We carried out an unannounced inspection of the service on 8 and 11 December 2017. Friary Fields is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Friary Fields Care Home provides accommodation for up to 34 older people and people living with

dementia. At the time of the inspection 15 people were living at the service.

A registered manager was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During the home’s previous inspection in July 2016 we identified improvements were required in relation to the management of medicines, safety to the external environment and communication between the staff team. At this inspection we found action had been taken to make these improvements and no further concerns were identified.

People were now protected against the risk of their prescribed medicines not being effectively managed. New audits and checks had been implemented; protocols were in place for people who were prescribed medicines to be taken as and when required. The medicines policy and procedure had been updated. The external environment was found to be safe; any garden equipment was stored and secured appropriately. Communication between staff had improved and staff were found to work together effectively.

People were protected from avoidable risks. Staff were aware of their role and responsibilities to protect people from of any type of abuse. Risks associated to people’s needs, including the environment had been assessed, planned for and were regularly monitored and reviewed.

People were supported by an appropriate number of staff that were deployed effectively. The service was found to be clean and hygienic; the provider was working towards an action plan with the local Clinical Commissioning Group to ensure the prevention and control of infection measures were in place. Incidents and accidents were recorded, monitored and action was taken to reduce further risks.

People were supported by staff who had completed an appropriate induction, ongoing training and opportunities to review and discuss their work and development needs. People received a choice of meals and their dietary, nutritional needs and preferences were known and understood by staff. People’s health needs had been assessed and planned for and the staff worked well with external healthcare professionals to effectively support people’s health needs and outcomes.

The principles of the Mental Capacity Act (2005) were followed when decisions were made about people’s care. Deprivation of Liberty Safeguards were in place for some people where required.

People were supported by staff who demonstrated a good understanding of their needs and were found to be caring and kind, showing empathy and compassionate in their approach. Staff were aware of the importance of respecting people’s privacy and dignity and they maintained high standards of this. People’s diverse needs were known and understood by staff and they were encouraged as fully as possible, to be involved in discussions and decisions about their care and support.

People were provided with information about how they could access independent advocates. The environment met people’s physical needs and those living with dementia. There were no restrictions of when people’s friends or relatives could visit them.

Staff supported and encouraged people to participate in daily activities. Staff had information to support them to provide a person centred approach in the delivery of care and

This inspection took place on 18 July 2016 and was unannounced.

Friary Fields Care Home provides accommodation for up to 34 older people and people living with dementia. 20 people were living at the service at the time of the inspection.

Friary Fields Care Home is required to 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. A registered manager was in place.

Improvements in the systems and processes to check the management of medicines were required. Protocols to advise staff about the administration of prescribed medicines to be taken as and when required were not available. Information about people’s preferences of how they took their medicines was not available for every person.

Staff were aware of their responsibilities to protect people from abuse and avoidable harm. Staff had received adult safeguarding training and had available the provider’s safeguarding policy and procedure.

Risks to people's individual needs and the environment had been assessed. Staff had information available about how to meet people’s needs, including action required to reduce and manage known risks. These were reviewed on regular basis. Accidents and incidents were recorded and appropriate action had been taken to reduce further risks. The internal environment was safe but action was required to ensure the external building was kept safe at all times.

Safe recruitment practices meant as far as possible only suitable staff were employed. Staff received an induction, training and appropriate support. There were sufficient experienced, skilled and trained staff available to meet people's individual needs.

People's healthcare needs had been assessed and were regularly monitored. The provider worked with healthcare professionals to ensure they provided an effective and responsive service. However, for one person staff had not followed recommendations from a healthcare professional and this had impacted on the person’s health.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. People received a choice of meals and independence was promoted.

The registered manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), so that people's rights were protected. Where people lacked mental capacity to consent to specific decisions about their care and support, appropriate assessments and best interest decisions had been made in line with this legislation. However, these lacked specific details in places and had not been reviewed. Where there were concerns about restrictions on people’s freedom and liberty, the registered manager had appropriately applied to the supervisory body for further assessment.

