Frithwood Nursing Home

Frithwood Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provided both nursing and personal care and is registered to care for up to 26 people. At the time of our inspection, 26 people were living at the service. All the people were over the age of 65 years and some people were living with the experience of dementia.

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

The provider did not always ensure risk management plans had been developed to provide staff with guidance on actions which could mitigate identified risks related to a person’s health and wellbeing. When an incident and accident or safeguarding concern occurred the provider did not always identify lessons which could be learned to reduce the risk of reoccurrence.

The provider did not always ensure the home’s environment was appropriate to meet people’s needs. People’s nutritional needs and preferences were not always met. Care plans did not always provide staff with information on people’s support needs and their wishes in relation to how their care should be provided. The provider had a range of quality assurance processes, but these were not always robust enough to indicate when improvement was required.

The provider had a robust recruitment process to ensure new staff had the skills and knowledge for the role. Medicines were managed and administered safely and as prescribed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Relatives were happy with the care and support their family members received. People felt the staff were kind and caring and they supported them to make decisions about their care. The provider has a procedure for the investigation of complaints. People’s communication support needs were identified. Staff felt supported by the management of the 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 30 October 2018).

Why we inspected

We inspected due to the length of time since the last inspection.

Enforcement and Recommendations

We have identified breaches in relation to person centred care, safe care and treatment, premises and equipment and good governance at this inspection.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Prior to this inspection, we received anonymous concerns highlighting some areas of poor practice at the home. We considered these as part of our inspection and in assessing how well the service was meeting the five key questions we asked of providers. We found that the service was rated good in all key questions.

Frithwood Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provided both nursing and personal care and is registered to care for up to 26 people. At the time of our inspection, 22 people were living at the service. All the people were over the age of 65 years and some people were living with the experience of dementia.

The service is owned and managed by MD Homes, a partnership which also owned other similar services, mostly in North-West London.

There was a registered manager in place who had been running the service since June 2015. 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 and associated Regulations about how the service is run.

Risks to people's wellbeing and safety had been assessed, and where risks had been identified, the provider had taken appropriate action to mitigate these.

There were procedures for safeguarding adults and staff were aware of these. Staff knew how to respond to any medical emergencies or significant changes in a person's wellbeing.

Staff followed the procedure for recording and the safe administration of medicines.

The service employed enough staff to meet people's needs safely and had contingency plans in place in the event of staff absence. Recruitment checks were in place to obtain information about new staff and ensure they were suitable before they started working for the service.

There were systems in place to protect people from the risk of infection and the environment was clean and free of hazards.

The provider had sought relevant guidance and had taken steps to improve the environment to meet the needs of people living at the service and in particular of those living with the experience of dementia.

The provider was aware of their responsibilities in line with the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards (DoLS). Staff had received training on this. People’s capacity to make decisions about their care and treatment had been assessed. Processes had been followed to ensure that, when necessary, people were deprived of their liberty lawfully.

People's health and nutritional needs had been assessed, recorded and were being monitored. People had access to healthcare professionals as they needed, and their visits were recorded in people’s care plans.

People were supported by staff who received regular training and who were regularly supervised and appraised to ensure they were skilled and competent to care for people living at the service.

The provider told us they ensured that lessons were learned when things went wrong, such as speaking with staff and providing additional training as needed, to prevent reoccurrence.

We saw that staff supported people in a kind and caring way and interacted with them throughout the day. People were supported with their individual needs in a way that valued their diversity, values and human rights.

Staff provided a range of activities to people using the service. The provider had purchased new activity material and staff consulted people about what they wanted to do.

People’s wishes about end of life care were recorded in their advanced care plan and people’s needs were met when they reached the end of their lives.

The provider had robust systems to monitor the quality of the service and put action plans in place where concerns were identified.

People's needs were assessed prior to receiving a service and care plans were developed from the assessments. Care plans were comprehensive and contained details of people’s background and care needs.

There was a complaints procedure in place which the provider followed. However, no complaints had been received in the last year.

Staff told us that the provider was approachable and supportive and encouraged an open and transparent culture within the service. There were regular staff meetings where relevant issues were raised.

The provider sought guidance and support from other healthcare professionals and attended workshops and provider forums in order to keep abreast of developments within the social care sector and shared important information with staff.

At the inspection of 10 October 2017, we checked if the provider had met the requirements of the warning notice, and if they had put in place adequate systems to monitor, assess and make improvements. We found the provider had taken action and had made the necessary improvements in relation to the management of medicines. This meant that the provider had met the requirements of the warning notice. We found the provider had improved their auditing systems to identify shortfalls in the management of medicines and take action where needed. They had also made improvements in relation to training and the environment.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Frithwood Nursing Home’ on our website at www.cqc.org.uk.

