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Fremington Manor Nursing and Residential Home Outstanding

Reports


Inspection carried out on 9 January 2019

During a routine inspection

Fremington Manor Nursing and 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.

Fremington Manor Nursing and Residential Home accommodates a maximum of 60 people. People’s conditions varied, but the service placed a strong emphasis on end of life care and working collaboratively with local palliative care services.

The building comprises the original manor house with a purpose-built extension. There were 40 people resident at the time of the inspection.

The inspection took place on 9 and 10 January 2019 and was unannounced.

At our last inspection we rated the service good. At this inspection we found the standard of service had further improved and we have rated it as outstanding.

Why the service is rated outstanding.

People using the service were the priority at Fremington Manor Nursing and Residential Home. People received care, treatment and support tailored to their individual needs and of a very high standard.

A community hospice nurse said of the end of life care at the service, “(The service) puts patients first. There is nothing too much for patients. The registered and deputy managers have a deep commitment to palliative patients.”

There was exceptional commitment to meeting people’s diverse needs. This had included those associated with beliefs/faith, age and gender. The service continually researched information. This knowledge helped them provide empathy, in particular where people’s choices were in opposition to evidence based practice, such as pain and infection management.

The service was very caring because of the total commitment of staff to people’s welfare. People said staff were very kind. Staff expertly managed difficult, and sometimes embarrassing, situations putting the person at ease and upholding their dignity. Privacy and dignity were fully promoted.

The management understood the importance of valuing staff, all of whom spoke very positively about their work and praised the registered manager and provider organisation. There were robust systems for ensuring a safe and high standard of service. Any concern was promptly dealt with, openly and honestly and with a view to continual improvement. People’s, and staff views were always considered. Staff supervision ensured staff received the support they needed and any change at the service was managed expertly, listening to staff views throughout.

People received a high standard of care and treatment. One health care professional said, “The (staff) are second to none.” Staff praised their training, which fully equipped them for their work. External health care expertise was sought appropriately.

People had an in-depth assessment of their needs and wishes. Care plans enabled staff to understand important aspects of the person they were caring for. Risk was well managed in the least restrictive way possible.

People were fully protected through robust recruitment, staffing, infection control and management of the premises. Medicines were expertly managed for people although we have made one recommendation, based on one person’s records. All risk was effectively assessed and managed, in least restrictive ways.

Adaptation suitable for meeting people’s needs in a safe way was available where possible. All necessary equipment was in place to promote people’s independence and maintain safety. There were robust arrangements should an emergency occur, such as a fire.

People’s legal rights were understood and protected. Where people lacked capacity to make informed decisions these were made in their best interest.

People received a healthy and nutritious diet. There was a lot of choice of food and any negative feedback was followed up with the intention of meeting people’s preferences. Food and fluid intake concerns were properly manag

Inspection carried out on 23 May 2016

During a routine inspection

This inspection took place over two days on 23 and 24 May 2016. It was unannounced on the first visit. The second visit took place in agreement with the service. The inspection team consisted of: two adult social care inspectors on day one and one adult social care inspector with a pharmacist inspector on day two.

Fremington Manor Nursing and Residential Home is registered to provide accommodation with nursing or personal care for up to 60 people. The service is intended for older people and is divided into two units within the main building; a residential unit for people with a lower level of care need and a nursing unit for people with a higher level of care need. Each area has its own staff team. During our visit, there were 54 people living at Fremington Manor.

The service had a registered manager. 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.

People lived in a home where they were relaxed and comfortable. The atmosphere was homely and friendly and people told us they liked living there. Their comments included, “The whole place is good … kitchen, laundry, gardener… I am in danger of leaving someone out … I just want to say it is very good” and “I think this service is outstanding. I can’t fault it. The staff are all very caring. I consider it a real privilege to be here.” Two relatives said, “It is the best … the attitude of all the people here … people are looked after well and I don’t want to leave anyone out” and “It’s the ambience here and the attitude of staff … staff are friendly and encourage conversation … people are spoken to like a member of the family … they don’t lose their identity.”

Staff knew people well and cared for them as individuals. People received care suitable for their needs and with generally enough staff on duty. An agency was used to cover any gaps in the staff rota. Staff were safely recruited, trained and enjoyed their work. Two people said, “It’s top notch here …. staff are all lovely” and “I am very happy here … they look after me well.” Staff felt supported by management and felt part of a team. They had a good understanding of safeguarding and knew how to recognise the different types of abuse. They knew the correct action to take and who to report any concerns to.

Each person had a care plan with suitable risk assessments in place. Care plans included key information and were up to date. Health and social care professionals were involved in people’s care and their advice acted upon. Good working relationships had been developed with the local GP surgery. Mental capacity assessments had been carried out and applications made to the local authority if people were deprived of their liberty.

