Fremington Manor Nursing and Residential Home

Fremington Manor Nursing and Residential Home is a residential care home providing personal and nursing care to 48 people aged 65 and over at the time of the inspection. The service can support up to 60 people.

The service is a large country manor house which has been extended and adapted to meet the needs of people who are frail and elderly. There are passenger lifts to all floors with bedrooms on two floors and mainly communal spaces on the ground floor. There are level access garden areas.

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

The current deployment of staff within the service had not ensured people’s needs were consistently met. All of the people and relatives we spoke with told us they currently felt staffing levels at the service did not ensure people’s needs were met in a timely way. People gave examples of how the current staffing levels had impacted them. Staff feedback in relation to staffing levels was also consistent in that the current numbers did not ensure care was consistently and safely provided.

The current governance systems in operation had not identified the areas of concern we found during the inspection. There were both service and provider level monitoring systems in place but neither had resulted in the identification of failings or change to staffing deployment. Following the inspection, we raised immediate concerns with the provider about staffing. Immediate steps were taken by the provider to review staffing dependency levels and an action plan was produced and sent to the Care Quality Commission (CQC).

People were cared for by staff who understood their responsibilities to safeguard them. There were systems in place to ensure medicines were ordered, stored, administered and disposed of safely. People’s individual care and treatment needs were planned and were reviewed regularly to ensure the support provided reflected their current needs.

The service environment was effectively maintained to ensure people were supported safely. Infection control measures within the service promoted people’s health, safety and welfare. There were no restrictions on visiting at the time of the inspection in line with government 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. There were systems in place that ensured people who were deprived of their liberty were done so with the appropriate legal authority.

There was effective governance in place around incidents and accidents, the service environment and care planning. The service manager had recently commenced employment with the provider and was new in post. They were currently looking at ways to engage with people, their relatives or representatives and staff to enhance the service. There were links with the local community established for the benefit of people living at Fremington Manor Nursing and Residential Home.

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

Rating at last inspection and update

The last rating for this service was Good (published 4 September 2021).

Why we inspected

The inspection was prompted in part due to concerns received about staffing. A decision was made for us to inspect and examine those risks.

We also looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to staffing and good governance.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Fremington Manor is a residential care home providing personal and nursing care to 51 people aged 65 and over at the time of the inspection. The service can support up to 60 people.

Fremington Manor is a large country manor house which has been extended and adapted to meet the needs of people who are frail and elderly. There are passenger lifts to all floors with bedrooms on two floors and mainly communal spaces on the ground floor. There are level access garden areas.

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

People told us their experience of care and support had deteriorated over recent weeks due to lower level of staffing. Comments included “We are waiting much too long for call bells to be answered. The staff are doing their best, but they have been very short staffed” and “Staff are always very hurried; they are working hard but there is not enough of them and standards have slipped a little.” We heard that up until recently people’s needs were being met in a timely way.

The service does not currently have a registered manager, but the deputy manager was acting as interim manager. She and the operations manager were fully aware of staff shortages and were working to address these in a number of ways. They had recently lost 14 staff who left for various reasons and they were actively recruiting to fill these posts. They had new staff waiting to start but this was being held up due to waiting for the right checks to be in place to ensure they were suitable to work with potentially vulnerable people.

Staffing had also been short due to staff having to self-isolate as they had been in contact with someone who had tested COVID-19 positive or had recently tested COVID-19 positive themselves. The acting manager was seeking back up support from agencies but there was a shortage of agency workers to fill these gaps across the county. This was a regional and national issue at the time of writing the report.

The operations manager and interim manager held an extraordinary meeting following our first day of feedback where we identified people were being impacted from the low staffing levels. They agreed that meeting people’s basic needs had to take priority and so all staff, including ancillary staff such as kitchen, housekeeping and maintenance staff were being asked to help with tasks to support the care team. This included assisting with getting meals to people and where needed assisting with them eating their meal. The service had already ensured that all staff, irrespective of their role, had received moving and handling training and training on assisting people to eat and drink safely. The activities team were also asked to assist with aspects of care until the care team were up to sufficient numbers.

Following the inspection, we were informed that the provider had sourced four agency staff from outside of the area and had used a recruitment agency to find an interim experienced manager so the deputy manager could support the care team on the floor. We felt that in the circumstances the service were doing all they could to address the staff shortages.

We identified that due to the low staffing levels, records were not always being completed. On the first day we identified a person who was telling us they were hungry and thirsty. They were unable to assist themselves and there was no record of when they had last been supported to eat and drink. The service was in the process of moving from paper records to electronic records so some of the records may have been missed due to this change over. The provider made the decision to continue with the move to electronic records and by the second and third day of the inspection we could see a huge improvement in records such as food and fluid monitoring. Seventeen people had been identified as being at risk of poor food and fluid intake and they had records to show when food and fluid was offered and how much they had eaten and drunk each day. This meant the potential risk identified had been mitigated.

Therefore, people were supported to have a balanced diet. Where people were at risk of poor hydration or nutrition, they were being supported and monitored.

People received their medicines safely, and in the way prescribed for them.

Staff had training, support and supervision to ensure they had the right skills and qualities to meet people’s needs safely and effectively. Recruitment processes were robust. Staff understood safeguarding processes.

Systems and quality processes ensured all aspects of care delivery, the building and equipment were being reviewed and monitored on a regular basis. This included ensuring the views of people, their families and other stakeholders were considered.

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

Rating at last inspection

This service was registered with us on 21/06/2021 and this is the first inspection. Although there had been no change to the provider, they had changed their legal entity, so this inspection covers all five key questions, and this is classed as their first rating.

Why we inspected

We plan to inspect all newly registered services within a 12-month period. We brought this inspection forward due to receiving information of concern that people’s needs were not being met due to low levels of staffing. We did find evidence to show staffing levels had fallen below the providers’ assessed levels, but this was due to sickness, staff self-isolating due to COVID-19 and staff leaving. The provider and interim manager had done everything they could to mitigate this risk.

We found no evidence during this inspection that people were at risk of harm from this concern, but we identified potential risks to harm which the provider had already identified themselves and had an action plan to address this.

Please see the safe and well-led sections of this full report.