Frithwood Nursing Home is a nursing home for up to 26 older people, some of whom were living with dementia. There were 22 people living at the service at the time of our inspection. There was one room which was shared by two people. The service was managed by MD Homes, a private organisation which managed five nursing homes in North West London.

There was a registered manager in post at the time of our inspection. 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.

There were effective systems in place for the management of prescribed medicines.

People were supported by staff who were well trained, supervised and appraised, and training was delivered by accredited trainers.

The provider had taken steps to improve the environment to support people living with dementia.

There was a registered manager at the service at the time of our inspection. 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.

Frithwood Nursing Home is a nursing home for up to 26 older people, some of whom were living with the experience of dementia. There were 22 people in residence at the time of our inspection. There was one room which was shared by two people. The service was managed by MD Homes, a private organisation which managed five nursing homes in North West London.

Staff did not always follow the procedure for recording and the safe administration of medicines. This meant that people were at risk of not receiving their medicines safely.

The provider had a number of systems in place to monitor the quality of the service and put action plans in place where concerns were identified. However, medicines audits had failed to identify the issues we found.

We found two repeated breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to the management of medicines and governance. You can see what actions we told the provider to take at the back of the full version of this report.

Staff received training identified by the provider as mandatory. However some of the courses were delivered by the registered manager who was not qualified to deliver this training. Training specific to the needs of the people who used the service was delivered by external certified trainers. This equipped staff with the skills to provide appropriate and effective care for people using the service.

There were organised activities at the service and we saw people being involved in these on the day of our inspection. However, there was a lack of person centred activities.

The environment was not designed in a way to support people who were living with the experience of dementia.

People’s capacity to make decisions about their care and treatment had been assessed. Processes had been followed to ensure that, when necessary, people were deprived of their liberty lawfully.

People told us they felt safe at the home and trusted the staff. They told us staff treated them with dignity and respect when providing care. Relatives and professionals we spoke with confirmed this.

We saw people being cared for in a calm and patient manner.

People gave positive feedback about the food and told us they were offered choice. People had nutritional assessments in place. People had access to healthcare professionals as they needed, and the visits were recorded in their care plans.

People, relatives and professionals we spoke with thought the home was well-led and the staff and management team were approachable and worked well as a team.

The care plans we looked at were signed by relatives or representatives. We saw evidence of best interests assessments where people lacked the capacity to make decisions about their care and support.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans were reviewed and updated monthly and included instructions for staff to follow to ensure people’s needs were met. Care plans contained information about people’s daily routines and preferences.

The provider had processes in place for the recording and investigation of incidents and accidents. Risks to people’s safety were identified and managed appropriately.

There were enough staff on duty to meet people’s needs in a timely manner.

People felt safe when staff were providing support. Staff had received training in safeguarding adults and demonstrated a good knowledge of this and what they would do if they thought someone was being abused.

Staff received regular supervision and an annual appraisal, and told us they felt supported by their manager. There were regular staff meetings and meetings with relatives.

Recruitment records were thorough and complete and the provider had ensured that staff had appropriate checks prior to starting work.

There was a complaints process in place and most people and relatives told us they knew who to complain to if they had a problem. Relatives were sent questionnaires to gain their feedback on the quality of the care provided.

We made recommendations in relation to the environment and consent.

We are proposing to take further action against the provider for the breach of regulation in regards to safe care and treatment. We will add full information about CQC's regulatory response at the back of the full version of the report after any representations and appeals have been concluded.

The inspection took place on 1 March 2016 and was unannounced.

The last inspection of the service was on 23 October 2014 when we found one breach of Regulation because the provider had not always obtained people’s consent to their care and treatment or acted in accordance with the Mental Capacity Act 2005. At this inspection we found the provider had made the necessary improvements with regards to this. However, we found breaches of other Regulations.

Frithwood Nursing Home is a nursing home for up to 26 older people. Some people were living with the experience of dementia. There were 26 people living at the service at the time of our inspection. There were three rooms which were shared by two people each. The service was managed by MD Homes, a private organisation who managed five nursing homes in North West London.

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 and associated Regulations about how the service is run.

People were at risk because cleaning products, containing dangerous chemicals, were not always stored securely and had not been correctly labelled.

The electrical cables in the sluice room had been damaged and presented a risk for people accessing this room.

People received their medicines as prescribed. However some of the practices for the storage and administration of medicines meant that people were at risk.

The environment was not always designed and used in a way which reflected people’s preferences and took account of their needs.

People’s privacy and dignity was not always respected. Some staff were rude towards the people who they were supposed to be caring for. The staff did not always show people respect, offer them choices or think about the care they were providing from the person’s perspective.

