This inspection took place on 5 September 2018 and was unannounced.

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 c

Felbury House is a care home without nursing for 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 another care home without nursing for a maximum of 24 older people in Woking, Surrey.

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 w

Felbury House is a residential home which provides care and accommodation for up to 28 older people with physical health needs some of who are living with dementia. One person said “The staff are very caring people.” Respite care is also provided (Respite care is short term care which gives carers a break by providing care away from home for a person with care needs).

On the day of our inspection there were 28 people living in the home. This inspection took place on 16 September 2015 and was unannounced.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People told us care staff treated them properly and they felt safe. We saw staff had written information about risks to people and how to manage these in order to keep people safe. Staff had received training in safeguarding adults and were able to tell us they knew the procedures to follow should they have any concerns.

Care was provided to people by a sufficient number of staff who were appropriately trained. People did not have to wait to be assisted. One staff member said they had never had a role in care work before and were nervous about manual handling of people, but the training was good and gave them the confidence to move people in a safe way.

Processes were in place in relation to the correct storage and auditing of people’s medicines. Medicines were administered and disposed of in a safe way.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The registered manager and staff explained their understanding of their responsibilities of the Mental Capacity Act (MCA) 2005 and DoLS and what they needed to do should someone lack capacity or needed to be restricted to keep them safe. However we identified that the process to assess someone who lacks capacity and support them to make decisions was not in place.

People were provided with homemade, freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night. The registered manager said that people could regularly go out for lunch if they wished.

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed positive interactions and it was evident people enjoyed talking to staff. People were able to see their friends and families as they wanted and there were no restrictions on when people could visit or leave the home.

People and their families had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. Staff ensured people had access to healthcare professionals when needed. For example, details of doctors’ and opticians’ visits had been recorded in people’s care plans.

People’s views were obtained by holding residents’ meetings and sending out an annual satisfaction survey. Complaint procedures were up to date and people and relatives told us they would know how to make a complaint if they needed to.

The provider had quality assurance systems in place, including regular audits on health and safety, infection control and medication. The registered manager met CQC registration requirements by sending in notifications when appropriate. We found both care and staff records were stored securely and confidentially.

We saw information that the people who used the service had been fully involved in the initial planning process of their care and support. The people who used service had their needs assessed by appropriately trained staff prior to them being offered a place at the service. Care and treatment was planned and delivered in line with individual care needs.

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.