People received their medicines in a safe way. Improvements and new systems were put in place to make sure people received their medicines safely.

People were very positive about the food and enjoyed varied, nutritious and appealing meals. Relatives comments included, “The food is so good”, “The food is amazing” and “Have you seen the food … it’s wonderful.”

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Staff recognised the importance of family and friends who were welcomed at all times. A friend said, “We ordered ‘tea for three on the lawn’ recently and it was absolutely brilliant.” A relative said, “I have nothing but praise. They really look after people well. We are always made welcome. Very good service.”

People lived in a home which was maintained and decorated to a high standard. There were large grounds for people to sit and relax in.

There was a complaints policy and procedure in place with information about how to raise concerns or complaints. All complaints were dealt with appropriately and people informed of the findings. The service had rece

Inspection carried out on 14 July 2014

During a routine inspection

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the days of our inspection there were 51 people living at Fremington Manor. The inspection was completed by two inspectors. We brought forward this planned inspection as we had received some information of concern from a relative of a person living at the service. We had also received a notification from the service about one person who had developed some pressure damage to their skin since being at the service.

The summary is based on conversations with 14 people living at the service, eight relatives and 18 staff. We looked at records of people's care and quality monitoring systems used with the home. We also spent time observing how care and support was being delivered to people.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe because there were sufficient staff with the right skills to meet people's assessed needs. We observed care being provided in a way which showed staff understood the needs and risks of people they were caring for. Where risks for people's health had increased, professional support had been requested. The person who had developed pressure damage had been referred to tissue viability specialist nurse team and their wounds were healing. We saw documentation to show, staff were now instructed to check and record their action in relation to pressure care at least two hourly.

We found the service kept people safe by providing a clean and well maintained environment. Staff used person protection equipment (PPE) such as gloves and aprons and we observed hand washing at appropriate times to help reduce the risk of infection and keep people safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw the service had used these safeguards appropriately to protect and uphold people's rights.

Is the service caring?

People we spoke with gave very positive views about the care and support they received from staff. Comments included ''Staff are very attentive, I couldn't wish for better'' and ''Staff are wonderful. I couldn't praise them enough, they are all 100% fantastic, caring, patient, cheerful. They make sure they spend time with you, which is really important.'' All our observations showed staff providing care and support in a kind and respectful way.

Is the service effective?

We found the service was effective because care and support was being well planned and delivered by a staff group who understood people's needs and wishes. Where people's needs highlighted the need for specialist equipment such as pressure relieving cushions or mattresses, these were provided and their effectiveness was monitored.

Is the service responsive?

We found the service was responsive to people's needs and wishes. For example, where people's healthcare needs had changed, their GP and other healthcare professionals were contacted quickly for advice and support to enable the service to provide the right care, support and treatment.

We heard how the service looked at meeting people's social and emotional needs, through regular activities and trips out, as well as their activities person spending one to one time with people who preferred to spend time in their own rooms or were unable to get out of their bed due to poor health.

Is the service well-led?

We found the service was well led by a manager who knows the people who live at the home and her staff group. People we spoke with knew who the manager/matron was and said they were confident in her ability to manage the service and to deals with any concerns or worries they may have.

The views of people who live at the home, their families and staff were taken into account when reviewing the quality of the care and support provided. People were asked to complete questionnaires, attend meetings and were asked for feedback via one to one meetings. We also saw the company were completing their own quality audit to include all aspects of the service.

Inspection carried out on 2 May 2013

During a routine inspection

During this unannounced inspection we spoke with eight people who lived at the home, with two visiting relatives and with ten staff members. We also spoke with two visiting health care professionals. We also spent some time observing care practices. We looked at some key documents including care plans, risk assessments, staff rotas and information about how the home ensured that they had qaulity monitoring and audit processes in place. This helped us to make a judgement about how well the service was run.

People we spoke with told us that they were happy with the care and support provided. Comments included ''staff are very good, the home is nice and clean and I feel safe and well cared for.'' ''The staff are all very good. I really couldn't ask for better.''

We saw that there was a robust medication system in place, using electronic bar coded information. There were sufficient skilled and experienced staff and we observed care and support being delivered in a kind and respectful way.

Care was well planned and included a variety of social events and activities that encouraged people to remain engaged and involved in their surroundings.

Systems were in place to review and monitor the quality of care and services provided. This included seeking the views of people living at the home as well as staff.

Inspection carried out on 7 August 2012

During an inspection to make sure that the improvements required had been made

We carried out this unannounced inspection on the afternoon and evening of 7 August 2012 as part of our planned inspection programme. We were also following up on a previous compliance action in relation to care planning in wound care management.

