Frank Foster House

Frank Foster House is a residential care home providing personal and nursing care to up to 80 people. The service provides support to older people and younger adults, some of whom may be living with dementia, physical disability or sensory impairment. The service accommodates people in one adapted building over 2 floors. At the time of our inspection there were 65 people using the service.

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

People were not always protected from the risk of harm. The service was not always well led. The management of risk needs to improve in relation to fire safety and people’s personal emergency evacuation plans [PEEPs].

We have made recommendations to the registered manager around staffing levels, staff deployment and audit processes.

People were supported by staff who had been recruited safely. The provider ensured staff received training that met people's needs. People received their medicines from trained staff who had their competencies checked by management.

People were protected from the risk of abuse. Staff knew how to identify signs of abuse and felt comfortable raising concerns with the registered manager.

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.

The registered manager acted in accordance with their legal and regulatory requirements and shared information in an open, honest and timely manner.

The service involved people and those important to them in a meaningful way. People's views were listened to and acted upon, meaning they had a direct say in the running of their home.

The registered manager and provider encouraged an open culture of learning from incidents, accidents and other relevant events.

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 outstanding (published 14 May 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, caring 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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection.

The registered manager has taken immediate action to lessen the risks identified during this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Frank Foster House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Appropriate and safe processes were in place to facilitate people having visitors at the service in line with the current government guidance.

New admissions to the service required a negative test and 14-day isolation period.

The registered manager ensured regular COVID-19 testing was carried out for staff and people living in the service.

The service had introduced and maintained effective systems and processes to prevent the spread of infection. Staff wore PPE and received training in Infection Prevention and Control (IPC). The service carried out checks to assess staff competency for hand hygiene and IPC knowledge.

The registered manager told us that the whole staff team had worked together to support people and each other during the pandemic.

Frank Foster house is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Frank Foster house provides care for up to 80 people including people living with dementia.

The home 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 and associated Regulations about how the service is run.

During our inspection, we found exceptional standards of care. A committed and well-trained group of staff who demonstrated the right values and attributes provided this. We observed staff supporting people in a kind and caring manner. Independence, privacy and dignity was promoted and respected. Staff took account of people’s individual needs and preferences and people were encouraged to be involved in making decisions about their care.

People, family members, staff and visiting professionals spoke very highly about the registered manager and the leadership of the home stating they were approachable, caring and very responsive to people and staff needs. The registered manager sought feedback about the quality of the service provided to people and/or family members, staff and visiting health professionals. There was an on-going quality monitoring process in place to identify areas of improvement required within the service. Action was taken when an area for improvement had been identified.

Staff were trained to protect people from potential abuse and understood how to safeguard them. People had risks to their safety assessed and there were plans in place to reduce the risks, which staff understood and followed. People who lived at the home and staff members we spoke with said there were enough staff on duty to meet individual needs. People received their medication as prescribed and the records were of a good standard. The home was clean, well- maintained and provided a safe environment for people to live and staff to work in. There were systems in place to learn from incidents and when things went wrong to avoid this happening again.

People had their needs assessed and were supported to meet them by trained and knowledgeable staff. People’s nutritional needs were assessed and professional advice and support was obtained for people when needed. The service worked well in partnership with other health professionals to ensure that people received good healthcare. Staff understood and effectively applied in practice the principles of the Mental Capacity Act, 2005 (MCA) and the Deprivation of Liberty Safeguards. People had maximum choice and control of their lives and staff assisted them in the least restrictive way possible. We have made a recommendation that the service find out more about training for staff, based on current best practice, in relation to assessing people’s capacity in keeping with the principles of the MCA.

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People had care plans that were informative and had been regularly reviewed and updated. People and their relatives had been involved in the care planning process and their reviews. There were opportunities for people to follow their interests and take part in a wide range of activities. People's communication needs were considered and they had support to follow their religious beliefs and cultural practices. People understood how to complain and complaints were responded to in line with the provider's policy.

Further information is in the detailed findings below.

At this inspection on 4 February 2014, we found that people experienced care and support that met their needs. Care records had been improved in line with the manager's action plan. We spoke with six staff. Staff were able to demonstrate their awareness of people's individual needs and how these were to be met in line with the person's plan of care.

We spoke with five of the 69 people using the service at the time of our inspection. They told us they received the care they needed. One person said, 'The care is very good. They really don't mind how many times you use the buzzer, including at night. They always come and tell you to ring it anytime. They check on you anyway. The staff give everything, it's wonderful.'

We spoke with three visiting relatives who all confirmed they were satisfied with the level and quality of the care provided at the service. A visiting relative told us, 'I watch what is going on and see that the staff take time to talk with and reassure people if they are a bit upset and even give them a hug if they need it. I am happy with the way [person] is cared for.'

We looked at the care records of four people who used the service. We found that people's care was not always planned in a way that ensured they received the care they needed.

People were provided with a choice of suitable and nutritious food and drink. People told us they really enjoyed the food, that there was ample food available and this included snacks at any time, including during the evening. One person told us, "The food is wonderful'.

Staff were supported to deliver care safely and to an appropriate standard. People who used the service told us that staff were helpful and worked hard.

People who used the service told us that while they had no complaints, they would feel confident to raise any complaints and felt that they would be listened to. One person said, 'I have never had a complaint. If I did, I would definitely speak with one of the staff. I will tell you why. They would want to find out and want to fix it for you.'

We found that the required improvements had been made. We looked at the quality assurance systems in the home. They were implemented routinely so as to be effective and they ensured that people's views were properly taken into account. This meant that the provider had an effective system to assess and monitor the quality of the service that people received.

We found improvements to the quality and security of people's personal care records. A plan of care was in place for each person whose file we looked at. They were up to date and regularly checked to ensure they remained so. This meant that staff had the information they needed to help them to meet people's assessed needs.

We saw that people's personal care records were locked away when not being used by staff. This meant that people's information was treated with respect and kept securely.