Archived: Mary Fisher House

Updated 11 April 2019

The inspection: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team: One inspector and an inspection manager.

Service and service type: Mary Fisher House is a care home. People in care homes receive accommodation and personal care. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with CQC. This means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager was also the appointed nominated individual to act as the main point of contact with CQC.

Notice of inspection: This inspection was unannounced.

What we did: We reviewed information we had received about the service since the last inspection. This included details about incidents the provider must notify us about, such as allegations of abuse; and we sought feedback from the local authority and other professionals who work with the service. The registered manager completed a Provider Information return. Providers are required to send us key information about the service, what they do well, and improvements they plan to make. This information helps support our inspections.

We spoke with four people and one relative to ask about their experience of the care provided. We spoke with three members of care staff, the deputy manager and the registered manager.

We reviewed a range of records. This included four people's care and medicine records. We looked at three staff files around staff recruitment and records in relation to training and supervision of staff, records relating to the management of the home and a sample of policies and procedures, maintenance records and the complaints procedure. Following the inspection, we received feedback from three relatives and a social care professional. We spoke with a specialist nurse practitioner and contacted the local fire prevention officer.

Updated 11 April 2019

About the service: Mary Fisher House provides residential care for up to 24 older people and people living with dementia. At the time of the inspection 23 people lived at the service.

People’s experience of using this service: The service was under the management of a court appointed administrator. Since their appointment in November 2018 the administrator had acted to meet recommendations and breaches found at the last inspection. Planned improvements were at an early stage and therefore progress on work carried out thus far was inevitably limited.

The registered manager displayed a commitment to providing high quality person-centred care. However, owing to other work commitments they had not implemented effective management systems to achieve this.

We found continued breaches of regulations regarding risk management and governance. Risk assessments were not being used effectively to identify potential risk and measure progress. Effective management systems for the prevention and control of infection had not been established.

Audits undertaken had not always identified where improvements were needed so appropriate action could be taken. For example, in relation to medicines management, environmental and hygiene standards and staffing.

Although staff knew people well some records required updating to reflect people’s changing needs or care preferences. Best interest decisions made on people’s behalf were not always recorded. We could not be confident people were supported to have maximum choice and control of their lives and staff would support them in the least restrictive way possible; policies and systems did not clearly support this practice. This meant people were at potential risk of receiving inconsistent or unsafe care.

We have identified a further breach in relation to the environment. Areas of the service were being refurbished. However, not all work was completed to a satisfactory standard to meet the law and published best practice guidance. People living in the service had complex needs including dementia care needs. The service had not been suitably adapted to include suitable use of signage and decoration to assist people to orientate themselves.

People had limited access to washing and bathing facilities. Although the registered manager told us boilers were to be replaced at the time of our inspection there was only an intermittent supply of hot water.

We have made recommendations about medicines handling and care planning to incorporate best practice to achieve improved outcomes.

People spoke positively about the registered manager; they felt they received good care and support from staff. They told us they were treated with respect and dignity and enjoyed the opportunities available to participate in activities.

Rating at last inspection: Requires improvement (report published 1 August 2018). Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve to at least Good. At this inspection we found the provider had failed to demonstrate sufficient improvement in their systems and remains rated Requires Improvement for the second consecutive time.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will meet with the nominated individual and the service’s administrator following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress.

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