The inspection took place on 20 March 2018, 21 March 2018, and 26 March 2018 and was unannounced.

Furzehatt 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.

Furzehatt Residential and Nursing Home is divided into two units. The residential and nursing unit are situated within the same building and divided by a reception area at the main entrance. The nursing unit provides nursing care for a maximum of 32 people and the residential unit supports a maximum of 29 people. At the time of the inspection 28 people were being supported on the nursing unit and 18 people within the residential part of the service.

There was a management structure in place. The service had a registered manager. 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 last inspection on the 14 and 15 April 2016, we rated the service as Good overall. At this inspection we rated the service as Requires Improvement. This is because systems were not always in place to keep people safe, this included, medicines, risk management, and incident reporting. Staff were not always provided with sufficient information to meet people’s needs consistently and safely. Quality Audits had not been effective in identifying concerns we found at this inspection. The quality of care across the service was not always consistent.

Prior to the inspection we had received concerns from the local authority safeguarding team, regarding people’s care at the service. A safeguarding meeting had taken place with the local authority prior to the inspection and we were told a number of safeguarding investigations in relation to these areas of concern were on-going and therefore not concluded at the time of the inspection. We did not look at these specific investigations as part of the inspection, however, we did use this information to inform us about how we needed to conduct the inspection and areas of care we needed to consider and review.

The local authority had also informed us prior to the inspection, that due to the high number of concerns received, they had met with the provider and requested an improvement plan and assurances about people’s safety. Due to the concerns the local authority had agreed a suspension on all residential and nursing placements, whilst investigations were ongoing and improvements made. At the inspection the registered manager confirmed these suspension arrangements, and that they also would not admit any privately funded people during this time.

The Care Quality Commission had also spoken to the registered manager and written to the registered provider on two occasions since the last inspection about concerns raised by relatives about people’s care and medicine issues in the home. The registered manager and registered provider had responded to requests for information about these concerns at the time and had provided us with assurances about people’s safety. However, despite these assurances issues relating to people’s safety were found during this inspection.

During this inspection we found inconsistencies in systems and the quality of care provided across the service. When concerns we found related to a particular part of the service, we have reported on this by referring to either the nursing or residential unit. This information can be found within the full version of the report.

At this inspection we found people were not always safe. People did not always receive medicines in a way they were prescribed and staff did not always have guidance to follow to help them decide when certain medicines needed to be given. Systems were in place to report medicines incidents, however, staff were not in all cases clear about the type of med

The inspection took place on the 14 and 15 April 2016 and was unannounced.

Furzehatt Residential and Nursing Home provides care and accommodation for up to 62 people. On the day of the inspection 59 people lived in the home. The service provides care for people with physical and mental health conditions, which includes people living with Dementia.

The service had 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.

Support plans did not in all cases provide consistent or up to date information for staff. Guidelines in place to check people when they were in alone in their bedrooms and to monitor weight were not in all cases being followed or documented as agreed.

On the days of our inspection there was a calm, friendly and homely atmosphere. People appeared relaxed a happy. People and their relatives all spoke highly of the care and support Furzehatt Residential and Nursing Home provided. One person said, “I am happy here, we get the best of everything, I am 100% satisfied”. Staff interacted with people in a caring and compassionate way. For example, staff spent time sitting with people and checked they were comfortable and happy. One staff member kneeled down next a person and said how lovely their nails were, which had just been manicured by staff.

The design and décor of the building had been carefully thought out and took account of people’s needs. People were able to move safely around the building and had sufficient space to enjoy time on their own or in the company of others.

People told us the staff were caring and they felt they mattered. They said staff listened to them and respected their wishes. Staff we spoke with were clear about the importance of respecting people. They consistently spoke about people being individuals and treating people as they would like to be treated. Comments from staff included, “When supporting people with personal care, I put myself in their position and think how I would feel and treat them with the upmost respect”, “I’m here for people’s best interests. I’m here to care and that’s what I do. I make sure everyone is happy and well looked after”.

A range of activities were available to meet people’s needs and particular interests. Staff had considered innovative ideas to evoke memories and trigger reminiscent thoughts and conversation. For example, memory boxes and personalised activity baskets had been put together and provided in each person’s bedroom.

The service had an open door policy, relatives and friends were welcomed and people were supported to maintain relationships with those who mattered to them. Staff were well supported through induction, supervision and on-going training. Staff were encouraged to enhance their skills and professional development was promoted.

Staff told us they were supported and encouraged to question practice. Staff said they were aware of the values of the service and these were regularly discussed and promoted. Staff were inspired and motivated to provide a good quality service and had a clear understanding of their role and what was expected of them.

People had their medicines managed safely. People received their medicines on time and in a way they preferred. Care and support focussed on each person’s individual needs, their likes, dislikes and routines important to them. When people were unable to consent to their care or support discussions took place to ensure decisions were made in their best interests. When people’s needs changed staff reacted promptly involving other social and healthcare professionals if needed. The food in the home was of a good quality and catered for people’s specific dietary needs and preferences.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? We also looked to see if the required improvements identified at our inspection in May 2014 had been made. We found improvements had been made. We also received information of concern about the service over the medication systems in place.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We spoke to ten people who used the service and they said they were all happy with the care provided. They said they were treated with respect and dignity by the staff. There were enough staff on duty to meet the needs of the people who received care at the home and people were able to say they felt safe living at Furzehatt. For example when a bell was used by one person staff responded immediately to ensure they were safe.

