Fridhem Rest Home

We found the following examples of good practice.

People could nominate three named visitors, and the essential care giver role was available in addition to this. Visitors were required to produce a negative rapid COVID-19 test prior to visiting their relative. Additionally, health declaration and temperature checks were completed. The essential care giver role included enhanced COVID-19 testing which was supported by staff.

External health and social care professionals, and visitors, evidenced COVID-19 vaccination status, and had to produce a negative rapid COVID-19 test before entering the care home. Furthermore, health declaration and temperature checks were completed. The only exception to this was for emergency workers, to ensure no delay of their review and care for people.

Personal protective equipment (PPE) was available at the care home, and guidance for PPE usage was displayed. Staff were observed to wear PPE correctly, and wore uniforms whilst at work. The registered manager told us visitors had received guidance from staff relating to the safe use and removal of PPE.

The care home was visibly clean and hygienic. Frequently touched areas, such as door handles and handrails, received enhanced cleaning. Staff told us they had access to the required equipment, and cleaning products, to maintain a safe environment.

Fridhem Rest Home is a residential care home providing personal care to 23 people at the time of the inspection. The service can support up to 25 people. The home was supporting older people some of whom were living with different forms of dementia. The service is over two floors.

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

There were some really positive aspects to the care people received at the home, it was clear staff and the management team had worked hard during the pandemic and had continued to do so. But there were also some shortfalls which could place some people at the potential risk of harm.

The registered manager and management team were not routinely assessing the risks which people faced and considering how to manage these risks. When plans were made to manage some risks, these were not complete.

The registered manager and management team were also not assessing some risks associated with COVID-19. This included when they took action contrary to government advice. There were no risk assessments completed, advice had not been sought from professionals and the local authority and plans had not been made to manage these risks. Placing people, staff, and the service itself at risk.

Timely actions had not been taken to promote people’s safety in response to potential fire risks. Essential staff recruitment checks were not completed. With no further action from the registered manager to try and manage this issue. We also identified shortfalls with the management and auditing of people's medicines.

The management and provider of the service was not effectively assessing, and auditing key aspects of the care provided. When audits were completed these were lacking in information to demonstrate a thorough and effective audit had been conducted.

People spoke positively about living at Fridhem Rest Home, one person said, “You wouldn’t get better than here, I count myself lucky everyday for living here.” Another person said, “The staff look after us very well. We can do whatever we want to do.” A person’s relative said, “I’m always made to feel welcomed and there’s always tea and biscuits.”

There was a positive culture at the home. People felt they were well looked after and had formed friendly relationships with the staff. The staff spoke well of the support they received from each other and the leadership of the home.

The registered manager had made improvements to the home to improve people’s experiences of living at the Fridhem Rest Home.

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

Rating at last inspection

The last rating for this service was good (published 1 November 2017).

Why we inspected

This was a planned inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fridhem Rest Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified three breaches of the regulations in relation to the leadership of the home and promoting people's safety. Some aspects of people's safety were not being managed appropriately. There was a lack of effective oversight and processes in place to assess and monitor the quality and safety of the service. Staff recruitment checks were not complete to ensure people were safe around staff.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Fridhem Rest Home provides accommodation and personal care for up to 25 older people, some of whom may be living with dementia. There were 21 people living at the home when we visited.

There was a registered manager working at the service. 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 of the Health and Social Care Act and associated Regulations about how the home is run. Two managers run the service, who are also owners of the business, one of them is the registered manager. The registered manager was not available on the first day of the inspection, however, the other home manager was. We met with the registered manager on the second day of the inspection.

We last inspected the service in June 2016 and found some shortfalls in the service provided. The provider was not meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At that inspection, we also found that the systems in place to monitor or assess the quality and safety of the service provided were not effective. Accidents and incidents were logged, but analysis of this information was not completed which could identify any emerging themes or trends.

We asked the provider to provide an action plan to explain how they were going to make improvements to the home. At this inspection, we found that improvements had been made.

Staff knew how to keep people safe from abuse. Staff were confident that if they had any concerns they would be addressed quickly by the registered manager. Risks to people had been assessed and regularly reviewed. Actions had been taken to mitigate these where necessary. Checks had been made on the environment to ensure the service was safe. Equipment to support people with their mobility, such as hoists had been checked to ensure people were safe.

