Fulford Care & Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last inspection, this key question was rated requires improvement, improvements have been made and this key question is now rated good and is no longer in breach of regulations. People were protected from the risk of harm and abuse, staff understood how and who to report concerns to. Where people required applications to be made in their best interests under the Mental Capacity Act 2005, these had not always been made in a timely way. The registered manager addressed this concern immediately. People were involved with managing their care and support, including risks. Staff were provided with clear guidance to support people safely. There were now enough trained and skilled staff deployed to support people, staff were recruited safely. Medicines were now stored and managed safely. Audits were conducted to highlight areas of concern. Staff and managers learned from audits, adverse events and near misses.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager told us they had prioritised building good relationships which meant open channels of communication. People and their relatives told us they would be listened to if they had any concerns or suggestions. A relative told us, “Staff tell me about everything, any issue I talk to them and it’s all sorted... We are involved and we get a weekly phone call. We have a meeting every couple of months with our parents. They (management) keep us informed and involved. I can’t fault it.”

The registered manager was keen to drive improvements through learning from feedback, incidents and near misses. The registered manager described how they were creating an open culture to encourage staff to admit mistakes for growth and development, also to give suggestions, views and ideas. A staff member told us, “We have meetings and changes are made, for example, we might have some different paperwork to complete or we might have extra monitoring to do for the residents, this might be because of falls or something.”

Processes were in place to monitor and review incidents, accidents, falls and near misses. Action was taken where required, for example, where a medicine error had been made, staff members were mentored and coached and additional checks were undertaken to prevent the error from reoccurring.

People told us their wishes and needs were considered before they moved into the service. People had access to external health advice and attended appointments. One person told us, “I’m very happy here. Everything I like or need is here. I feel very relaxed. It’s very lovely. I couldn’t imagine being back in my flat and living alone. I was frightened all the time; I’m not frightened here. If I woke up and felt unwell, I’d get help straight away. I don’t feel worried. I like it here. It’s my home now.”

Health and social care professionals gave positive feedback about the service and said managers and staff worked with them so people received a safe and effective support. Comments included, “I have observed care staff to take a good person-centred approach adapted for each person’s individual needs. I have really felt that care staff are caring and are willing to go the extra mile to ensure that patient’s needs and wishes are met.” And, “The management team are always open to suggestions, and I feel their communication has improved. When supporting any home, I like to work with the staff within the home as they will be the ongoing care provider. They know the residents best and therefore; we work together to enhance the best ways to support an individual within the home. They appear happy to trial different management techniques, equally advising what they have tried before for a resident and what wasn’t appropriate.”

Staff were aware of when people had health or social care professional input. When discussing the pathway for people staying for a short term assessment period, a staff member told us, “We work with the managers and social workers for new admissions, we call the hospital to speak to them (people), family or nurses for feedback. We have a discussion for how they would benefit from being at Fulford, the deputy manager will go out to see them so they can recognise a face when they come in. I work alongside the occupation therapists who also work in the community also. When they (people) leave Fulford the occupation therapist continues to work with them once they are home.”

People received a continuity of care when either admitted or discharged from the service. The majority of people lived at Fulford Care and Nursing Home on a permanent basis, however, some people stayed there for a period of assessment before returning to their previous homes. The admission process had recently been reviewed as a learning response to a safeguarding concern. Pre-admission assessments helped ensure people’s health and social care needs could be met by staff and that the service was right for the person, as well as the person being right for the service. People, their relatives, health and social care professionals were involved in the planning.

Staff and management had not always worked within the principles of the Mental Capacity Act 2005 (MCA). People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, this is through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Prior to our assessment, the registered manager had recognised that some people had not been assessed under the MCA for a DoLS application, they had planned to make applications for these people but had not prioritised this, this meant some people were potentially being unlawfully deprived of their liberty. We discussed the delay in applications with the registered manager who addressed the concern immediately. Where people had a DoLS in place, they were assessed appropriately and any conditions to their authorisations were being met. Systems to safeguard people from the risk of harm or abuse were in place and followed. The provider’s policy was clear for staff to understand should they have a safeguarding concern. Where safeguarding concerns were identified, they had been escalated to the local safeguarding team and CQC were appropriately notified. Safeguarding concerns were thoroughly investigated and lessons learned were shared with staff.