Staff were kind, caring and respectful towards the people they supported. They had a person centred approach and a clear understanding of people's individual needs, routines and what was important to them.

The provider enabled people who used the service and their relatives or representatives to share their experience about the service provided.

People were involved as fully as possible in their care and support. There was a complaints policy and procedure available and people were confident to report any concerns or complaints to the registered manager. People had some information about external services that could provide support. The registered manager had information leaflets about independent advocacy services that they were going to make available for people.

People were supported to participate in activities, interests and hobbies of their choice. Staff promoted people’s independence.

The provider had checks in pla

This inspection was carried out to follow up on our previous inspection in July 2013, where we found the provider was not compliant with two outcomes.

Prior to our visit we reviewed all the information we had received from the provider, including an action plan detailing how they would comply with the compliance action we set at the previous inspection. During the visit we spoke with a relative and asked them for their views. We also spoke with the registered manager, a senior care worker, two care workers and a housekeeper.

We looked at the prevention and control of infections policy and procedures and other records within the service, including three people’s care files. We also did a tour of the communal bathrooms and toilets.

A relative spoke highly of the care and support their relative had received whilst residing at the home.They told us the manager had responded very quickly to the request for a short term placement. Comments included, "I've been so impressed with the home, in my opinion the manager is really on the ball, they came to the hospital to do an assessment but not just about medical needs, they took the time and trouble to get to know my father as a person." And, "All the staff have been smashing in supporting my father, they are kind and caring. The care has been excellent."

We found the provider had made the required improvements to become compliant with these outcomes.

Prior to our inspection we reviewed all the information we had received from the provider. During the inspection we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with two relatives for their views and spoke with four members of staff this included care staff and the cook. The registered manager was not available on the day of our inspection but we spoke with the provider (owner).

We also looked at service information, care plan files for four people and did a tour of the building.

The relatives we spoke with told us they felt communication was good with the registered manager and staff. They said they were consulted and involved in decisions about their relative’s needs. Comments included, “The manager is very approachable, and they listen to what you have to say, I feel involved in my husband’s care.”

We observed people being served their lunch and drinks throughout the day. We saw people were offered choices and the menu provided nutritional and well balanced meals.

We saw improvements had been made to the cleanliness of the home but we found further work was still required.

We observed staff who interacted with people constantly during the day. Staff appeared very knowledgeable, competent and experienced in supporting people with a dementia type illness.

We found some of the records used were not up to date or reflective of people’s needs.

Prior to our visit we reviewed all the information we had received from the provider. We used observation to help us understand the experiences of people using the service, because due to the communication needs of some people who used the service, they were not able to tell us their experiences.

We spoke with two people who used the service, three relatives and a visiting professional. We also spoke with the registered manager, four members of staff and looked at service information, records and carried out a tour of the building.

People told us they were treated with dignity and respect and their care needs were well met. One person told us, “I like living here; they (staff) are very good at their job.” Another person said, “I feel the staff involve me and listen to me.”

Relatives we spoke with told us they felt they were involved in their relatives care and treatment. Comments included, “Communication is very good, they (staff) are straight on the phone if they need to tell me something. I have the upmost respect for the staff.”

Relatives and a visiting professional we spoke with described the home as homely, warm and welcoming. They said staff were competent, experienced and knowledgeable. One person told us, “The staff are very friendly; they make me feel my mum is special. I know she (mum) is safe and well cared for.” Other comments included, “Whenever I visit there are always activities happening, staff interact really well with the residents.”

Some people living at Friary Fields Care Home had limited verbal communication and were not able to tell us about their experience of the service. Other people living at Friary Fields Care Home did not want to talk to us about their experience of the service. We therefore observed care, inspected care plans and the premises to evaluate the quality of support provided to people living at Friary Fields Care Home.