Archived: The Friendly Inn

The Friendly Inn provides accommodation and personal care for up to 30 people. There were 24 people living in the home on the day of our inspection visit some of whom were living with dementia.

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

The provider had appointed a new management team since our last inspection and changes had been made to drive forward improvement. A service improvement plan was under constant review and further improvements were planned to take place. A range of new audits and checks had been introduced which demonstrated progress had been made. However, further time was needed to ensure improvements made were sustained.

The management of risk in the home had improved and staff had a better understanding of how to mitigate risks. Immediate action was taken to address the risks we identified in relation to fire safety.

Lessons had been learnt when things had gone wrong. Learning from accidents and incidents had been shared with staff. The management team understood their legal responsibilities to protect people and had shared important information with the local authority and CQC when required.

Staff were recruited safely and there were enough staff on duty to meet people's needs. Staff had received training and support, so they were more confident in their abilities to provide safe and effective care. Staff understood their responsibilities to protect people from abuse or discrimination.

People felt safe and had increased confidence in the ability of staff to deliver effective care. Feedback from people and relatives was gathered by the management team and was used to support continuous improvement.

Relationships with other healthcare professionals had improved which helped support people’s health and wellbeing. Mealtime experiences had improved. The home was clean and infection prevention measures were effective.

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.

The management of people’s personal information had improved. Staff were attentive and responsive to people’s needs. Care was provided in a dignified way. People’s right to privacy was respected and their independence was promoted.

People were happy with the social activities available to occupy their time. People enjoyed the food and their nutritional needs were met. People received their medicines as prescribed and had access healthcare professionals when needed.

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

Rating at last inspection (and update)

The last rating for this service was inadequate (published 10 June 2019) and there were multiple breaches of regulation. The provider sent us an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Enforcement

Since the last inspection we recognised that the provider had failed to notify us of incidents. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted the fixed penalty and paid this in full.

This service has been in Special Measures since June 2019. During this inspection the provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experiences of using this service:

• Risks to people’s health, wellbeing, safety and the environment were inadequately managed.

• Governance systems to monitor the quality and safety of the service were inadequate.

• Some staff lacked confidence in the provider to support the home and demonstrate good leadership.

• People's independence was not always respected and promoted.

• Improvements were required in promoting person-centred care. Some care records lacked important information.

• Staff had not completed the training they needed to provide high quality, safe care.

• Accurate analysis of accidents and incidents to identify patterns and trends to prevent reoccurrence did not take place. That meant lessons were not always learnt when things went wrong.

• Staff did not always follow good infection control practice to prevent infection.

•People received their medicines when they needed them but checks of people’s medicines were not always effective.

• People felt they received effective care and treatment from health professionals. However, support was not always sought in a timely way.

•Staff were not always available at the times people needed them to keep them safe.

• Despite our findings people and relatives felt the home was well run and they felt safe.

• Staff were recruited safely.

• Staff were caring in their approach and showed people kindness.

• Care was provided in a dignified way and people's right to privacy was respected.

• The home was clean, and the environment supported people living with dementia.

• People spoke positively about the food provided.

• Overall, people enjoyed the activities available to them.

• Some people’s end of life wishes had been recorded.

• People and their relatives knew how to make a complaint.

Following our inspection, we notified the Local Authority commissioners about the areas of concern we identified.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 11 Regulated Activities Regulations 2014 – Need for consent

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Regulation 18 Regulated Activities Regulations 2014 – Staffing

Regulation 18 of the Care Quality Commission Registration Regulations 2009. Notifications of other incidents.

Rating at last inspection: Good. The last report for The Friendly Inn was published on November 2017.

Why we inspected – The inspection was prompted by a notification of a potential serious incident. At the time of our inspection, we were aware of an ongoing police investigation. Whilst this inspection did not examine the circumstances of the incident, we considered the provider's management of risks.

