Archived: Dr French Memorial Home Limited

The service supports mainly older people, with mental health or physical health needs.

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

Feedback from relatives and people on the care provided at Dr French Memorial Home Ltd was positive such as kind and caring staff, clean and well-maintained environment and a responsive management team. However, we found significant concerns throughout the inspection which impacted on safety and quality of care and people's well-being.

We were concerned that despite quality issues being raised at the last two inspections, remedial action in key areas to ensure people’s safety had not been implemented. We remained concerned at the lack of care planning documentation including risk assessments. We also found continued concerns with supervision, lack of effective audits and medicines management.

At the last inspection we found people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We found the provider and registered manager did not have a comprehensive understanding of their obligations under the Mental Capacity Act 2005. We found that this remained the case at this inspection.

We found the provider and registered manager did not provide effective leadership, to support the staff to provide good quality care to all the people living at the service.

Although staff understood how to safeguard people from abuse. The registered manager could not show they had taken all remedial action to safeguard people from abuse. The registered manager and provider had not understood their obligations to notify CQC of all significant events.

There were insufficient records to evidence that extremely vulnerable people were receiving adequate food and hydration.

For people who had lived at the service for some time, long standing staff worked hard to provide person-centred care. But lack of person-centred care planning, and the lack of information in care plans meant the information was not there for new staff to follow. Also person centred information related to new people entering the service was not captured on care plans.

We found issues with recruitment of staff as not all checks had taken place in line with legal requirements prior to staff starting work. This meant the provider had not taken all reasonable steps to ensure staff were safe to work with vulnerable people. This was resolved by the time of writing this report.

Whilst we found the home was odour free and clean, we found issues with infection control and staff were not always using personal protection equipment, including masks effectively.

Rating at last inspection and update

At the last inspection we rated this service requires improvement (the final supplementary report was published on 29 October 2021).

At that inspection we identified significant concerns regarding the governance of the service and safe care and treatment of people. This resulted in two Warning Notices being issued against the provider and registered manager related to safe care and treatment, and good governance of the service.

We also found breaches of the regulations in relation to person centred care and the need for consent.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dr French Memorial Home Limited on our website at www.cqc.org.uk

Why we inspected

We undertook this inspection on 18 February and 1 March 2022 to check the provider had followed their action plan, and to confirm they now met legal requirements related to the Warning Notices and the breaches of the regulations.

We carried out a full comprehensive inspection covering all five domains, safe, effective, caring, responsive and well-led.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified four repeat breaches in relation to safe care and treatment, person centred care, consent and governance of the service at this inspection. We have identified new breaches of the regulations around meeting nutritional and hydration needs, safeguarding and notifying CQC of other events. We have also made a recommendation in relation to the way the staff training is recorded.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Follow up

For services in special measures we usually return to inspect within six months. In the coming months, we plan to meet with the provider and registered manager, and work with the local authority and local health professionals to monitor actions for improvement.

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information, we may inspect sooner.

The Doctor French Memorial Home Ltd is a residential care home providing accommodation and personal care for up to 27 people. At the time of the inspection there were 24 people living at the service, three of whom were on a respite placement.

The service supports a range of people, some of whom have dementia or mental health needs as well as physical health needs.

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

People and their family members told us staff were kind. Staff worked hard and were motivated in their role.

However, we were concerned that the provider and registered manager did not provide effective leadership, to support the staff to provide good quality care to all the people living at the service. We remained concerned at the lack of care planning documentation including risk assessments. We also found continued issues with supervision, lack of effective audits and medicines management.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We found the provider and registered manager did not have a comprehensive understanding of their obligations under the Mental Capacity Act 2005.

For people who had lived at the service for some time, long standing staff worked hard to provide person-centred care. But lack of person-centred care planning, and the lack of care plans did not support person-centred care.

No staff had been recruited since the last inspection. Staff received training to carry out their role and there were enough staff to meet people's needs.

Staff understood how to safeguard people from abuse. The registered manager understood their obligations to notify relevant bodies of safeguarding concerns.

The home was clean and odour free. The service had successfully prevented a COVID-19 outbreak at the service through a range of measures. There were increased infection control prevention and control practices in place.

Rating at last inspection

At the last inspection we rated this service requires improvement (published on 15 February 2021).

