Frinton House

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.

The service had been rated requires improvement at the last two inspections. At the last inspection in December 2016 there were two breaches of regulations and requirement notices were issued. Breaches were in relation to a lack of good governance and a failure to give appropriate consideration to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) in accordance with legal requirements. (The MCA promotes choice in decision making and DoLS provide legal safeguards for people who may be deprived of their liberty for their own safety.) We asked the provider to complete an action plan to show improvements they would make, what they would do, and by when, to improve the key questions in effective and well-led to at least good. At this inspection we found the provider was now meeting legal requirements and in some areas was providing an outstanding quality of care.

This comprehensive inspection took place on 1 and 6 February 2018.

There was excellent leadership in the home and the registered manager had an open door policy which staff valued. Staff were fully involved and committed to achieving the home’s and organisation’s values and vision. The organisation had extensive systems to monitor and review the quality of the care provided.

Appropriate referrals were made to health care professionals when needed, and people were supported to attend health appointments, such as the GP or dentist. Staff had worked together to support one person who had complex health needs and an innovative and imaginative solution had been found that ensured the person received the treatment and supported needed to make an excellent recovery. There were excellent links with specialists to ensure guidance and support was obtained to meet people’s complex needs. Where possible, easy read documentation had been used to help people understand difficult topics and situations. Feedback from professionals who supported people and from relatives was unanimously positive.

People were treated with utmost dignity and respect by kind and caring staff. Staff had an extremely good understanding of the care and support needs of people and had developed positive relationships with people. Relative's had complete confidence in the staff and told us they were always made to feel welcome at Frinton House. People’s achievements were displayed in a ‘Loud and Proud’ cabinet and relatives told us there had been an increase in parties and gatherings to celebrate people’s achievements.

Staff worked hard to ensure people’s dreams and aspirations were met. One person had been supported to have a meal out in a hotel as they had not previously done this. The person told us this had been a very special evening and they had enjoyed getting dressed up. Staff took lots of photographs to mark the occasion and these were shown to us with pride and enthusiasm. The person was very happy their dream had been achieved. This person had also been supported to start part-time voluntary work and they were very proud of how well this was going. Extensive work had been taken to increase the variety and range of activities people participated in, and staff told us people were happier as a result. This included attending college courses, having aromatherapy, attending drumming classes and lots of trips to places of interest.

Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the Frinton House. People’s needs were effectively met because staff had the training and skills they needed to do so. Staff were extremely well supported with induction, training, supervision and an annual appraisal of performance. Training was specific to the needs of people living at Frinton House. ‘Sign’ training (A form of sign language used alongside the spoken word to enhance communication) had been planned for people and staff to complete together so this was an inclusive event and to ensure consistency.

People were encouraged to be involved in decisions and choices when it was appropriate. MCA assessments were completed as required and in line with legal requirements. Staff had attended MCA and Deprivation of Liberty Safeguards (DoLS) training. Best interests meetings, with a multidisciplinary approach, were held when necessary to ensure people’s needs were met.

Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. People’s medicines were managed safely. There were robust procedures to ensure risks to people's safety were identified, assessed and managed. When incidents occurred they were reviewed promptly to ensure the risk of a reoccurrence was minimised.

People met weekly to decide the menus for the following week. Pictorial images were used to assist some people to choose the meals they wanted. People were involved in food preparation and support was provided in line with people’s individual needs. Menus were varied and demonstrated people received varied and well balanced diets.

Further information is in the detailed findings below.

At our last inspection in January 2016 we found improvements were required in relation to safety, consent, person centred care and good governance. Warning notices were issued and the provider was required to be compliant with the regulations by 20 June 2016. The provider sent us an action plan that told us how they would address these issues. We carried out this unannounced inspection on 14 and 20 December 2016 to check the provider had made improvements and to confirm that legal requirements had been met. We found that the provider had not fully addressed the breaches of the regulations in relation to consent and good governance. Although significant progress had been made in relation to person centred care further work was required to embed this into everyday practice. We found the provider met the regulations in relation to safety.

There was no 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. An acting manager had been appointed and they had applied to be registered and an interview had been arranged.

DoLS applications had been made in respect of some people. (A DoLS is used when it is assessed as necessary to deprive a person of their liberty in their best interests and the methods used should be as least restrictive as possible). Although there were restrictions in place and applications had been submitted to the local DoLS team staff were not sure if some people needed them.

Record keeping in some areas was not detailed and did not show the actions taken by staff to address matters. For example, in relation to the management of complaints and people’s activities. Although progress had been made in providing person centred care, further work was required to demonstrate that the plans made were followed.

Staff had a good understanding of people as individuals, their needs and interests. Some people attended day centres and college and people were also supported with activities both within and outside of the home daily. Since the last inspection the lounge and dining room had been redecorated and there was a relaxed and homely appearance.

There had been significant progress in addressing the requirements of the last inspection to drive improvements in the quality of the support provided to people and to support staff. The provider had strengthened the systems for monitoring the management and quality of the home. Through regular internal monitoring, the registered manager ensured that staff were clear about their role and the actions to be taken to meet people’s needs. Where shortfalls were identified, action plans were drawn up and matters had been addressed in a timely manner. There was a continual system of review and evaluation to drive improvement.

