Falstone Manor

People’s experience of using this service and what we found

People felt safe living in the home and receiving support from staff. They were happy, comfortable and spoke highly of staff members and management. One person told us, “They [staff] are always there and are excellent in my point of view. I can have a chat with them anytime.”

Infection control processes were embedded into the service and staff followed government guidance in relation to infection control and prevention practices, in particular, relating to COVID-19. Staff wore appropriate PPE when supporting people. Staff and visitors to the home had their temperature checked and completed a risk assessment. Staff and people were taking part in a regular COVID-19 testing programme. There were enough staff to meet people’s needs.

Staff supported people to meet their social needs. People had access to a range of either one to one or group activities in the home and could choose what they wanted to do. Staff also supported people to maintain relationships important to them.

The home was well managed. People and relatives were complimentary about the home and felt the manager was very approachable and open. An effective quality assurance process was in place.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 10 December 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about staffing levels, activities and overall management of the home. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe, Caring and Well-Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Falstone Manor on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Falstone Manor is registered to provide accommodation for up to 51 people with residential and nursing care needs. 48 people were using the service at the time of the inspection.

People’s experience of using this service and what we found

At the previous inspection, medicine records were not always up to date and audits had not always identified or actioned issues in a timely manner. At this inspection, we found these issues had been addressed.

People and family members told us the service was safe. Appropriate arrangements were in place for the safe administration and storage of medicines. Risks were well managed and checks were carried out to ensure people lived in a safe and clean environment.

Although we received mixed responses regarding staffing levels at the home, our observations and evidence viewed did not raise any concerns. A dependency tool was used to calculate staffing levels and regular analysis was carried out into call bell response times.

The provider had an effective recruitment and selection procedure and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

People’s needs were assessed before they started using the service. Staff treated people with dignity and respect. They helped to maintain people’s independence by encouraging them to care for themselves where possible.

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 provider had a complaints procedure and people were aware of how to make a complaint. An effective quality assurance process was in place. People, family members and staff were regularly consulted about the quality of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 20 December 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Falstone Manor is a care home with nursing. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Falstone Manor can accommodate 51 people in one adapted building across three floors. It is situated in a residential area of Roker, Sunderland near the coast. At the time of the inspection 46 people were resident, some of whom were living with a dementia.

At our last inspection in September 2017 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to Good Governance and Staffing. Following this inspection, the provider sent us an action plan which included detailed actions and dates by which actions would be achieved. As part of this inspection we were able to evidence some improvements been made as a result of those actions taken.

The service did have a registered manager who had been in post since January 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 2008 and associated Regulations about how the service is run.

The provider had a robust recruitment process in place to ensure that only suitable people were employed to care for vulnerable people.

Staff had received training in safeguarding practices and were able to describe how they would keep people safe from harm and abuse.

Regular risk assessments and care plan reviews were carried out to ensure that people’s care was appropriate for their needs.

The provider had a good system in place for recording any incidents and accidents which allowed for analysis of any emerging trends. Any issues highlighted were addressed and where applicable involvement from other Health Care Professionals was sought.

Medication records showed that medication was handled safely, including the receipt, storage, and disposal of medication. People we spoke with told us they received their medication on time. However, we identified an ongoing issue with how some people’s medication was documented in terms of administration.

The home was clean, bright and free from malodours. We saw evidence of regular environmental checks to ensure the home was clean and tidy. Records showed that regular health and safety premises checks were carried out.

Staff training records showed that staff had received regular training which provided them with the skills they required to look after people safely. Staff also received regular supervision sessions with their manager.

People were supported to maintain a good level of nutrition and hydration. People we spoke with were complimentary regarding the food served. People had access to a range of healthcare services such as dieticians, GPs and hospital appointments.

People and their relatives we spoke with praised staff for the care they received. They told us that staff were thoughtful, respectful and maintained people’s dignity at all times.

Prior to any admission to the service, the provider carried out a detailed assessment to ensure that the service was able to meet people’s needs in terms of their care and well-being

The provider provides a range of social activities both within and outside of the home with a dedicated activity co-ordinator employed to oversee this.

Regular meetings took place for people, relatives and staff.

