Fryers House - Care Home with Nursing Physical Disabilities

Updated 30 April 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted, in part, by notifications about medicines errors and recent injuries to two people living in the home that had not been noted in a timely way.

Though these incidents had been thoroughly investigated by the service and the local authority as appropriate, we bought the inspection forward by three months so we could ensure that the service was compliant with regulations and providing safe care.

Inspection team:

The inspection team consisted of one adult social care inspector, a specialist advisor who was a nurse and an expert by experience who had knowledge and experience of similar services.

Service and service type: Fryers House is a care home. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

This was an unannounced inspection and no notice was given of our visit.

Inspection site visit activity started on 1 April 2019 and ended on 2 April 2019. We visited the location to see the manager and office staff; and to review care records and policies and procedures.

What we did:

We reviewed the Provider Information Return that had been completed in December 2018. The provider completes this at least once every year to tell us what the service is doing well and about any plans to improve.

During our inspection we spoke with six support workers, the registered manager, the deputy manager / clinical lead, a cook, a volunteer coordinator, four registered nurses, a domestic staff member, two volunteers, a visiting GP, six people living in the home and six relatives of people living in the home.

We reviewed records maintained by the service including records of accidents, incidents and complaints, audits and quality assurance reports, health and safety monitoring, three peoples care records and five staff recruitment files.

We sought feedback from ten health and social care professionals and received eight responses.

Updated 30 April 2019

About the service: Fryers House Care Home with Nursing is a residential care home that was providing personal and nursing care to 23 people at the time of the inspection.

People’s experience of using this service:

Staff completed training in safeguarding and could recognise signs and symptoms of possible abuse in people.

Risks concerned with people’s health care and the environment were assessed and reduced as far as was practicable.

A new facilities management system automatically alerted issues in the premises such as water safety concerns or fire call points needing to be tested.

Due to having insufficient staff employed there was heavy use of agency staff. Risks associated with using agency staff were mitigated as the provider had forged working relationships with several agencies who provided regular staff to the service when possible.

A robust recruitment campaign was underway supported by a recruitment specialist. Recruitment procedures were robust and all necessary pre-employment checks were completed before staff commenced in post.

Medicines were safely managed following a high number of errors over the past year. A new EMAR system had reduced actual medicines errors however there were still issues with the system that the provider was working to address.

People’s needs were assessed before moving to the home and at intervals throughout their time there. Protected characteristics of the Equalities Act 2010 had been identified and people’s needs in these areas met.

There was a broad range of mandatory training courses and staff members were supported to complete qualifications such as diplomas in their specialist fields.

All new staff and agency staff were allocated time to read care plans before supporting people to ensure they approached the support as the person wanted it.

Staff participated in supervision every six weeks and the provider was undergoing a programme of annual appraisals when we were on site.

People could eat their meals when and where they wanted. People were supported by staff who showed empathy and meals were provided in the most appropriate way, for example, pureed.

There was good access to healthcare services such as the GP, physiotherapist and nutritional specialist. Healthcare provided was proactive, some people, prone to having infections were prescribed a low dose of antibiotic to minimise risk of infections developing.

The premises were purpose built and in very good decorative order. Rooms were personalised, and the appearance was homely.

The provider complied with the principles of the Mental Capacity Act 2005 and applied for Deprivation of Liberties Safeguarding authorisations as needed.

The service was extremely caring. Staff supported people with extremely complex health and social care needs in an empathetic and empowering way. Staff were experts in interpreting the non-verbal communications of many people and chatted with them as if old friends.

Staff clearly enjoyed spending time with the people they supported and told us they were the main reason they worked at Fryers House.

Staff ensured they had peoples consent before providing care and responses to people were caring, timely and appropriate.

The phrase, ‘dignity is at the heart of everything we do’ was displayed in both houses and it was clear that staff applied this at all times.

People were supported to access the community and a range of in-house activities. If they felt unable to access group sessions, staff could support with activities in people’s rooms however this was subject to available staffing.

The Accessible Information Standard had been met and information was presented to people in the most appropriate manner for them.

Complaints were welcomed and responded to as per the complaint’s procedure.

End of life care was planned for and delivered in partnership with local healthcare practitioners. Staff had attended training in the ‘Six Steps to Success in End of Life Care’ at a nearby hospice.

The management team were very supportive of staff and aware of and trying to address issues for such as pay rates that staff felt strongly about.

Audits were completed, and the registered manager had clear oversight of the service. Notifications of significant events were completed.

People, their relatives and staff were encouraged to feedback about the quality of the service and regular quality assurance questionnaires were issued.

The provider had developed positive links to the local community.

The service met the characteristics of Good in most areas; more information is in the full report.

Rating at last inspection: Good. Report published 23 February 2017.

Why we inspected: This was a scheduled inspection that was bought forwards due to information received about risks in the service.

Follow up: We will continue to monitor information received about the service and will reinspect as per our reinspection schedule.

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