Frindsbury House

People’s experience of using this service: The service had improved since we last inspected it. Everyone we spoke with was positive in their feedback. Comments included; “I feel good living here”, “The staff do a good job” and “I wouldn’t change anything. I would recommend the home to people like me.”

People were safe at Frindsbury House. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. The provider followed safe recruitment practices. One person said, “I am safe because the carers care for us. If I have little worries, the staff talk to me.”

Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them. They felt a part of their local community and were supported to use local resources to their advantage.

Staff understood the importance of promoting people’s choices and provided the support people required while promoting and maintaining independence. This enabled people to achieve positive outcomes and promoted a good quality of life.

People were involved in the running of the service and were consulted on key issues that may affect them.

People received the support they needed to stay healthy and to access healthcare services. Each person had an up to date support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

Rating at last inspection: Requires Improvement (Report published 28 March 2018)

Why we inspected: At our last inspection, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to the risk of abuse that was not always minimised. The management of medicines was not always safe and there were inconsistent processes in the medicines' management documentation. The provider had not carried out sufficient checks to explore the staff members' employment history to ensure they were suitable to work with people who needed safeguarding from harm. Records relating to drinks people had were not accurate or complete. Audit systems were in place but identified actions had not been completed and records were not always complete, accurate and robust.

We asked the registered provider to take action to meet the regulations. We received an action plan on 2 March 2018, which stated that the registered provider would take action to meet the regulations by 30 May 2018.

At this inspection, we found that improvements had been made in relation the five requirements made above.

Follow up: We will continue to monitor the service through the information we receive. We will carry out another scheduled inspection to make sure the service continues to maintain a Good rating.

Frindsbury House provides care and support for up to 23 people with a range of physical disabilities including Huntington's disease and also caters for people with learning disabilities. Frindsbury House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. 23 people currently used the service.

At the last Care Quality Commission (CQC) inspection on 15 December 2015, the service was rated Good in Safe, Effective, Caring, Responsive and Well Led domains with overall Good rating.

At this inspection we found the service Required Improvement.

There was a new manager at the service. The previous registered manager left her position in May 2017. The new manager was undergoing registration with the Care Quality Commission. 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 gave us positive feedback about the service they received. People told us they felt safe and well looked after. However, the records we looked at did not always match the positive descriptions people had given us. Most of the relatives who we spoke with during our visit were satisfied with the service.

People continued to be safe at Frindsbury House. However, the risk of abuse was not always minimised. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse but these were not always followed.

Medicines had not been managed safely. Medicines had not recorded, stored or monitored effectively.

The provider did not follow safe recruitment practice. Gaps in employment history had not been explored to check staff suitability for their role.

People were supported to eat and drink enough to meet their needs. However, people did not always received food and drink in a safe way following guidance that had been given by healthcare professionals.

Although, effective systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service, these had not been rigorously followed. The provider was aware of some of the concerns we found at the inspection but no record of action taken was seen.

Records relating to people’s care and the management of the home were not always well organised and adequately maintained. For example, the recording of medicine room temperatures and accuracy of stock had not been maintained.

The manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support.

Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

People received the support they needed to stay healthy and to access healthcare services.

People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

There were enough staff to keep people safe. The manager continued to have appropriate arrangements in place to ensure there were always enough staff on shift..

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

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

Staff received regular training and supervision to help them to meet people's needs effectively.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Staff showed they were caring and they treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs.

The manager ensured the complaints procedure was made available in an accessible format if people wished to make a complaint. Regular checks and reviews of the home continued to be made to ensure people experienced good quality safe care and support.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

We found five 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.

Frindsbury House provides care and support for up to 23 people with a range of physical disabilities including Huntington's disease and also caters for people with learning disabilities. Frindsbury House is a large home with ample communal space, extensive gardens and purpose built activity and craft rooms for use by the people who use the service. There is disabled access including a wheelchair accessible lift to the first floor. At the time of our inspection, 21 people lived in the home.

There was a registered manager at the home. 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 were protected against the risk of abuse. People told us they felt safe. Staff recognised the signs of abuse or neglect and what to look out for. Both the registered manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

The home had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs such as physical disabilities, behaviour that challenges and details of how the risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to people.

There were sufficient numbers of staff to meet people’s needs. Staff had the knowledge and skills to meet people’s needs, and attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

Staff were recruited using procedures designed to protect people from unsuitable staff. Staff were trained to meet people’s needs and they discussed their performance during one to one meetings and annual appraisal so they were supported to carry out their roles.

Safe medicines management processes were in place and people received their medicines as prescribed.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the home complied with these requirements.

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.

People’s care plans contained information about their personal preferences and focussed on individual needs. People and those closest to them were involved in regular reviews to ensure the support provided continued to meet their needs.

Staff were aware of signs and symptoms that a person’s mental health may be deteriorating and how this impacted on the risks associated with the person’s behaviour. People were supported as appropriate to maintain their physical and mental health.

Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with the Commission.

People were treated with respect and involved as far as possible in planning their care and activities.

People received care and support that was well planned and sensitively delivered.

People received the medicines they needed when they needed them.

The home had been designed with the needs of the people who lived there in mind and was suitable for them.

Effective quality assurance procedures ensured that people were provided with a good service.

Overall we found that this service was safe, effective, caring, responsive and well-led and had achieved compliance with all the standards we inspected. We have made some comments that the provider may find it useful to note to make sure that the home continues to provide a good service.

People told us that they liked the service. One person told us 'I think it's wonderful here'. Another person told us 'I think the staff are really nice.

Staff told us that they felt supported and were able to talk to managers about how the service was run.