Favorita House Residential Home

Favorita House is a residential care home providing personal care to 12 older people and people living with dementia at the time of the inspection. Favorita House accommodates up to 16 people in one adapted building.

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

People felt safe at Favorita House. They were treated with dignity and respect and their lifestyle and equality needs and choices were understood and respected. People had privacy.

People were protected from the risks of harm and abuse and any concerns they or staff had, were listened to and acted on. Risks had been assessed with people. People had agreed ways to support them to remain independent and safe.

Staff supported people to remain healthy. People were offered a balanced diet which met their needs. People’s medicines were managed safely. The building was clean, and people were protected from the risk of infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People had planned their care with staff and were supported to maintain their routines. They were encouraged to take part in a range of activities they enjoyed. People had been invited to share their end of life preferences and these had been followed.

The registered manager had oversight of the service. Regular checks were completed on the quality of care people received. People, their relatives, staff and visiting professionals were asked for their views of the service. These were listened to and acted on to improve the service.

The registered manager understood their legal responsibilities and had shared information with us and others when they needed to.

There were enough staff to support people when they needed. Staff had the skills they required to care for people and were supported by the management team. Staff were recruited safely.

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

Rating at last inspection and update

The last rating for this service was good (published 6 April 2017).

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.

Favorita House provides accommodation for up to 16 older people who need support with their personal care, some people are living with dementia. Accommodation is arranged over two floors. A stair lift is available to assist people to get to the upper floor. The service has 12 single bedrooms and 2 double bedrooms, which people can choose to share. There were 12 people living at the service at the time of our inspection.

We last inspected this service in January 2016. We found the service was in breach of two regulations and required the provider to make improvements. The provider sent us information about actions they planned to take to make improvements. Their performance rating was displayed in the entrance hall of the service and the provider had informed people, their relatives and other stakeholders; ‘We take on board the areas CQC has asked us to improve and we are happy to make alterations for the benefit of all’. At this inspection we found that the provider and registered manager had made the necessary improvements.

The registered manager was leading the service and was supported by a deputy manager and the providers. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection we found that not all the required checks had been completed to make sure new staff were honest, trustworthy and reliable. Action had been taken complete all the required checks including obtaining a full employment history. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Previously we found staff had not completed all the training they needed to fulfil their roles. Since our last inspection staff had completed the training they needed to provide safe and effective care to people. Most staff held recognised qualifications in care. They met regularly with a member of the management team to discuss their role and practice and were supported to provide good quality care.

The registered manager had oversight of the service. Staff felt supported and were motivated by them. Staff shared the registered manager’s vision of a good quality service and told us they would be happy for their relatives to live at Favorita House. Records in respect of each person were accurate and complete.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). No one was the subject of a DoLS authorisation at the time of this inspection. People were not restricted and went out alone or with the support of staff if they preferred.

The requirements of the Mental Capacity Act 2005 had been met. Staff supported people to make decisions and respected the decisions they made. When people lacked capacity to make a specific decision, decisions were made in their best interests with people who knew them well.

Assessments of people’s needs and any risks had been completed and care had been planned with people to meet their needs and preferences and keep them safe. Staff followed the guidance in people’s care plans to provide consistent care.

Changes in people’s health were identified quickly and staff contacted people’s health care professionals for support. People’s medicines were managed safely and people received their medicines in the ways their healthcare professional had prescribed. People were offered a balanced diet and food they liked.

Staff were kind and caring to people and treated them with dignity and respect at all times. Staff knew the signs of abuse and were confident to raise any concerns they had with the provider. Complaints were investigated and responded to. People had enough to do during the day.

There were enough staff, who knew people well, to provide the support people wanted. People’s needs had been considered when deciding how many staff were required to support them at different times of the day. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

Favorita House provides accommodation for up to 16 older people who need support with their personal care. Accommodation is arranged over two floors. A stair lift is available to assist people to get to the upper floor. The service has 12 single bedrooms and 2 double bedrooms, which people can choose to share. There were 11 people living at the service at the time of our inspection.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were treated with dignity and respect at all times. One person told us, “I am very happy here and would recommend the home to someone else. I’m satisfied with everything they are doing”.

The manager provided leadership to the staff and had oversight of the service. Staff were motivated and felt supported by the manager. The staff team had a clear vision of the aims of the service. Staff told us the manager was approachable and they were confident to raise any concerns they had with them.

There were enough staff, who knew people well, to meet their needs at all times. The needs of the people had been considered when deciding how many staff were required on each shift. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

Effective staff recruitment systems were not in operation and information about the character and identity of staff had not been obtained to make sure staff did not pose a risk to people. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Staff were not consistently supported to provide good quality care and support. Staff had not completed all the training they needed to provide safe and effective care to people. Some staff held recognised qualifications in care. Staff met regularly with the manager to discuss their role and practice and any concerns they had.