At that inspection we identified three breaches of regulation around person centred care, safe care and treatment, and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dr French Memorial Home Limited on our website at www.cqc.org.uk

Why we inspected

We undertook this focused inspection on 10 August 2021 to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvements. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified repeat breaches in relation to safe care and treatment, person centred care and governance of the service at this inspection. We have identified a new breach, need for consent, at this inspection. We have made a recommendation in relation to pre-admission assessments to the service.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information, we may inspect sooner.

The Doctor French Memorial Home Ltd is a residential care home providing accommodation and personal care for up to 27 people. At the time of the inspection there were 21 people living at the service, one of whom was a respite placement.

The service supports a range of people, some of whom have dementia or mental health needs as well as physical health needs.

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

Relatives told us that people were safe, staff were kind and that their family members received good care and support.

However, we had concerns regarding some numerous aspects of the management of the service. We found care planning documentation was incomplete; it lacked personalised information and risks to people’s physical and mental health, mobility or nutrition were not identified. This meant people were at risk of harm as there was insufficient documentation to guide staff in caring for people.

We found audits were of varied quality and had not identified areas of concern we found at the inspection in relation to the giving of medicines, staff supervision, lack of food choices and care planning. The pandemic had contributed to the inability of the provider to monitor quality at the service.

Although medicines were safely stored and documented, we witnessed one incident of the unsafe giving of medicines to a person.

Whilst people were supported to be independent by staff to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; we were not confident the policies and systems in the service supported this practice.

We have made a recommendations in relation to mental capacity assessments.

The home was clean and odour free. The service had successfully prevented a COVID-19 outbreak at the service through a range of measures. There were no new admissions to the service .There were increased infection control practices and audits, staff were financially supported whilst isolating and were expected not to work at any other service to prevent cross infection.

Staff recruitment processes and procedures were safe. Essential checks on staff had taken place on staff before they started working for the service. Staff received the training and support to carry out their role effectively through a mixture of online and face to face training. There were enough staff to meet people's needs.

Staff understood how to safeguard people from abuse. The registered manager understood their obligations to notify relevant bodies of safeguarding concerns.

Rating at last inspection

At the last inspection we rated this service Good. The report was published on 9 March 2019.

We also previously looked at the infection control and prevention measures in place on 3 November 2020. We received information of concern about infection control and prevention measures at this service. This was a targeted inspection looking at the infection control and prevention measures the provider has in place.

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

Why we inspected

We carried out a full inspection of this service on 16 December 2020. The inspection was prompted in part due to concerns received about medicines management and lack of personalised care for people. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have identified three breaches of regulation around person centred care, safe care and treatment, and good governance. The failings found are detailed in the main body of the report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information, we may inspect sooner.

We found the following examples of good practice

•The provider had appropriate arrangements for visiting to help prevent the spread of Covid 19. All visitors were required to have their temperatures taken and wash their hands on arrival. All visitors and staff were expected to wear a face covering.

• The service had a garden area to facilitate safe visiting for families. However, people were not currently receiving any visits from families due to the tier 2 restrictions in place.

•The provider had appropriate arrangements to test people and staff for Covid 19 and was following government guidance on testing.

•The provider had ample Personal Protective Equipment (PPE) at the service to ensure that staff could provide care safely. We saw that internal training had taken place with staff regarding CV19 and the use of PPE, with a limited number of staff receiving training from an external source.

• Staff working conditions were conducive to staff being transparent regarding their health and their wellbeing. The provider supported them when they became unwell and when they returned to work.

•There were sanitiser points available throughout the building and thorough cleaning was done daily of all communal areas and people's bedrooms.

•All people admitted to the home were required to have a test before admission and appropriate systems were in place to ensure safe transfer.

•To ensure people were free of the virus, they were isolated in their rooms on initial admission to the service until any potential incubation period had passed.

•The provider ensured that people using the service could maintain links with family members and friends. People were supported to keep in touch by phone and virtual technology.

• The provider had a named external clinical lead who was providing regular weekly contact with the service.

We were mostly assured that the service that this service met good infection prevention and control guidelines.

¿ Whilst there have been no cases of CV-19 at the service, and the majority of staff were using PPE effectively, we noticed two staff not wearing face masks correctly. The registered manager told us they would ensure additional external training was pursued and appropriate use of PPE was discussed at each supervision and team meeting. Also the duty manager would check all staff were using PPE correctly during the shift.