The overall rating for this service is inadequate and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe and a rating of inadequate remains for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

Enforcement: Full information about CQC's regulatory response to the more serious concerns found in inspections is added to reports after any representations and appeals have been concluded.

The home was last inspected on 13 October 2016. At that inspection we found improvements had been made since our inspection in May 2016. However, the provider needed time to demonstrate to us the improvements made had been sustained and additional areas identified as requiring improvement had been addressed.

During this visit we saw further improvements had been made and sustained over a 12 month period which benefited the people who lived at the home.

The home had a registered manager. 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 felt safe and were happy living at the home. Procedures were in place to protect people from harm. Staff understood their responsibilities to keep people safe and were confident to raise any concerns with their managers.

Risk assessments and management plans were in place and most contained up to date information. Despite omissions in records discussions with staff demonstrated a consistent approach to the management of risks.

People received their medicines as prescribed and medicines were stored safely. People received appropriate health care to meet their needs.

Accident and incident records were completed. Analysis of the incidents to identify patterns or trends had been completed to reduce the likelihood of them happening again. Equipment was checked by staff and external contractors to make sure it was safe to use.

People told us the staff had the skills and knowledge they needed to care for them effectively. New staff were provided with effective support when they first started work at the home. Staff had completed training the provider considered essential to be effective in their roles.

The staff demonstrated an understanding of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) which meant that they could ensure peoples' rights were being protected. The managers understood their responsibility to comply with these requirements. For people who were assessed as not having the capacity to make all of their own decisions, records showed their families and health care professionals had been involved in making decisions in their best interests. Staff always obtained people's consent before they provided care and support.

Most of the people we spoke with provided positive feedback about the food and dining experiences at the home. Overall, staff demonstrated good knowledge of people’s dietary needs.

People spoke positively about the staff that provided their care. Staff showed concern for people's wellbeing and demonstrated they knew the people they cared for well. A keyworker system was in place. This meant people were supported consistently by a named staff member.

People were encouraged to be as independent as they wished to be. People were treated with respect and were cared for in a dignified way.

We received positive feedback about how people's care was personalised to meet their needs. People received care which was in line with their wishes and preferences.

People were encouraged to maintain relationships important to them. Relatives were encouraged to be involved in their relative’s care and there were no restrictions on visiting times. People spoke positively about the varied social activities that were available to them to occupy their time.

People and their relatives were invited to attend regular meetings so they could make suggestions about how the home was run. People and their relatives knew who to speak with if they had any concerns or complaints about their care and all felt confident concerns would be dealt with appropriately and fairly.

Staff told us they enjoyed working at the home, they felt supported by the management team and they received regular supervision of their work. The provider and the managers promoted an open culture by actively encouraging feedback from people, their visitors and staff to put forward their suggestions to make continual improvements at the home.

More effective systems to monitor and review the quality of the home were in place since our last inspection. There was an emphasis on continually looking for ways to improve the service people received, and also looking at learning if care fell below the standards the provider expected.

The service was last inspected on 4 and 11 May 2016. At that inspection we found there were four breaches in the legal requirements and Regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014.

These breaches were in relation to the safe care and treatment people received. There was not enough staff to meet people’s needs, and staff were not deployed effectively. People had not been involved in planning their care and their care records were not accurate. People were not satisfied with the social activities provided. Systems and quality assurance processes were ineffective to monitor and improve the safety and quality of the services provided to people.

We rated the home as inadequate overall and it was placed into special measures. We wrote formally to the provider and made a decision to impose a condition on their registration. This meant that no one could move in to, or return from hospital to the home without our prior permission. We also met with the provider to give them the opportunity to assure us of the actions they were going to take.

The provider sent us an action plan to inform us of the improvements they planned to make.

At this inspection on 13 October 2016, we checked improvements had been made. We found sufficient action had been taken in response to the breaches in Regulations. However, there were some areas where further improvements were required and the provider had plans in place for on-going improvements to be made.