Staff knew the signs of possible abuse and were confident to raise concerns they had with the manager or the local authority safeguarding team. Plans were in place to keep people safe in an emergency.

People’s needs had been assessed to identify the care they required. Care and support was planned with people and reviewed to keep people safe and support them to be as independent as possible.

People received the medicines they needed to keep them safe and well. Action was taken to identify changes in people’s health, including regular health checks. People were supported by staff to receive the care they needed to keep them as safe and well as possible.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). Arrangements were in place to check if people were at risk of being deprived of their liberty and apply to the supervisory body for a DoLS authorisation when necessary.

Processes were not in operation to assess if people were able to make decisions but this did not impact on people using the service. Consent to care had been obtained from people. People were supported to make decisions and choices and decisions were made in their best interests if they were not able to do this. The requirements of the Mental Capacity Act 2005 (MCA) had been met. We have made a recommendation to improve practice in relation to this.

People were supported to participate in a wide variety of activities that they enjoyed. Possible risks to them had been identified and were managed to keep them as safe as possible, without restricting them.

People told us they liked the food at Favorita House. They were offered a balanced diet that met their individual needs. A wide range of foods were on offer to people each day and they were provided with frequent drinks to make sure they were hydrated.

People and their representatives were confident to raise concerns and complaints they had about the service with the manager and provider and had received a satisfactory response.

The manager and deputy worked with people and staff and checked that the quality of the care was to the standard they required. Any shortfalls found were addressed quickly to prevent them from happening again. People and their representatives were asked about their experiences of the care and these were used to improve the service.

Systems were not in place to check staff management processes such as training and recruitment and the provider was not aware of the shortfalls we found during the inspection. Following our inspection he provider took immediate action to put systems in place to check all areas of the service.

The environment was safe, clean and homely. Maintenance and refurbishment plans were in place. Appropriate equipment was provided to support the people to remain independent and keep them safe. Safety checks were completed regularly.

Accurate records were kept about the care and support people received and about the day to day running of the service. These provided staff with the information they needed to provide safe and consistent care to people.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We made a recommendation to improve practice in relation to assessing people’s capacity to make decisions.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe. People were treated with respect and dignity by the staff. People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

We inspected medication management and found that there were suitable procedures in place to ensure that people received the right medicines at the right time, with the support of appropriately trained staff.

Is the service effective?

The service was effective. People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. We saw that where appropriate people had signed and confirmed that they had been involved in writing them and they reflected their current needs.

Is the service caring?

The service was caring. We saw that staff interacted well with people and knew how to relate to them and how to communicate with them. People living in the home made positive comments about the staff, with remarks such as 'the staff are kind and good'.

Is the service responsive?

The service was responsive. We found that the staff listened to people, and took appropriate action to deal with any concerns.

Records showed that the service was responsive to people's changing needs. For example, when a person felt unwell their doctor was called.

Is the service well-led?

The service was well-led. The company and the manager had systems in place to provide ongoing monitoring of the home. This included checks for the environment, health and safety, fire safety and staff training needs.

There were 13 people using the service and we met and spoke with some of them.

We found that where possible people were asked to give consent and were involved in the decisions about the care and support they received. People told us that they were asked for consent before any care took place and their wishes respected. One person said 'The staff always ask me if it is alright if they do something. They explain what they need to do'.

People said they liked living at the service and felt safe. People told us that they received the care and support they needed to remain well and healthy. We found records to show how people's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and well being.

People said that they were satisfied with the service they received. We found that staff took time to explain where possible the options available and supported people to make choices.

Staff were supported and supervised to undertake their roles effectively and safely. Some staff had not received up to date training. People told us they thought the staff were very good and knew what they were doing.

Systems were in place to monitor the service that people received to ensure that the service was satisfactory and safe. People told us they did not have any complaints but would not hesitate to speak to the manager or staff if they had any concerns and they would be listened to.

People told us that they were treated with respect by the staff that supported them and that their privacy was maintained. They said that their likes and dislikes were taken into consideration. They felt listened to and supported to make decisions about their care. They said that they received the health and personal care they needed and that they were comfortable.

Some people were aware that they had a care plan. They said they had been involved in planning their care and what they needed had been discussed with them. However, care plans did not always reflect the individual and personalised care being provided and did not show how risk would be managed.

People told us they received their medicines at regular times and staff asked them if they had any discomfort or pain. One person said, "If I am in any pain the staff give me the tablets prescribed by my doctor".

People we observed were involved in what was happening in the home. Staff engaged with them every time they walked past and they were encouraged to participate in the activities.

People told us that they thought that there were enough staff on duty and they knew what they were doing. They said if they had any problems they would speak to the manager or deputy manager and they would be listened too. They told us they did not have to wait long if they wanted anything.