People were comfortable in the company of staff and felt safe, people and their relatives said if they had any concerns of safety they would speak with staff or management. One person told us, “Yes, the staff are very helpful and it’s very homely. If there’s a problem, if anything is wrong, you can talk one-to-one and it’s sorted out.”

Staff completed safeguarding training and demonstrated a knowledge of types of abuse and who they would report to if they had any concerns, this included within the service and to external agencies. A staff member told us, “We report any concerns to [registered manager] and the care team leaders. Outside the company we can speak to the CQC, police and West Sussex Council.”

We observed staff supporting people safely and with kindness. People who were subject to DoLS authorisations and applications appeared settled; we did not observe anyone trying to leave the home. People were able to go out in the garden as they wished and we observed people going out with their friends and family.

People were involved in care planning so staff were aware of how certain conditions affected the person and how they wished to be supported. A relative told us, “[Person] is terrified of being hoisted, but they do it in a safe way. They tell her, ‘Hang on to this.’ It’s done safely.” Staff had completed risk assessments to enable a person to continue their enjoyment of gardening, the person told us, “I really get on well here, I like to be busy, and I do all sorts of things. We’re making the garden much nicer for everyone. I’ve planted tomatoes and those will go in the garden, we’ll eat them, the kitchen will use them.”

We observed a person was being supported to move into their wheelchair by use of a hoist, the person looked at ease with the staff who were supporting them safely, staff and the person were communicating throughout.

Risks to people’s health were assessed, mitigated and managed. For example, people who lived with health conditions, such as, epilepsy or Parkinson’s disease had appropriate care plans to guide staff on how to support them safely. People’s care records showed staff were following actions to reduce risks to people.

Risk assessments and the associated care plans provided details on how to safely support people. A staff member told us about how people are involved and said, “With the care planning, we ask them (people) directly as much as we can about how they like us to do things for them.” Another staff member said, “The managers do the assessments and the care plans are written. We get the chance to read them and if anything changes or if a resident tells us they want things done differently, we update them.”

Staff ensured the environment was appropriate for people. A staff member gave an example and said, “We make sure there is no clutter on the floor. We have one resident who is blind, we make sure we don’t move things round their room as they know where everything is.” The registered manager told us about the plans for the garden and said, “We are trying to get the gardens ready for spring and summer, new tables and chairs coming. More seats, parasols, more benches and more planters. We asked relatives to donate a plant, there’s a bird feeder going up. Important for relatives to sit out there with their loved ones. We have a gardening club every week.”

Regular health and safety checks were completed, this included of the general environment and equipment such as, hoists and stand-aids. The registered manager told us wheelchairs were visually checked over, there was no documentation to support this, however, they introduced a new check list and schedule during the assessment. Risk assessments were completed for fire safety and risks, such as, legionella.

People had bespoke wheelchairs and mobility aids to safely access and use areas the service. Where needed, aids and adaption were made for people’s comfort and safety. A person told us, “I’ve got these (handles) on the side on the bed. It’s lovely because I can hang on to the side of the bed. I can’t fall out of the bed and I hang on to them to move. It’s marvellous if you’ve got a bad spine.”

Staff used equipment to promote people's safety and independence, for example, some people were given adapted cutlery and crockery to enable them to eat and drink without assistance. We saw accessible planters in the gardens which were at a height for people to use if in a wheelchair.

Improvements had been made since our last inspection. We observed there were enough skilled and experienced staff deployed to support people and keep them safe. Staff were available and responded to people’s requests quickly. Staff had time to chat to people socially. Call bells were answered promptly. Staff deployment was now overseen by a member of the management team, this meant staff breaks were staggered to ensure sufficient numbers at all times.

