Archived: Friary Lodge

Friary Lodge is a 'care home.' The service is registered to support up to 15 older people, some of whom may be living with dementia. At the time of our inspection, nine people were using the service.

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

There were no assessments about choking for people who were known to be at risk, and no guidance for staff to follow about actions to take in the event of a choking incident. Assessments about other types of risk however were in place and offered staff advice about reducing the likelihood of them happening.

Staff did not always follow processes to minimise the risks from the spread of infection. We have made a recommendation about this.

People were treated with respect, kindness and compassion. People were supported by a staff team that knew them well and understood how to meet their needs. Staff knew how to support people to communicate and express their views. People were supported to maintain relationships with those who were important to them.

People, relatives, staff and a health care professional spoke positively about the service and the care provided.

People were supported to eat and drink healthily and maintain a balanced diet. Menus were not available in an accessible format to help people living with dementia make informed choices. We made a recommendation about this.

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.

Information on how to raise concerns or complaints was available, and people and their relatives were confident any concerns would be listened to and acted upon.

Effective recruitment procedures were in place to check that staff applying for positions were of good character and suitable to provide care and support to people living in the service before they were employed.

Staff had received training in safeguarding adults from abuse and understood their responsibilities and the actions they should take if concerns were identified.

There were sufficient numbers of staff deployed to meet the care and support needs of people.

Some areas of the building needed improvements. We have made a recommendation about this.

There were systems in place to monitor the quality of the service. However, these processes had not picked up and addressed the issues we found during this inspection.

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 02 December 2016).

Why we inspected

This was a planned inspection based on the previous rating. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Friary Lodge is a care home registered to provide accommodation, personal care and support for up to 15 older people. At the time of our inspection, 11 people were living in the home.

Friary Lodge has a dining and lounge room on the ground floor with a conservatory used as additional dining and lounge space. The conservatory opens up to a large accessible garden with a patio area. The home has 15 bedrooms with three double bedrooms capacity, spread across three floors with bathroom facilities. Six bedrooms are with ensuite facilities and nine bedrooms have a washbasin facility. The first floor is accessible via chairlift. The home has kitchen and laundry facilities.

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.

People using the service told us they felt safe at the service. Staff had a good understanding of the safeguarding procedure and their role in protecting people from harm and abuse. The service had systems to identify and manage risks. Risk assessments were individualised and regularly reviewed. The care records were well maintained detailing information on people’s nutrition and hydration needs. Care plans and risk assessments supported the safe management of people's medicines.

The service kept accurate records of medicines administered by staff and maintained effective systems in medicines management. The service was clean and had measures in place to prevent cross contamination.

People and their relatives were very happy with the quality of food. There was choice of food at meal times, and staff supported people to eat when this was needed. People and their relatives told us staff were always available and easy to get hold of. The service had sufficient numbers of staffing to meet people’s individual health and social care needs. The service worked closely with various health and care professionals to support people with their needs and wishes. People received a GP visit on a weekly basis.

The service followed safe recruitment practices. Staff received induction and regular training, and records confirmed this. Staff told us they found supervision useful and received regular one-to-one and group supervisions and six monthly performance review assessments.

The service operated within the legal framework of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People told us staff asked their consent before supporting them. The registered manager and staff demonstrated a good understanding of the procedures under MCA and DoLS.

The service was exceptionally caring. People told us they had good relationship with the staff and found them considerate, thoughtful, kind and caring. Staff knew people very well, treated them like individuals and provided person-centred care and had built strong trusting relationships with people. Staff recognised people’s need to remain independent, and enabled and supported them wherever possible to remain independent. The service supported and empowered people in maintaining their relationships with family and friends, this ensured people were not isolated. The service had pet animals and people enjoyed their company.

The care plans were personalised and people’s life histories, individual needs and likes and dislikes were recorded. People and their relatives were involved in planning their care. People and their relatives were asked about their views. The service supported people with a range of activities. People and their relatives told us they were asked for their feedback and their complaints were acted upon promptly.

People, their relatives, staff and health and care professionals spoke highly of the registered manager and told us the service was very well run. The registered manager was unceasingly trying to improve lives of people by continually reviewing people’s care plans and to ensure the best possible outcomes. The registered manager worked in partnership with various organisations, and with health and social care professionals to ensure the service supported people to maintain healthy lifestyle.

