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. Staff had a good knowledge of people’s needs and abilities which meant they provided safe and effective care.
Staff received essential training to meet people’s individual needs, and effectively used their skills, knowledge and experience to support people and develop trusting relationships. Staff told us the training they received equipped them to meet people’s needs.
There were enough trained and experienced staff to be responsive to meet people’s needs. People told us they felt safe living at Low Furlong and relatives supported this. Staff knew how to keep people safe from the risk of abuse. Staff and the registered manager understood what actions they needed to take if they had any concerns for people's wellbeing or safety.
The registered manager and care staff understood their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge and people’s records ensured people received consistent support when they were involved in making complex decisions, such as decisions around their personal safety or where they wanted to live. Staff gained people’s consent before they provided care and supported people to retain as much independence as possible.
People were supported to pursue various hobbies and leisure interests but this was an area the registered manager planned to further improve to ensure people continued to have a variety of activities that personally interested them. Thought was given to where people lived within the home so common interests and personalities benefitted those in encouraging new friendships and being able to share similar interests.
People received meals and drinks that met their individual dietary requirements. People received support from staff when they required it, and anyone at risk of malnutrition or dehydration, were monitored and if concerns were identified, advice was sought and followed.
People knew how to voice their complaints and complaints made had been resolved and lessons learnt to prevent similar issues reoccurring.
The home was clean, free of odour and staff wore personal protective equipment (PPE) at the necessary times. Regular spot checks and effective monitoring ensured standards of cleanliness were maintained. There had been no outbreaks of sickness or contagious illness since the home re-opened.
There was a clearly defined management structure that supported people and each other. The management team worked well together and were committed to providing a high quality service to people. The registered manager had a clear vision for the development of the service and demonstrated a commitment to implement best practice and increase links with the wider community. The registered manager and staff were passionate about delivering a good service and were working towards improving people’s experiences at the home.
The registered manager had submitted a Provider Information return (PIR) to us, they and the provider understood their legal responsibility to notify of us of important and serious incidents.
Further information is in the detailed findings below.