There were enough staff to meet people’s needs. Staff had a good understanding of the risks associated with supporting people. They knew what actions to take to mitigate these risks and provide a safe environment for people to live in. Staff understood what they needed to do to protect people from the risk of abuse. Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the home.

There were safe procedures in place for the management of medicines. People had access to healthcare professionals when they needed specific support. This included GP’s, dentists and opticians.

Staff had the skills and knowledge necessary to provide people with safe care. Training was provided which was specific to meeting people’s needs. Since the last inspection staff had received training on person centred care, record keeping and positive behaviour support. Staff received regular supervision and support from management which made them feel valued. A staff member told us, “Supervision is done regularly, there is a very good team here, we help each other, it’s brilliant.”

Staff spoke positively about the way the service was managed and the open style of management. They valued the increased involvement of the external management through their attendance at staff meetings and regular visits. People and staff also had opportunities to attend events run by the organisation nationally to share the home’s views and to hear about other services.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

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.

This comprehensive unannounced inspection took place on 28 January and 02 February 2016.

Good governance had not been maintained. Although there were systems and processes in place they had not been carried out effectively to ensure required improvements were made to the service. Audits by the registered provider had not been carried out in a timely manner and where they had been done the reports of these audits had not been sent to the home.

Areas of the home had been adapted to meet the needs of one person and although this had made a significant difference to this person, this, and some of the behaviours displayed by this person had a negative impact on some of the people at Frinton House. Whilst the registered manager had identified that the service was not able to continue to meet this person’s needs without it impacting on others, there had been a delay in taking action to ensure that more appropriate accommodation could be found. At the time of our inspection this matter was beginning to be addressed.

There were safe procedures in place for the management of medicines. However, protocols for the use of medicines prescribed on an as required basis were not detailed and it was therefore unclear when these medicines should be administered.

Although individual risks assessments were carried out, when changes occurred to people’s needs they were not always updated to ensure that people were safe and had all the equipment they needed to maintain their safety.

The registered manager and staff had training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, had assessed that some restrictions were required and made referrals for authorisations. However, there was no documentation to demonstrate that the least restrictive option had been used.

Some people led very busy lives which included attending day centres, college courses in the evenings and they had regular opportunities for walking, shopping and eating out in cafes and restaurants. One person was supported to attend church regularly. However, others had fewer opportunities for daily activities and records showed a strong emphasis on car rides and watching DVDs. It was not always clear what the purpose of outings were and there were no systems in place to monitor if people were happy with these outings.

Staff knew people’s individual needs and were able to describe to us how to provide care to people that matched their assessed needs. However, we observed some care practices that did not demonstrate that people’s dignity was always maintained or that a personalised service was provided.

People had access to healthcare professionals when they needed it. This included GP’s, dentists and opticians.

People told us that they liked the food. Relatives also spoke positively of the food provided. One relative said that the, “Meals are top quality, wonderful.” Systems were in place to ensure that there were sufficient quantities of fresh food available and the location of the home meant that additional shopping could be done to cater for people if they changed their mind about what was on the menu.

There were enough staff who had been appropriately recruited, to meet the needs of people. Staff were aware of how to recognise and report safeguarding concerns.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special

measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made. Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found a number of 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.

Below is a summary of what we found. This summary describes what people and staff told us, what we observed and the records we looked at. We used a number of different methods to help us understand the experiences of people using the service. People using the service had complex needs, which meant that some were not able to tell us their experiences.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that staff had completed training on the subject and further training had been identified as needed in relation to the recent changes in DoLS.

Is the service effective?

Care plans provided clear information about how people's needs should be met and they were reviewed at regular intervals. Staff spoken with had a good understanding of people's support needs. This demonstrated that staff had been given clear advice to meet people's needs.

We saw that when people needed specialist advice and support, arrangements were made for this to happen.

Is the service caring?

People were treated with respect and dignity. They explained to people what they were doing and offered them a choice of activities. One person told us, 'I go to church every week and I enjoy that.'

Is the service responsive?

We saw that people's needs were regularly reviewed. Records confirmed that people's preferences, interests and diverse needs had been recorded. We saw that when one person's needs changed, specialist advice was obtained and as a result the person's bathroom had been refurbished and a new walk in shower facility had been fitted.

People had access to activities that were important to them. During our inspection people returned from a bowling trip. Those who could speak told us that they had enjoyed the activity and others demonstrated via facial expressions that this had been a pleasurable experience.

Is the service well led?

We saw that the organisation had a range of measures to monitor the quality of the service provided at Frinton House. Although the frequency of the external management visits had decreased recently, we saw a report of a visit carried out following our visit and this demonstrated that the gap in visits had not had an impact on the running of the home. One person told us that they had regular residents' meetings. They said, 'We choose our meals at the meeting every week.'

Care plans included detailed information about the needs and abilities of people. There was evidence that people were involved in making decisions about their care.

People received a varied and well balanced diet and they were able to make decisions about menu choices.

The provider had systems in place to continually monitor and improve the service. There were systems in place to ensure that anyone wishing to make a complaint could do so.

In this report there are three registered managers named. Patrick Mooney and Kevin May were not in post or managing the regulatory activity at this location at the time of the inspection. Their names appear because they were still registered managers on the Care Quality Commission register at the time.