Freshfields Residential Home

Updated 12 February 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by one inspector, one inspection manager and one Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The inspection manager was observing the inspector as part of Care Quality Commission’s quality assurance processes. They also assisted with the inspection.

Service and service type

Freshfields Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced and took place on 07 January 2020.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with eleven people who used the service and five relatives about their experience of the care provided. We spoke with seven members of staff; one of the directors, the registered manager, four care staff and the chef. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included three people’s care records and multiple medicine records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found with specific regard to training and seeking consent.

Updated 12 February 2020

About the service

Freshfields Residential Home is a residential care home registered to provide personal care, support and accommodation for up to 36 people in one adapted building over three floors. At the time of our inspection the care home accommodated 34 people, many whom were living with dementia.

People’s experience of using this service

There were risk assessments in place to monitor risks to people. However, these were not always holistic. Recruitment procedures at the service were not always robust, there were gaps in people’s employment histories which were not explained. People were not supported to have maximum choice and control in their lives and staff did not support them in the least restrictive way possible. The policies and systems in the service did not support this practice. Mental capacity assessment forms were not always completed with people. There were no consent to care forms, although people told us, and observations confirmed that staff always sought consent. Some staff had not completed their mandatory training. The provider gave us assurances this training would be completed in the months following our inspection. People’s information was not always kept securely. Quality assurance processes did not identify the issues we found at inspection.

The service decoration was not dementia friendly and we have made a recommendation about this.

Although some people had mixed views about staff numbers, the management team were able to demonstrate with dependency tools and rotas there were enough staff to meet people’s needs. Staff understood people can be at risk of abuse and knew who to report it to if they suspected it. There were infection control measures in place and staff understood infection prevention. Medicines were managed safely. Lessons were learned when things went wrong.

People’s needs were assessed before using the service to ensure they could be met. Staff received an induction before starting employment. Staff received supervision and appraisals. People were supported with their healthcare needs and the service worked with other agencies to the benefit of people. People mostly enjoyed the food they were provided and were supported to eat and drink healthily.

People and their relatives told us they were treated well. Staff understood equality and diversity. People could express their views and be involved with choices around their care and treatment. People told us their dignity was respected and their independence promoted.

People’s needs and preferences were recorded in care plans. The service provided activities for people. The service made information accessible to people with communication needs. People were able to make complaints and when doing so these were responded to appropriately. The service worked with people who were at the end of their lives and recorded their wishes before this occurred.

People told us they thought highly of the management team. The management team were responsive to inspection findings and wanted to improve the service to the benefit of people who lived there. People and staff held meetings and were engaged with the service. People and staff were able to complete surveys to assist with improving the service. The service had a presence within the local community.

Rating at last inspection

The last rating for this service was Good (published 14 July 2017.)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to good governance and people providing consent. Please see the action we have told the provider to take at the end of this report.

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.