Friary House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Pre-admission assessments were in place for people. However, assessments of people’s care and treatment assessments were not holistic and did not include aspects such as health, personal care, emotional, social, cultural, religious and spiritual needs. Assessments of people’s care, and treatment needs had not considered specific issues that are common in certain groups of people which could result in poor outcomes for them if not addressed. For example, conditions such as swallowing difficulties, contractures, epilepsy, skin integrity problems and dementia in older people. This placed people at risk of harm and their needs being unmet.

A relative told us, “Yes, [registered manager] spent time with my [relative] and myself reading through [relative’s] care plan and has always discussed any changes that [they feel] are required as they arise.” A person told us that they had not seen their care plan.
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The registered manager explained that they no longer have a reminiscence activity but planned to bring this back. We reviewed the activities planner for February 2025 and noted only 6 activities had been organised in the 28 days of the month. There was no information to show what happened on days where activities had not been planned. This meant that people were at risk of not having their emotional, social, cultural, religious and spiritual needs met and were at risk of further health deterioration due to lack of appropriate mental stimulation.

A staff member told us, “Not every person is the same, therefore I feel care should be done in the way the individual likes and to show interest towards the individual. When a new resident moves in we get to know them and can have conversations they relate to or are interested in, play music they like and ensure they have foods they enjoy.”

We found no evidence of any activities designed specifically for people living with dementia. Providing a variety of approaches and activities helps people feel engaged and valued. We reviewed peoples support notes. These identified there was a lack of recorded activities. People were at risk of not receiving person centred care or achieving positive outcomes.

A family member told us, “I believe Friary House provides a good life for [relative], within [relatives] limitations. Entertainment, and art and crafts are regularly provided. [Relative] also is taken out on trips locally around Weymouth, which [relative] really enjoys”.

People told us that they did not get asked for feedback.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when they moved between different services.

We found the risk of choking, contractures or skin integrity breakdown were not effectively managed, and appropriate referrals to healthcare professionals were not always made when needed. We also found instructions from healthcare professionals had not always been recorded in people’s care plans and risk assessments. Safe swallowing plans from the Speech and Language Therapy (SALT) team for people were not mentioned in their care plans, resulting in staff potentially being unaware of safe swallowing requirements for them. This meant people could receive meals prepared to an inappropriate texture causing significant harm.

The service did not establish effective communication and information sharing within the team, which placed people at risk of not having changes in needs met. For example, there was no evidence that team meetings took place, and that handovers were used to discuss what was needed.

A relative told us, “there are regular visits from a healthcare professional and they have arranged visits to a day hospital or emergency department when needed”.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

A staff member told us, “we had a resident who wished to lose weight so they could be more independent and spend a Christmas at home with [their relative], they asked if they would be able to join [slimming club] the manager or deputy manager would take them to the slimming club weekly and the cook supported their weight-loss by adjusting the menu to their requirements. They loved going to the sessions with [staff member] and [staff member] and lost so much weight. As a team we supported them and yes, they managed to walk to the car and spend Christmas Day at their relative’s home with their family, it was wonderful to see”.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We found no evidence of records monitoring people’s epileptic seizures to establish possible triggers, trends or patterns. This increased risks of complications as a result of epilepsy.

Care plans did not always include people’s goals, so the service did not monitor if goals were being achieved. This meant people were at risk of not receiving person centred care.

A relative told us, “They have regular visits from medical staff and the care staff always listen to any concerns we may have about mum's health. They also pick up on changes in [relatives] health and needs and deal with them as well as possible.”

A staff member told us, “We have input from a GP practice and nursing teams who will inform staff what they want for specific residents when it comes to their skin integrity, diabetes etc. We record and report any changes and take photos to keep things updated.”

The provider did not tell people about their rights around consent, or respect these when delivering care and treatment.

Consent to care and treatment was not sought in line with law and guidance. The registered manager did not understand their responsibilities under the Mental Capacity Act 2005 and had not completed mental capacity assessments or best interest decisions as required under the Act. We saw mental capacity assessments (MCA’s) and best interest decisions (BID’s) that were not decision specific and listed all decisions on one form. For example, washing and dressing, medication, incontinence, food and drink and not going out on [their] own. We found no evidence least restrictive practices had been considered in the BID process. The service did not have MCA’s and subsequent BIDs completed for all people who had care plans that included acts intended to control or restrain them. For example, the use of bedrails, infrared sensors and chemical restraint. This meant that people were being unlawfully deprived of their liberty.

We were not assured training in the Mental Capacity Act 2005 was effective as staff and the registered manager had limited skills and knowledge in this area.

A relative told us, “Yes they encourage [relative] to make choices, and they listen to what they want.  They provide active encouragement but will ultimately be guided by what they know of their preferences and what [relative] wants.”