We found care and treatment was planned and delivered in a way that ensured people's safety and welfare. We found that there were clear risk assessments and links to care planning. People’s care was in line with the care plans. People, who were able to communicate with us, told us they felt their care was safe. One person said, “The staff are very good and always help me”.

People had the correct equipment in place to meet their assessed needs. One person who had moved from the residential side of the home to receive nursing care had appropriate pressure relieving equipment in place. One person for whom a hoist and slide sheet was used to move and reposition them had this equipment in their rooms. Staff were fully trained on their use to ensure people felt safe when this was being carried out.

Staff had received medication training to ensure they were suitably qualified to administer medicines.

Is the service effective?

We discussed people's care needs with staff and they told us about people's needs and how they liked their care to be delivered. Staff we spoke with were able to tell us in detail what they did to support people and knew what to do for them if they needed any additional support. For example, staff told us about one person whose health had deteriorated recently. They went onto say how they now needed to be supported to maintain their health, for example assisting them with their food and fluids.

Is the service caring?

People we spoke with who lived at the home told us that staff were caring and looked after them well. One person told us, “The staff are very kind to me”. A relative we spoke with said "The care mum receives is great -I am so pleased she lives here".

We observed people being supported to take part in an activity in the residential side of the home. We saw people were treated with respect and affection. As an example, we saw one person became confused about the activity they were taking part in. We saw a member of staff approached them, assisted this person and encouraged them to continue. We saw the person responded well to the member of staff who was patient and supported them at their own pace.

This demonstrated to us that the staff were patient and caring towards the people who lived at the home.

Is the service responsive?

We saw that the home responded quickly to changes in people’s needs. We saw for example that care plans and assessments were reviewed regularly to identify changes in people’s condition. We saw that for one person admitted with a pressure sore the home had provided suitable pressure relieving equipment.

The staff spoken with confirmed that the home covers any vacant shifts with either agency staff or their own staff completing additional hours, to ensure sufficient staff were available to meet people’s needs. On the day we visited we saw sufficient staff on duty to meet the needs of people living in the home.

Is the service well-led?

The Registered Manager and many of the staff had worked at the home for some time. Staff were aware of the needs of the people living at the home and were able to meet them. We saw the Registered Manager of the home was experienced and knowledgeable.

Staff we spoke with told us they enjoyed working at the home, and felt they were well supported. They understood who was in charge and their individual roles. Staff told us “We always support each other”. Another staff member said “I am fairly new to the home but know that I can always ask someone for help”.

Staff told us they were clear about their roles and responsibilities. All the people spoken with were happy with the staff working in the home. One visitor said, “I am very happy with the care mum receives and I am always kept informed on what is happening to her”.

We carried out a previous inspection in October 2013. During this inspection we raised concerns about staffing levels, the management of medicines and records. The provider sent us an action plan informing us of the improvements which would be made. We reviewed these areas during our inspection on 9 May 2014.

We found staffing levels in the residential unit had improved and a further registered nurse was due to start working imminently in the nursing unit which would improve the staffing levels on that unit. Medicines management in the residential unit had improved considerably with staff having undertaken training and audits in place. Improvements were still required in relation to records and ensuring people's confidential information was kept secure, care plans reviewed as people's needs changed and ensuring observation record charts were completed promptly by staff.

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found. The summary is based on our observations during the inspection, speaking with thirteen people using the service, the staff supporting them, speaking with a visiting healthcare professional and from looking at records.

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

Is the service safe?

We spoke to 13 people during our inspection, nine on the nursing side and four on the residential side of the home. People told us “It’s very nice here, the girls are lovely”; “Good food and you get second helpings, plenty of tea too”; “There’s bingo, usually something on every day” and “They are helping me regain my independence”.

We found people were treated with respect and dignity by the staff. During our inspection we spent time observing the care people received in both the residential unit and the nursing unit. We noted the interactions were good and showed staff respect towards people at the home. People told us they felt safe at the home.

There were systems in place to make sure managers and staff learned from events such as accidents and incidents, complaints and investigations. We saw the home had made significant changes since our previous inspection to make aspects of people's care safer, particularly concerning the management of medicines.

We spoke with staff and they had a good knowledge of people’s care needs and consulted external health professionals promptly when people’s needs changed. All staff had received an induction and some staff had received additional training to manage more complex health conditions.

Safeguarding procedures were robust and staff understood how to safeguard the people they supported. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us they had not needed to submit any applications. Policies and procedures were in place and the manager had liaised with the local DoLS team. The manager and senior staff had been trained to understand when an application should be made, and how to submit one. Recruitment practice was safe and thorough and during our inspection we found the levels of staff on duty were good.

Is the service effective?

