The inspection was unannounced and took place on 16 and 17 May 2018.

Frindsbury Hall is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Frindsbury Hall is registered to provide accommodation and personal care support for up to 74 people but can accommodate only 64 people as a number of double rooms have been converted into single rooms to meet people’s needs and preferences. Accommodation is arranged over three floors. There are 24 single and two double rooms on the ground floor in Rochester and Upnor units; there are 22 single and 3 double rooms on the first floor in Hever and Cooling units; and there are 8 single rooms in Windsor unit on the second floor.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

The service was run by a registered manager and they were present for part of the first day and throughout the second day of our visit. 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 and their relatives told us they felt safe and comfortable and were treated with dignity and respect. They said they were offered suitable activities and enabled to be as independent as possible.

Staff were available in sufficient numbers and had received the training they required for their role. New staff were checked to make sure they were suitable to work with people.

A new medicines system had been introduced and was working effectively to ensure medicines were managed safely and people received their medicines as prescribed.

Links were maintained with the local community through regular afternoon teas being held for older people who lived nearby.

Care plans and assessments of risk continued to detail how people wished to be supported and staff understood how to follow this guidance to meet people’s individual needs and keep them safe.

The service had maintained its accreditation with the Gold Standards framework, a coordinated approach to end of life care. A listen and talk member of staff had been employed with the specific role of talking to people and their family members. This added a valuable dimension to how the team helped people and their families towards and at the end of their life.

The provider had a complaints procedure in place and people who used the service and their relative were aware of how to make a complaint.

Staff felt well supported by the registered manager and people and their relatives said the service was well run and the registered manager was approachable. The service worked in partnership with other organisations and sought their advice to improve outcomes for people. The provider continued to have a quality assurance process in place and people and their relatives were regularly asked for their views about the service and how it could be improved.

Further information is in the detailed findings below.

The inspection was carried out on 24 and 25 May 2016. The inspection was unannounced.

Frindsbury Hall Care Home is registered to provide accommodation and personal care for up to 63 older people. There were 50 people living there on the day of our inspection. People living in the home required varying levels of nursing and personal care. For instance, support to manage conditions such as diabetes, Parkinson’s disease or help to move around. The home also provided short term rehabilitation and respite care on the third floor for a maximum of eight people. The accommodation was arranged over three floors. A passenger lift was available to access all floors.

At the last inspection on 18 November 2014, we found two breaches of the Health and Social Care Act 2008 ( Regulated Activities ) Regulations 2010. The breaches were in relation to people’s full individual care needs not being incorporated within care plans and discrepancies in the way medicines were administered and counted. The provider sent us an action plan telling us how they were going to make changes to improve the service.

At this inspection we found that the provider had taken action to address the breaches from the previous inspection and had made many improvements to the service provided.

A registered manager was employed at the home and had worked there for many years so knew the service well. 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 home had recently been refurbished and decorated to a good standard. The environment was very well presented, clean with nice furnishings. The garden was of a good size, well maintained, a pleasant area to look out on or sit in.

The property was well maintained and free from hazards. All equipment was checked and serviced on a regular basis. Environmental risks inside and outside the building were identified and managed, keeping people, visitors and staff safe from harm.

The provider employed registered nurses who had the professional expertise to lead the staff team in caring for the nursing and personal care needs of people in their care. There were sufficient staff employed and on duty to assist people with their assessed needs. The provider made sure the registered nurses had access to the training required to ensure their continuous professional development. The registered manager had a training schedule in place to easily monitor the training of each staff member. Training updates were booked to make sure staff were skilled in the areas required for their job role.

People and their relatives told us they felt safe and they knew how to raise any issues they had. The provider had procedures in place to guide staff in their responsibilities if they had suspicions of abuse. Staff themselves showed they understood their role and said they would always report any concerns they had. They had no doubts that any worries they had would be listened to and acted upon by the registered nurses or registered manager.

The registered manager or a registered nurse carried out an initial assessment with people before they moved into the service. Registered nurses developed care plans with people to make sure staff had the correct guidance to support people in the way they wanted. Individual risks were identified and assessed to introduce control measures, keeping people safe from harm.

Medicines were managed reasonably well. The protocols used to guide the registered nurses when to administer ‘as and when necessary’ (PRN) medicines could have had been more detailed to aid consistency. We have made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which app

The inspection was carried out on 18 November 2014 and was unannounced. At the previous inspection in July 2013, we found that there were no breaches of legal requirements.

Frindsbury Hall Care Home provides accommodation, personal and nursing care for up to 63 older people. The accommodation is arranged over three floors. A passenger lift is available to take people between floors. The range of care provided includes long term care and short term care for people after they have left hospital. There were 47 people living in the home when we inspected. Nursing care was provided to people who needed it and there was access to equipment to meet their needs, such as hoist. These enabled people to be safely transferred, for example from chair to chair. Some people had a secondary diagnosis of dementia. However, people living with dementia as a primary condition, were referred to other services that could better meet their needs.