The service had records of monitoring checks of various aspects of the service ensuring efficient systems were maintained to improve the quality of care delivery. The registered manager involved people, their relatives, staff and health and care professionals in improving the quality of the service delivered.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

There were eleven people living at the home at the time of the inspection. We spoke with eight of them and two people visiting people at the home.

Is the service safe?

People told us that they felt safe within the home, with support from competent staff. They told us 'Staff are excellent,' 'They are on the ball,' and 'It's a very well run place.' It was a hot day on the day of our visit, and we saw staff offering people drinks on a regular basis throughout the day.

The GP visited the service at least once weekly, and people were confident that they could always be seen if needed. Appropriate systems were also in place for the safe administration of medicines at the home.

Recruitment systems were sufficiently rigorous to ensure that all necessary information was available about new staff and that they were of good character for the protection of people living at the home.

Is the service effective?

People told us that staff were very competent at meeting their individual needs effectively. One person told us 'I couldn't wish for better care.' Staff said that they received appropriate support and training to enable them to deliver care and support to people to an appropriate standard.

People were supported to pursue their own hobbies, and join in social groups outside of the home, although there was room for further development of group activities within the home. People were satisfied with the 'freshly cooked' food provided and described 'amazing cakes' made at the home. They were happy with the laundry service, noting 'My clothes are always clean.'

Is the service caring?

People were highly satisfied with the way they were cared for at the home. They told us 'I'm very pleased about the way I'm treated here,' 'They are such nice people ' very kind - whatever my whim,' 'They are always attentive,' 'They're really kind,' and 'I always seem to be getting pampered.'

Visitors told us that they always felt welcome, with a cup of tea offered when they arrived. People were particularly appreciative of the birthday celebrations arranged for people living in the home, and the "extra little touches" they described such as individual Christmas presents provided to each person and 'leaving Easter eggs at the side of your bed.'

Is the service responsive?

People told us that they were able to make choices about their lives within the home. They noted 'I get up when I like,' 'We are asked what we like,' 'I go out when I like,' and 'They will make you something else if you don't like what's on the menu.'

The manager was clear that she was careful to assess people's needs before admission to ensure that they could be met effectively by the home. We saw that staff had identified people's cultural and religious needs, and taken steps to address these, for example identifying a cultural social group for one person to attend in the local area.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. Staff we spoke with showed that they understood the needs of individual people they cared for. People living at the home had strong confidence in the home's management. They told us 'I couldn't wish for better,' 'It's like living in a five star hotel,' 'It's excellent,' 'A very well run place,' and 'The Manageress is very nice ' you can talk to her if you have any trouble.' We saw that appropriate quality assurance systems were in place to ensure that the home's standards were maintained.

We found that people were treated with respect and dignity. People's comments included, 'staff try their best to help' and 'they treat me well.' People indicated to us that they made choices about their care and that staff were responsive. 'They never rush me,' one person said.

People said they received the care and support they needed. Comments included, 'there's always a drink here and I can ring the bell if I'm thirsty.' We found that care was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found there were systems to assess and monitor quality and risk at the service. These included consideration of people's views. Comments included, 'any problems, I talk to them and they try to sort it out.'

There were a number of arrangements in place for the management of people's medicines. However, when we checked medicines supplies against records, we found some discrepancies. This meant that there were occasions when people may not have received their medicines as prescribed and records of administration were not accurately kept.

We also found that recruitment procedures were not effective at demonstrating that new staff were of good character. This may have put the safety of people who use the service at risk.

The healthcare needs of people had been met. Medication had been administered as prescribed. Comprehensive assessments, including risk assessments had been carried out. Appropriate care plans had been prepared for people. These were regularly updated. We observed that people who use the service appeared comfortable and relaxed.

Arrangements were in place to ensure that people who use the service were protected from abuse. People who use the service stated that they felt safe in the home. Staff had been provided with safeguarding and other essential training. They were knowledgeable regarding their roles and responsibilities.

The home had arrangements for monitoring the quality of care provided. Regular audits and checks had been carried out. A consumer survey had been organised and the results indicated that people and their representatives were very happy with the care provided.