The home had a registered manager. 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 provider had increased their staffing levels and improvements to the way their staff were deployed. However, staffing levels in the afternoon were yet to meet the level identified by the provider’s new staff dependency tool. An activities co-ordinator had been employed and the non-caring duties care staff were expected to complete, such as kitchen work had reduced since our last visit. This ensured care staff were available at times when people needed them.

Improvements had been made to the way the risks associated with people’s care were managed. Where risks were identified, for example where people were at risk of falls, detailed risk management plans had been implemented to minimise risks. Staff had received falls awareness training and risk assessments were reviewed monthly in-line with the provider’s policy to ensure the information for staff to follow was correct. However, not all risks had been identified at the time of our visit. Risks relating to one person’s mental health had not been identified and plans were not in place to minimise the person’s anxieties or provide re-assurance to others.

The recording and monitoring of accidents had improved. Analysis to identify patterns or trends had been completed to reduce the likelihood of them happening again. Regular quality audits of the home were conducted to monitor and improve the care provided by the service.

The provider had made improvements in how medicines were managed and administered. This meant people received their medicines when they needed them and people’s medicines were mostly managed safely. Staff who administered medicines had received training and their competency had been assessed by the registered manager.

The provider had made improvements which ensured people received the food and fluids they required to maintain their health. Those people assessed as at risk of dehydration or malnutrition were provided with additional support and monitoring to meet their needs.

During our last inspection people and their relatives told us some staff were not always kind and caring. At this visit everyone we spoke with was positive about the care they received. We saw staff engaged well with people. Relatives and friends were able to visit the home at any time.

People had been involved in planning their care. Care plans had been improved since our last visit. They described how people wanted to receive their care and support and the choices they were able to make for themselves.

We saw staff were attentive to people’s needs and people were supported to make daily choices. Staff asked people for their consent before providing assistance. The managers and staff understood their responsibilities and the requirements of the Mental Capacity Act and the Deprivation of Liberty Safeguards. People and relatives told us the staff treated them with respect and dignity. People told us the staff encouraged them to be independent.

During our last inspection we found the provider had failed to notify us and the local safeguarding team when people had experienced multiple falls which had resulted in injuries. During this inspection improvements had been made. The managers had completed further training to develop their understanding of their responsibilities. Reporting procedures had been reviewed and improved. The provider’s safeguarding policy had been reviewed and had been communicated to the staff.

People told us they attended healthcare appointments when they needed them. People's records showed how the home worked in partnership and maintained links with health professionals such as the district nurses. This meant people who lived at the home received the appropriate health care to meet their needs.

The mealtime was positive for people. The provider had made improvements since our last visit because people told us they enjoyed the food. The atmosphere in the dining room was calmer than when we last visited and a variety of different foods of people’s choice had been added to the menu.

Records showed a programme of regular training updates supported staff to keep their skills and knowledge up to date. New staff members were provided with effective support when they first started work at The Friendly Inn. Staff told us they were encouraged by the provider to further develop their knowledge and skills.

During our last inspection people were not satisfied with the social activities that were provided to occupy their time. During this inspection improvements had been and there was more stimulation for people living with dementia.

During our last inspection people and their relatives did not have the opportunity to formally feedback any issues or concerns. Further improvement is required in this area because this opportunity remained unavailable.

Staff felt supported by the management team and told us they enjoyed working at the home. However, staff told us they did not have one-one meetings with their manager to discuss their individual training and development needs.

People and their relatives told us they knew how to make a complaint if they wished to do so. A system was in place to manage complaints received about the service. No complaints had been received within the last six months.

During our last visit we saw records containing people’s personal information was accessible to others. During this visit we saw the provider had made improvements, and we were assured confidential information could not be seen by people unauthorised to see it.

The Friendly Inn provides personal care and accommodation for up to 30 older people. A number of people were living with dementia and had high physical care needs. There were 30 people living at the home when we carried out our inspection. This included one person who was in hospital on our second visit.

