Friary House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.
 

The service was previously in breach ofthe legal regulationsin relation to staffing, safeguarding service users from abuse and improper treatment and person-centeredcare. Improvements were found at this assessment, and the service was no longer in breach of this regulation.

The service was previously in breach ofthe legal regulationin relation to safecare and treatment. Improvements were found at this assessment. However, medicine management still required improvement and therefore the service remained in breach of this regulation.
 

This service scored 62 (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 have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.
Accidents and incidents were recorded, reported and actions taken to mitigate risks. Information was shared with staff members at handover or during team meetings. Records were reviewed each month. However, checks for themes and trends that might help to reduce the possibility of recurrence were not always completed.

Following an unwitnessed fall, a relative told us, “Next day a community nurse organised a review and they put their collective heads together as it wasn’t obvious what had caused the fall.” The provider had linked with healthcare professionals to try to learn why a person had fallen and how to prevent them falling again.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider had positive working relationships with local healthcare professionals. There was a weekly ‘ward round’ completed by a paramedic from the GP surgery. The provider gave a list of people who may be unwell or in need of a healthcare review all of whom saw the paramedic.
The electronic care record had sufficient information to share should there be an emergency and healthcare services needed an overview of their condition and needs.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

The provider had a log containing an overview of safeguarding, notifications to CQC and Deprivation of Liberties Safeguarding (DoLS) applications and authorisations. People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes this is usually through the Mental Capacity Act 2005 (MCA) application procedures called the Deprivation of Liberty Safeguards.

The log was completed with minimal information, some had dates, some also had closure dates however there were no names or information about what they referred to. When there had been a death, there was no record if it was expected or had been referred for investigation by the police or the Coroner. The lack of information meant analysis of events could not easily be completed. However, staff had a clear understanding of actions to take should they suspect abuse had occurred and referrals to the local safeguarding team had been made. This was an improvement from our last assessment however; additional information was needed in the log in order for the provider to identify themes and trends that may contribute to reducing future occurrences.

People and their relatives felt the service provided at Friary House was safe, staff were kind and people were comfortable receiving care from them.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments had been completed for a range of different individual needs. For example, falls, skin integrity and medication. Risk assessments had proved effective to mitigate risk to people’s health and wellbeing. One person had frequent falls both at home and in hospital but had not fallen since their admission to Friary House. Use of call bells, an understanding of when the person may need additional support due to their fluctuating physical health and assisting the person with physiotherapy prescribed exercises had enabled them to live more safely with reduced risk of injury.

The provider worked with healthcare professionals and relatives to enable people to live fulfilled and safe lives.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider ensured all necessary servicing and checks were carried out and the premises and equipment were safely maintained. For example, regular sampling was completed for water hygiene monitoring and fire alarm checks were completed each week. Contractors were engaged to complete servicing as needed.

There were dementia friendly aspects to the premises. It was well lit and there was signage on communal areas such as toilets and the dining room to enable people living with dementia to navigate the premises.

The service improvement plan evidenced improvements that had been made to the environment and ongoing plans to improve further.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

We found 2 staff records did not have full employment histories which were legally required to be included. The registered manager knew both staff members and was able to tell us why there were gaps and immediately confirmed this information with the staff members. The provider should ensure future auditing of staff records would identify any similar issues and ensure compliance with regulations

There was no impact on people in this instance however not completing all pre-employment checks may mean staff not suited to working in a care setting may be recruited.

Staff records contained supervision records indicating regular 1-to-1 meetings with managers had taken place.

People and their relatives thought there were enough staff deployed to provide them with support. One relative told us, “At the beginning (April 25) I would have said there were not enough staff and I know they were trying to recruit more then. For instance, it took a long time to get people back upstairs. There have definitely been more staff employed over the last 6-7 months which has made a big difference.” A second relative said, “I do think there are enough staff. You can’t be everywhere at once and at occasional times it might take a little while to find someone, but I have never seen anyone in distress.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The premises were clean and there were no malodours. Infection prevention and control was regularly audited and ensured all cleaning was appropriate, timely and effective. People’s relatives told us, “When I visit, I have always found the home spotless,” and “From the moment we walked in unannounced it had a good, homely feel; looked efficient; caring and spotless.”

Staff used personal protective equipment (PPE) as needed for tasks such as personal care and serve food.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

Improvements have been made since our last inspection; however, further improvement was still required, and some previously identified issues had not been fully addressed.

There were suitable arrangements for ordering, storage and disposal of medicines, including for medicines needing cold storage and those requiring extra security. A review of medicines administration records (MARs) showed that people generally received their regular medicines as prescribed.

Some people were prescribed ‘as required’ (PRN) medicines, including medicines with variable dosages. However, supporting guidance was not always in place or sufficiently detailed to enable staff to administer these medicines safely, consistently and in line with people’s individual needs and preferences. For example, at the time of the inspection, 1 person had prescribed 2 PRN laxatives with variable dosages. They did not have clear guidance in place for staff on which medicine to administer, or the circumstances in which the dosage should be varied. This meant that people might not have received these medicines when they were needed.

A review of care plans found that while there was person centred information present in some, it was not consistent throughout records and key information was sometimes missing. For example, in 3 people’s records we found that continence care plans did not always reference constipation even though the person had laxatives prescribed. This meant staff might not have recognised or responded appropriately to changes in a person’s condition, risking delays in identifying and treating constipation.

During the inspection, we reviewed records for 1 person prescribed daily medicines for a serious medical condition, including emergency medicines to be administered when required. However, there was no care plan in place to guide staff on the person’s condition, the signs and symptoms to monitor, or the action to take if deterioration occurred. In addition, there was no written guidance to support the use of the emergency medicines and staff were not trained how to administer the medicine. This meant staff may not have been able to recognise deterioration or respond appropriately in an emergency, placing the person at risk. This issue had been identified at the previous inspection, and we found a similar concern affecting a different person.

Some people were prescribed high risk medicines such as anticoagulants; however, risk assessments were not always in place for these medicines. This put people at risk of avoidable harm and delayed treatment. This issue had been identified at the previous inspection, and we found a similar concern affecting a different person.

Following the inspection, the provider acted to address some of the concerns identified and submitted evidence to demonstrate that improvements had been made.