Archived: Felmingham Old Rectory

Felmingham Old Rectory is a residential home that was providing personal care and accommodation to 28 people at the time of the inspection. Most were adults aged over 65 although one service user was under this age.

People’s experience of using this service

People did not consistently and routinely have their basic care needs met. Their dignity was compromised, and they lived in a home that was odorous and required repair. Equipment was not accessible to them as they needed it and they were sometimes supported by staff who were inattentive and dismissive.

People had not been involved in the planning of their care and the decisions around those. They had not been consulted on the service they received or asked for their opinions. Where people lacked capacity to make their own decisions, actions had not been consistently taken to uphold their rights. People did not receive a service that was caring and individual to them. People were not treated in a consistently respectful manner and the care and support they received did not consider their past lives, feelings and aspirations.

Full recruitment checks had not been completed on potential staff and the service was running on a high number of agency staff which compromised continuity of care. People were supported by staff that were demotivated and did not feel valued or listened to. Staff were not fully trained, supported or supervised and lacked direction. We saw that there were enough staff on duty but that they were ineffective and that the home was chaotic. This impacted on the poor service people received.

The risks to people, both individually and regarding the environment, had not been fully identified or mitigated and people were placed at risk. The environment was poor. We found it to be unclean and in need of repair. People had been placed at risk of infection and this was demonstrated by the high number of people either confirmed as having an infection or showing signs of an infection. The service had failed to report this to Public Health as required.

People’s nutritional needs were not met, and the service failed to adhere to good medicines administration and management practices. People had received input from health professionals, but their recommendations were not consistently followed by staff putting their health and wellbeing at risk.

The service had unstable management and the governance systems in place were ineffective. The provider had long identified concerns within the service but failed to make improvements. There was no registered manager in place as required by their registration with the Care Quality Commission (CQC). The provider had failed to protect people in their care.

Rating at last inspection

The service had been rated as good in all areas at its last inspection. The report was published on 10 November 2016.

Why we inspected

This was a comprehensive inspection and had been planned for later in the month of May 2019. However, due to receiving serious concerns from other stakeholders, the inspection was brought forward.

Enforcement

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

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

Felmingham Old Rectory is a residential care home that was providing personal care to 16 people aged 65 and over, and younger people, at the time of the inspection. The service can support up to 41 people. The home is an adapted period building set in its own grounds. Accommodation is over two floors.

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

People remained at risk of avoidable harm through the provider’s failure to consistently identify, assess, manage and mitigate risk. This included putting people at risk of abuse and receiving unsafe care. People did not receive their medicines as prescribed and this had resulted in harm.

The governance of the service remained ineffective. This was due to inconsistent and changing management and failure to promptly act on identified concerns. There was a lack of accountability on behalf of the provider and a failure to act promptly on long identified concerns. This had resulted in people receiving unsafe care that exposed them to the risk of avoidable harm.

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 inadequate (report published 6 June 2019) where nine breaches to regulations were found.

Shortly following our last comprehensive inspection in May 2019, the local authority terminated their contract with the service. This resulted in nine people being moved out of the service. At the time of this inspection in June 2019, urgent reviews were being undertaken of all other local authority placed people with the view of finding alternative placements for them.

Why we inspected

We received concerns in relation to the management of risk and the governance arrangements. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service since our last inspection in May 2019 which indicated we did not need to reinspect the other Key Questions of Effective, Caring and Responsive. Ratings from the previous comprehensive inspection for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains inadequate. This is based on the findings at this inspection. We found evidence that people were at risk of harm from these concerns. Please see the Safe and Well-led sections of this full report.

Following our inspection, the provider took some action to mitigate the risks found.

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

Enforcement

At this inspection, we have identified breaches in relation to the safe care and treatment of people, the governance of the service and the provider’s regulatory responsibilities.

Our findings at this inspection confirmed the actions we took following the comprehensive inspection completed in May 2019 where serious and widespread concerns were found. Following that inspection, we took urgent enforcement action to restrict admissions into the service. Further enforcement action was taken which cannot be reported on at this time.

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 continue to closely monitor information we receive about the service, and work with partner agencies, until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Felmingham Old Rectory provides residential care for up to 41 older people. At the time of this inspection there were 30 people living within the home. All of these people were living with dementia and few could tell us verbally about their experiences of living in the home.

The accommodation is over two floors of a period building with a number of communal areas including lounges, a dining room and two conservatories. Some bedrooms have en-suite facilities.

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.

At our last inspection in October 2015, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to cleanliness, infection prevention and control issues and the governance of the service. At this inspection, carried out in October 2016, we found that the provider had made sufficient progress to no longer be in breach of the regulations.

