Archived: Friarn House Residential Home

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

We found the following examples of good practice.

The provider had not had an outbreak of Corona virus within in the home. At the time of the inspection all residents and staff had tested negative.

When staff came on shift, they were expected to record their temperatures and gel their hands before entering the building. Staff were asked to change their clothes when coming on shift, they used a staff toilet near the front entrance to get changed and put on their personal protective equipment, (PPE). A staff member told us, someone made us bags to put our clothes in and put our names on the bags.

Staff had received training in infection control, including how to safely put on and take off PPE such as gloves, aprons, and face coverings. The registered manager also told us; they had received this additional training as part of the support offered through Public Health England.

We saw staff wearing appropriate PPE and changing their PPE when moving from room to room. Due to the recent outbreak the provider had stopped all visitors coming into the home, this was to help prevent the virus entering the home. One staff member told us, “We support people to use phones and other technology to keep in touch”.

We reviewed the providers visitor’s policy and the registered manager assured us, when visitors do visit the home they are asked to wash their hands, wear PPE and maintain social distancing.

The home was split into three floors and staff could isolate each floor, but the registered manager told us they had not implemented zoning as every staff member and resident continued to test negative in the home. The registered manager was having regular contact with their GP, but this had stopped recently. The registered manager said they would contact Public Health England and the local commissioning team for support in the event there was outbreak in the home.

The provider was not admitting people to the home currently as they had no vacancies. The registered manager told us if they did have vacancies, no one would be admitted without a negative test first and their belongings would go into isolation for 72 hours prior to the person moving in, the providers admissions policy confirmed this was the correct process for the home.

The registered manager ensured regular testing was carried out, weekly for staff and monthly for people living in the home, this was in line with Covid testing guidance. The registered manager told us, and records confirmed, they gained consent from relatives for people who were not able to consent to testing, this information was recorded in line with the Mental Capacity Act.

Friarn House is a care home that provides personal care for up to 16 older people. At the time of the inspection, there were 15 people living at the service.

People’s experience of using this service:

People who were able to communicate with us told us they felt safe. People who were not able to tell us about their experiences looked comfortable and relaxed in the presence of staff.

People were cared for by a consistent staff team who had received sufficient training to carry out their roles. People received assistance to take their medicines as prescribed.

People were supported to access health care services. People’s dietary needs were assessed and where needed, people received support to eat and drink.

People received care that was kind, respectful and responsive to individual needs. Care plans were comprehensive and reviewed each month. People and their relatives knew how to complain. No people were receiving end of life care at the time of our inspection visit.

The registered manager worked in partnership with other organisations to make continuous improvements and develop best practice.

More information is in detailed findings below.

Rating at last inspection:

Good (report published in September 2016).

Why we inspected:

This was a planned inspection based on the rating from the last inspection. The service remained rated Good overall.

Follow up:

We will monitor information received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

Friarn House is registered to provide accommodation and personal care for up to 16 people. It specialises in the care of older people who have a dementia. On the days of the inspection there were 16 people living at the home.

The last inspection of the home was carried out on 18 February 2014. No concerns were identified with the care being provided to people at that inspection.

There was a registered manager in post. 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. The registered manager had managed the home for a number of years and had a good knowledge of the needs of the people who used the service. Everyone described the registered manager as open and approachable. People and staff said they felt able to discuss any issues with them.

We were unable to speak with some people in this home due to limited verbal communication.

We therefore gathered information by talking to staff, observing care and reading relatives' satisfaction surveys. We saw kind, caring and compassionate interactions from staff. Staff we spoke with were happy in their work, enthusiastic and confident. This was reflected In the atmosphere of the home. People who could not speak with us appeared happy and relaxed.

People were supported by sufficient staff numbers and staff told us they were always willing to cover shifts to ensure people received a consistent and reliable service. On both days of the inspections we saw people did not have to wait long for staff assistance. People and the staff knew each other very well and these relationships were valued.

Whilst the staffing structure was clear, improvements were needed in the supervision process for all staff. Although staff said they received supervisions, there were no records which showed appropriate on going and periodic supervisions were taking place. However staff appeared motivated and supported. The registered manager said supervisions were currently linked more to information sharing for all staff, or “Informal chats”, but would review the process with immediate effect.

Evidence showed that staff were suitably qualified, skilled and experienced. Staff had nationally recognised qualifications. One member of staff who had recently been through an induction period commented the induction process had been “good”. They said they felt they had learnt a lot more about people’s rights under the Mental Capacity Act (MCA).

Most people who lived at the home were supported to make decisions about the care and treatment they received. Where people were unable to consent, records showed any decision made on their behalf had been done in their best interest and ensuring their legal rights were protected.

Care plans were personalised and contained information to assist staff to provide care in a manner that respected their needs and individual wishes. Risk assessments which outlined measures to minimise risks and keep people safe were held in people’s care plans.

People’s nutritional needs were assessed to make sure they received a diet in line with their needs and wishes. Where concerns were identified with people’s nutrition, staff sought support from professionals such as GP’s and speech and language therapists

Safe systems were in place to protect people from the risks associated with medicines. Medicines were managed in accordance with best practice.

The provider sought people’s feedback and took action to address issues raised. Any issues raised from the feedback questionnaires were dealt with and people and relatives informed of the issues raised and action taken. People and their relatives all felt the leadership of the home was good. Comments included “My mum is so happy and settled, I think it because she knows all the staff”.

People were supported to access external health professionals, when required, to maintain their health and wellbeing.

There were quality assurance systems in place to monitor care, and plans for ongoing improvements. Audits and checks were in place to monitor safety and quality of care. If specific shortfalls were found these were discussed immediately with staff at the time and further training could be arranged if necessary

We saw evidence which showed that staff were suitably qualified, skilled and experienced. Staff we spoke to were happy in their work, enthusiastic and confident. This was reflected in the atmosphere of the home.

All staff were trained in safeguarding. The staff we spoke to were all knowledgeable regarding different types of abuse and demonstrated a confidence in reporting procedures.

At lunch time we observed well balanced nutritious meals being served in a relaxed dining room.

The provider had systems in place to regularly monitor and assess the service provided. Regular audits and satisfaction surveys allowed for continuous assessment and improvement of the service.

We saw that staff spoke with people in a friendly and polite manner. We noted that staff were sensitive and discreet when offering assistance which helped to maintain people's dignity.

People we spoke with were happy with the care that they received. Comments included 'It's a nice place to live' and 'I'm very well looked after.'

Care plans that we read contained assessments of need and outlined how needs would be met. The assessments were regularly reviewed to ensure that they reflected people's up to date needs. This meant staff had up to date guidance on how to support each individual.

People said that they thought that there was always enough staff on duty. One person said 'The staff are lovely and chatty' another person told us 'They always have time to help me when I want help, they'll do anything for you.'

No one we spoke with had any complaints about the service they received. People who were able to express an opinion said that they would be comfortable to speak with a member of staff if they were unhappy about the service they received.