There were enough staff to ensure people were safe and had their needs met in a timely way. Medicines were stored safely, people received their medicines when they needed them

Staff received training to make sure they had the skills and knowledge to carry out their roles. Specialist training such as diabetes and supporting people living with dementia had been completed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Staff understood their responsibilities under MCA, people’s capacity had been assessed and when required best interests meetings had been held and recorded. Staff encouraged people to make decisions about their day-to-day care and remain as independent as possible.

People told us that they enjoyed the food. People had a choice of meals and were supported to maintain a healthy diet in line with their choices, preferences and any healthcare needs. People’s health was assessed and monitored. Staff took prompt action when they noticed any changes or decline in health. Staff worked closely with health professionals and followed guidance given to them to ensure people received safe and effective care.

People’s dignity and privacy was maintained by staff. People told us staff were kind and caring. Staff spent time with people and were genuinely interested in them and what they wanted to say. Staff explained how they maintained people’s dignity and how they encouraged choice.

There was a programme of activities available for people to enjoy. People were able to access the community regularly including outings further afield in the homes own mini bus. Care plans were detailed and had been reviewed regularly and up dated to reflect people’s changing needs.

Information about how to complain was on display in the service. People and relatives knew how to complain and were confident that any concerns they had would be listened to and acted on.

Audits were in place to monitor the quality of the service people received. When improvements or developments were identified, action were taken to address and implement these. Accident and incidents were recorded and reviewed by the home’s managers. These were analysed to identify any patterns or trends and plans were put in place to reduce the risk of them happening again in the future.

Staff told us that they felt supported by the home’s managers and that the home was a good place to work. Staff were clear that the home’s managers wanted to run a high quality service. Staff understood their roles and responsibilities and the vision of the service by treating people with dignity, respect and ensuring people had a voice.

Staff supported people to maintain friendships and relationships. People’s friends and family could visit when they wanted and there were no restrictions on the time of day. People, staff and relatives received an annual survey to enable them to voice their opinions of the service and these were acted on. Staff and relatives meetings were held regularly.

Services that provide health and social care to people are required to inform the Care Quality Commission CQC) of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

The home has had the current registered manager in post since before October 2010. 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 CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service was not meeting the requirements of DoLS. The registered manager had not acted on the requirements of the safeguards to ensure that people were protected.

You can see what action we told the provider to take at the back of the full version of the report.

People felt safe living at the home. Staff were aware of safeguarding people from the risk of abuse but they did not know how to report concerns to the relevant agencies. Individual risks to people were assessed by staff and reduced or removed. There were adequate servicing and maintenance checks to equipment and systems in the home to ensure people’s safety.

There were enough staff available to meet people’s needs and additional staff were available if required.

Medicines were safely stored and administered, and staff members who administered medicines had been trained to do so. Staff members received other training, which provided them with the skills to carry out their roles, although training updates were not always available and this meant that staff knowledge was not always up to date.

People enjoyed their meals and were able to choose what they ate and drank. Staff members worked together with health professionals in the community to ensure suitable health provision was in place for people.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. People’s needs were responded to well and support was always available. Care plans contained information about how staff should support individual people with their needs. Staff members understood the MCA and presumed people had the capacity to make decisions. Where someone lacked capacity, best interest decisions had been made.

A complaints procedure was available and people were happy that they did not need to make a complaint. The registered manager was supportive and approachable, and people or other staff members could speak with her at any time.

The home did not effectively monitor care records and other systems to assess the risks to people and the quality of the service provided.

A risk assessment had been completed to ensure people could safely access the garden area. Checks were also completed to ensure hot water was safe to use.

The service had a policy and procedure to guide people in how to make a complaint and there was clear information about taking complaints further.

We saw that people's individual care needs were identified and that staff members were given clear guidance on how to assist people with their personal care.

People lived in a bright, clean and spacious home. However, the provider did not regularly undertake appropriate checks and, where necessary, assess potential risks to ensure people were not placed at risk of harm.

Staff we spoke with told us they felt supported in their work and that they were well trained to be able to provide care and support to people living at Fridhem Rest Home.

We saw that people were not made aware of how to make a complaint if they wanted to. Complaints policy's and procedures were out of date and did not contain accurate information to advise people who to speak with should they feel they wanted to make a complaint.