We spent time at the home talking to six people who currently live there, as well as five members of staff. We also observed how care and support was delivered through the afternoon and evening, including tea time.

Some people that live at this service have dementia and therefore not everyone was able to tell us about their experiences. To help us understand the experiences of people we used our SOFI (Short Observational Framework for Inspection) This tool allows us to spent time watching what is going on in a service and helps us record how people spend their time, the type of support they get and whether they have positive experiences. Some people using the service were able to tell us their views.

We looked at some of the key records kept by the home. These included care plans, risk assessments, staff recruitment records and medication records. This helped us to better understand how well the home was run.

People we spoke with who were able to share their experiences of living at the service were very positive. Comments included ��staff have been very kind, I really can�t grumble. The food has been excellent. I met with the chef to talk about what I liked and disliked. They are really very helpful and accommodating here.��

One visiting relative told us ��so far so good, they seem to know what they are doing and staff are all very nice and welcoming.��

We found that the care planning records had improved since our last visit. Staff were more familiar with the new care planning system. We saw that clear records had been kept for people that were at risk of pressure care damage. Systems were in place to quality monitor care plans and the review of care records.

We observed staff providing care and support in a kind and sensitive manner and we were told by staff that they felt well trained and supported to do their job. We saw that there was a robust recruitment process in place that ensured only staff suitable to work with vulnerable people were employed.

Inspection carried out on 1 February 2012

During a routine inspection

We brought forward this planned review of compliance as a result of some anonymous information of concern. This information identified possible issues in the care and welfare of people and one health and safety issue. The health and safety issue was referred onto another regulator who had reported back that there are no identified issues of concern that need to be addressed.

We carried out an inspection at the service on the 1 February 2012. We spent seven hours at the home talking to people living there observing how staff interacted and provided care and support throughout different times of the day. We also spent time talking to care staff, nursing staff, and the senior management staff of the home. We looked at some key records, these included care plans, risk assessments, staff rotas, training schedules and recruitment records.

People who live at the home told us that they were overall happy with the care and support they received. Comments included �I couldn�t be treated any better, the staff are lovely.�� �Wouldn�t wish for better, I have no complaints, the staff have a lot to do so you need to be patient sometimes.� �In many respects it�s very good here, I get on well with most staff, but when I use my call bell, they do not respond quickly enough and sometimes feel like I bossed around a bit by some staff, because they are very busy.��

We were also told by one person that they sometimes had to wait for quite long periods for pain relief, as when they used their call bell care staff answered quickly, but a nurse was not always available to administer the pain relieving medication. In talking to care staff we also heard that they felt that during the afternoon shift when there were fewer staff rostered on, that call bells did not get answered as quickly as they would have liked. One staff member said ��we can be run off our feet sometimes with only three carers on the unit, especially if people are unwell and need care in their room.�� Another staff member told us �we have three staff on in the afternoon until four and then from four until nine pm we have four care staff on per unit. This is not always enough if we have people who require two (staff) for hoisting.��

We have fed this back to the registered manager who told us they were already looking at increasing the afternoon care staff to one extra and looking at where they could be more flexible with care hours to provide more input at key busy times.

We saw that the manager had introduced a new care plan system, although not all plans had been updated to the newer documents. We looked at six plans in detail and saw that there had been a pre admission assessment for people and that relevant information had been obtained from other health and social care professionals. We found that in one case important health care needs identified by a health care professional had not been identified or included as part of the homes plan. The nurse on duty for one unit was unaware of this person's nursing needs. They did not know that the person had pressure care damage and follow up needs. There was no care plan in place to show how these needs were to be addressed and no entries in the daily records of how these needs had been monitored or if and how the wounds had been dressed.

We also found another example of a wound care plan that had not been updated or reviewed regularly so it was unclear whether the treatment had been successful. Care staff and nursing staff we spoke with did confirm that dressings had been applied and treatment had been successful but the care plan did not evidence this. We have spoken to the registered manager who said this would be addressed as a matter of urgency.

We observed staff providing care and support in a kind and respectful way. We saw that staff who came in for training and were not on shift still spent time engaging with people and asking about how they were. We observed safe moving and handling with hoists and standing aids. Staff spent time talking to people about what they planned to do before moving them.

We asked for some additional information from the registered manager following the inspection. This was evidence of staff training and we saw that where there were some gaps, further training was being organised. Staff we spoke with felt that they were given good training and support to do their job, and they were able to demonstrate a good understanding of peoples needs when asked.

We saw that the home had good evidence of where they have answered complaints and issues of concern and we are aware that they have made appropriate referrals to the adult safeguarding team in the past. There is further work that should be done in respect of quality assurance in doing regular checks on care plans.

Reports under our old system of regulation (including those from before CQC was created)