Friern Residential Care Home

Friern Residential Care Home is a care home registered to accommodate up to 18 people. Its services focus mainly on caring for older adults who have mental health conditions. On the day of our inspection there were 18 people residing at the home.

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

People had access to healthcare services and were involved in decisions about their care. Partnerships with other agencies and health professionals enabled effective outcomes for people.

People's care was planned and risks to their safety and wellbeing were assessed. The service reviewed these plans regularly, involving people in these reviews and asking for their opinions.

Staff had completed safeguarding training and understood their role in identifying and reporting any concerns of potential abuse or poor practice.

Staff were recruited to the service safely and people's medicines were administered safely. The service was clean and with no unpleasant smell. Staff knew how to use and dispose of personal protective equipment (PPE) safely.

People had been living at the service for many years but had been assessed before care had begun. People were involved in planning their care and care was personalised to meet their needs detailing their likes and dislikes.

People and staff praised the managers of the service and agreed that they were approachable, knowledgeable, fair and did their job well. The staff team worked well together and supported the registered manager.

The staff team was committed to providing a high-quality service. They had undertaken training so that they were skilled and knowledgeable to effectively meet people’s needs. Staff understood their responsibilities to report any concerns.

People were given choices about the way in which they were cared for. Staff listened to them and knew their needs well.

Care plans contained information about each person’s individual support needs and preferences in relation to their care and we found evidence of good outcomes for people.

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.

Recruitment practices were safe and relevant checks had been completed before staff worked at the service.

The managers of the service actively sought the views of people and their relatives about the running of the service, and they dealt promptly with any concerns that people raised.

The provider had systems in place to monitor and improve the quality and safety of the service provided. There was a positive culture throughout the service. Staff told us they enjoyed working at the service and felt valued.

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

Rating at last inspection

At the last inspection we rated this service Good. The report was published on 24 May 2018

Why we inspected

This inspection was prompted by a review of the information we held about this service. This report only covers our findings in relation to the Key Questions Safe and Well Led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. On the day of our inspection there were 18 people using the service.

We inspected Friern Residential Care Home on 11 April 2018. At our previous inspection in December 2015 the service was rated as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had 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 and associated Regulations about how the service is run.

People told us they were very happy with the care and support they received. Staff working at the home demonstrated a good knowledge of people’s care needs, significant people and events in their lives, and their daily routines and preferences.

Staff told us they enjoyed working in the home and spoke positively about the culture and management of the service. Staff described management as supportive and confirmed they were able to raise issues and make suggestions about the way the service was provided.

The manager of the service provided good leadership and people using the service and staff told us they promoted high standards of care.

The service was safe and there were appropriate safeguards in place to help protect the people who lived there. People were able to make choices about the way in which they were supported and staff listened to them and knew their needs well. Staff had the training and support they needed. There was evidence that staff and manager at the home had been involved in reviewing and monitoring the quality of the service to drive improvement.

Recruitment practices were safe and relevant checks had been completed before staff worked at the home. People’s medicines were managed appropriately so they received them safely.

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the number of people with complex needs in the home.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People's views on the service were regularly sought and acted on.

Staff demonstrated that they were caring and always ensured they treated people with dignity and respect.

At our last inspection we had made a recommendation in relation to the activities on offer. The service had addressed this issue and people now participated in a range of different social activities and were supported to aces the community. They also participated in shopping for the home and their own needs and were supported to maintain a healthy diet.

The service worked in co-operation with other organisations such as healthcare services to deliver effective care and support

The service listened and responded to people's concerns and complaints, and used this to improve the quality of care. The service learnt lessons and made improvements when things went wrong.

During this inspection we observed medicines given to two people at lunchtime. We saw that people came individually to the office and their medicines were given professionally. The administration record was signed after the medicine had been observed as swallowed.

Some people were able to use their own inhalers and others sometimes refused their medicines. Both were recorded on the medication administration record and there was evidence that the prescriber was involved in monitoring the effects of refusing medicines on the person's medical condition.

Managers told us about the training in the safe handling of medicines that all staff had received and also the audits that they regularly carried out to ensure that medicines were given appropriately.

We carried out our own checks of records and stocks of medicines and could see that people were receiving their medicines as prescribed.

We saw that there were records of receipts, administration and disposal of medicines but these records were not always accurate. We counted six samples of medicines dispensed into their original boxes to see if we could reconcile records with stocks. Four could not be reconciled and we could not be sure if they were being administered as prescribed.

One medicine prescribed to be applied every 72 hours was being administered every 96 hours. We saw also that a medicine in a box labelled 9mg contained tablets in a strength of 6mg and we were told that the prescriber supplied these loose with no written instructions for administration.

Overall we found that arrangements were not in place for using medicines safely and people who use the service were not protected from the associated risk. We are taking action to ensure the provider becomes compliant with the regulations.

We also found that environmental matters arising from our last inspection had been addressed.

We spoke with seven of the 12 people who were using the service at the time of our visit. Most people were happy with the services and how staff treated them. Comments included, 'we're treated like kings.' We found that there were better overall standards of occupation of people, and that people's views were taken into account in respect of service delivery. People also had clearer support plans in respect of their looked-after money.

However, we found minor concerns in respect of adequate maintenance and the proper operation of the premises. The dishwasher was not working because there was no electrical outlet for it to connect to, and there were recent occasions including during the inspection when one person's hot water supply in their room was not working.

There were also moderate concerns in respect of medicines that the service supported people with. This included some cases where people's prescribed medicines had run out, or were about to run out without arrangement for further stock. There were also cases where there was a discrepancy between the remaining stock and records. Arrangements at the service failed to protect people against the risks associated with the unsafe use and management of medicines.

We found that appropriate checks were undertaken before staff began work, and that staff were supported in their work.

However, people told us there was little to do despite activities being planned, and that they had no involvement in their care plans. A few people told us staff could raise their voices when other people using the service challenged the service. We found that suitable arrangements were not in place to ensure people's dignity, that people's views were not sought in relation to their care, and that activity provision was not appropriate.

We found there to be up-to-date care plans in place for people. However, in respect of the support of people with managing their money, these failed to meet people's individual needs and ensure their welfare and safety.

We also found that some records such as for complaints and incident investigations were not kept, and that not all notifiable incidents were reported to us. This failed to protect people against the risks of unsafe or inappropriate care.

People spoke positively about staff at the service. Comments included, 'staff are kind and friendly', and 'there's always staff around.' We found that staff were appropriately trained and supervised, and that there were enough staff to meet people's needs.

People had no concerns about how medicines were managed at the service. However, we found that medicines were not always safely kept, because a medicine requiring refrigeration was not stored at an appropriate temperature to ensure the potency of the medicine.

Most people told us they were happy with the cleanliness and maintenance of the building. However, even though there had been much refurbishment under the new provider, we found inappropriate standards of cleanliness and maintenance in parts of the premises. This may have compromised people's health and safety.