There was a registered manager employed 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were not always managed safely and care plans did not always cover every aspect of people health needs. There were some discrepancies with the medicine stock counts. Also, staff competency in administering medicines safely was not up to date.

People felt safe. The registered manager and nursing staff assessed people’s needs and planned people’s care to maintain their safety, health and wellbeing. Risks were assessed by staff to protect people. People’s comments included, “Mum feels comfortable, happy and safe” and “Mum is warm and well cared for, I am completely satisfied”.

Restrictions imposed on people’s freedom were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the registered manager understood when an application should be made for what and they were aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.

People told us that staff had the right attitude. They said “Staff are nice and friendly.” Others said, “I was sorry to leave my home but I am very happy here.” We observed friendly care being provided. People were encouraged to get involved in how their care was planned and delivered. Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected. Staff ‘Dignity Champions’ had been trained to challenge poor care and acted as role models to educate and inform other staff about dignity and respect.

Incidents and accidents were recorded and checked by the registered manager to see what steps could be taken to prevent these happening again.

Staff had received training about protecting people from abuse and showed a good understanding of what their responsibilities were in preventing abuse. Procedures for reporting any concerns were in place. Staff reported that they had confidence the manager would respond appropriately to any concerns they raised. Managers had access to and understood the safeguarding policies of the local authority. Staff said, “I would whistle blow to social services if I had any concerns”.

Managers ensured that they had planned for foreseeable emergencies, such as during periods of extreme weather or in the event of fire or flood, so that people’s care needs would continue to be met.

Robust recruitment policies were in place and had been followed. Safe recruitment practices included background and criminal records checks prior to staff starting work. The registered manager ensured that they employed enough staff to meet people’s assessed needs. Staffing levels were kept under review and were adjusted according to people’s assessed needs.

We observed that when people needed care staff responded quickly. People told us they received their care from staff who were aware of their individual needs. People said, “Staff have the skills to meet our needs.” “Staff are well trained and they are always using the training room”.

Staff supported people to maintain their health by staff ensuring people had enough to eat and drink. People were happy with the food and refreshments they received at the service. Their comments included, “There is always a jug of water in the room and their favourite fruit juice drink”. “I like the food, you get big dinners and there’s plenty of choice”. Staff understood people’s food likes and dislikes and dietary requirements. Meal times were relaxed and promoted positive social experiences for people as they chatted about their interests with others.

If people complained they were listed to and the registered manager made changes or suggested solutions that people were happy with.

People felt that the home was well led. They told us that managers were approachable and listened to their views. The registered manager of the home and other senior managers provided good leadership. This was reflected in the positive feedback given about the home by the people who experienced care from them. Staff said, “The manager works with us, they don’t have a problem if we talk to them about the running of the home”. The registered manager took the time to check what was happening in the home and ask people about their experiences of the care.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

People who we spoke with told us that they were happy with the care provided. They said, "I like to go to bed late, I can choose when I go and when I want to get up." "They are so good to us here, very friendly and kind." "I have been very pleased with it, you feel as if they really care."

Relatives who we spoke with told us, “Staff are absolutely brilliant, they work really hard. Management are excellent, always willing to listen." "Never seen anything like it, how good it is."

Comments from people who had completed the recent customer satisfaction survey included, "Very caring and very friendly staff, always helpful and it's lovely to know X is well looked after." "Well pleased with everything, cannot fault it." "I am completely satisfied."

We found that people or their representatives had been involved in decision making and giving their consent for care and treatment.

People were provided with appropriate care and support that met their needs.

People received the medication they needed at the time they needed it.

Robust recruitment and selection procedures meant that only suitable care and nursing staff were employed in the home.

There was an effective system to regularly assess and monitor the quality of service that people received.

Overall we found this home had achieved compliance. We have made one comment that the provider may find useful to note.

You can see our judgements on the front page of this report.

We carried out an unannounced inspection visit to this service on 23 August 2012. There were 52 people living in the home at that time. The atmosphere was happy and relaxed. We spoke with people who lived in the home, staff, the manager and visitors. Everyone we spoke with told us they enjoyed living, working in, and visiting this service.

A relative who was visiting the home talked about their relative’s care and treatment. They said, “Within six weeks of moving in here they were much better, the nurses really know what they’re doing.” People who lived in the home told us what it was like to live there. They described how they were treated by staff. They told us about their involvement in making choices about their care and treatment. People told us they always felt safe in the home. Some of their comments included:

"I feel very settled here. Everyone is very kind. The staff are always around if I want any help." “If anything is worrying us we only have to ask and they put it right straight away.” "I really like living here. They look after me very well. They are very good at respecting my privacy and dignity.” "It’s a very happy home. We all have a good laugh together. You never feel like you’re a nuisance no matter how much help you need.” “I know the staff are really busy but they always have time for a chat.”

You can see our judgements on the front page of this report.