Low Furlong

Low Furlong is a purpose-built residential home registered to provide accommodation and personal care for up to 68 people, including people with dementia. At the time of our inspection visit there were 58 people living at the home. Care is provided across two floors. Communal lounge and dining areas were located on both floors. People's bedrooms were en-suite and there were further communal bathroom facilities located on each floor.

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

People, relatives and external healthcare professionals spoke of very high standards of care at Low Furlong because of the exceptional leadership within the home. The registered manager was committed to achieving high standards and this was reflected in the motivation demonstrated by staff to ensure every person received care that met their individual and unique needs.

There was a strong sense of equality and collaborative working between staff because they felt their views and opinions were valued. The registered manager nurtured staff to reach their full potential and recognised when they had gone ‘above and beyond’ to make a person’s day better.

There was a strong emphasis on continuous improvement through the provider’s governance processes and feedback from other stakeholders. People, relatives and staff were involved in what happened in their home and were empowered in a variety of ways to have a say in how the service was run.

The registered manager promoted a culture of being open and honest, so people had confidence in the service being provided. Learning from incidents and complaints was a key contributor to improvements in the home.

There was a culture of encouraging staff to spend time with people and build relationships to support people’s emotional and social wellbeing. There was a full programme of activities which were designed not only to engage and entertain, but to also give people a sense of usefulness and purpose and help them feel valued. People were supported to maintain lifelong connections with the local community and maintain relationships and build memories with those who were important to them. Managers and staff had a strong commitment to supporting people and their relatives before and after death.

People and relatives told us the care, support and kindness they received from staff meant they were confident Low Furlong was a safe place to live. People told us there were enough staff to meet their needs and they did not need to wait when they called for support. Risks to people were regularly assessed and there were plans in place to help mitigate risks. Staff shared information about changes in people so any emerging risks could be managed.

People received their medicines as prescribed and staff understood their role in following good infection control practices.

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 13 December 2017).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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.

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 changed from Good to Outstanding based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection on 25 January 2016 the service, which was registered to provide care up to 44 people, was rated requires improvement. We found a breach of the regulations because medicines were not administered and managed safely. We found people had limited opportunities to be stimulated mentally and physically and audit systems needed better organisation to show improvements when identified, where actioned.

Following the last inspection visit, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Responsive and Well led to at least good. Before we could return to check improvements had been made, the home closed because of a planned re-development and people and staff were re-located to another home within the provider’s organisation.

Low Furlong is a care home that reopened in July 2017. People in care homes receive accommodation and nursing and/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.

Low Furlong is now registered to provide care for up to 67 people. On the first day of our inspection visit, 40 people lived at the home and when we returned the following day, this had increased to 42 people.

There was a registered manager at the home. 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, we found a number of improvements had been made and the provider was no longer in breach of the regulations. Medicines were administered safely by trained and competent staff and regular checks ensured medicines had been given when required. People felt there was more to occupy them and regular activities and events improved people’s mental and physical wellbeing. Following the re-opening of the home, a new registered manager was in post supported by a deputy manager and a senior care team. There were improved systems of audits and regular checks to ensure people received good care in an environment that was safe, from a staff team that were caring and responsive to meet people’s needs.

We received extremely positive feedback from people who lived at Low Furlong and their relatives, about the staff who cared for them and the support from the management team. People told us they were very happy with the care and support they received. They said staff were, excellent, extremely caring and had made a positive difference to how they lived their lives.

People who received end of life care, were supported by a staff team that were sensitive and respectful of people’s individual wishes. Relevant healthcare professionals worked in partnership with the home to ensure end of life care was as pain free and dignified as possible. Relatives were pleased with the support they and their family member received.

People were encouraged to make their own decisions about the care they received and care was given in line with their expressed wishes. People were supported to maintain important relationships and to keep in touch with people that were important to them.

Care plans contained accurate, detailed and relevant information for staff to help them provide the individual care people required. People and relatives were involved in making care decisions and reviewing their care to ensure it continued to meet their needs.

For people assessed as being at risk, care records included information for staff so risks to people’s health and welfare were minimised. Staff had a good knowledge of people’s needs and abilities which meant they provided safe and effective care.

Staff received essential training to meet people’s individual needs, and effectively used their skills, knowledge and experience to support people and develop trusting relationships. Staff told us the training they received equipped them to meet people’s needs.

There were enough trained and experienced staff to be responsive to meet people’s needs. People told us they felt safe living at Low Furlong and relatives supported this. Staff knew how to keep people safe from the risk of abuse. Staff and the registered manager understood what actions they needed to take if they had any concerns for people's wellbeing or safety.

