Frethey House

We found the following examples of good practice.

People said they felt safe at the service. One person said, “Staff always make sure I am ok. The staff here are lovely”. People confirmed they saw their loved ones regularly. Visitors also confirmed that regular visits were facilitated, and precautions were in place to ensure lateral flow tests were taken and personal protective equipment was available to them One visitor said, “They are very welcoming here…” Another said, “You can’t fault them here”.

The registered manager took action to ensure people admitted to the service had their COVID-19 status recorded on admission.

There were processes to minimise the risk to people, staff and visitors from catching and spreading COVID-19. These included regular testing of staff and people living at the service and testing of visitors to the service.

People said they felt safe at the service. One person said, “Staff always make sure I am ok. The staff here are lovely”. People confirmed they saw their loved ones regularly. Visitors also confirmed that regular visits were facilitated, and precautions were in place to ensure lateral flow tests were taken and personal protective equipment was available to them One visitor said, “They are very welcoming here…” Another said, “You can’t them here”.

The service had a good supply of PPE. Staff confirmed they had all they needed to work safely. We observed most staff and management were using PPE correctly. One member of staff was reminded about the position of their mask.

Signage was in place to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

Staff had received training in the use of PPE, infection control and hand hygiene. The registered manager confirmed that refresher training was being organised.

There were sufficient staff to provide continuity of care and support. Regular agency staff were used to cover any staff absences. Recruitment of additional care and domestic staff was underway.

Infection prevention and control policies and procedures were in place and kept under review to ensure they were reflecting current guidance. There were safe processes in place to take appropriate action during an outbreak.

Some improvements were needed to ensure people were fully protected from catching and spreading infections. The registered manager took action to ensure COVID-19 vaccination information for visiting professionals and contractors was confirmed and recorded.

Frethey House is a nursing home providing personal and nursing care to people aged 65 and over. At the time of the inspection there were 23 people living at the home, which is registered for up to 43 people. The service cares for older people with nursing needs, living with dementia and mental health needs. The accommodation is arranged over two floors with two units on each floor. The downstairs units are called Hawthorn and Bramble. The two upstairs units are Willow and Rowan, which are accessed via separate staircases.

People’s experience of using this service and what we found

People, relatives and staff all reported improvements since the last inspection. People and relatives said, “Things are getting better,” “[The registered manager} has got the team settled and the atmosphere had improved.” Staff said, “Things have improved a lot, such as staffing and team morale” and “We are able to give people time and attention.”

People received a safe service because staffing and skill levels had improved, and sickness levels had fallen. This meant people received care from regular staff they had got to know and trust. People’s risk assessments and care plans provided staff with more detailed, up to date information about how to safely care for each person.

Improvements to the environment had been made and staff were more aware of health and safety in the home. Staff had a good understanding of signs of abuse and felt confident any safeguarding concerns reported were listened to and responded to.

We were assured the service were following safe infection prevention and control procedures to keep people safe. The service had ongoing monitoring arrangements to ensure all aspects of infection control followed best practice guidance.

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 received effective care and consistent support from experienced staff with the right skills to meet their needs. Staff monitored people's health and wellbeing and worked with other professionals to make sure people received the treatment they required. Improvements in standards of care had been made.

People and relatives consistently reported staff treated them with compassion, kindness, dignity and respect. Care plans and risk assessments were more detailed, personalised and up to date about people’s care needs and any preferences.

Staff felt better supported and reported improved communication, team working and staff morale. Where mistakes were made, staff were supported to learn lessons and improve practice through further training and support.

Improved quality assurance and monitoring systems were being used effectively to make continuous improvements. Senior managers visited the service regularly to carry out additional checks, offer support and ensure improvements were achieved. All five breaches of regulations found at the previous inspection had been addressed.

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

Rating at last inspection: Requires improvement. (Report published September 2020). At this inspection the rating has improved to Good.

Why we inspected

This was a focused inspection to check whether improvements had been made since we last visited. We reviewed the Safe, Effective, Caring and Well-led domains only. Our report is based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the Responsive key questions were not looked at on this occasion.

Follow up: We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Frethey House is a nursing home providing personal and nursing care to people aged 65 and over. At the time of the inspection there were 29 people living at the service. The service is registered for up to 41 people with nursing needs, it is not a specialist service for people living with dementia or mental health needs. The accommodation is arranged over two floors with two units on each floor. The downstairs units are called Hawthorn and Bramble. The two upstairs units Willow and Rowan are accessed via separate staircases.

People’s experience of using this service and what we found

There have been four changes of manager at the home since November 2018 and a number of staff had left. These rapid changes had destabilised the home and adversely impacted on people’s quality of care and on their confidence in the service.

A new manager was appointed in May 2019 although they were on leave when we visited. They had begun to make improvements and further improvements were planned.

People and relatives said, “It has been lacking leadership, you need good leadership, that filters down,” “Good staff are not staying” and "It is a mixed experience lately, a lack of communication and direction.”

Staff vacancies and short-term sickness were affecting recommended staffing levels and there was high use of agency staff. People and relatives said; “The staff do their utmost and are very attentive when they come, but they don’t have the time.” Following the inspection, the provider increased staffing levels.

People did not always receive safe care and treatment. Improvements were needed in medicines management and in minimising environmental risks. People’s risk assessments lacked detail to guide staff on how to minimise risks.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Improvements were needed in consistently assessing people’s mental capacity and in documenting best interest decisions, particularly about the widespread use of pressure mats and bedrails. Also, in involving people’s representatives and families in best interest decisions, where people lacked capacity.

People spent a lot of time in their rooms and there wasn’t enough to occupy them, and relatives were worried about isolation. A second activity co-ordinator had just been appointed, so work was underway to improve activities.

Although recent improvements in quality monitoring had been made, these were not fully effective. Care records lacked detail about how to meet people's individual needs. There were gaps in daily records and people’s care plans were overdue for review and were not always up to date about their needs.

People did not always receive person-centred care and treatment that was appropriate, met their needs and reflected their personal preferences. People were offered opportunities to take part in activities, although activities were not personalised to meet people’s interests or their specific needs. Efforts were underway to improve these.

People’s feedback about the quality of food and choices on offer was mixed. Some improvements had been made and more were planned. People who needed support to eat and drink did not always receive the support they needed.

People said they felt safe. Families were made welcome and could visit anytime.

Five breaches of regulations were found at this inspection. These related to failures in dignity, consent, safe care and treatment, good governance and staffing. Further actions were needed to address risks and make required improvements.

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

Rating at last inspection: Good (Report published March 2017). At this inspection the rating has deteriorated to requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Please see the action we have told the provider to take at the end of this report.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good.

People remained safe at the home. People told us there were adequate numbers of suitable staff to meet their needs and to spend time socialising with them. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People received their medicines safely.

People continued to receive effective care because staff had the skills and knowledge required to effectively support them. People’s healthcare needs were monitored by the nurses and care staff and people said they had access to healthcare professionals according to their individual needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The home continued to provide a caring service to people. People told us that staff were kind and patient. A visitor told us, “The staff are brilliant, always polite and very respectful. They look after [relative] very well.” People, or their representatives, were involved in decisions about the care and support they received.

The service remained responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. Complaints were fully investigated and responded to.

The service continued to be well led. People told us the management within the home was open and approachable. The registered manager and provider sought people’s views to make sure people were at the heart of any changes within the home. One person told us the registered manager was, “Always around will have a chat and laugh”. The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.