People who lived in the home told us they were happy with the care they received. People's health and care needs were assessed. Specialist health care professionals were involved where appropriate and the equipment they needed as identified in their care plans.

Where people were not able to make certain choices and decisions we found evidence that relatives and representatives had been involved in the care planning process. Regular care plan reviews were carried out to ensure they reflected people's current needs. Weekly clinical meetings reviewed people whose health needs had changed.

Is the service caring?

People told us they were supported by kind and attentive staff. We observed that staff were patient and went at the person's pace when assisting them with their mobility, food, and medication. We observed staff patiently reassuring people who were worried and people told us that staff supported them to regain their independence where possible. Staff understood Furzehatt Care Centre was people's home and we saw good relationships had been built between staff and people.

Is the service responsive?

People's needs had been assessed before they moved into the home. The manager visited people and carried out an assessment to ensure the service was able to meet their needs. The service employed an activities person and people had access to activities that were important to them.

We saw the complaints procedure was available on the noticeboard in the corridor. Several people told us they felt able to speak to the manager or staff if they were unhappy about something. They felt confident that the service would deal with any matters to their satisfaction.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. We spoke with a visiting healthcare professional who told us the manager and staff at the home contacted them if they had concerns and followed their advice.

Staff told us they were clear about their roles and responsibilities and care staff told us they would report any concerns they had about people to the registered nurse. Staff told us they had regular meetings with the manager. This helped to ensure that people received a good quality service at all times.

We visited the home in response to information received about a range of concerns. There were 59 people living at the home when we visited. We spoke with 12 people who lived there, six relatives and asked them about the care and treatment provided. We looked in detail at three people's care records and spoke to nine staff about people care needs.

Most people and relatives we spoke with were very positive about the home. One person said "they will do anything you want them to do", another said "nothing is too much trouble" and a third said "they look after me very well". One relative they liked the fact that the careworkers had worked at the home for a long time, another relative said "all in all, I'm a very satisfied customer". One person said they found the home quite noisy at times. Four of 18 people and relatives we spoke thought the food could be improved.

We found that people's care needs were being met and risks were well managed. People and relatives we spoke with told us they felt people were safe at the home and they knew who to raise any concerns with. We looked at all areas of the home and found they were clean and well maintained. We observed that some staff were not following the homes infection control policies and procedures in relation to the use of aprons and gloves. This meant people could be at risk from infections and improvements were needed. The provider carried out a range of quality checks at the home and took corrective action when needed.

We (The Care Quality Commission) conducted an unannounced visit to Furzehatt Care Centre on 4 July 2012 and a second day on the 11 July 2012 as part of a programme of scheduled inspections.

We met the majority of people who use services and eight relatives, talked with the staff and checked the provider’s records.

We looked at the care records of seven people who use services. We met them, looked at records and asked staff about their care. The manager and deputy manager also provided information.

One person told us, “Wonderful place”. We talked with most of the people who lived in the home but some people were not able to communicate verbally to us in a meaningful way.

We saw people’s privacy and dignity being respected and staff were being helpful. Comments from people who lived in the care home included,” I feel spoilt” and “the staff are very nice and I have no complaints”, ‘food is very good sometimes but not other times”. There is a choice of meals”.

One person told us, “I was a wreck before I came in and the staff have really helped me”. People told us that if they had any concerns that they would speak to staff or the management and felt confident that appropriate action would be taken.

We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people’s choices and preferences. We looked in detail at the care seven people received. We spoke to staff about the care given, looked at records related to them, met with them and observed staff working with them.

We saw that the staff had a good understanding of people’s individual needs and that they were kind and respectful. They took time to work at people’s own pace.

We observed people being supported to make decisions about their lives and be as independent as possible. We saw that people’s care records described their needs and how those needs were to be met. Several staff told us how any information about new admissions to the home would be communicated to them.

During our visits to the home we saw sufficient staff on duty to meet the needs of people living in the home. We spoke with eight staff members working over the two days of our visit. Some staff stated that the home could be short of staff when people were on leave or sick and others said that it would depend on the needs of people currently living in the home. The manager confirmed that new staff had recently been employed and one staff said that staffing levels at the home were adequate and consistent to meet people's needs in a timely way.

We visited Furzehatt Care Centre after receiving concerns about staffing levels, cleanliness and the management of medicines. We spoke with eleven people during our visit and one relative. We spoke with ten members of staff including the registered manager and we looked at ten people's care records.

People told us "I'm well looked after, no complaints"; "Marvellous place". We found people were involved in their care, treatment and support choices where possible. People were able to express their views about the running of the home and their care through resident's meetings and annual questionnaires.

We found people had their needs assessed and these reflected people's individual needs. However, we found people's changing needs were not always identified which put their welfare and safety at risk. The home was introducing a clinical indicators tool to monitor people's welfare.

We found the home was clean and there were procedures in place to minimise the risk of infection. Staff had been trained in infection control and the cleanliness of the home was monitored through regular audits.

We found that there were not always sufficient staff on duty to meet the care needs of people at the home, particularly on the residential side of the home. The home were actively recruiting to address the shortfalls. We found improvements were required to the management of medicines to ensure people received the medicines they were prescribed.