Furze Hill House is a service that provides residential care and support for up to 40 older people some of whom may be living with dementia. At the time of this inspection the service was full with a waiting list in place. The accommodation is over two purpose built floors that are accessible by a lift. There are a number of communal areas and the service has an accessible garden.

At the last inspection carried out in January 2016, the service was rated Good. At this inspection carried out in November 2017 we found the service remained Good.

Following our last inspection in January 2016, the service had been in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the risks associated with medicines administration and management had not been fully mitigated. At this inspection carried out in November 2017 we found that improvements had taken place and that the service was no longer in breach of this Regulation.

Effective processes were in place to help reduce the risk of harm or abuse to people both on an individual basis and collectively. Regular maintenance had taken place on the premises and equipment and adverse events such as the outbreak of fire had been assessed and mitigated. There were enough staff to meet people’s needs on an individual basis who had been suitably recruited.

Staff had received the training and support to deliver appropriate care to people’s assessed needs. Their practice was monitored and staff had the opportunity to develop their skills and knowledge. People’s nutritional needs were met and they had access to healthcare professionals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The premises had been designed in consideration of those that used it and included clear signage and appropriate decoration.

Staff demonstrated a kind, caring and professional approach to the delivery of care and support. They were respectful towards those that used the service and each other. They supported people to maintain their dignity and independence and confidentiality was preserved. People had been included in the planning of the care they received and staff sought consent before assisting people.

A person centred service was delivered that took into account all aspects of people’s lives. Information had been sought on people’s life histories to help staff build meaningful relationships with them. End of life care was delivered sensitively. The service took complaints seriously and saw them as opportunities to further improve the service.

The service was well organised, well-led and appropriately managed. There was a registered manager in post who had experience, knowledge and understood their responsibilities and accountability. Systems were in place to monitor the quality of the service and these were effective at ensuring a good quality service was delivered. People’s feedback and suggestions were consistently sought on the service, listened to and acted upon as appropriate.

Further detailed information can be found in our full report.

This inspection took place on 18 and 21 January 2016 and was unannounced.

Furze Hill House is purpose-built and provides residential care for up to 40 people, some of whom may be living with Dementia. Accommodation is over two floors and all rooms have en-suite facilities. The home has a hairdressing salon, café area and chapel on site. At the time of the inspection, 37 people were living in the home.

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 this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people’s medicines were not managed in a consistently safe manner. You can see what action we told the provider to take at the back of the full version of this report.

People received care and support from staff who had the skills and knowledge to perform their roles. Staff were well-trained and safely recruited. Staff were happy in their roles and felt supported by the management team. The culture was one of openness and reflection with a focus on the development and improvement of the service.

The service has robust procedures in place to prevent and protect people from the risk of abuse. Staff understood the types of abuse that could occur and how these may present in the people they supported. They knew how to report any concerns they may have. People were protected from harm as risks to themselves and the premises had been identified, assessed and reviewed on a regular basis.

Medicines were not safely managed in a consistent manner. The recording of medicines administration put people at risk as it was not consistently accurate or complete. The service failed to identify that a person required medical treatment in order for medicines to be safely administered. The service stored medicines appropriately and safely.

Staff demonstrated that the training, support and development they had received contributed to people receiving compassionate and individualised care. The service encouraged staff to gain qualifications and improve their skills and knowledge. Staff knew the personal preferences of those they supported and choice was actively encouraged.

People benefited from staff who were happy in their work and felt valued. Staff demonstrated good team working and effective communication. The service encouraged people to contribute to the development of the service.

Staff demonstrated a caring, compassionate and courteous approach when assisting people. They demonstrated respect between themselves and others. People’s dignity, privacy and independence were promoted.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. Although the service had not assessed people’s capacity in a time and decision specific way and staff’s knowledge was variable, the service had made applications to the supervisory body for them to consider whether a person needed to be legally deprived of their liberty. Staff fully understood the need for consent and gained this when assisting people.

People received care and support in an individualised way as their care plans were detailed, person centred and relevant to them as individuals. People’s needs had been identified, assessed and reviewed on a regular basis.

People had access to a variety of healthcare professionals that promoted their health and well-being. Staff sought specialist advice as required and acted upon recommendations. Staff had a good understanding of the health needs of the people they supported.

The home understood, and met, the social and leisure needs of the people living there. A variety

The people we spoke with told us they were happy living at Furze Hill House. One person said, “Staff treat you with respect and always speak nicely to you, but you can still enjoy being teased”. Another person described their experience as, “It's great here, like a four-star hotel”.

People told us that they were involved in making decisions about their care and treatment. One person told us, “They talked about my care plan and I know what’s in it”. Records showed that people were involved in planning their care wherever possible. People also said they enjoyed the food and that they had choice. One person with specific dietary needs described how the staff made sure they always got the correct food. We saw choices of food being offered at lunch time and people being assisted to eat their meal.

We looked around the home and saw that it was clean and tidy with no unpleasant odours. Staff were well trained about control of infection and processes were in place to ensure that the environment was hygienically clean.

We spoke with staff and looked at the records held about them. Appropriate checks were undertaken to ensure that staff were suitable to work with vulnerable people. Staff received training and support to do their job effectively.

People told us they knew how to complain and would raise concerns if they were unhappy. There was a complaints procedure in place and also a comments log for people to complete if they wished.

People told us they liked living at this home. One person said, "I like it here." Another person told us, "The staff are very kind." "I feel safe and I don't have any worries." People said they liked the staff and told us they were very kind and caring. They said that staff were always about except for when they were on their breaks. One person told us they were hoping, weather permitting, to go out for a walk with a member of staff during the afternoon.

People told us they could spend their day where and how they wished. One person said, "I can do what I like." People were seen in various parts of the home including the cafe area, main lounge and dining room. People were also spending time in their rooms and one person described how they were going to their room to do some art work.

People described how staff gave them choices and that these choices were respected. One person said, "They give me a bath and wash my hair before I go to bed. It's lovely." People told us they would speak with a member of staff if they had any concerns or worries. They were confident that staff would act in their best interests.

People told us they liked living at the home. They described the staff as 'exceedingly kind' and 'approachable'. One person said that staff were kind and respected the way she liked to spend her time.

People told us they felt involved in the planning of their care. One person described how she sat with her key worker to discuss how her care and support was provided and she signed to show she agreed.

People at the home told us their choices and preferences were respected. One person described how staff supported her to spend time as she wished and where she wished. She said she did not tend to join in activities because she preferred to spend her time quietly and this was always respected.

People told us they felt safe and trusted the staff. They said they knew how to complain if they were dissatisfied and they were confident they would be listened to and action taken as necessary.