Fryers House - Care Home with Nursing Physical Disabilities

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed 4 quality statements for this key question. People, relatives and staff told us people received safe care at Fryers House. Risks associated with people’s health conditions and support needs were well managed, but the quality of records was inconsistent. The registered manager had already identified this and was working on improvements. There were effective processes in place to learn from accidents and incidents and staff understood these. Records about some types of medicines needed improving. Despite this, people received their medicines as prescribed. Staff were familiar with people’s needs, and people told us their medicines were well managed. There were enough appropriately skilled staff to support people safely. Staffing levels were monitored, and care staff were being upskilled so they could support people with their health conditions when out of the home.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they could speak up. They said they had no concerns for their safety and felt informed about all aspects of their care. People and relatives told us staff listened to them and if anything had gone wrong, they acted to make improvements. For example, a relative said, “Initially at the start of the care, there were some minor issues but as we have got to know each other, all that has gone away.”

Staff told us how lessons learned from incidents were shared. Comments included, “We [nurses and management team] all sit down together and discuss it” and, “It depends on what happens, but we might have a quick handover with staff to make sure it doesn’t happen again, and they [staff] know what happened and why. Then we would discuss it at end of shift handover and at the daily meeting with the nurses.”

When accidents, incidents or untoward events occurred at the service there was a robust system in place to review these. The registered manager analysed events to identify learning and ensured that this was shared with staff, people and other stakeholders where needed. We saw examples of where procedures and people’s care plans had been updated as a result of learning from incidents.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us risks associated with people’s health conditions or support needs were well managed. People explained how staff supported them to reduce risks such as skin damage and choking. People said they were involved in any decisions about how to manage their risks. For example, 1 person told us, “I am always involved as I still have full capacity. They won’t make any changes to my diet without discussing this with me and the SALT (Speech and Language) team as well.” People also told us how staff respected their decisions around risk management. For example, 1 person said, “Staff will come in and ask if they can turn me. I prefer to tell them when I need turning and they’ll always come and do it.”

Staff were knowledgeable about how to support people with risks and knew what measures were in place to reduce them. For example, staff understood which people required a modified diet to reduce the risk of them choking and what topical creams people needed to reduce the risk of skin problems.

We observed people were supported in line with their risk assessments, for example, when being supported to move and to eat.

Some records about people’s risks needed improvement. For example, wound care plans were difficult to navigate, plans did not always specify frequency of dressing changes, and photographs were inconsistently in place. This increased the risk of wounds not being treated effectively. We discussed our concerns with the registered manager who had already identified these issues. Following our site visit, they had improved the risk assessment process and care plans about wound management. Other risk assessments were of high quality, detailed and person centred. For example, some people had been assessed as being at risk of choking. Care plans informed staff what consistency of food people required, how to position people to reduce the risk, how to monitor and assess whilst supporting people to eat and drink and how to ensure people had swallowed their food completely. Records demonstrated people’s risks were mostly being monitored and reduced. For example, repositioning charts showed people who were at risk of skin breakdown were being supported to reposition in line with their risk assessments. We identified occasional gaps in these records and discussed this with the registered manager. They told us following the site visit they had implemented a robust checking system to ensure risk monitoring records were complete.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Most people and their relatives told us there were enough staff to meet their needs. However, some said staffing levels fell short on occasion. Comments included, [Staffing levels] are good, I wouldn’t say that it’s ever understaffed.”, “There’s definitely enough staff, we’ve never had to search to find someone.” and “Recently, on a couple of occasions, I have felt the home is a bit short staffed.” People were pleased they were supported by a consistent staff team. For example, 1 person said, “When I came here, I was surprised at the number of permanent staff which had been recruited. At my old home there was a lot of agency staff, so it was nice coming here.” People and relatives told us staff knew people well and had the skills to provide them with safe care. For example, 1 person told us, [Staff] are told clearly what my needs are. If I need [support with my health condition], then they are there like a shot.” Another person said, “[Staff] have got to know me and my needs well now.” One person told us care staff needed additional training to support them with their health conditions when they went out. This was because nurses were not always available. The registered manager had organised this training for care staff. Some people told us they could make choices about staffing such as the recruitment of staff and choosing who supported them with personal care.

Most staff told us there were enough staff to meet people’s needs although some said an additional staff member would be beneficial in 1 area of the home. For example, 1 staff member told us, “I think the staffing here is fine apart from [1 area] in the house. The workload is way too much for the number of staff working there. The people that live [in the area] are very dependent so it’s difficult to meet everyone’s needs at the same time.” The registered manager and operations manager told us they would review this. Staff were positive about the induction and training they had received to equip them for their roles and said training had improved since the new registered manager had been in post. Comments included, “I have no concerns with staff skill and knowledge. I’m happy with the training I have had here. I don’t think there is any other training I would like to do at the moment.”, “We keep doing training. If the managers feel like we need something such as tracheostomy or suctioning training they arrange it, it keeps our skills up and keeps us excited.” and “We have a lot more support and training now [Registered manager] is here, the training side of things has really improved.”

We observed staff to support people in a timely way and call bells were answered promptly during our site visit. Staff supported people in line with information in their care plans and risk assessments and demonstrated they knew people well. People were relaxed with staff, and it was evident they had good relationships.

Processes were in place to check staffing levels were appropriate. These included using a staff dependency tool, call bell audits and observations. The registered manager and operations manager told us they were reviewing staffing levels in 1 area of the home based on the feedback we received during our inspection. Systems were in place to ensure staff received the training, support and supervision needed for their roles. Training compliance had improved since the registered manager had started in the home. They were also in the process of upskilling care staff so people who needed particular support with health conditions could go out more often. Safe recruitment practices were mostly followed before new staff were employed to work with people. We did identify gaps in 1 staff members employment history. We discussed this with the registered manager who explored this to ensure safety and told us of their plans to ensure all relevant checks were taken in the future to make sure staff were suitable for their role.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us they received their medicines as prescribed. For example, 1 relative said, “[Person’s name] takes lots of medication. It is very professionally organised and administered. People said they received ‘as required’ medicines such as pain relief when they needed it. A person said, “If I am in pain I will ask for [pain relief]. They will always give me what I need, unless the nurse is on a med round but if they’re not it’s here within 10 minutes.

Staff responsible for managing medicines were aware of safe practice. They confirmed they had received training and competency checks. They knew people well and supported them in the way they preferred.

Medicine records needed improvement. For example, protocols for ‘as required’ medicines were of a varying standard and did not always provide staff with enough information on when and why people might need their medicine. Topical application records did not always provide clear instructions for staff on where and when to apply creams and body maps were not always present in all the records we looked at. A pharmacist audit had recently taken place and improvements to processes had been made and were in the process of being made. Following the inspection, the registered manager confirmed records had improved. Time was needed to embed these. Despite the issues identified with some medicine records, people received their medicines as prescribed.