Frances Bolitho Care Home

Originally the service was fully commissioned as Discharge to Assess (D2A) beds by the NHS. This meant people came to stay for short periods for rehabilitation following a stay in hospital, with the intention of returning home or elsewhere. The D2A contract ended in March 2022. The service now supported some permanent residents, some people staying for respite and a few people remaining from the D2A process who continued to receive therapy support.

Storage was a challenge at the service. One communal bathroom was unusable as it was stacked full of equipment, much of which was not being used. For example, many walking frames and perching stools, along with raised toilet seats and other rehabilitation aids. Boxes of dressings and oxygen masks were found in corridors. The residents dining room held boxes of COVID-19 tests and Personal Protective Equipment (PPE). The clinical lead explained, "There is no other place for them to be stored." We have made a recommendation about this in the effective section of this report.

Unsecured confidential information and an unlocked key cabinet were found in the manager's office. This room was open and unattended throughout the inspection. This meant there was a risk confidential information and keys to various places in the service were accessible to people without the appropriate authority.

The communal shower room held many unnamed toiletries and multiple unopened packs of bars of soap, one opened bar was found in use on the sink. The service was in a COVID-19 outbreak and the use of communal toiletries and soap bars increased the risk of cross infection. The clinical lead arranged for these to be disposed of immediately.

A recent COVID-19 outbreak had meant several care and ancillary staff were off sick at the time of this inspection. There were no domestic staff on duty on the day of our inspection. We were told the day and night care staff were carrying out cleaning and laundry tasks in their absence. However, there was no cleaning schedule available for care staff to complete, to record when high touch point areas and key areas such as bathrooms and toilets, had been cleaned to help reduce the risk of spread of COVID-19. This was immediately addressed during the inspection.

Records relating to the induction of new staff were not available. We have made a recommendation about this in the effective section of this report.

People were supported by staff who had been appropriately trained and were skilled in their role. Staff had received regular supervision and were provided with appraisals, although the clinical lead did not hold an effective overview of this.

Mental capacity assessments had been carried out where it was indicated as necessary. Deprivation of Liberty Safeguards (DoLS) authorisations had been applied for appropriately. No authorisations for restrictive care plans, were in place at the time of this inspection.

Recruitment procedures were robust. There were sufficient staff on shift to support people at the time of this inspection. Several staff had been off sick with COVID-19 in recent weeks. The service was using agency staff and were being supported by the local authority. However, the rotas showed not all shifts had been covered by the planned number of staff. This had not impacted on people's care.

Care plans were completed for each person and contained details of the person's needs and preferences. Care plans had been regularly reviewed and updated. Risks were identified, assessed, recorded and reviewed regularly.

People's care and support needs were assessed before they started using the service. People received support to maintain good health and were supported to maintain a balanced diet. Some people were having their food and drink intake recorded and were regularly weighed.

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.

People told us they felt safe with staff. There were systems to help protect people from abuse. Staff had received training on how to recognise abuse.

Staff understood the importance of respecting people's diverse needs and promoting independence.

People told us they liked living at Frances Bolitho and that the staff were caring and responded when they called. People commented, "I like it here, nice food, and I don't think of the carers as staff they are more like friends" and "Carers are great, food is great, no concerns. I see my GP and my social worker. I just want to get home to live by myself again soon."

Staff were positive about working at Frances Bolitho. Comments included, "(Clinical lead) is so very caring and kind, they are very supportive" and "I am really enjoying this role and the staff have all been welcoming, as have the residents. Lovely clean environment that has a very homely feel."

People and staff were asked for their views by the provider through a survey, responses had been audited and acted upon. Staff meetings had been held to seek the views of staff and share information.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk