Archived: Felbury House

About the service

Felbury House is a residential care home providing accommodation and personal care to up to 30 people aged 65 and over, some of whom were living with dementia. At the time of our inspection, there were 24 people living at the service.

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

People told us they felt safe and that staff were kind towards them. Staff had received safeguarding training and knew how to recognise signs of abuse. Staff knew how to report concerns.

Staff were aware of risks associated with people’s care and ensured people were provided with the most appropriate care. Care plans including the management of risks were recorded in a comprehensive and person-centred manner. Plans were in place to protect people in the event of a fire.

We were assured the service were following safe infection prevention and control procedures to keep people safe.

People using the service, relatives and staff were complimentary about the management of the service. They told us they felt they could approach the leadership team if they had any ideas on areas of improvement of the service. Visiting healthcare professionals spoke of the positive culture and responsive management of the service.

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

Rating at last inspection

The last rating for this service was Good (published 4 December 2018).

Why we inspected

This was a targeted inspection based on the previous rating, the information we held about the service and in line with our transitional regulatory approach framework. Targeted inspections do not look at an entire key question, only part of a key question based on the information we have received about the service. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

This inspection looked at certain key lines of enquiry in the key questions of Safe and Well-led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has not changed following this targeted inspection and remains Good.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Felbury House 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.

The home can accommodate a maximum of 30 older people. There were 27 people living at the home at the time of our inspection. The home is operated by Grey's Residential Homes Ltd. The provider also operates a care home for a maximum of 24 older people in Woking, Surrey.

There was a registered manager in post at the time of our inspection. The registered manager had been appointed since our last inspection and completed their registration with CQC in February 2018. 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 and associated Regulations about how the service is run.

At the last inspection on 3 August 2017, we found the provider was breaching regulations in relation to safe care and treatment, person-centred care, consent and governance. People’s care was not always provided in line with the Mental Capacity Act 2005 (MCA). We served a warning notice about this issue. Suitable steps were not always taken to minimise the risks involved in people’s care. Medicines were not always stored in a safe environment and there was not enough guidance for staff about some people’s medicines. Some people had needs that were not reflected in their care plans, which meant staff did not have guidance to follow about how to meet these needs. The provider's quality monitoring systems were not effective in identifying shortfalls. After the inspection, the provider sent us an action plan telling us how they planned to make improvements.

At this inspection, we found that improvements had been made in all these areas. People’s care was provided in a safe way that was responsive to their needs. Medicines were managed safely and people’s rights under the MCA were respected. Effective quality monitoring systems had been developed, which had improved the management oversight of the service.

The provider, registered manager and staff had worked together to achieve these improvements, which had resulted in tangible benefits for people. For example, the number of falls had significantly reduced due to the falls prevention measures implemented at the home. These included exercises to improve balance and mobility and considering how people’s medicines may affect their risk of falls.

The provider, registered manager and staff had all attended training in the MCA to ensure they understood its principles and application. The tools used to assess people’s capacity had improved, which meant they were effective in identifying when people may need support to make decisions. People’s care plans were personalised and reflected all aspects of their care. Staff had clear guidance to follow about how to provide the care and support people needed.

The areas in which the home performed well at the last inspection continued to be its strengths. People and relatives praised the caring nature of staff, including when people neared the end of their lives. Many people and their relatives highlighted the welcoming, family atmosphere as an aspect of the home that they valued highly. People had developed positive relationships with the staff who cared for them and enjoyed their company. Many staff had worked at the home for some years and knew the people they cared for and their relatives well. Friends and families were encouraged to be involved in the life of the home

The provider and registered manager formed a strong leadership team and provided good support to staff. Staff were committed to providing high quality care and felt valued by the provider and registered manager for the work they did. Staff had the training and support they needed to perform their roles. They worked well as a team to ensure that people received good care.