The provider has a range of quality assurance systems in place which included a variety of in-house monthly audits. In addition to these, the service is also inspected by the provider’s own quality assurance team which identifies areas of risk and supports improvements . However, a review of the audits identified that not all audits had identified issues found on inspection and further improvements to audits were required.

Feedback is sought from people and their relatives via monthly meetings along with an annual questionnaire which is sent out for people to complete.

A complaints policy and procedure was in place.

Falstone Manor is a three storey home that provides personal care, nursing care and support for up to 51 people, some of whom are living with dementia. At the time of the inspection there were 45 people using the service.

The home did not have a registered manager. The manager registered with CQC had left in August 2016. Since this date there had been at least three temporary managers in post. In order to stabilise management arrangements at the home the provider had been proactive in arranging for an experienced registered manager from an adjoining home to provide leadership to Falstone Manor. At the time of this inspection this situation was under review and due to be evaluated to assess the potential outcome on the home and people using the service. 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 was triggered due to a number of concerns we received about inadequate staffing levels. These included people having to wait considerable periods of time for assistance; people being left unsupervised in communal areas; people left in bed or put to bed early due to a lack of staff and no personalisation or choice. Although we did not find evidence that people were put to bed early, we observed some examples of the other concerns raised with us. For example, we saw

people were often left unsupervised in communal areas, sometimes for significant periods of time. People and relatives gave us positive feedback about the caring nature of the staff providing their care, however they told us due to staff shortages they did not always receive the personalised care they required. We also saw examples of people having to wait a considerable amount of time for assistance.

Without exception people, relatives and staff told us staffing levels at the home were insufficient to meet people’s needs appropriately. People described to us how they often had to wait for assistance. Staff members confirmed they were unable to help people in a timely manner. People, relatives and staff had consistently raised concerns about staffing levels since January 2017. Following out inspection the provider confirmed that people’s dependency levels and staffing levels were regularly reviewed. The provider us with a copy of the most recent review and details of a plan to trial a change to how staff were deployed in the home.

People and staff told us there had been numerous temporary managers and a lack of leadership to make improvements to the care provided at the home.

Staff members were not receiving regular supervisions and appraisals. Some staff said they did not always feel supported, particularly in relation to staffing levels. Moving and assisting training was overdue for some staff.

Some care records were inaccurate. Although people’s care plans were in the process of being updated, progress to date had been limited. Periodic reviews of people’s care were also overdue for most people.

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

Safeguarding concerns were dealt with effectively with appropriate referrals made to the local authority safeguarding team. Staff had been trained in safeguarding and had a good understanding of safeguarding and the provider’s whistle blowing procedure.

Medicines were stored and administered safely. Staff had received the training they needed and medicines records were completed accurately.

There was a system of health and safety checks to help ensure the building and equipment were safe for people, such as checks of fire safety, water systems and specialist equipment. The provider had developed plans to deal with unforeseen incidents or emergencies. Personal emergency evacuation plans (PEEPs) had been written which described people’s support needs in an emergency situation.

Accidents and incidents were recorded and monitored. Reviews were carried out to check the correct action had been taken and to identify patterns or trends.

The provider had effective recruitment procedures in place to ensure the safe recruitment of staff. This included pre-employment checks to assess the suitability of new staff before they started working at the home.

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.

We observed people were supported to have enough to eat and drink in line with their needs. Where people required support or specialist equipment this was provided.

Care plans were in the process of being reviewed and updated. At the time of our inspection this review had not yet been completed.

Organised group activities were provided each day, however people in communal areas often lacked engagement and stimulation.

People and relatives knew how to complain if they were unhappy with the care provided at the home. Previous complaints had been logged and investigated.

There were opportunities for people, relatives and staff to share their views about the service.

The manger and deputy manager had implemented the provider’s quality assurance system and regular audits were being completed.

Falstone Manor is a three storey home that provides personal care, nursing care and support for up to 51 people. Some of whom are living with learning or physical disabilities. At the time of the inspection there were 49 people living in the service.

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.

Staff had a good understanding of safeguarding and whistleblowing, and were confident in their role of safeguarding people. Safeguarding concerns were investigated with outcomes fed back to staff. Where necessary, practices were changed in order to prevent reoccurrences.

Medicines were managed safely, effectively and in a way which reflected people’s individual needs. All records were up to date and fully completed, with medicine audits being carried out regularly. Staff competency to administer medicines was regularly checked.

