The inspection was carried out on 03 and 06 October 2017. The first day of our inspection was unannounced.
Friston House provides accommodation, residential and nursing care for up to 81 older people. The home comprises of three units. The main building has two floors and accommodates people with residential needs with early onset dementia on the ground floor; and people with nursing needs on the first floor. There is a separate ‘Memory Lane Unit’ for people who live with dementia and nursing care needs. The home has a garden and courtyard areas available for all of the people.
On the day of our inspection there were 80 people living at the home. People had a variety of complex needs including people with mental health and physical health needs and people living with dementia. Some people had limited mobility, pressures ulcers and some people received care in bed.
The service had a registered manager. 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. The registered manager had been off work for some time. The deputy manager had been managing the home until August 2017, which is when the provider had put in place a peripatetic general manager.
At the last inspection on 25 August 2015 the service was rated Good overall and Requires improvement in Safe. We had made a recommendation in the Safe domain that prescribed thickening powders were kept locked away to prevent accidental ingestion.
At this inspection we found that that there had been improvements to the storage of thickening powders. However, activities to meet people’s individual needs to help keep people active and stimulated had deteriorated. We made a recommendation about this.
Most staff had undertaken training relevant to their roles. Some staff required updates and training relevant to meet people’s health needs. We made a recommendation about this.
Some people experienced care which was task led. We made a recommendation about this.
Medicines were well managed. Medicines were stored and administered appropriately. Some medicines were prescribed on a ‘when required’ basis. There was guidance in place for each person’s when required medicine.
Staff had a good understanding of what their roles and responsibilities were in preventing abuse. The safeguarding policy gave staff all of the information they needed to report safeguarding concerns to external agencies.
The provider followed safe recruitment practice. Essential documentation was in place for all staff employed. Gaps in employment history had been explored to check staff suitability for their role. There were suitable numbers of staff deployed on shift to meet people’s assessed needs. Some people told us about delays to calls bells being answered. We made a recommendation about this.
The premises were well maintained, clean and tidy. The home smelled fresh. Areas of the home had been decorated to help people orientate in their environment. More improvements were planned.
Staff were supported to gain qualifications and were supported in their roles. They had received regular supervision meetings.
Meals and mealtimes promoted people’s wellbeing, meal times were relaxed and people were given choices.
Staff had a good understanding of the Mental Capacity Act 2005 and supported people to make choices. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority by the management team.
People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner. Feedback from healthcare professionals was positive.
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.
Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the home was calm and relaxed. Staff treated people with dignity and respect.
People’s care was person centred. Care plans detailed people’s important information such as their life history and personal history and what people can do for themselves. People were supported to be as independent as possible.
People’s views and experiences were sought through surveys and meetings. People were listened to. People and their relatives knew how to raise concerns and complaints.
There were quality assurance systems in place. The management team and provider carried out regular checks on the service. Action plans were put in place and completed quickly. Staff told us they felt supported by the management team.
The management demonstrated that they had a good understanding of their role and responsibilities in relation to notifying CQC about important events such as injuries, safeguarding concerns and deaths.