The provider and registered manager encouraged feedback from people and their relatives and used this to improve the service. Residents’ and relatives’ meetings took place regularly and satisfaction surveys were distributed and collated. If complaints were made, they were investigated and responded to appropriately. Action was taken to address any concerns complainants raised. Staff and professionals involved in the home were also encouraged to give their views about how the service could improve.

Staff treated people with respect and supported them to maintain their independence. People had access to a wide range of activities and outings and to be involved in their local community. Staff ensured that no-one became socially isolated. People enjoyed the food provided and their views were considered when menus were planned. Relatives also provided positive feedback about the quality of the food and said they were encouraged to join their family members for meals. People’s nutritional needs were assessed and any specific dietary requirements were communicated by care staff to the chef.

People’s healthcare needs were monitored and they were supported to access medical treatment if they needed it. Staff had established effective working relationships with health and social care professionals to ensure all aspects of people’s care were addressed.

Staff were always available when people needed them. The provider’s recruitment procedures helped ensure that only suitable staff were employed. Staff attended safeguarding training and knew how to recognise and report abuse. Checks were carried out regularly to ensure the home and any equipment used in providing people’s care was safe. There were plans in to ensure people’s care would not be interrupted in the event of an emergency.

Further information is in the detailed findings below.

The inspection took place on 3 August 2017 and was unannounced.

There was a registered manager in post at the time of our inspection. 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 and associated Regulations about how the service is run.

At the last inspection on 16 September 2015, we found the provider was in breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Assessments had not been carried out to determine whether people had the capacity to make decisions about their care. Where decisions had been made by others about people’s care, there was no evidence that an appropriate process had been followed to ensure decisions had been made in people’s best interests.

Following this inspection, the provider submitted an action plan telling us how they would make improvements in order to meet the relevant legal requirements.

At this inspection we found that insufficient action had been taken to ensure that people received their care in line with the Mental Capacity Act 2005. The tool used to assess people’s capacity to make decisions was not suitable for this purpose. As a result, the tool was not effective in determining whether people had the capacity to make decisions about their care.

Applications to deprive people of their liberty had been made inappropriately. Applications for DoLS authorisations should only be made where people have been identified as lacking capacity to make decisions about their care and treatment. However applications had been submitted incorrectly for five people who had capacity to make decisions about their care. Although people were not being unlawfully restricted, the registered manager’s lack of understanding of their responsibilities under the MCA meant there was a risk that people’s legal rights could be breached.

Suitable steps were not always taken to minimise risks to people. Many people were independently mobile and staff respected their wishes to remain independent. Risk assessments had been carried out that identified many people were at risk of falling. However there was no evidence that effective action had been taken to address these risks, such as the development of falls prevention care plans. When falls or accidents had occurred, the provider had not taken prompt action to minimise the risk of further incidents. Accidents were recorded but not reviewed to ensure that measures were put in place to reduce the risk of similar incidents occurring again in the future.

People’s medicines were not always managed safely. Medicines requiring refrigeration were not stored appropriately and there were no protocols in place for people who had been prescribed medicines ‘as required’ (PRN).

Following the inspection, the registered manager contacted CQC to advise us of the action they had taken to address the concerns regarding falls prevention and medicines management. This included collating details of falls in order that themes could be identified and improving the documentation used to record incidents and accidents. The registered manager also confirmed that they had returned the medicines that had not been stored appropriately and developed individual protocols for all people prescribed PRN medicines.

Some people had needs that were not reflected in their care plans, which meant staff did not have guidance to follow about how to meet these needs. For example one person had been diagnosed with epilepsy but there was no care plan in place to inform staff how they should manage this condition. Two people had been identified as being at high risk of developing pressure ulcers. There was no care plan in place to guide staff about the care these people needed to maintain the integrity of their skin. One person had been identified as being at risk of depression but there was no evidence that action had been taken to address this risk.

