Fremantle Court

Fremantle Court is a care home providing personal and nursing care to up to 90 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 83 people using the service.

The home accommodates people in a purpose-built property with 6 wings. Each wing has single, en-suite bedrooms, with adapted bathrooms and lounge/dining areas close by. There are several quiet areas around the building as well as shared facilities, including a hairdressing salon and cinema room.

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

People told us they felt safe at the service. There were systems to protect people from abuse and staff told us they felt confident in speaking with senior staff and managers if they had any concerns. Risks to people’s health and safety were effectively managed and action was taken to minimise the likelihood of injury or harm. The premises were well-maintained, clean and regular checks were carried out to ensure it was safe.

There were enough staff to meet people’s needs. Staff had been recruited using robust procedures. People provided positive feedback about staff, although a couple of people felt there were some barriers to how their care was delivered where English was a second language for staff. For example, in how they were spoken with.

People received their medicines safely. Records were well-maintained and staff were regularly assessed to ensure they followed safe medicines procedures. We have made a recommendation regarding improving protocols for medicines prescribed for occasional use, in order that these are centred on the needs of each person.

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.

The service had experienced changes of managers over recent years. This was something staff, relatives, people who used the service and external agencies commented on. They were keen for the new manager to stay and told us about the improvements they had made in the short time they had been at the service.

Improvements had been made to records management and governance systems. There were systems to engage with people and seek their feedback. Staff were kept up to date with people’s health and well-being through handovers and daily morning meetings.

Community professionals spoke positively about how staff and managers engaged with them and listened to their advice, to improve people’s care. Relatives also told us how their family members’ health and well-being had improved since living at the service.

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 requires improvement (report published 8 February 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about medicines and staffing. A decision was made for us to inspect and examine those risks. We did not find evidence people were at risk of harm from these concerns.

We 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fremantle Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Fremantle Court is a purpose-built residential care home providing personal and nursing care to up to 90 people. The home was divided into 6 separate units, each of which has separate adapted facilities spread across 2 floors. At the time of our inspection there were 79 people using the service.

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

The provider had struggled to retain registered managers for some time. The inconsistency in leadership had impacted on people’s outcomes and staff morale. There had been interim regional support managers who had filled in for the registered manager’s post. There was a new experienced registered manager who had only been in post for 4 months and was working through an improvement plan. The provider’s quality assurance processes were not always used effectively to drive improvement.

People’s care plans were not always complete or up to date. We found a discrepancy of a controlled medicine stock which had not been logged in. Risks to people's safety and well-being were managed through a risk management process. However, we found some of the risk assessments were not always reviewed in line with the provider’s policy.

Staff records of supervisions and support had not been completed in line with the provider’s policy. However, staff told us they felt supported by the new registered manager and said they were approachable and available.

We found the home was using agency staff and their deployment and oversight could be improved.

People’s dining experience varied between units. On some units, people experienced a positive dining experience. However, we saw staff support during meals could be improved on the other units.

People living at Fremantle Court told us they felt safe living in the home. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place.

People received their medicines as prescribed. Staff had the necessary skills to carry out their roles. Staff had regular training and opportunities and the new registered manager had started staff supervisions and we saw appraisals scheduled.

People had opportunities to participate in meaningful activities and we saw evidence people were involved in choosing activities and following their hobbies.

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. Staff had a particularly good understanding of when the principles of the Mental Capacity Act should be applied. People were supported to meet their nutritional needs and complimented the food at the 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 11 October 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We 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

We have identified a breach in relation to record keeping and ineffective quality assurance processes at this inspection. 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 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.

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

Fremantle Court was made up of six wings, each overseen by a care manager. The entire service was overseen by a deputy manager and a registered manager. The registered manager had implemented a number of changes and new initiatives since the previous inspection and these had improved the service.

People and relatives spoke highly of the service they received at Fremantle Court although they raised some concerns about staffing numbers, staff seeming rushed and staff talking amongst themselves. This information was shared with the registered manager and the provider. They told us they were currently working on improving staffing issues and would investigate and respond to issues relating to staff behaviours.

The service had strong person-centred values and placed people’s wellbeing at the heart of their work. People received personalised support which met their needs and preferences. Staff worked hard to provide people with varied activities and stimulation that met their interests.

Risks to people’s health, safety and wellbeing were assessed and acted upon. We found a risk assessment for one person had not been completed to give staff clear direction on how to minimise the risks for this person. However, staff knew people’s needs well and were taking action to protect people. Following our inspection, the registered manager sent us copies of the updated risk assessment they had put in place for this person.

People were protected from potential abuse by staff who had received training and were confident in raising concerns. There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable.

