About the service: Furzeham Lodge is a residential care home that provides accommodation and support for up to 22 older people, some of whom may be living with dementia or physical frailty. At the time of the inspection there were 22 people living at the home.

People’s experience of using this service: People were happy living at Furzeham Lodge and told us they felt safe and well cared for. Staff were seen to be kind, caring and it was clear staff knew people and their relatives well.

People were not always protected from the risk of avoidable harm. We found risks such as those associated with medicines had not been managed safely.

We found staff were using people’s bedrooms to take their allocated breaks. The registered manager took immediate action to stop this practice.

People were not always supported to have maximum choice and control of their lives and whilst we did not find that people were being disadvantaged, we have recommended the provider reviews all documentation in relation to the management of people’s finances.

Other risks to people were being assessed and management plans were in place to ensure risks were mitigated as much as possible and staff were aware of their responsibilities to safeguard people.

There were sufficient numbers of staff employed to ensure people’s needs were met. Staff had time to sit and engage people in conversation and to support people’s involvement in social activities. Recruitment practices were safe and staff were well-trained.

The home was clean, well maintained and people were protected from the risk and/or spread of infection as staff had access to personal protective equipment (PPE).

People and their relatives were involved in making decisions about their care. The registered managers worked in partnership with health and social care professionals. The provider had systems in place to review, monitor and improve the quality of service provided, but these did not always identify shortfalls.

We have made a recommendation in relation to systems in place to monitor, the quality and safety of the services provided.

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

Rating at last inspection: The home was previously rated as Good. The report was published on 1st September 2016.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

Enforcement: We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have also made recommendations in relation to mental capacity and quality assurance systems. Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will continue to monitor intelligence we receive about the home until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Furzeham Lodge is a registered care home for up to 22 people who require care and support. It does not provide nursing care; this is provided by the community nursing team. The unannounced inspection took place on the 9 and 13 June 2016 by one adult social care inspector. The service was previously inspected on 27November 2013 and was found to be meeting the requirements of the regulations we inspected at that time.

The home had a registered manager. 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 the time of the inspection there were 20 people living at the service. Some of these people were living with Dementia. During our inspection we observed a calm and relaxed atmosphere in the home. Staff interacted with people in a friendly and respectful way.

People told us they felt safe and well cared for and people praised the atmosphere of the home. Staff, people and Health Care Professionals (HCP) said they were happy with the care being provided at the home. Staff were knowledgeable about the people they were caring for. .Each person had a care plan detailing their care needs. Staff delivered care to people that met their individual personal needs. They fully involved their families if this was appropriate. Staff consistently demonstrated affection and warmth in their relationships with people. People praised the standard and the cleanliness of the home.

Recruitment systems were in place; new employees underwent the relevant pre-employment checks before starting work. Care staff had completed an application form and the registered manager carried out robust checks when they employed staff. There was a good system in place for ordering, storing and returning medicines; We found systems were in place to make sure people received their medicines safely.

People, staff and health care professionals told us they were happy with the care being provided at the home. People’s needs had been assessed prior to them moving into the home. Each person had a care plan which had been developed with them and their relatives. These care plans contained information about each person’s needs and how staff should meet these. Care staff spoke confidently about people’s individual care needs and how they met these.

Staff knew how to recognise and report the signs of abuse and had received training in safeguarding people. They were confident about how to raise concerns if they were concerned about anyone.

The registered manager and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed and best interest decisions made in line with the MCA. At the time of the inspection, a number of applications had been made to the local authority in relation to people living at the service. This meant people’s legal rights were protected.

There were systems in place to monitor and improve the quality of the service provided. Checks and audits were undertaken to make sure full and safe procedures were adhered to. People and relatives had been asked their opinion of the quality of the service –and were invited to attend regular meetings with the registered manager.

People told us they enjoyed the food and that there was plenty of it. Meals were appetising and people were offered choice.

People who lived at the home told us " there is an easy going family atmosphere ". A family member who was visiting the home told us " I am always made welcome".

We saw that staff were respectful and caring towards the people who lived at the home. People were treated with dignity and compassion.

We noted that staff gave people time to make decisions and questions were asked in an appropriate way for the person to understand. Staff gave eye contact and positioned themselves so that the person they were speaking to could see their face and their expression.

We looked at staff files and found that the recruitment process was standardised, that details of applicants qualifications and experience were documented and checked and that DBS checks and two references were present for each staff member. This showed us that the people are cared for by staff who are properly qualified and able to do their job and that staff are appropriately checked to ensure the safety of the people who live at the home.

The service had a nice friendly atmosphere. It was warm and inviting and we saw people laughing and enjoying each others company. I lovely smell of home cooking filled the air.

At our inspection of September 2012 we had identified concerns in relation to the involvement of people or their supporters with the planning and assessing of their care needs. This was a particular issue in relation to the planning of end of life care.

Following the inspection the home sent us an action plan telling us how they intended to improve this.

On this visit we found the home had taken positive action to improve the recording of people's involvement in their care planning. We also found that they had provided new systems for the recording of people's capacity to make decisions. Records had also been provided to support families and individuals in making decisions in relation to their end of life care, including the levels of treatment they would like at that time. This information was being shared with supporting medical services to ensure that all parties involved with the individuals care were clear about their wishes.

On our visit we looked at the records for five people living at the home, spoke with five people receiving care and two visiting relatives. We also observed the interactions between people living at the home and the staff caring for them, and how people spent their time. This was because many of the people at the home were not able to discuss with us their experience of living there due to memory loss or difficulties with communication.

We saw that staff interacted well with individuals, and were clear about anticipating their needs. Relatives we spoke with told us that staff were responsive to individuals, and that the home was very good. One person told us "it's a very homely place. Carol (the manager) is a great strength and drives the place forward". Another relative told us that their relative was looked after well and that they had no concerns about their care.

One person living at the home told us that the staff were very good and looked after them. They told us they enjoyed spending time in their room as they had a view of the sea and there was always something different to watch.

We looked at five plans for people. The care plans we saw were comprehensive and included the strengths of the individual including personality traits and characteristics. This demonstrated a respect for the individual. However one plan we saw contained a non resuscitation form which had not been completed in accordance with the Mental Capacity Act, and did not protect people.