Figbury Lodge

Figbury Lodge is a care home providing personal and nursing care to up to 80 older people, some of whom are living with dementia. The home had 20 transitional beds; this meant that people were admitted into the home temporarily following discharge from hospital. People living on the transitional unit had access to rehabilitation and therapists. There were 66 people living at the home at the time of inspection.

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

People and their relatives told us they were happy with the care at Figbury Lodge. Improvements had been made in all areas of the home and further improvements were planned. Infection prevention and control procedures were in place to keep people safe during the coronavirus pandemic. The home was clean and tidy.

People and their relatives were complimentary about the staff. One relative said, “I’ve never experienced anything other than kindness.” They told us communication with the home is good, especially during the times when visiting has been restricted. The home has tried in a variety of ways to keep people and their loved ones connected and a recent survey showed this had been appreciated.

Staff felt supported and had the necessary skills and experience to support and care for people. Staff told us they worked within a good team and felt the home had improved. People had care plans which were personalised to their needs. Regular reviews ensured people were involved. People knew how to make a complaint or raise a concern and, were confident it would be addressed in a timely and efficient manner.

Staff were described as kind and caring, including reception staff, kitchen staff, domestic support and care staff. One relative told us, “The staff have been absolutely superb.” Staff told us things had improved within the home and they felt proud to work at Figbury Lodge.

People had access to healthcare when needed and records showed input from a variety of professionals. Health and social care professionals who worked with the home were positive about their interactions.

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. People told us staff asked their consent. Staff understood the importance of gaining consent from people.

People, their relatives and staff were complimentary and had confidence in the management of the home. The registered manager and deputy manager were well thought of and known to be effective. A relative said, “I do think it’s well managed.”

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 18 March 2020) and there were multiple 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 31 January 2020, 3 February 2020 and 4 February 2020. Breaches of legal requirements were found. We carried out a focused inspection on 22 September 2020 and to follow up on a warning notice issued for the breaches in safe care and treatment and good governance. We found the provider no longer in breach of those regulations. The provider completed an action plan after the comprehensive inspection to show what they would do and by when to improve staffing, need for consent and person centred care.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions effective, caring, responsive and well-led which contain those requirements. 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 ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

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.

Figbury Lodge is a purpose-built residential care home providing personal and nursing care to up to 80 older people, some of whom are living with dementia. The home had 20 transitional beds, this meant that people were admitted into the home temporarily following discharge from hospital. People living on the transitional unit had access to rehabilitation and therapists. There were 59 people living at the home at the time of inspection.

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

Improvements had been made in the management of medicines and risk assessments for people living at Figbury Lodge. Staff had undergone training and new processes had been introduced to ensure people were kept safe. Staff told us there had been a lot of improvement and changes since the last inspection. Systems to monitor the service had been introduced and the registered manager told us this made sure they could have an overview of the home. Staffing levels were adequate. However, staff told us there was not enough staff in some areas. The registered manager used a dependency tool completed by senior staff within the home which confirmed there was enough staff for the home. They told us they kept this under continual review.

Improvements had been made to documentation relating to care activities such as fluid and food charts. Staff had received additional training to ensure records were detailed and accurate. The home was clean and tidy and there were robust procedures in place for infection prevention and control, which followed government guidance in light of the coronavirus pandemic.

People felt safe. Their relatives were complimentary of how the staff had worked throughout such a difficult period and were supportive of the measures taken by the home to keep their loved ones safe from Coronavirus. Staff told us they worked well as a team and enjoyed their job. There was a team atmosphere within the home and staff told us they had worked hard to keep everyone upbeat. There were visiting restrictions in place and relatives told us that although it was very upsetting and difficult, they were grateful to the home.

Staff told us the registered manager was approachable and visible. The registered manager told us the whole staff team had worked so hard throughout the year and were “amazing”. People and their relatives had been asked for their feedback and this has been positive. Professionals who work with the service were positive about the improvements made at the home.

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 18 March 2020) and there were multiple breaches of regulation. We served a warning notice for one regulation, which told the provider the date they had to be compliant by. The provider sent us an action plan after the last inspection to show what they would do and by when to meet the other regulations. At this inspection we found improvements had been made and they were no longer in breach of the regulations we looked at.

The rating remains requires improvement. The service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

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

We carried out an unannounced comprehensive inspection of this service on 31 January 2020, 3 February 2020 and 4 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements in relation to safe care and treatment and good governance. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings 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 coronavirus and other infection outbreaks effectively.

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

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.

Figbury Lodge is a residential care home providing personal and nursing care to up to 80 older people, some of whom are living with dementia. The home had 20 transitional beds, this meant that people were admitted into the home temporarily following discharge from hospital. People living on the transitional unit had access to rehabilitation and therapists. There were 44 people living at the home at the time of inspection.

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

People told us they were happy living at the home. However, we identified several shortfalls and governance systems were not robust enough to keep people and staff safe. Potential risks to people's health and welfare had not been consistently assessed. There was not always guidance for staff to mitigate the risks. Records of the care people received were not always accurate or complete or produced in a timely manner. Medicines were not always managed safely. The service completed a dependency tool which showed the home was overstaffed, the feedback we received during the inspection was that there were not enough staff, the management team told us they would be working to resolve this conflict.

People’s rights were not always protected when a person lacked capacity to make certain decisions. The Mental Capacity Act 2005 had not been followed to ensure care was delivered in a person’s best interest. Consent was not always sought from those who had legal authority to give it.

People’s right to privacy was not always observed as records and confidential documents were not secured properly. Care and support plans were not always personalised, accurate or complete. People did not have end of life plans in place which took account of their final wishes and preferences.

Staff told us they did not always feel confident in their role due to lack of training. Professionals had concerns about the training and knowledge of staff while supporting people living with dementia. Governance systems and management oversight was not robust enough to identify the shortfalls found within the inspection.

People and their relatives told us staff were kind and caring, we observed many respectful, kind and compassionate interactions during the inspection. Staff told us they worked well as a team and did the best for the people living within the home. The home was clean, tidy and people had access to enough food and drinks. Activities were held within the home and people told us they enjoyed them. Accidents and incidents had been recorded with actions and the interim manager had started to analyse them to identify patterns and trends. People had access to healthcare when they needed it and working relationships with professionals had recently improved.

People knew how to make a complaint and they had confidence in the management of the home that they would address their concerns. Staff told us the interim manager had made a big difference in the home and the registered manager felt supported. The registered manager had made all notifications to CQC as required by law. The registered manager, senior management team and provider told us they were fully committed to making improvements at the home and work had started during the inspection to identify issue’s and create action plans.

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

Rating at last inspection

This service was registered with us on 4 September 2019 and this is the first inspection.

Why we inspected

The inspection was prompted due to concerns received about staffing, medicines, care planning and training.

We found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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.

Enforcement

We have identified breaches in relation to medicines management, assessment of risk, consent, staffing, person centred care and governance of the service. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.