Franklin House Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People received safe care from supportive staff who understood their individual risks and how best to support them. There were systems in place to keep people safe from abuse and harm. There were enough staff to support people at quieter periods but people occasionally had to wait for support at busier times. There were robust processes in place to ensure staff were recruited safely. Medicine administration was safe but improvements to documentation was required. The home was clean and tidy.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were protected from the risks of abuse and staff were trusted to keep them safe. One person told us, " I feel happy and safe here because I can call staff if I need anything. I would speak with the manager, or deputy if I had any worries."

The registered manager understood safeguarding policies and procedures. They were competent in the investigation and escalation processes. The registered manager told us there was a structured process to monitor how staff interacted with people through regular observations. Staff we spoke with were confident to report concerns and satisfied that action would be taken to investigate them. A staff member told us, "There are [safeguarding] policies in place. I would alert [registered manager] of any concerns, or contact the local authority, the CQC or the provider." Staff understood consent, the principles of DoLS, decision-making and mental capacity.

We observed the management team monitoring staff behaviours and interaction with people in the communal areas. We saw safeguarding and whistleblowing information and the relevant contact numbers were displayed in the service.

The provider had policies and procedures in place for safeguarding and whistleblowing to protect people from the risk of abuse. The service followed safeguarding procedures and made referrals to the local authority, as well as notifying the CQC as required. Staff had received training in safeguarding and whistleblowing. The registered manager understood their responsibilities and we saw evidence they had informed people when something went wrong. The culture of the service was open and transparent. The service was working within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The provider had mental capacity assessments in place and information about people's level of understanding and capacity was recorded in their care plans and risk assessments. Where people required best interest decisions, these were collaborative and decision specific. The service escalated concerns to the local authority as needed and DoLS were being applied for as required. People's human rights were respected.

People and relatives had been involved with their care planning and ongoing risk management. One person told us, "I feel the staff here are supportive. I think that the carers understand my needs and handle me with gentle care." A relative added, "[Relative] is hoisted and has a pressure relief chair. The staff have been trained to use it and seat her in an optimal position."

Staff understood about risk and how to keep people safe. They told us they have received adequate training in managing risks and had specific training to manage people's needs, such as Diabetes. Staff supported people to manage their health and personal care needs. Staff told us they were competent in monitoring people's health needs and escalated concerns appropriately as needed.

During the first day of inspection, we observed a number of staff supporting people with their moving and handling needs. We noted 2 incidents where specific staff members did not demonstrate best practice in moving and handling. We fed this back to the registered manager who addressed the incidents with the staff members involved and arranged them to have their moving and handling competencies re-assessed. The provider also arranged for additional moving and handling training to be delivered to all staff. We observed moving and handling practices on the second day of inspection and found all staff were using safe practice in moving and handling. All staff had received moving and handling training and had their competencies assessed. We saw staff supporting people with meals and drinks appropriately according to their level of need and staff followed care plans and risk assessments.

We reviewed 7 people's care records and risk assessments. People's care needs were risk assessed. Each person had risk assessments in place, with control measures about how to keep them safe. People’s ongoing risk assessments were reviewed on a regular basis and when needs changed. People received regular checks to ensure their safety. Although the checks were recorded, they were written retrospectively and were not time specific. We fed this back to the registered manager who implemented changes on the day to ensure staff recorded the checks as they occurred. People had personal emergency evacuation plans (PEEPs) which were specific to their individual needs to ensure their safety in the event of an evacuation. Staff observations were completed where they had their competency checks in areas such as catheter care and moving and handling to ensure this was done safely.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us staff supported people well. People commented, "I feel that the staff here are supportive" and, "I feel supported and staff know what they're doing." Relatives added, "Staff are generally caring and engage well with [relative]" and, "I feel that staff are supportive with [relative]. They seem to treat [relative] well and understand their dementia."

Staff received an induction when they first started working at the service, and training relevant to their roles. One staff member told us, "My induction and training was good. Everyone [staff] were friendly and helpful. I did 2 weeks of shadow shifts [observing experienced members of staff]." Staff had regular training and opportunities for supervision [one to one support sessions with their line manager]. A staff member commented, “I get regular one to one [supervisions]. They are fine." The provider used a dependency tool and had systems in place to monitor staffing levels. However, we received mixed feedback from staff. Some staff felt they needed more staff during busy periods. We fed this back to the provider who assured us they would review their staffing structures. Some staff raised concerns with us about night staff occasionally falling asleep on shift. We fed this back to the registered manager who explained an incident had occurred previously in relation to staff sleeping on shift and the staff members involved were subject to the provider's internal disciplinary process. The registered manager conducted additional night checks during inspection process and no concerns were found. The registered manager assured us the number of unannounced night check would be increased.