The registered manager and care staff understood their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge and people’s records ensured people received consistent support when they were involved in making complex decisions, such as decisions around their personal safety or where they wanted to live. Staff gained people’s consent before they provided care and supported people to retain as much independence as possible.

People were supported to pursue various hobbies and leisure interests but this was an area the registered manager planned to further improve to ensure people continued to have a variety of activities that personally interested them. Thought was given to where people lived within the home so common interests and personalities benefitted those in encouraging new friendships and being able to share similar interests.

People received meals and drinks that met their individual dietary requirements. People received support from staff when they required it, and anyone at risk of malnutrition or dehydration, were monitored and if concerns were identified, advice was sought and followed.

People knew how to voice their complaints and complaints made had been resolved and lessons learnt to prevent similar issues reoccurring.

The home was clean, free of odour and staff wore personal protective equipment (PPE) at the necessary times. Regular spot checks and effective monitoring ensured standards of cleanliness were maintained. There had been no outbreaks of sickness or contagious illness since the home re-opened.

There was a clearly defined management structure that supported people and each other. The management team worked well together and were committed to providing a high quality service to people. The registered manager had a clear vision for the development of the service and demonstrated a commitment to implement best practice and increase links with the wider community. The registered manager and staff were passionate about delivering a good service and were working towards improving people’s experiences at the home.

The registered manager had submitted a Provider Information return (PIR) to us, they and the provider understood their legal responsibility to notify of us of important and serious incidents.

Further information is in the detailed findings below.

Low Furlong is a residential home which provides care to older people including some people who are living with dementia. Low Furlong is registered to provide care for up to 44 people. At the time of our inspection there were 42 people living at the home.

There was 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.

Staff knew how to keep people safe from the risk of abuse. People told us they felt safe living at Low Furlong and relatives agreed their family members felt safe and protected from abuse or poor practice.

The registered manager assessed risks to people’s health and welfare and wrote care plans that minimised the identified risks. However, some care plans and risk assessments required updating to make sure staff provided consistent support that met people’s needs.

There were enough staff on duty to meet people’s health needs. The registered manager checked staff suitability to deliver care and support during their recruitment process. The premises were regularly checked to ensure risks to people’s safety were minimised.

People’s medicines were not always managed, stored and administered safely in line with GP and pharmacist prescription instructions. For example, the processes to administer medicines covertly (disguised in food or drink for example) were not thorough enough to ensure people received their medicines safely in line with manufacturer’s guidelines. Records of controlled drugs did not reflect the stock we found on the day. When we returned, the registered manager had records to show they had been recorded and disposed of as required.

People were cared for by kind and compassionate staff, who knew their individual preferences for care and their likes and dislikes. Staff understood people’s needs and abilities and they read care plans and received updated information at shift handovers. Staff received training and support that ensured people’s needs were met effectively. Staff were encouraged to develop their skills and knowledge, which improved people’s experience of care.

The registered manager had limited understanding of their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Two people had a DoLS in place at the time of our inspection. The registered manager acknowledged people’s care plans did not always record information to make sure they had the proper authority to deprive a person of their liberty if it was in their best interests. For people with complex needs, records were not completed to show that their representatives or families and other health professionals were involved in making decisions in their best interests.

People were offered meals that were suitable for their individual dietary needs and met their preferences. People were supported to eat and drink according to their needs, which minimised risks of malnutrition. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health, and when their health needs changed.

People and their representatives were not always involved in care planning reviews although they said staff provided the care they needed. Care was planned to meet people’s individual needs and abilities and care plans were reviewed although some information required updating to ensure staff had the necessary information to support people as their needs changed. However, people’s physical and mental stimulation was limited because they were not proactively supported to purse their own hobbies and interests.

The quality monitoring system included reviews of people’s care plans and checks on medicines management. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence. Improvements were required in assessing risks to people and how staffing levels were determined to ensure safe levels of care were maintained to a standard that supported people’s welfare.

We found a breach 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.

People who lived at the home told us, 'It's nice here and I am looked after well.'

We saw staff were kind and attentive when they delivered care to people. We saw people were supported and encouraged to maintain their independence.

We looked at three people's care records and saw their care plans reflected their personal needs. We saw the members of staff supported people as detailed within their care plans.

We saw that people were provided with a good choice of food and they told us they were happy with the choices available to them.

We spoke with three staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Care staff had received training to enable them to look after people safely. We saw some of the staff had a formal meeting with the manager.

We found the service had good systems in place to monitor the quality of service provided at Low Furlong.