The provider had processes in place to mitigate the risk of employing staff who were not suitable to work in the service. Staff received an induction, ongoing training, regular support and appraisal of their performance.

People benefited from receiving care and support from staff that told us they were happy in their roles, felt valued and listened to. Staff morale was good and they demonstrated team working abilities. There were enough staff to meet people’s needs.

Staff demonstrated a kind and patient approach when delivering care and support. They demonstrated respect and empathy. People were supported to remain as independent as possible and encouraged to make their own decisions.

Care was delivered discreetly and people’s dignity and privacy was maintained. Staff were aware of confidentiality and took steps to protect this. People had the freedom to spend the day as they wished and were supported to do this.

Processes were in place to help reduce the risk of people experiencing abuse. Staff had received training in this topic and demonstrated knowledge of how to prevent, protect, identify and report abuse.

The individual risks to people had been identified and appropriate measures had been implemented to manage these. The service encouraged positive risk taking. Accidents and incidents had been robustly recorded and analysed to identify any trends in order to mitigate future risk.

The risks associated with the building and work practices had been assessed and checks were in place to help mitigate the risks associated with these. Robust maintenance checks were in place and comprehensively recorded. An emergency plan was in place to manage adverse events.

People received their medicines as the prescriber intended. The service used an electronic system to manage and administer people’s medicines that assisted in mitigating risk. Staff had received training in this and had their competency to perform this task assessed.

The service had introduced infection prevention and control leads and had made improvements in their processes since our last inspection in October 2015. Further improvements were still required and the service had a development plan in place to achieve this.

Improvements had been made in making the environment more stimulating for those people living with dementia. The garden had been refurbished and was accessible. People had freedom to move around the home and gardens.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service had made appropriate referrals for consideration to legally deprive some people of their liberty and care and support was being delivered in ways that did not overly restrict people.

Care plans had been developed in order to provide person centred care and they were individual to people’s needs. Regular evaluations and reviews had taken place to ensure any changing needs were met.

Staff knew the likes, preferences and concerns of those they supported. They were able to tell us about people’s life histories, needs and personal circumstances. We saw that staff knew how to reassure and comfort people when they became upset. People received regular stimulation and interaction.

People received enough to eat and drink and had a choice in this. Snacks and a choice of drinks were available throughout the home. The service made prompt and appropriate referrals to a wide range of healthcare professionals as and when required. The healthcare professionals we spoke with told us that the service followed their recommendations and that staff had good knowledge of the people living in Felmingham Old Rectory.

The home had a comprehensive system in place to monitor the quality of the service and drive improvement. They had identified that further improvements were required in relation to the environment of the home and a plan was in place to achieve this. Complaints were investigated and responded to appropriately and they were used to develop the service further.

The registered manager and senior management team had a good overview of the service and processes were in place to ensure this. People told us that the management team were supportive, approachable and had worked hard at driving recent improvements.

Following our inspection on 31 May 2013 we required that the provider produce an improvement action plan. This advised us that a refurbishment and redecoration programme was scheduled to commence in July 2013 which would be completed in six weeks. This had not happened. We were advised by the regional manager that work would now be commencing in June 2014 and that the refurbishment project was out to tender.

However, the old conservatory had been replaced and the garden had been tidied. The bathrooms and toilets were of a satisfactory standard of cleanliness. Minor maintenance issues noted from the previous inspection had been resolved. During this inspection a fire installation contractor was on site carrying out an upgrade to the current system.

We were satisfied that progress had been made and there was a commitment to carry out substantial improvements to the premises.

People's care records and assessments were comprehensive and up to date. We saw staff supporting people appropriately. We observed a relaxed and friendly atmosphere in the home and it was clear that people trusted the staff supporting them.

Staff were appropriately trained and received regular supervisions and appraisals.

An effective complaints process was in operation and complaints were responded to promptly, with investigations being undertaken if necessary.

The premises required substantial improvement to bring parts of it up to a modern standard. The current provider took over in October 2012 and lot of the work required had been outstanding for a considerable period prior to this. Whilst there were indications that work would be commencing there was a considerable amount to be done. We also found routine maintenance and cleaning lacking in some areas.

We found better information within care plans that were acted upon and reviewed. People were being offered the support that was correct for them.

On walking around the building we found a number of bedrooms that had been improved upon by the removal of stained carpets, the replacement of furniture and the purchasing of new soft furnishings. There was no unpleasant odour detected when walking around the home and areas were tidy and clean.

Audits that had been completed showed what action was required to improve the service and people were consulted about the quality of the service.