Records were kept for all accidents and incidents including details of investigations, outcomes and action taken. The registered manager analysed accidents and incidents to identify any trends and put additional measures in place to reduce the likelihood of any reoccurrences.

People had risk assessments in place and associated care plans were clearly linked and updated in line with risk assessment reviews. There were also general risk assessments regarding the premises and environment.

Staff were recruited in a safe and consistent manner with all necessary checks carried out. Staffing requirements were assessed in line with peoples’ needs. The registered manager also considered the skill mix and gender of staff. From staffing rotas we saw staffing levels were consistent. At the time of the inspection the home had two vacancies for night time nurses. Those roles were being covered by two agency nurses who had both worked in the service for at least 12 months to ensure consistency for people.

Staff received regular training on mandatory subjects such as safeguarding adults, management of medicines and moving and handling. They also received training on specific subjects relating to people's needs. The registered manager was pro-active in encouraging staff to complete training as and when it was due. They had introduced an internal competition whereby staff were split into three teams and by the end of the eight week period, the team who had completed the most training assigned to them won the competition and a prize.

Staff felt supported in their roles. They received regular supervisions as well as direct observations and annual appraisals. Staff felt these were useful in discussing training and development wishes.

We observed people and staff during mealtimes. People were enjoying their meals, some independently and others with support from staff. Menu choices were available for people and support provided by staff was caring, compassionate and at an appropriate pace for each person

We saw and people told us staff were "lovely" and "nice" and that they were friendly and chatty. Staff spoke to people in a gentle and friendly manner, referring to them by name. People responded positively. Throughout the inspection there was laughter and smiling from people in the service.

Care plans were personalised, detailed and contained people’s personal preferences, likes and dislikes. Care plans were up to date and reflective of each person’s individual needs.

There was a wide range of activities available both within the home and in the community for people to become involved in and enjoy. The home had a full time activity co-ordinator and two volunteer activity co-ordinators who worked with people and family members to design activities programmes tailored to people using the service both as a group and individually.

The provider had a robust quality assurance and audit schedule in place which was carried out in practice. This ensured the quality of the service provided was assessed and monitored from every aspect and appropriate action was taken to improve and develop the service where possible.

Is the service safe?

The home had systems in place to keep people safe. When people were admitted attention to their needs was demonstrated, and suitable risk assessments were generated. The environment was clean and hygienic, and equipment was in good repair. Night time staffing was more of a concern as not all agency staff used had the right capability to deliver essential care.

Is the service effective?

The staff we spoke with understood the needs of each person. One person said, 'The staff work hard and are wonderful, their attention saved my life as I was very ill when I came in.' Observations of staff showed that they knew what people wanted and made sure they received the care necessary to keep them well.

Is the service caring?

Observations and feedback showed that the staff within the home were caring and attentive. Systems within the home identified people's needs and how to meet them. One person said, 'My relative has been in other places, but its better here. The staff are very patient and considerate'. Another person said 'I couldn't fault the staff they are so caring.'

Is the service responsive?

Systems within the home showed it was responsive to changing needs. Staff were observed offering choice in a variety of ways giving people the chance to make decisions for themselves. Records showed that care plans were changed when people's needs changed. The dietician commented, 'The home is careful to adhere to our guidance.'

Is the service well-led ?

There was a new manager in place who was experienced. She was in the process of improving the home. One person said, 'The new manager is making a difference to the home there is a better atmosphere now.' Another person said the home was 'very well run'. The manager was reducing the use of agency staff and there were four nurses and four care staff waiting for their final checks before commencing work at the 2 homes.

We saw on the day of our visit, there were sufficient qualified, skilled and experienced staff to meet people's needs. The provider had a system for checking the quality and safety of the service and records were maintained and held securely.

We spoke with two relatives who were positive about the care their relatives received. Both relatives we spoke to felt their relative was safe but expressed a wish for more staff at the home.

We found people's privacy, dignity and independence was respected and people experienced care, treatment and support that met their needs and protected their rights. People who used the service were protected from the risk of abuse and the provider had an effective system to regularly assess and monitor the quality of service that people received.

The provider could not demonstrate there were enough qualified, skilled and experienced staff to respond to people's needs.