People’s individual needs and preferences were not always being met.

The provider had a registered manager in post, however, there was no contingency plan for when the manager was absent and therefore people living at the service had been placed at risk of poor practice.

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

There were procedures designed to safeguarding people and the staff knew what to do if they thought someone was at risk of abuse.

The risks to people’s safety and wellbeing had been assessed and were recorded.

There were enough staff on duty to meet people’s needs.

People’s capacity to consent to their care and treatment had been assessed and the provider had acted in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

The staff received the training and support they needed to care for people.

People’s nutritional needs were assessed and they had a variety of freshly prepared food.

The staff worked with other healthcare professional to assess and meet healthcare needs.

People told us they liked the staff and found them caring.

People’s needs were assessed and care was planned to meet these needs.

There was an appropriate complaints procedure and people knew how to make a complaint.

There were systems to monitor and audit the service and plans for improvement.

We found that the provider had taken action following on from two recent incidents involving medicines, including retraining for staff on how to manage controlled drugs, however medicines were not managed safely as improvements were needed to some medicines records and staff did not have sufficient information to enable them to administer some medicines safely.

The inspection was carried out by an inspector during one day. This helped answer our five questions;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care plans had details of people's needs and how these were to be met. These plans were regularly reviewed by staff. Risk assessment related to the care and support being provided were regularly reviewed to ensure people's individual needs were being met safely.

The medicines prescribed to people using the service were stored in a secure appropriate manner. We saw that the Medicines Administration Records (MAR) charts for all the people using the service were correct and information was clearly recorded.

There was one nurse and one care worker on duty at night providing care and support for 26 people over two floors of the home. A staff member we spoke with said "If something happened downstairs and we are upstairs we don't know and can't deal with it". This meant that staff at night could not ensure the safety and welfare of people using the service and meet their individual needs.

The service had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that the service had clear processes in place if they required to access the Deprivation of Liberty Safeguards that managers and staff could follow.

Is the service effective?

There was no evidence that people using the service and their relatives were involved in the development and review of care plans so they could ensure that the plans were tailored to their needs.

Is the service caring?

We saw that staff did not always communicate and interact with the people using the service when providing care and support to them. People were not always treated with dignity and respect and were not involved in decisions relating to their daily care and activities.

Is the service responsive?

The home worked closely with the local palliative care nursing team to provide support for people using the service and their relatives.

The home did not have a system in place to identify and review people's resuscitation and end of life plans. There were no care plans describing people's wishes and what support they wanted at the end of their life.

Is the service well led?

At the time of our inspection the service did not have either a registered manager nor a manager in post. The operations director explained that they were in the process of recruiting a new manager and an existing manager from another of the provider's care homes would provide interim cover for the service.

We saw that the training records did not provide accurate information relating to the training completed by staff. Staff did not have regular supervision or annual appraisals with their manager.

The service did not have a quality assurance system in place. Records seen by us showed that between January 2014 and May 2014 only three weekly audits of medication and care plans had been completed.

We found that people and/or their representatives were asked for their consent to the planned care and treatment. People were supported to make decisions about their daily routines and we saw staff encouraging people to make choices.

People's needs were assessed and care plans developed that took account of their likes, dislikes and preferences. Any risks to individuals were also assessed to ensure that action was taken to minimise these and keep people safe. People told us that they felt well looked after by staff and said, "the staff are very good here" and "they (staff) go out of their way to help."

People were offered a variety of nutritious meals and were supported to eat sufficient amounts to maintain their wellbeing. People were able to choose alternatives if they did not want what was on the menu for a particular day and they told us, "the food is generally very good here" and "I can have something else if I don't want what they give me but they know what I like."

The premises had recently been extended at the time of our inspection. We found the home to be clean and well maintained and people were supported to personalise their bedrooms.

Staff attended training at regular intervals to ensure that they had the skills and knowledge to meet people's needs effectively. We found that staff were not receiving regular supervision and annual appraisals but this was in the process of being addressed by the Operations Director for the home.

Care records contained care plans and risk assessments that had been reviewed at regular intervals to ensure that staff had the correct information to enable them to effectively meet people's needs. People were supported to see a range of healthcare professionals to ensure that any medical conditions were treated and monitored. People told us that they felt well cared for by staff. A relative spoken with said, "they are remarkably patient and very kind".

There were appropriate arrangements in place for the management of medicines. Only staff with the appropriate experience and training were able to administer medicines in the home and medicines were stored and administered safely.

There were sufficient numbers of staff to meet people's needs effectively. However, we noted that the manager was being included as a member of staff on shift which meant that at busy times the manager may not have been able to fulfil their management duties effectively as well as provide adequate support on the shift. There was an effective complaints management system in place.