During the inspection we observed appropriate levels of staffing to support people during parts of the day, however, during other periods staff were very busy and took time to attend to people. For example, during lunch time, one person waited some time before staff attended to them. We fed this back to the provider who assured us they would review their staffing structures. Staff had received Dementia training, however not all staff we observed and spoke to had good knowledge of supporting people with Dementia. A relative told us, "I feel they [staff] need to have more dementia training. For example, just recently a young girl, who was a new carer, was asking my [relative] repeatedly to tell them what [relative] had done on the previous day. These seemed to be inappropriate questions as [relative] could not possibly recall what had happened." We fed this back to the provider who arranged external dementia training to be delivered to all staff.

Staff were recruited safely and had the necessary safety checks in place before starting work, including a criminal record check to confirm they were suitable to work with people. Disclosure and Barring Service (DBS) checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff had received an induction when they first started working at the service and training relevant to their roles had been provided. Staff had received Dementia training. Staff had opportunities for regular supervision [one to one support sessions with their line manager]. The provider used a dependency tool and had systems in place to monitor staffing levels. However, we received mixed feedback from staff. Some staff felt they needed more staff during busy periods. We fed this back to the provider who assured us they would review their staffing structures.

People told us, "I think the home is clean and tidy. The cleaner comes into my room every day and sweeps, dusts, wipes around the sink and empties the bin" and, "I like my room because it is clean, and I've got lots of bits and bobs there from my own home. It's my space." A relative added, "I feel that [relative's] room is kept clean, her room is cleaned daily." People and relatives told us staff wore personal protective equipment (PPE). Comments included, " I feel that staff wear PPE correctly" and, "I feel that the staff seem to wear PPE effectively."

Staff knew how to maintain Infection control and prevention (IPC) measures. They told us they have received appropriate training in IPC and PPE was always available. Comments included, "PPE is available all the time", "I received regular training in IPC, hand washing and PPE" and, "I received a good level of training [in IPC]."

We found the service tidy and clean. We saw the kitchen was clean and kitchen staff followed IPC principles. We observed domestic staff cleaning the service. We saw processes had been changed in the laundry room according to the local authority's advice. We saw staff supporting people with their personal care and hygiene. We observed staff wearing and disposing PPE appropriately.

The local authority had recently completed an IPC audit and found areas of improvement. During our inspection we found the provider and registered manager had addressed the issues highlighted by the local authority. Measures were in place to control and prevent the spread of infection. The environment was visibly clean. Domestic staff followed cleaning schedules to ensure areas were regularly cleaned. Records showed IPC audits took place regularly which meant the service had processes in place to prevent and control infection. The service retained a rating of ‘5’ (the highest rating) from the Food Standard’s Agency (FSA), who are regulators for food safety and food hygiene. Staff had completed training in IPC.

People told us they received their medicines as required. Comments included, "I take my meds twice a day in the morning and evening. It always seems to be correct. I can have pain relief when needed" and, " I think my meds are okay because I'm keeping quite healthy." Relatives added, "There are no problems with medication" and, "I feel [relative's] meds seem to be well managed."

Staff had received training in administering medicines and had their competency assessed. One staff member told us, " I have had training [in administering medicines] and had a competency test." We spoke with a visiting GP who commented, "I visit every Thursday. Residents are safe here. There are good system in place. I am not concerned about anything. Anti-psychotic medicines are managed well, there are no issues and no concerns with over use."

Staff were trained to administer medicines. Staff had to undertake training before they could administer medicines and received regular competency checks to ensure they administered medicines safely. Medicines were managed safely. We observed safe practice when staff administered medicines. People received their medicines in a safe way and systems ensured timely administration of medicines. The recording of prescribed fluid thickeners and creams was unclear. Care staff administered the fluid thickeners and creams, however, this was not clear on the medication administration record (MAR); senior care staff filled out the MAR to document the administration. Body maps to help direct staff where creams were required to be applied were not always completed. The registered manager took action during the inspection and had implemented new processes to document the administration of fluid thickeners and creams. Medicines audit systems required improvement. The medicine audit tool had not identified the recording issues we found.