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 requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.
 

The service was previously in breach ofthe legal regulationin relation to personcenteredcare. Improvements were found at this assessment, and the service was no longer in breach of this regulation.

This service scored 63 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Care plans had been completed for people and whenever possible people, or their relatives had been involved in sharing information and preferences to ensure plans were person-centred. Pre-admission assessments were completed in peoples’ own homes or in hospitals should they be admitted from there. A relative told us, “The registered manager and deputy manager got as much information about [person] as they could (at an initial assessment meeting) and as soon as we all realised they needed to make the placement permanent, it was organised smoothly and efficiently.” Another relative was pleased with the assessment process and told us, “The deputy manager has taken some time collating family history for [person] which goes in the big red book and supports carers to know more about them and their likes and dislikes.”

Assessments and care plans were regularly reviewed with people and their relatives. A relative told us, “Whenever there is a review or any changes, the registered manager contacts me and we go through it together.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. However, they did not always do this in line with legislation and current evidence-based good practice and standards.
The provider completed assessments and regularly reviewed care plans. However, we found medicines practice was not always in line with current good practice guidance. This meant people were potentially at risk of harm from medicines administration. Concerns about medicines can be seen in the medicine’s optimisation section of this report.
The provider had used well known tools to assess some areas including for example, the Malnutrition Universal Screening Tool (MUST). This enabled effective monitoring of unplanned weight loss and aided decisions regarding referrals to dieticians and GPs. People were referred to the speech and language therapy (SaLT) team should they have symptoms of swallowing difficulties. Guidance from the SaLT team would then be followed and people would receive modified food and drinks if necessary to promote safe swallowing.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

The provider made appropriate referrals to health and social care professionals. A frailty practitioner attended the service weekly. They received a list of people to see and addressed their and any other concerns that arose about people. They were supported by a GP who had oversight of all care homes in the locality. Community nursing teams also regularly attended the service to provide specialist support.

We received positive feedback from healthcare professionals regarding the working relationship with Friary House staff.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People’s health needs were monitored and support with health concerns was sought in a timely way. Referrals were made to healthcare professionals and people regularly saw members of the frailty team.

Risk assessments and care plans for healthcare conditions were regularly reviewed with people and / or their relatives to ensure needs were met as people wanted them to be.

People were encouraged to complete personal care tasks and maintain and improve their mobility. Choices of meals were given so people could enjoy a healthy diet. The provider ensured that people maintained their independence whenever possible by encouraging them to complete tasks of daily living rather than receive full support.

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.

Audits were completed by the management team of people care and care records as well as accidents and incidents. However, they were not aways effective and had not always been reviewed to identify themes and trends or links in changes to people’s well-being. Additional improvement was needed in analysing collected information to enable the provider to reduce risk of harm to people and improve care delivered.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. The provider did not have a clear understanding of how to apply the Mental Capacity Act (MCA).

We reviewed an example of a consent form for ‘day-to-day care’. This is should not be a single decision as people may consent to some aspects of day-to-day care but not others. For example, they may wish to be independent with their medicines and healthcare but need support with mobility or bathing. Decisions should be specific so this could cover personal care, or assistance with the toilet for example.
In the record it should be stated what ‘concerns / triggers had given rise to the capacity assessment’. The recorded response was a statement that the person has dementia so is not able to weigh up the information to make a decision. A diagnosis of dementia does not necessarily mean the person lacks capacity. Some symptoms of dementia such as increasing confusion or being unable to retain information would be more suitable indicators a person may lack capacity. We were also concerned that different staff members had completed different parts of assessments meaning the staff member who had assessed a person’s capacity to make a specific decision, may not have been involved in the actual decision. This meant decisions may be made on behalf of people by staff not fully aware of their conditions. There had also been no allowance for fluctuation in capacity, requesting consent at different times of the day, using different people to ask the questions or in different locations. All may affect whether a person may have capacity.
The person the decision referred to had a legal representative who held a lasting power of attorney for them (LPA). (This is a person they have nominated to make important decisions for them.) In this record, we saw no evidence their LPA had been involved.
There was minimal impact from the lack of awareness of the MCA as staff routinely asked for consent before supporting people with any care activities.