About the service

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

The inspection took place on 20 and 21 October 2016 and was unannounced.

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

We conducted this inspection to follow up concerns identified at our previous inspection carried out on 31 May 2013. These concerns related to the premises. We found that whilst some areas had been improved, both externally and internally, further progress was due to be made.

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.

One person we spoke with living at the home told us “Staff are very good, very kind and very brilliant. I wouldn’t want to live anywhere else.” One person had moved to another home to live nearer to their relative. The relative had written a letter of thanks to the home and said that by the time their family member left Felmingham Old Rectory they had been on far less medication than when they arrived, attention had always been given to their appearance and they always looked well.

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.

This inspection visit took place following an inspection in July 2012, to see what improvement had been made. We found the home had made vast improvements to the environment with plans for many more improvements over the next four months.

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.

We spoke with several people living in the home. However, many of those people were unable to verbally communicate their experience of using the service. We spent time, in the communal areas, observing their experience and responses to the care given. We spoke with one visitor who told us they were satisfied with the service provided to their relative. They said the home kept them up to date with any relevant information about the person they were visiting and they seemed happy when they saw them. They said staff treated them well and that people seemed to be well cared for.

This inspection took place on 06 and 07 October 2015 and was unannounced.

Felmingham Old Rectory provides accommodation and care for up to 41 people. At the time of our inspection 30 people were living in the home. Many of these people were living with dementia and few could tell us verbally about their experiences of living in the home.

A registered manager was 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.

This inspection identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to cleanliness and infection control concerns and the governance of the service.

People’s rooms and ensuite facilities were not always clean. We found several rooms that required attention despite two or three housekeeping staff being on duty during the two days of our inspection. Poor monitoring of the service meant that these concerns were not acted upon, even though they had been identified during the last infection control audit.

Due to poor communication some staff were not aware of the extent of their accountability or responsibility for certain tasks which lead to these tasks not being carried out effectively or not being carried out at all. The manager had not ensured that tasks that had been delegated to other staff had been carried out. Training and support had not been provided to the activities co-ordinator which resulted in people not receiving adequate social support.

You can see what action we told the provider to take at the back of the full version of the report.

The environment, both internally and externally, was not conducive or stimulating to people living with dementia.

There were enough staff on duty to meet people’s needs. Staff underwent a robust recruitment process to ensure the risks of employing unsuitable staff were minimised.

People had good access to a range of healthcare professionals. Staff were quick to identify if someone was unwell and sought advice and support promptly. They implemented instructions from healthcare professionals in a timely manner to ensure people received the support they needed.

Staff were kind and friendly but did not always act promptly to support people’s dignity by ensuring their clothes were clean. They knew the people they supported well and were able to speak with us about people’s needs and preferences in detail.

Improvements were required to ensure that the service sought and acted upon the views of people’s relatives and staff in how the service provided care and support for people. This was particularly important because most people living in the home were unable to communicate in any detail about their wishes or preferences.