Incidents and accidents were investigated, and actions were taken to prevent reoccurrence. Fremantle Court was clean, welcoming and pleasantly decorated. Staff received training to meet the needs of the people living in the service.

People’s needs were assessed, and care was planned and delivered to meet legislation and good practice guidance. There were two qualified nurses on duty in the service at all times to ensure people received the nursing care they needed.

People received their medicines as prescribed by their doctor and there were processes in place to manage the ordering, storing and disposal of medicines.

People were fully involved in the planning and delivery of their care and this was done in a way which encouraged independence. People’s support plans contained personalised information which detailed how they wanted their care to be delivered.

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 was strong leadership at the service. People and staff spoke highly of the management team and there was a positive culture at the service with people and staff feeling their voices were listened to. There were effective quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided.

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

Rating at last inspection:

The last rating for this service was Requires Improvement (published June 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating. This inspection was carried out to also follow up on action we told the provider to take at the last inspection.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We previously inspected the service on 5 and 6 September 2016. The service was not meeting the requirements of the regulations at that time. We found breaches of regulations in relation to meeting people’s nutritional and hydration needs, not submitting notifications regarding outcomes to deprive people of their liberty and not ensuring recruitment procedures were operated effectively. During this inspection we found the provider was in continued breach of one of these regulations. However, recruitment procedures and submitting notifications had improved and the provider was now meeting these regulations.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions in safe, effective and well led to at least good.

We found during this inspection the provider did not have systems in place to manage medicines effectively and people at risk of dehydration, did not receive adequate fluids.

There was a registered manager in post at the time of our inspection. 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.’

Fremantle Court 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 care home accommodates 90 people in one adapted building. At the time of our inspection there were 85 people using the service.

The care home accommodates 15 people in six separate units, each of which have separate adapted facilities. Two of the units specialises in providing care to people living with dementia. The service referred to the units as ‘wings’.

On arrival at the service we were ‘let in’ by a member of staff who did not ask us who we were or who we had come to see. The member of staff opened the door for us and walked off leaving us standing in the main foyer for several minutes until a senior member of staff arrived and asked us who we were. We pointed this out to the registered manager who said they will investigate this.

In general people reported that they felt safe and reasonably well cared for living at the service. We received comments such as, “Overall there is not a problem living here, the staff are caring.” “Oh yes, I feel safe here and I know my [family member] is living just up the road, not far away.” “They are trained, but not on attitude and respect.” Relatives we spoke with reported they felt their family member was well cared for, we received comments such as. “[Relative] is happy, they (staff) are all helpful and it certainly saves me the hassle.”

Medicines were not managed effectively. Some people did not receive their medicines as the prescriber intended. We saw occasions where stock was not available and people did not receive their medicines. We saw on one occasion staff signed medicine records without administering the medicine.

Risk assessments had been completed for people with an identified risk. However, we found some records relating to the risks were not always completed.

We could not be sure people who had been identified as at risk of dehydration did not always receive sufficient fluids, due to poor recording of fluid intake. Air flow mattress checks were not always completed to ensure the mattress was at the correct setting.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; policies and systems in the service did not support this practice.

Safeguarding adults’ procedures were in place and staff understood how to protect people from the risk of abuse. There was a whistle blowing procedure available and staff said they would use it if necessary.

There were sufficient numbers of suitably qualified staff employed at the service. Staff had completed an induction programme when they started work and they were up to date with the provider’s mandatory training.

We received some negative feedback about the staffing levels at the service. People and relatives told us staff were often stretched. Staff told us staffing was a problem. However, during our inspection we saw that there were sufficient staffing levels to meet people’s needs.

The provider’s recruitment process ensured only suitable staff deemed suitable to work with people in a care setting were recruited.

Staff sought consent from people in line with the relevant legislation. The registered manager was knowledgeable about when a request for a DoLS application would be required. Applications had been submitted to the relevant local authority.

The service ensured people had access to healthcare professionals when required. The GP carried out routine visits and advice was sought from other professionals such as speech and language therapists when necessary.

The service had a complaints procedure which was available for people and their families to use as necessary. The registered manager took action and responded to people’s concerns within a specified timeframe.

The provider’s internal quality monitoring system was not effective and did not identify issues we found during our inspection.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the management of medicines and meeting people’s hydration requirements. You can see what action we told the provider to take at the back of the full version of this report.

We previously inspected the service on 4 March 2015. The service was meeting the requirements of the regulations at that time.

Fremantle Court provides residential and nursing care for up to 90 people. This includes care of people with dementia. The home was full at the time of our visit.

The service did not have a registered manager in post. 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. A new manager had been in post for six weeks and would be submitting an application for registration in due course.