The provider’s quality monitoring systems were not effective in identifying shortfalls. For example quality audits had failed to identify that there were no protocols in place regarding medicines prescribed ‘as required’ or that there was no suitable storage for medicines requiring refrigeration. The audit of accident records had failed to identify that no action had been taken following accidents to reduce the likelihood of similar incidents occurring in the future. People’s care was not being comprehensively planned.

People were cared for by kind staff who showed compassion towards them and their families. People, relatives and professionals all praised the care provided by staff. However we found that people’s overall experience of care was affected by the provider’s failure to identify where improvements were needed.

There were enough staff deployed on each shift to meet people’s needs. People told us they felt safe at the home because staff were available when they needed them. Relatives said staff responded to people’s care needs promptly and had time to provide people’s care in an unhurried way.

People were protected by the provider’s recruitment procedures. The provider made appropriate pre-employment checks to ensure that only suitable staff were employed. Staff understood their responsibilities in terms of safeguarding and knew how to report concerns if they suspected abuse. They had attended safeguarding training and were able to describe the different types of abuse people may experience.

The provider maintained appropriate standards of safety in the home, including fire safety. There were plans in place to ensure people would continue to receive care in the event of an emergency.

People were supported by staff who had received the training they needed to carry out their roles. Staff received regular one-to-one supervision which gave them opportunities to discuss their training and development needs. People were supported by a consistent staff team. Agency staff were rarely used which meant that people were supported by staff who were familiar to them and who understood their needs.

People enjoyed the food provided at the home and their views were taken into account when menus were planned. People told us they always had a choice of meals and could have alternatives to the menu if they wished. Relatives said their family member’s nutritional needs and preferences were known by the chef. They told us staff encouraged their family members to eat and drink to ensure they maintained adequate nutrition and hydration.

Staff monitored people’s healthcare needs and supported them to access medical treatment if they needed it. People told us they were able to see a doctor if they felt unwell and relatives said their family members’ health was monitored effectively. Care plans demonstrated that healthcare professionals were involved in people’s care where necessary.

People were supported by kind and caring staff. People had positive relationships with the staff who cared for them and enjoyed their company. They said staff treated them with respect and supported them to maintain their independence. Relatives praised the caring nature of staff and highlighted the friendly and welcoming atmosphere in the home, which they said benefited their family members.

People were supported to maintain relationships with their friends and families. There were opportunities for people to take part in meaningful activities and to go out into their local community. People were protected against the risk of social isolation because they were encouraged and supported to engage with others.

There were appropriate procedures for managing complaints and people knew how to raise concerns if they were dissatisfied. There had been no complaints received since the last inspection.

People told us the registered manager and senior care staff were approachable and they could always speak to the registered manager or a senior member of staff if they needed to. Relatives said the registered manager and staff maintained good communication with them about their family member’s care. They said their views about the home and the care their family members received were listened to and acted upon.

Staff told us the registered manager provided good support to the staff team and listened to any concerns they had. They said the registered manager valued them for the work they performed. The registered manager had established links with health and social care professionals and was aware of their responsibilities in terms of submitting statutory notifications when notifiable events occurred. Staff communicated information about any changes in people’s needs effectively and maintained daily records of the care people received.

During the inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of this report.

People told us that they were "very well looked after here" and "the staff consult me if any change in my care and have provided me with all the correct support they needed to remain comfortable".

People who used the service were protected from the risk of abuse, the provider had taken steps to identify the possibility of abuse and prevent abuse from happening. The home had a safeguarding procedure which made reference to the local authority safeguarding vulnerable adults from abuse providing guidance for staff to follow should an incident occur.

The service had procedures in place to ensure that staff employed were skilled in the delivery of care and had the correct checks to keep people safe. People we spoke to could not comment of the recruitment procedures of the home but they told us that they felt "very safe when the staff were assisting them and that they all appeared to know what they were doing".

The service had a well developed quality assurance (QA) policy in place to enable them to gain feedback from the people who used the service and their families or representatives.