Fryers House - Care Home with Nursing Physical Disabilities

People’s experience of using this service:

Staff completed training in safeguarding and could recognise signs and symptoms of possible abuse in people.

Risks concerned with people’s health care and the environment were assessed and reduced as far as was practicable.

A new facilities management system automatically alerted issues in the premises such as water safety concerns or fire call points needing to be tested.

Due to having insufficient staff employed there was heavy use of agency staff. Risks associated with using agency staff were mitigated as the provider had forged working relationships with several agencies who provided regular staff to the service when possible.

A robust recruitment campaign was underway supported by a recruitment specialist. Recruitment procedures were robust and all necessary pre-employment checks were completed before staff commenced in post.

Medicines were safely managed following a high number of errors over the past year. A new EMAR system had reduced actual medicines errors however there were still issues with the system that the provider was working to address.

People’s needs were assessed before moving to the home and at intervals throughout their time there. Protected characteristics of the Equalities Act 2010 had been identified and people’s needs in these areas met.

There was a broad range of mandatory training courses and staff members were supported to complete qualifications such as diplomas in their specialist fields.

All new staff and agency staff were allocated time to read care plans before supporting people to ensure they approached the support as the person wanted it.

Staff participated in supervision every six weeks and the provider was undergoing a programme of annual appraisals when we were on site.

People could eat their meals when and where they wanted. People were supported by staff who showed empathy and meals were provided in the most appropriate way, for example, pureed.

There was good access to healthcare services such as the GP, physiotherapist and nutritional specialist. Healthcare provided was proactive, some people, prone to having infections were prescribed a low dose of antibiotic to minimise risk of infections developing.

The premises were purpose built and in very good decorative order. Rooms were personalised, and the appearance was homely.

The provider complied with the principles of the Mental Capacity Act 2005 and applied for Deprivation of Liberties Safeguarding authorisations as needed.

The service was extremely caring. Staff supported people with extremely complex health and social care needs in an empathetic and empowering way. Staff were experts in interpreting the non-verbal communications of many people and chatted with them as if old friends.

Staff clearly enjoyed spending time with the people they supported and told us they were the main reason they worked at Fryers House.

Staff ensured they had peoples consent before providing care and responses to people were caring, timely and appropriate.

The phrase, ‘dignity is at the heart of everything we do’ was displayed in both houses and it was clear that staff applied this at all times.

People were supported to access the community and a range of in-house activities. If they felt unable to access group sessions, staff could support with activities in people’s rooms however this was subject to available staffing.

The Accessible Information Standard had been met and information was presented to people in the most appropriate manner for them.

Complaints were welcomed and responded to as per the complaint’s procedure.

End of life care was planned for and delivered in partnership with local healthcare practitioners. Staff had attended training in the ‘Six Steps to Success in End of Life Care’ at a nearby hospice.

The management team were very supportive of staff and aware of and trying to address issues for such as pay rates that staff felt strongly about.

Audits were completed, and the registered manager had clear oversight of the service. Notifications of significant events were completed.

People, their relatives and staff were encouraged to feedback about the quality of the service and regular quality assurance questionnaires were issued.

The provider had developed positive links to the local community.

The service met the characteristics of Good in most areas; more information is in the full report.

Rating at last inspection: Good. Report published 23 February 2017.

Why we inspected: This was a scheduled inspection that was bought forwards due to information received about risks in the service.

Follow up: We will continue to monitor information received about the service and will reinspect as per our reinspection schedule.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Fryers House provides nursing care and accommodation for up to 24 people with a physical disability. The service is located in two accessible purpose built buildings in the town of Romsey. At the time of our inspection there were 22 people using the service.

The home had a registered manager in place. 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.

People told us they felt safe and staff were aware of the procedure to take if abuse was suspected.

Quality assurance systems were not being fully effective at driving improvements and maintaining quality. Reviews of assessed risks had not been completed within the providers own time scale.

We found the provider had made significant steps to improve the staff's knowledge of the Mental Capacity Act 2005. It was not meeting the requirements of the Mental Capacity Act (MCA) 2005. People's capacity to consent to care was not clearly recorded and completed. Consent to care paperwork was not always completed correctly and it was unclear whether the person had capacity to consent to their care or not.

Staff were recruited safely and records included appropriate checks as well as proof of identity to ensure they were suitable for the role they were employed to undertake.

There were enough staff deployed to meet the care and support needs of the people living in the service. The registered manager monitored staffing levels regularly to ensure appropriate numbers of staff were deployed.

People received their medicines as prescribed. Systems were in place to regularly audit the medicines held at the service and appropriate records were being kept.

People had sufficient to eat and drink and were supported to maintain a balanced diet. They had access to a range of healthcare professionals and services.

People were looked after by caring staff who knew them well. They were supported to express their views and were treated with dignity and respect.

People were supported to follow their interests and take part in social activities.

People and their relatives thought that the home was well-led. They all spoke positively about the registered manager and the staff group.

Complaints policies and procedures were in place and were available to people and visitors. Relatives told us they were confident that they could raise concerns or complaints and that these would be dealt with appropriately.

Notifications were routinely submitted to the Care Quality Commission when required.

We spoke with the relatives of three people who use the service who were all positive about the care their relative was receiving. One relative said 'I can't imagine it being better anywhere else' and another said 'the staff are so good, we have confidence in them.'

Staff demonstrated a good understanding of the terms 'safeguarding' and 'whistleblowing' and knew how to report issues should they arise. This protected people from the risk of abuse.

We saw training records up to March 2013. There was evidence that updates for fire safety, first aid and infection control had been booked. There was also evidence of clinical training for nursing staff which included tracheostomy training and use of a ventilator.

The service monitored it's call bell system. Call response times which were in excess of five minutes were highlighted and investigated. Some people who used the service were unable to use a call bell and there was a system in place to check if the person was alright every 30 minutes.

Systems were in place to ensure people received effective safe and appropriate personalised care and support.

Appropriate checks and procedures were in place to make sure that all staff and volunteers were safe to work with vulnerable people. The provider was able to access relevant and up to date training to help their staff meet people's needs.

The home was well cared for and the physical environment was pleasant and comfortable. The residents and relatives whom we spoke with remarked on how friendly and approachable the staff were.

The management and leadership at the home was proactive and looking towards constant improvement. They demonstrated this through the ways in which they consulted with and involved the residents in their own care and also with regard to the development of the service.