The service was last inspected on 11 January 2016. At that inspection we found a number of improvements were required and the registered manager told us they had plans in place to ensure these were made.

Following the last inspection we received information of concern from various sources about the quality and safety of care provided at the home. This included concerns in relation to the management of risks associated with people experiencing falls and there not always being enough staff available to provide care and support. We therefore undertook a further comprehensive inspection in response to these concerns.

There was a registered manager in post . A requirement of the service’s registration is that they have a registered manager. 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 we spoke with had mixed views about whether they felt safe at the home. We found risks associated with people’s care, in particular around falls, were not always identified, assessed and monitored to make sure people were protected from the risk of harm. We spoke with the Local Authority and Clinical Commissioning Group (CCG) about concerns we had identified.

Medicines were not always managed safely. We could not be sure creams were applied as prescribed. Accidents and incidents had been recorded however; it was unclear how this information had been used to identify any patterns or trends, to help prevent them from happening again. Safeguarding referrals to protect people from abuse had not always been made.

Staffing levels and arrangements were insufficient to maintain people’s safety. Staff were not always available at the times people needed them. Care staff were required to complete additional duties such as laundry and meal preparation, which meant they were not always able to meet people’s needs and keep them safe.

Overall, individual staff members demonstrated a caring approach and people were offered choices however, staff had limited time to spend with people and we saw little interaction between staff and people throughout our visits. It was not clear how people had been involved in planning their care to ensure they received care and support that met their needs and preferences. People were not supported to pursue their hobbies and interests, particularly for people living with dementia.

The provider did not have sufficient systems and processes in place to assure themselves that people received a good quality service that met their needs. People’s opinions of the service were not always sought and listened to. Quality monitoring processes were not effective to ensure improvements to the service were identified and acted upon in a timely manner, for the benefit of people who lived there.

People knew how to make a complaint if they wished to do so. However, some people were not satisfied with how their complaint had been handled.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We formally wrote to the provider and asked them to submit an urgent action plan to tell us how they were going to mitigate the risks. We also imposed a condition on the provider’s registration which meant that they required our written consent before admitting or re-admitting people into the home. We met with the provider to share our concerns and gave them the opportunity to provide assurances of actions taken to ensure the safety of people who lived at the home. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service will therefore be placed in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Friendly Inn provides accommodation for up to 30 people including some people who have dementia. At the time of the visit 27 people lived at the home.

The service had a registered manager. 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 living at the home and we saw enough staff on duty to keep people safe. Risk assessments were in place to minimise the risks to people’s safety and staff had a good understanding of how to minimise risks, however records were not always updated.

People received their medicines as prescribed from competent trained staff. Medicines were stored safely and securely.

Infection prevention required improvement in some areas of the home. The provider was recruiting more domestic assistants to maintain the required standards of cleanliness.

Recruitment checks were carried out prior to staff starting work at the home to make sure they were suitable for employment. New staff received an induction prior to working independently and staff received training in health and social care to develop their skills further.

People were not always supported in line with the Mental Capacity Act 2005(MCA) to make important decisions. Assessments of people’s capacity were not always completed. People were verbally consenting to their care and support but this was not always reflected in their care records.

Staff were kind and patient and people told us staff showed them respect. People were encouraged to maintain relationships with people important to them.

People told us they enjoyed the food, which met their dietary needs. They told us they were able to have drinks and snacks throughout the day.

People and their families were positive about the care being provided however they told us they knew how to make a complaint. Some concerns were raised about the laundry service and the registered manager told us action would be taken to address this.

People had some opportunities to put forward their views on the service provided and further plans for opportunities were in place.

People and the staff were positive about the management team and the running of the home. There were processes to monitor the quality and safety of the service provided.

We reviewed care plans and records of care, staff files, and records of the quality assurance processes. We checked how information was stored and managed. We used our findings to answer the five key questions: is the service safe, effective, caring, responsive and well led?

This is a summary of our findings.

Is the service safe?