We received positive feedback about the service. People said they were treated with kindness and compassion and staff were respectful towards them. Comments included "The staff are kind and caring," “All the staff are lovely and very caring” and "I find the care very good and the staff very caring."

Healthcare professionals expressed positive views of the service. One told us said “Everyone I have dealt with has been helpful and with regards to watching them interact and care for residents, this has been with respect and with their best interests at the centre of their care. I always find Fremantle welcoming, clean and a pleasure to visit.” Another healthcare professional told us "It's really clean and people are friendly there. I'd be quite happy for my relative to be there." A third healthcare professional said people were consulted and staff “Checked with residents to see what they wanted,” in terms of options for treatment. They added "They speak to people like equals."

People were protected from the risk of harm. There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. Risk assessments had been written and were followed, to reduce the likelihood of injury or harm to people during the provision of their care.

The service did not always carry out appropriate checks to make sure relatives had the legal authority to make decisions on behalf of people who lacked capacity. We have made a recommendation about checking who can legally make decisions on people’s behalf. People who did have capacity told us staff asked for their permission before they carried out tasks. The Care Quality Commission had not been informed about the outcome of applications to the local authority to deprive people of their liberty. This meant we were unable to evaluate what restrictions were placed upon people and how the service managed these.

We received mixed responses to whether there were enough staff to meet people’s needs. Some people felt weekends were more stretched. However, we found people received the care they required whilst we were at the service. Staff received appropriate support through a structured induction, supervision and training. There were good communication systems at the home to make sure information about people’s health and welfare was documented and shared with staff. Robust recruitment procedures had not been carried out when recruiting nurses. Checks had not been made of their nursing qualifications and registration with the Nursing and Midwifery Council, to ensure they had the appropriate qualifications to provide care and treatment.

People were supported with their healthcare needs and were referred to external healthcare professionals as required. We found people’s nutrition and hydration needs were not always met effectively by staff. This meant some people were at risk of weight loss or dehydration. We found people’s medicines were not always given to them in accordance with their prescriptions. Medicines were not always promptly returned to the pharmacy for disposal, or stored safely.

We found staff did not always follow good hygiene measures. We have made a recommendation about infection control practices.

The building was well maintained and complied with gas and electrical safety standards. Equipment was serviced to make sure it was in safe working order. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

The provider regularly checked quality of care at the service through visits and audits. There were clear visions and values for how the service should operate and staff promoted these. Records were maintained to a good standard and staff had access to policies and procedures to guide their practice.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to medicines practice, staff recruitment and meeting nutritional needs. We also found a breach of the Care Quality Commission (Registration) Regulations 2009. This was in relation to notification of the outcome of applications to deprive people of their liberty. You can see what action we told the provider to take at the back of the full version of this report.

We returned to the service on 4 March 2015 to check whether improvements had been made. This was after the date the provider told us all actions to improve the service would be completed.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service effective?

' Is the service well-led?

This is a summary of what we found -

Is the service effective?

We found Fremantle Court provided an effective service.

Improvements had been made to the personal information in people's care plans. This included details about their histories, interests, families and what was important to them. This helped staff provide personalised care, especially where people have dementia and may not be able to express their needs.

Is the service well-led?

We found Fremantle Court provided a well-led service.

Improvements had been made to monitoring of the service. We spoke with the registered manager and their line manager about how the service was monitored now. They told us they had learned from the findings of the last inspection. Systems had been put in place to ensure actions were completed to improve the service. This included a weekly heads of department meeting and checking progress with meeting targets. This helped ensure the service had effective measures in place to assess the quality of people's care.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the questions we always ask:

' Is the service effective?

' Is the service well-led?

This is a summary of what we found -

Is the service effective?

We found Fremantle Court needed to take action to become an effective service.

There were some improvements to how people's care and welfare was managed. Each care plan now contained an assessment of the person's risk of developing malnutrition and plans were in place to minimise high risks. People's weights were now being recorded and we could see people had been referred to their GP or dietitian where weight loss was noted. This helped ensure people received appropriate treatment to keep them healthy and well.

At the last inspection, we asked the provider to take action to include information in people's care plans about their backgrounds and histories. This was to help staff provide personalised care, especially where people have dementia and may not be able to express their needs. We found there was a template on which to record personal information but these had not been fully completed. Other information in the care plans we read was not sufficient in documenting people's preferences and what was significant to them. This meant there was a risk of people not receiving support that was sensitive to their needs.

Is the service well-led?

We found Fremantle Court needed to take action to become a well-led service.

Following the last inspection, the provider sent us an action plan which outlined the changes they would make to become compliant. They told us all actions would be completed by 30 October 2014.

