Freshfields Residential Home

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.

At our previous focused inspection on 22 July 2015, the service was meeting the legal requirements.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was well led with evidence of effective quality assurance systems in place to ensure the quality of care delivered was monitored and continuously improved.

There were safeguarding systems in place which were known and understood by staff. Staff demonstrated an understanding of the incident and accident reporting procedure and were able to explain any learning that had taken place following some falls resulting in injuries.

People and their relatives told us they felt Freshfields was a safe place to live. They thought there were enough staff to meet people’s needs.

People told us their privacy and dignity was respected. They were involved in how the service was run and told us they were asked their views on issues such as meals and how they spent their time. They told us they were able to make a complaint if they were unhappy with any aspect of their care.

Care plans were person centred and were completed after consulting with people and their relatives. They included peoples religious, emotional and physical support needs and preferences.

People were enabled to maintain a balanced diet that met their individual needs. Food and fluid charts and regular weight checks were in place for people at risk of malnutrition.

Staff were supported by an approachable management team that ensured monthly staff meetings took place and supervision. There was a comprehensive induction and training program which ensured staff were up to date with practice and able to deliver evidence based care.

Recruitment systems were robust and included appropriate checks to ensure that only suitable staff were employed.

The service worked according to Mental Capacity Act to ensure that where people lacked capacity decisions were made in their best interests following appropriate guidance and involvement of relevant professionals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

We found that medications were stored securely and administered safely. The home's physical environment was well maintained and various safety checks were carried out, such as checking fire alarms. Checks were carried out on staff before they began working at the service, including obtaining two employment references. The service had a complaints system in place and people we spoke with knew who they could complain to if they wished. One said 'I would tell one of the workers if anything was wrong.'

We saw that staff treated people using the service with respect and care. Personnel and training records we reviewed showed that staff were suitably skilled and qualified.

The standard of food was good and people were encouraged to eat full meals, without being unnecessarily pressured.

The provider had an effective system in place to measure the quality of the service.