The care plans we looked at showed that risks to people's health and well-being were assessed. Care plans described the actions staff should take to minimise the identified risks. People’s likes, dislikes and preferences were known to staff.

People told us they felt safe. We found people were protected from abuse and from the risk of abuse. This was because the manager checked that staff were suitable to work with vulnerable people before they started working at the home. Staff received safeguarding training. They understood the various forms of abuse and knew what they should do if they suspected anyone was at risk of abuse.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The deputy manager knew about a recent judgement by the Supreme Court in relation to (DoLS) and was checking the latest guidance for changes in the local authority's policy and procedures. The manager knew they might need to review people’s needs and understood how to make an application to the local authority if they needed to deprive people of their liberty.

Is the service effective?

People told us they were happy with the care they received and their needs were met. It was clear from our observations and from speaking with staff that they understood people's care and support needs and knew them well. People told us they got up and went to bed when they wanted to. We saw people had furnished and decorated their rooms to their own taste and preferences.

Is the service caring?

People were supported by kind and attentive staff. People told us they had a choice of meals. We saw people were supported to follow their own interests and join in group activities if they wanted to. A member of care staff told us, “In the afternoon, we watch a movie or make cakes, or listen to music, have tea and watch soaps. Whatever habits people had at home, we try to maintain.”

We saw care workers were patient and encouraged people to make their own decisions. A care assistant told us, "I can back off when their body language or face tells me to. I understand the triggers. You can’t force an issue. I offer and encourage.”

Is the service responsive?

People's needs and abilities were assessed before they moved into the home. The care plans we looked were regularly reviewed and changed as people's needs changed. We found staff supported people to see other health professionals, such as doctors, dieticians and community psychiatric nurses when they needed to.

The manager listened to people's comments and suggestions and took action to resolve issues straight away. People we spoke with told us they felt comfortable about raising any issue with the staff or manager because they always got a positive response.

Is the service well led?

The manager conducted internal quality reviews and actively consulted with people and their relatives through surveys and meetings. We saw complaints were investigated thoroughly and actions were taken to provide a satisfactory resolution.

Staff had a good understanding of their role and responsibilities for delivering a quality service. Staff told us about the quality assurance checks they made and the actions they took when they identified any issues. A care assistant told us they had team meetings, daily handover meetings and one to one supervision sessions. They told us, “We talk about any concerns, staffing issues and I can ask for a private chat anytime.”

We observed staff interacting with people with kindness. They demonstrated through one to one discussions with us that they knew the care needs of the people they were looking after.

We found the environment clean and comfortable. One person who used the service told us,” Staff are nice here, its ok I suppose.”

We reviewed the care of four people with varying levels of need and found most of their needs were being met.

We saw people’s bedrooms and the general home environment was safe and most people were supported with appropriate equipment.

During the inspection on 23 October 2013 we noted there was not enough staff to meet the needs of people who used the service. We visited again on 29 October 2013 and saw that action had been taken to address this.

We examined records and found some discrepancies. For example some care plans, risk assessment tools and daily food diaries were not completed and updated appropriately to support people’s needs.

We noted appropriate referrals were made to outside specialists on behalf of people who lived there.

People spoken with told us they were satisfied with the care they received. Their comments included,

“They are friendly.”

“Mostly they’re alright. Some staff are more caring than others.”

” I feel safe here.”

We spoke with the registered manager, the deputy manager, and three care staff. We looked at some records relating to the running of the home, such as the staff duty rota and training records.

People were treated respectfully. We saw staff addressing people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs.

We saw a member of care staff talking with a person who was confused. The care staff sensitively interpreted what the person was trying to say. We saw from the person’s response that they felt relieved and reassured.

We saw that staff were knowledgeable about people’s needs and their likes and dislikes. They were kind, caring and attentive towards them. We saw that most people were supported to maintain their personal appearance.

We were concerned there were not enough staff on duty to safely meet people’s needs during the late afternoon and evening.