¿ The majority of chairs in the communal area were socially distanced, but two chairs that were occupied by people were not socially distanced. The registered manager told us they would ensure that at each shift that this would become part of the duty manager's role to check.

¿ Whilst there was a contingency planning document drawn up this had not been completed at the time of the visit, but the registered manager told us they were due to complete the document and would forward this to us in due course.

Since the visit the registered manager put further controls in place to ensure full compliance with good infection prevention and control guidelines. These included additional training for staff in the use of PPE; checks by the duty manager that all staff were using PPE correctly and that people at the service were socially distanced, and formalising the service’s contingency plan.

Further information is in the detailed findings below.

• Dr French Memorial Home Limited is a residential care home which provides personal care to older people and people living with dementia.

• At the time of our inspection, 23 people were using the service.

People’s experience of using this service:

• The service was safe and people were protected from harm. Staff were knowledgeable about safeguarding adults from abuse and knew what to do if they had any concerns and how to report them.

• Risks to people using the service were assessed and their safety was monitored and managed, with minimal restrictions on their freedom.

• There were sufficient numbers of suitable staff to meet people's needs and support them to stay safe.

• Medicines were stored, managed and administered safely. Staff were trained, and their competency checked.

• People using the service were supported to have sufficient amounts to eat and drink and maintain a healthy balanced diet.

• Staff demonstrated a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards. People using the service were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

• People were treated with kindness, respect and compassion. People also received emotional support when needed.

• The atmosphere in the home was calm and relaxed. Staff knew the people using the service well and were knowledgeable about their needs and preferences.

• People and staff spoke highly of the management team and told us they felt supported.

• CQC's registration requirements were met and complied with and effective quality assurance procedures were in place.

• More information is in the full report.

Rating at last inspection:

• At our last inspection, the service was rated "Good". Our last report was published on 11 August 2016.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

Dr French Memorial Home Limited is a care home registered to accommodate up to 27 people. Its services focus mainly on caring for older adults including those living with dementia. On the day of the inspection there were 24 people residing at the home.

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 told us they felt safe at the home and safe with the staff who supported them. They told us that staff were kind and respectful and they were satisfied with the numbers of staff on duty at the home.

The registered manager and staff at the home had identified and highlighted potential risks to people’s safety and had thought about and recorded how these risks should be reduced.

We saw satisfactory and accurate records in relation to the management of medicines at the home. Staff told us they had attended training in the safe management of medicines and felt confident in this area of their work.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and told us they would presume a person could make their own decisions about their care and treatment in the first instance. Staff told us it was not right to make choices for people when they could make choices for themselves.

People told us they liked the food provided at the home. We saw that choices of menu were available to everyone and the records showed that the menu was regularly discussed with people who used the service.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians and any changes to people’s needs were responded to appropriately and quickly.

People told us staff listened to them and respected their choices and decisions.

People using the service, their relatives and staff were positive about the registered manager and her management of the home. They confirmed that they were asked about the quality of the service and had made comments about this. People told us the registered manager took their views into account in order to improve service delivery.

Feedback from people and their relatives indicated that the service liaised well with health professionals. Two visiting professionals involved in people's care told us that the service worked well with them. We found that the service worked in co-operation with other providers involved in people's care and treatment.

We also found that people were cared for in a clean, hygienic environment, and that people were protected against the risks of unsafe or unsuitable premises.

However, we found that medication arrangements at the service, particularly in terms of handling, administration and recording, failed to protect people against the risks associated with the unsafe use and management of medicines. There was evidence that people did not always receive their prescribed medicines. We judged this as having a major impact on people who use the service.

We are taking action to ensure the provider becomes compliant with the regulations.

Everybody spoke positively about the staff team. 'Delightful staff, very caring,' one person told us. We observed that staff interacted warmly and inclusively with people who use the service. They worked as a team and attended to people in an unhurried and pleasant manner. They were skilled and experienced, and we found that appropriate checks were undertaken before new staff began working with people.

There were systems in place to enable people to experience care and support that met their needs. Staff knew how to engage with people who have dementia. This contributed to there being a calm atmosphere in the home. People's comments included, 'they're patient with me.' People spoken with confirmed that they trusted staff and felt safe, and that there was no problem in talking with staff or the manager if there were any concerns.