This inspection took place on 16 November 2017 and was an unannounced visit. We returned on 17 November 2017 so we could speak with staff and look at their quality assurance systems.

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. S

This inspection took place on 25 & 28 January 2016 and was unannounced.

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

When we visited Low Furlong we spoke with seven people who used the service and two relative’s to obtain their views about the home. We also spoke with a visiting professional, the manager, the deputy manager, five care staff, a member of the administration staff and the chef.

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.