At our last inspection, we found shortfalls around the deployment of staff. At this assessment improvements had been made; the call bell audit did not provide an effective analysis of trends, the registered manager showed us a more comprehensive audit which had recently been used and told us they planned to continue using it. Management had planned the rotas and staff allocations in advance and oversaw staff allocations to ensure appropriate skills mix so people were well supported. Staff were recruited safely, the management team ensured pre-employment checks had been carried prior to their appointment. New staff completed an induction period and had a period of shadowing more experienced staff to ensure their knowledge was embedded.

Although they spoke highly of staff, people gave mixed feedback about staffing levels in the service. Comments included, “Some days there is (enough staff), and some days there isn’t.” Another person said, “Staff are very helpful, if I need anything I just ask. They’re very busy of course but I can always find someone, even if I go to the office.” Despite the varied feedback about staffing levels, people told us staff answered their call bells promptly. The registered manager said they walked around the service daily and held casual conversations with people and had not received any complaints in respect of the number of staff working.

Staff also provided mixed feedback about the staffing levels, staff said shortness was due to unexpected absenteeism. A staff member told us, “Some days short, some days over, we do the best we can. Agincare have never been great at bank staff but they are working on this. Absences have decreased over the recent times but we still do have them. We have staff pick up more shifts now than ever as the atmosphere is nicer.” Another staff member said, “I don’t think there are enough staff, I will always defend Godwyn (dementia suite), when allocations are done, the floors have to be covered. I don’t think this is [registered manager’s] fault, this might be due to sickness. Not having agency can impact us.” The registered manager showed us they had sourced a local agency to provide care staff at short notice. Staff did not appear to know this; the registered manager told us they would reiterate this to staff. Staff felt supported in their roles and received supervision and regular training. Some staff took on a ‘champion role’ which meant they trained in areas of interest. The champions would cascade their knowledge to other staff and provide ‘micro training sessions’. For example, a staff member ran sessions in care planning, staff attended and showed a wish to become involved with the care planning for people. They took turns reading care plans and adjusted to suit the individual on a person-centred basis.

Staff had received training in infection prevention and control. Some staff had received additional training to become infection control champions. Staff shared with us improvements they had made through suggestions to the registered manager. For example, the placement of certain cleaning products on shelving and the use of different coloured aprons.

Staff received training in infection prevention and control techniques. The provider's infection prevention and control policies and procedures reflected current guidelines, the policy was highlighted as ‘policy of the month’ and had recently been discussed at the staff meeting. Staff and management understood where and how to seek advice should they have an outbreak.

The home was generally clean, housekeeping staff followed schedules to ensure each bedroom and communal space was cleaned daily. The building was old and parts of the environment was difficult to clean, for example, the stairwell was high and had cobwebs formed on the ceiling. The registered manager advised this had already been identified and a deep clean had been organised. We observed staff using personal protective equipment (PPE) appropriately.

People and relatives stated they were satisfied with the cleanliness at the service. A person commented, “Considering the amount of people walking through, I think it’s very clean.” Another person said, “Yes, it’s very clean. A gang of cleaners come in every evening.”

Staff were trained and assessed as competent to administer medicines safely. Guidance was in place to help staff understand when to give people their ‘when required’ (PRN) medicines and what dosage. Staff said they felt their training equipped them with the knowledge to safely administer medicines. One staff member said, “I do apply cream to residents, for example, Epimax. We have the body maps so we know where to apply the creams.”

People received their medicines as prescribed, those who required time specific medicines received them at the right time each day. A person told us, “They have their own group of nurses. First thing in the morning they bring the medication and at lunchtime and teatime, the same, and at 20:00 or 21:00 when you’re in bed. I’m quite happy with it.” We observed people were administered medicines respectfully in the way they wished, for example, a person’s medicine profile sheet stated they liked to take pills from a pot, we saw this was offered to them. Another person who resided in the dementia suite was offered their medicines, they started to sing a song about pills and the nurse sang with them.

At our last inspection management and storage of medicines were not always safe. At this assessment improvements had been made. New arrangements were in place for storing medicines. Improvements had been made to record keeping and to the information that was available to staff. Systems were in place to ensure that when additional medicines such as antibiotics were prescribed, these were obtained promptly meaning there were no delays in commencement of a new medicine. Staff had worked to forge close working relationship with the local surgery to avoid miscommunication and delays.