilitate effective communication.

An activities programme ran, and people could choose to participate in group sessions.

Reminiscence areas were evident throughout the service and a shop contained items that people could take to use such as CD’s or books and either keep or return once they had finished with them.

Relatives mostly knew how to complain and if they were unsure of the procedure knew that approaching senior staff would result in complaints being concluded in a timely way.

No-one was receiving end of life care when we inspected however there was a robust policy and procedure in place and staff received training at a local hospice.

The provider promoted person centred care and was committed to enabling people to lead fulfilling lives.

The registered manager completed notifications and required ad regular audits ensured there was clear oversight of the service.

People and their relatives completed surveys to inform the provider of their views of the service and regular residents meetings ensured people could be involved in discussions about aspects of the service.

Positive relationships had been developed with health and social care providers.

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 11 May 2017).

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.

Fordingbridge Care Home is registered to provide nursing care for up to 60 older people, some of whom live with dementia. There were 53 people living at the home at the time of our inspection. Accommodation is provided over three floors. The lower ground floor supports people who are more independent. The ground floor provides care for people with more complex cognitive needs. The first floor cares for people who are more physically frail. Each floor has a lounge, other communal areas, a dining room and a number of spacious bathrooms, in addition to en-suite bathrooms in all bedrooms.

The service had 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.

People were protected from abuse. Staff had received training in safeguarding people and were knowledgeable about the home’s safeguarding processes and procedures. Staff knew how to report any concerns.

People received their medicines safely and systems were in place to manage the ordering, storage and disposal of medicines effectively.

Robust recruitment procedures were in place and appropriate checks were carried out before staff were employed to ensure they were suitable to work in adult social care.

Risks to people had been assessed and measures put in place to mitigate the risks. Incidents and accidents were recorded and analysed to learn from them and reduce the likelihood of them happening again.

Staff received training, supervision and appraisal to support them in their role.

Staff were knowledgeable about the requirements of the Mental Capacity Act 2005. People’s capacity was appropriately assessed and any decisions made in people’s best interests were documented appropriately.

Staff were knowledgeable about the deprivation of liberty safeguards (DoLS). The registered manager had applied for appropriate authorisation where people needed to be deprived of their liberty.

Staff were kind and caring and showed compassion when people became upset or anxious. Staff respected people’s privacy, dignity and wishes about how they received their care.

People received the health care they needed. Staff organised visits from their GP, hospital appointments and other assessments to support their care, such as speech and language assessments when required.

People and the relatives were involved in reviewing their care. Records showed reviews took place on a regular basis or when someone’s needs changed.

The service had an open culture. People and their relatives told us they felt able to discuss any concerns with senior staff, nurses or the registered manager.

A range of audits and quality assurance systems were in place to drive improvements within the home. Surveys were sent out to people and relatives to obtain feedback and the results were analysed to assess their satisfaction.

The management team was visible and staff told us they were given opportunities to participate in developing the service.

Health and safety within the home was managed effectively. Regular maintenance around the home and servicing of equipment was carried out by maintenance staff.

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

Is the service safe?

We found that the warning notice had been met for the management of medicines and people's medicines were handled safely. However, some minor improvements were still required. We saw that a clear process was required to be in place for obtaining supplies of medicines for people coming into the service for respite care to make sure that there was continuity of prescribed treatment.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to ensuring there was continuity of prescribed treatment for people.

Is the service caring?

We found that the warning notice had been met in relation to dignity, respect and involvement of people using the service. We saw that staff treated people with kindness and respect. Staff took time to talk to people and explain how they were going to provide the care. We heard staff inducting a new member of staff and explained the importance of people's dignity and privacy, 'If the door [bedroom] is shut always give it a little knock.' We heard and saw how staff involved people in their care. For example, people made choices about what activities they wanted to do, and what they wanted to eat.

Is the service responsive?

We found staff to be responsive to people's needs. Staff were vigilant and acted quickly to respond to people who called for assistance. We saw that when people indicated they were in pain, staff responded appropriately, with re-assurance and compassion.

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and their friends and relatives had no concerns about safety. However, we found some practices within the home to be unsafe.

Staff understood how to safeguard people they supported. However, the provider's safeguarding policy did not include details of how to contact external agencies if they had concerns about people. This meant there was a risk that safeguarding referrals would not be made or investigated appropriately to keep people safe.

Arrangements for the management of medicines were not safe and people were not protected against the risks associated with poor medicine handling practices.

