Archived: Friarn House Residential Home

Updated 26 October 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Friarn House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Friarn House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was no registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.

During the inspection

We spoke with six people who used the service about their experience of the care provided. We spoke with eight members of staff including the acting manager, deputy manager, care workers and auxiliary workers. We also spoke to the newly appointed Clinical area lead.

We reviewed a range of records. This included three people’s care records and four medicines records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 26 October 2022

About the service

Friarn House Residential home is a residential care home providing accommodation and personal care for up to 16 people. The service supports people who may need support with living with dementia. At the time of the inspection there were 15 people living at the service.

People’s experience of using this service and what we found

People told us they were bored and had nothing to do. Comments included; “We need things to do” and “I’d like to go out more.” Other comments included; “There is nothing to do. I’m trying to get a coffee, but no-one comes in the lounge” and “Oh my goodness it’s so boring. You’ll be lucky to see anyone.” Also; “There are no staff about.”

People looked bored with no interaction, stimulation and little or no staff presence. Systems and processes had not been completed or updated as required. Audits were in place, however they had not been completed and concerns we highlighted on this inspection had not been identified.

There were insufficient staff working with people. There were two staff to care for 15 people. There was no staff dependency tool used to assess how many staff were needed to keep people safe. These two members of staff also had tasks to complete including, laundry, tea round in the afternoon and evening, cleaning after 2pm and at weekends. They also had to prepare supper and had to administer medicines in the morning and evening, which took 40 minutes each time. One care worker said, “I feel awful because I’m trying to hurry and make sandwiches and then I have no time with people.” Another said; “I’m very often the only staff member around.” One person required full assistance with their personal care, so staff needed to support them with a shower. This took 30 minutes, leaving only one staff available. However, they were also doing the laundry, so people were unsupervised during this time.

A staff member said; “We have raised the lack of staff on the floor many times and nothing happens. Over and over, nothing done” and “This place is like a racing track we go around and around like headless chickens. We don’t have any time.”

People were at risk due to a lack of care plans and risk assessments. Care plans did not contain information about people’s skin integrity. One person was now on an end of life pathway due to the deterioration in their health. No update care plan was in place showing this person’s current needs.

One person had no care plan in place. The staff confirmed this and said the person was at risk of falls, used a pressure mat in their room and was living with dementia. No care plan or risk assessment was in place in regard to people who’d had an allergic skin reaction. No care plan or risk assessment was in place for one person who was living with a particular type of dementia. They were continually breaking their reading glasses due to excessive cleaning and repetition and staff had no information on how to minimise this risk. One person, who was able to make their own hot drink did not have a risk assessment in place so staff could support them to maintain their independence while staying safe.

We found the provider had not reported and investigated possible safeguarding alerts. No up-to-date risk assessment, or referral had been sent to the appropriate people, for example the falls clinic, even though it was documented that one person had fallen 29 times in a little over six months. A body map held in this person’s file showed a high number of marks and bruises. On one occasion this person had a bruise and swollen ankle needing hospital treatment. This person then needed to wait 24 hours before being taken to hospital for treatment due to a lack of staff available. No accident form had been completed, it had not been investigated or passed to the local authority’s safeguarding team. No notification had been sent to CQC as required. No death notification had been sent to CQC following one person’s death.

People did not receive person-centred care. Two people were receiving end of life care in a shared room. They had no interaction from staff other than for tasks and meals. They spent all day lying in bed with nothing to look at. They were known to be friends but could not see each other and did not have any familial items around them.

The main lounge had chairs situated around the edge of the room. People were unable to see or hear the television.

People did not receive person centred care in relation to their continence needs. Continence management was poor meaning people were wearing continence aids which were often soiled when staff checked them. There was no evidence of staff pro-actively supporting people to maintain their independence in this aspect. Staff said they did not have time.

One person was living with a particular type of dementia. This meant they could experience abrupt mood changes, compulsive or inappropriate behaviour, disinterest and depression and repetition. There was no information for staff about this or guidance on how to meet the person’s needs.

There were no records of peoples’ individual activities. The activity co-ordinator had not had any training in dementia care, and they had not seen anyone’s care plan and did not know their needs, likes or preferences. They said; “I worry that I have no training, I just do what I think people will like. It would be nice to have some support. People are all at different levels of dementia.”

We found people had little or no interaction and people were left for long periods without seeing staff. Our observations showed there were no staff present for most of the day in the main lounge area and the call bell was out of people’s reach. People were put at risk due to lack of staff observation. One person in the lounge area was at a high risk of falls. During our observation people told us they were hungry and thirsty. One person was known to show distress by rocking. For long periods during the afternoon we observed them rocking in the dining room with no stimulation or engagement with staff. One person told us; “We have to shout out if we need help or rely on the person sitting next to us if we need the toilet.’

The only outside area was extremely dangerous with cracked and uneven surfaces. There were many items of broken equipment dumped in the garden, a rotten bird table and unsafe rotten benches. Large amounts of a noxious plant were in the garden and were easily accessible to people. Doors to the garden were left unlocked. People living with dementia and poor mobility were left unsupervised and would be able to access the outside area unobserved which would put them at risk. Due to the low numbers of staff there was no-one to support people to access the garden safely and so they were confined to the building, even during the warm weather.

The internal environment needed updating and attention and some areas were found to be dangerous. The office door leading to the basement was not locked. This meant it was accessible to people and was a risk due to the door leading to steep steps into the basement. The lounge door was a fire door but was propped open.

Bed bases in some rooms were heavily stained, broken and unfit for purpose. Bedrooms were very bare and unloved. Photo frames, paintings and personal items were not placed carefully and paintings were askew. Flannels and towels were all threadbare and the linen room held a minimal amount of extra linen. Sheets and pillows were very thin, and some were ripped. There were no locks on any toilets or bathrooms which did not protect their dignity.

People were unable to access the conservatory area as it was being used as a storage space for a hoist and stand aid.

Medicine audits had not been completed. We could not be sure people received their medicines as prescribed. Some people were prescribed ‘as required’ pain relief medicines. The protocols in place stated, ‘one tablet at night.’ However, also recorded was ‘up to eight 500mgs tablets in 24 hours’ also ‘one or two tablets to be given.’ Additional information was confusing and contradictory. Staff did not record how many tablets people were given or the time people had received this additional medicine. Therefore, there was no evidence people had been given their maximum pain relief of the up to eight tablets in 24 hours, or that they had been evenly spaced throughout the day. People were also receiving these ‘as required’ medicines on a regularly basis and not ‘as required.’ We also found medicines loose in the medicine cupboard and not in the original boxes. The service had a large number of medicines that required additional security, storage and signatures. These medicines were not documented as being held in the service as required. One person was prescribed a medicine that required them to have their blood pressure taken before administration. This had not been recorded as having been taken since March 2022.

There was no information about people being offered a food choice or involved in any menu planning. We were told by staff that they only had a budget of £3.00 to £3.50 a day to spend on each person’s food. Staff said it was ‘difficult to buy quality food’ and ‘they could never stay in budget.’

People had not been given the chance to feedback on the care and support they’d received. No resident meeting or quality assurance survey had been completed.

Cleaning and infection control procedures had not been updated in line with COVID-19 guidance to help protect people, visitors and staff, from the risk of infection. Not all PPE bins were suitable for use due to not being foot operated pedal bins.

Recruitment processes were followed in line with guidance. People received in house healthcare services, for example the district nurse team was supporting someone with their skin integrity.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible