Falstone Court

Falstone Court is registered to provide nursing and residential care for up to 40 people, some of whom live with dementia. When we inspected, 29 people were living at the service.

We found the following examples of good practice:

• Systems were in place to reduce the risk of infections. Clear signage, temperature checks and personal protective equipment (PPE) protocols were in place at the front entrance. Additional cleaning of all areas and frequent touch surfaces was in place. An additional staff room had been made available to enable social distancing.

• Staffing levels were safe, with people receiving a continuity of care. No agency staff were used, except for nursing staff – these were however ringfenced to this service and part of the service’s regular coronavirus testing programme.

• The service had worked flexibly to safely facilitate outdoor socially distanced visits. They were ready to re-implement visits should national guidance allow. The registered manager planned to convert a living room bay window into patio doors to enable visiting over the winter, should guidance allow. People were supported to keep in touch daily with their family members via video or telephone calls.

• Relatives provided extremely positive feedback about how staff kept people safe and well cared for.

• Infection control audits, additional infection prevention and control training and additional support for staff were in place.

Further details can be found in the key question below.

People’s experience of using this service: People were especially well cared for; staff were extremely kind and considerate. Staff went above and beyond to ensure people’s preferences were met and their independence enhanced. Staff and management were focused on delivering a highly personalised service.

New technology was embraced; it was used effectively to monitor people’s health and ensure specialist healthcare was accessed quickly.

People could participate in a wide range of events and activities which were based on their interests. Treating people with dignity and respect and as individuals were central to how the service operated. Staff were extremely compassionate; relatives gave praise for their kindness when providing end of life care.

People and staff felt especially valued; their views were listened to and respected.

People, relatives and staff told us the home was safe. Staff had a good understanding of safeguarding and whistle blowing; they knew how to raise concerns.

Staffing levels were sufficient to provide personalised care. New staff were recruited safely.

Medicines were managed well; people received the medicines they needed on time.

Incidents and accidents were monitored; the findings were used to make improvements and identify learning. Health and safety checks and risk assessments were carried out to maintain a safe environment.

Staff received good support and completed the training they needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People had enough to eat and drink and to access health care services when required.

People's needs had been fully assessed to identify the care they needed and wanted; this included considering needs relating to end of life care, culture and religion. This was used as the basis for developing personalised care plans.

The provider investigated complaints robustly.

The home was well managed. There was a structured approach to quality assurance; this was effective in identifying and addressing issues. People, relatives and staff had opportunities to provide feedback.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection: Good (the last report was published on 18 August 2016).

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor this service and inspect in line with our reinspection schedule for services rated outstanding.

Falstone Court is a two storey home that provides nursing or personal care for up to 40 people, most of whom are living with dementia. At the time of the inspection there were 39 people living in the service.

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 had a good understanding of safeguarding and were confident in their role of safeguarding people. Any safeguarding concerns were investigated with the outcomes fed back and practices changed if necessary in order to prevent reoccurrences. Staff also knew about the whistleblowing policy and told us they would use it if necessary.

People had risk assessments in place and associated care plans were clearly linked and updated in line with risk assessment reviews. There were also general risk assessments regarding the premises and environment.

Records were kept for all accidents and incidents including details of investigations, outcomes and action taken. The registered manager analysed accidents and incidents to identify any trends and put additional measures in place to reduce the likelihood of any reoccurrences.

Medicines where managed safely, effectively and in a way which reflected people’s individual needs. All records were up to date and fully completed, with medicine audits being carried out regularly.

Staffing requirements were assessed in line with peoples’ needs. The registered manager also considered the skill mix and gender of staff. From staffing rotas we saw staffing levels were consistent required. Staff were recruited in a safe and consistent manner with all necessary checks carried out.

Staff received regular training on core subjects such as safeguarding, Mental Capacity Act 2005 (MCA), deprivation of liberty safeguards (DoLS), moving and handling, infection control and management of medicines. They also received training on specific subjects relating to people's needs such as dementia awareness. Staff felt supported in their roles. They received regular supervisions, direct observations and annual appraisals.

The registered manager and staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Best interest assessments were evident within care files and DoLS authorisations were in place for most people who used the service.

We observed during mealtimes people were enjoying their meals, some independently and others with support from staff. There were choices available for people and support provided by staff was gentle and at an appropriate pace to each individual.

Care plans were personalised, detailed and contained people’s personal preferences, likes and dislikes. Care plans were up to date and reflective of each person’s individual needs.

There was a wide range of activities available both within the home and in the community for people to become involved in and enjoy. The home had a full time activity co-ordinator who worked with people and family members to design activities programmes tailored to people using the service both as a group and individually. Relatives spoke very highly about the activity co-ordinator and the range of activities that took place in the home.

Relatives told us they knew how to complain and would be confident in raising any concerns. Staff told us they felt supported in their role and could talk to the registered manager about anything.

The provider had a robust quality assurance and audit schedule in place which was carried out in practice. This ensured the quality of the service provided was assessed and monitored from every aspect and appropriate action was taken to improve and develop the service where possible.

We spoke with ten people who use the service and six visitors. The majority of people we spoke to could not express their views, but those that could, indicated they were satisfied with the service they received.

People who lacked capacity to make a decision were supported by decisions made in their best interests.

We saw staff speaking and responding to people in a happy, gentle and respectful

manner. We found records to show how people's health needs had been assessed before they came to live in the home and care plans with risk assessments were then completed once the person was in residence.

We found a sensory garden and also a sensory room for the use of people and visiting relatives.

We found the home to be clean, tidy and free from any malodorous smells. One relative said, 'I like to check under beds, that sort of thing. I have never had any cause for concern.'

We found that there were enough staff to provide appropriate care and treatment to the people living in the home and staff told us that they felt supported within the service and had opportunities to develop their skills with additional training opportunities. We found that the deputy had recently received a national dementia award.