During this inspection, we found the registered manager and provider had not ensured all the actions had been completed.

The provider had a system to monitor the service, including regular visits by a senior manager to assess the quality of care. The findings of our inspection show monitoring had not been effective in checking progress with completing the action plan to improve the quality of people's care. This meant that improvements had not been made in a timely manner.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

We found Fremantle Court provided a safe service.

There were policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Managers had been trained to understand when an application should be made and in how to submit one. This ensured there were proper safeguards in place.

We observed there were adequate staff to meet the needs of people living at the home. Relatives we spoke with confirmed there were always plenty of staff around. Staff were friendly and courteous when speaking with people and used people's preferred form of address. They answered people's questions patiently and politely and offered reassurance where people were anxious. We saw staff carried out their duties in an unhurried manner, giving time to people and answering call bells promptly.

The building was bright, spacious and well-designed. Accommodation was spread across two floors and divided into six groups. Each group had its own lounge, dining and kitchenette areas with additional quiet areas where people could sit or see their visitors. People had single occupancy bedrooms with en-suite facilities. They were encouraged to personalise their rooms according to their interests and tastes, to make them homely. The premises were accessible to people with disabilities throughout. For example, corridors and doorways were wide enough to accommodate wheelchair users.

People were protected from hazards at the service. For example, sluice areas were kept locked to prevent people coming into contact with contaminated material. We saw certification to show the gas and electrical installations at the home met approved safety standards. There were regular checks of the fire alarm and emergency lighting. This ensured they were fully operational and could be relied upon, when needed.

Is the service effective?

We found Fremantle Court needed to take action to become an effective service.

Care plans were in place for each person. We read six people's care plans. These provided assessments of people's care needs and the support they required. Risk assessments had been written for a range of activities and situations. For example, the likelihood of developing pressure damage and falling. Care plans had been written where people were assessed as being at risk. This helped reduce or control the potential for people to experience harm. However, we noted there was no nutritional risk assessment for one person whose records showed they may have been at risk of malnutrition. Additionally, there was only one record of them being weighed. This meant any potential weight loss may have gone unnoticed.

Care plans contained a section to record a personal profile of the person, such as their interests and hobbies, special memories and people and places that were important to them. The information was intended to help staff provide person-centred care for people with dementia. We found the profiles had not been filled in for three people's care plans and in another three they were only partially completed. This meant staff were not always aware of important information about people's backgrounds.

Activities were held in the home throughout the week. The people we spoke with said there was always something they could take part in. For example, during the week of our visit there was tai chi, watercolour painting, cake making and gardening. There was also a cinema room for people who liked watching films.

Is the service caring?

We found Fremantle Court provided a caring service.

People we spoke with were positive about standards of care at the home. Comments included 'I'm very happy here, I'd give it top marks,' 'The staff are all nice and it's kept clean,' 'It's very nice here and I've got no complaints. The staff are very good and there's a good choice of meals.'

There was good regard for people's privacy and dignity and they were supported to be independent. People were able to express their views and they were involved in making decisions about their care and treatment. People told us they made decisions such as when to get up and go to bed. They said they could spend time in their rooms or the lounges as they wished. We heard staff offered people choices at meal times and afternoon tea. They were then provided with what they had requested. The home involved people in staff recruitment interviews. The manager and other staff told us there were several people who were keen to be on the interview panels and they had provided helpful feedback about the suitability of candidates.

Is the service responsive?

We found Fremantle Court provided a responsive service.

People had access to external healthcare professionals, such as GPs and specialist nurses. Notes were kept of these visits to record any advice or recommended treatment. We saw the home facilitated a busy doctor's round and worked in partnership with the surgery to promote people's health.

There were arrangements in place to deal with foreseeable emergencies. Personal emergency evacuation plans had been written for each person. Staff were trained in fire safety and a range of fire safety checks was carried out at the home. For example, checks of alarm activation points and the emergency lighting. These measures helped to protect people's safety and welfare.

Is the service well-led?

We found Fremantle Court provided a well-led service.

The provider had an effective system to regularly assess and monitor the quality of service that people received. We read reports which showed the home's external line manager had visited on at least five occasions to assess care at the home. This included sampling care plan files, observing practice and checking whether there had been any safeguarding incidents, complaints or applications to deprive people of their liberty. Additionally, there had been audits such as an annual audit for nursing services. The report highlighted a need to improve clinical practice at the home. In response to this, the provider's specialist nurse advisor was working at the home to look at and improve practice.

The provider sought people's views through residents' meetings and surveys. We found changes were made to practice as a result of complaints / comments and incidents at the home. For example, closed circuit television was installed after someone had set fire to a skip in the car park earlier in the year.