Systems were in place to make sure that managers and staff reviewed events such as accidents and incidents, complaints and concerns. However, there was not always evidence to show that actions were always carried through. This increased the risk of harm to people and failed to ensure that lessons were learned from investigations.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events, safeguarding and medication that affect people's safety.

Risk assessments had been completed to guide staff in managing and minimising risks to people.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Applications to restrict people's liberty had been made where appropriate but the registered manager told us there was a delay with receiving authorisation from the local authority. The manager was aware of recent changes to the legislation and relevant policies and procedures were in place.

Is the service effective?

The service was not always effective. People's health care needs were assessed but not all care plans had information to guide staff in how to support people appropriately. Most care plans and risk assessments were updated to reflect people's changing needs. However, we could not find always find evidence that people had been involved in this. The provider referred people to other health care professionals, when necessary, for specialist advice and treatment.

Where people did not have capacity to consent the provider had not always acted in accordance with legal requirements. For example, best interest decisions had not always been carried out in line with the Mental Capacity Act 2005. This meant there was a risk that decisions were made about people's care without appropriate involvement of people, their relatives or representatives.

Is the service caring?

The service was not always caring. We observed that most staff spoke to people with kindness and respect. However, we found that not all staff were caring and compassionate, and saw that sometimes there was very little interaction by some staff with people they supported. This meant people's care and support was not always provided in accordance with people's wishes. We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in their care.

We spoke with two people being supported by the service and asked their opinions about the staff who supported them. Feedback was positive. One person told us that staff 'Treat me well' and another said 'Staff are wonderful.'

Is the service responsive?

We did not always find staff to be responsive. We saw on two occasions during our inspection that people were in pain or distress and required assistance and re-assurance. We saw that staff did not respond in a timely way.

People told us they knew how to make a complaint if they were unhappy. We saw that the service had logged nine complaints in the past twelve months. These had been responded to but it was not always clear how these had been investigated. In all but one case, the outcomes had been recorded in the complaint file.

Is the service well led?

We found the service was not always well led. There was a quality assurance system in place to identify and address issues and inform improvements. However, actions were not always followed up. For example, on the day of inspection we found that issues identified by our inspector with medication had been identified eight weeks previously during an internal audit. These had still not been addressed and were identified again during our inspection.

The registered manager and senior staff held supervision meetings with care staff to identify training needs and monitor staff performance. Staff told us that they were clear about their roles and responsibilities. They told us that they received training which supported them to carry out their roles. Staff meetings took place which enabled staff to discuss and plan improvements within the service.

We spoke with five relatives of people who lived in the home. Most of the comments we received were positive about the care provided. For example, one relative told us they had confidence that staff understood their family member's needs and were responsive to changes in their health. Another relative told us that staff looked after their family member "very well" and they felt assured of their safety.

A programme of activities was in place to help ensure people's social and emotional needs were met.

We found that there were arrangements in place to provide training and support to staff. Staff told us they felt supported in their work and received enough training to be able to carry out their work effectively. Relatives of people who lived in the home told us that staff were kind and caring. Most of the relatives we spoke with told us that they felt staff were well-trained and competent in providing care for their family members.

The home had records about people's needs and the care they received. These were stored securely and were located promptly when needed. However, we found that some records were not fully completed which potentially put people at risk of not receiving appropriate care.

We also looked at staffing arrangements in the home to ensure there were enough qualified, skilled and experienced staff to provide care. We found that there were enough staff to meet people's needs and staff worked in a flexible way to ensure that people received the support they required. Arrangements were in place to ensure that staffing levels were kept under review.

We found that staff demonstrated a good understanding of people's needs and were able to tell us how these were met. A training programme was in place to support staff with developing the necessary knowledge and skills for their role.

People who lived in the home, and their relatives, told us that they felt there were enough staff available and that staff had the right knowledge, skills and experience to help them.

We found that suitable arrangements were not in place to ensure staff knew how to support one person with challenging behaviour in a safe and planned way. Although staff were, on occasions, holding the person's hands or arm during personal care to prevent them from hitting out, this intervention was not recorded in their care plan or risk assessed. Staff training in physical intervention was not in place and staff were not clear about the home's policy on restraint.

The provider had procedures in place to protect people from abuse and ensure that people's rights were upheld. Staff were aware of these procedures and there was evidence that the home had liaised with external agencies regarding concerns about people's safety and welfare. Staff treated people who lived in the home with respect and dignity, enabling them to make choices and do things for themselves where possible, thus reducing the potential for abuse.