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Inspection carried out on 3 December 2018

During a routine inspection

Freegrove Care Home can accommodate up to 17 people. The accommodation is arranged over two floors with a lift available to access the upper floor. People in care homes receive accommodation and their care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection. Freegrove Care Home is owned and managed by Mrs C Duffin who, throughout this report, is referred to as the provider. This inspection took place on the 3 and 4 December 2018 and there were 14 people using the service.

The service is not required to have a registered manager. This is because the provider is registered with the Care Quality Commission as an individual and is providing the day to day management of the service. 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.

At our last inspection we rated the service as overall good. At this inspection, whilst we found some areas where improvements could be made, our findings continued to support an overall rating of good.

The areas for improvement were:

Notifications of incidents and accidents that had occurred had not always been sent to CQQ as required.

Some of the records relating to how the service was managed contained missing information or were not accurately completed.

Whilst incidents and accidents were investigated, these sometimes lacked robustness and learning from these was not yet being consistently applied.

The provider’s governance and quality assurance systems were not yet being fully effective at monitoring the quality and safety of the service.

Other areas were overall good.

There were times when staff could have been more effectively deployed. The provider is reviewing staffing arrangements to address this. Recruitment was safe.

Overall medicines were managed safely and people received their medicines as prescribed.

Staff followed infection control guidance and the home was visibly clean.

People had individual assessments of risk associated with their care and support and the staff knew how to support people in a way that minimised these risks.

Health and safety checks were carried out to ensure the safety of the building and equipment within it.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect.

Staff understood their responsibility to raise concerns and report on incidents and accidents.

People received effective care from staff that had the right skills and knowledge to carry out their role. Whilst staff felt supported in their roles. The frequency with which they were receiving supervision had declined.

The provider demonstrated a clear commitment to protecting people’s rights. Where people's liberty or freedoms were at risk of being restricted, the proper authorisations were in place or had been applied for.

People told us they enjoyed the food provided and staff were informed about whether people were nutritionally at risk.

Staff worked effectively with a number of health care professionals to ensure that people received co-ordinated care, treatment and support.

People were treated with dignity and respect and staff were kind and caring in their interactions with people.

People and their relatives were involved in making decisions and planning care.

People received care that was centred on them as an individual. Staff recognised and responded to changes in people’s health care needs.

People were supported to follow their interests and take part in social activities.

People and relatives were confident they could raise concerns or complaints and these would be dealt with.

People and

Inspection carried out on 29 February 2016

During a routine inspection

This inspection took place on the 29 February 2016 and the 2nd March 2016. The inspection was undertaken to check whether the provider had made improvements and was now meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. The inspection also looked at whether improvements had been made following enforcement action we took in June 2015.

Freegrove Care Home is a small family owned residential care home located in a residential area of Lymington. The home is arranged over two floors and can accommodate up to 17 people but at the time of our inspection there were 12 people living at the home. The home supports people with a range of needs. Some people were quite independent and only needed minimal assistance. Others were more dependent and needed assistance with most daily living requirements including support with managing their personal care and mobility needs. Some of the people being cared for in the home were living with dementia and a small number could display behaviour which challenged others.

The home did not have 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 and associated Regulations about how the service is run. The provider is applying to the Care Quality Commission (CQC) to remove the condition that requires them to have a registered manager in place. This was because they were now managing the home themselves.

The inspection found that a number of improvements had been made.

Action was being taken to embed the principles of the Mental Capacity Act 2005 within the care planning process. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people's liberty or freedoms were at risk of being restricted, the proper authorisations were in place or had been applied for.

The provider had made significant improvements to the governance arrangements in place. A range of audits were undertaken to assess and monitor the quality and safety of the service. These needed to be embedded and sustained to ensure that they continued to drive improvements.

There were sufficient numbers of staff deployed to meet people’s needs and appropriate recruitment checks took place before staff started working at the home. People received effective care from staff that had the right skills and knowledge to carry out their role.

Staff had received training in safeguarding vulnerable adults and had a good understanding of the signs of abuse and neglect. They were aware of what to do if they suspected abuse was taking place.

People’s records contained appropriate risk assessments which covered a range of areas. Care workers said that the risk assessments told them what they needed to know about each person and how to deliver their care safely.

People’s medicines were managed safely. The home was clean and food was being stored safely in line with guidance from the Food Standards Agency. People told us they enjoyed the food provided and staff were informed about whether people were nutritionally at risk.

The home worked effectively with a number of health care professionals to ensure that people received co-ordinated care, treatment and support.

People were treated with dignity and respect. Staff were kind and caring in their interactions with people and people and their relatives were involved in making decisions and planning care.

Records were written in a manner that helped to make sure people received care that was centred on them as an individual. Changes to people’s needs were effectively communicated within the staff team.

People knew how to make a complaint

Inspection carried out on 25 September 2015

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

This inspection took place on 25 September 2015. The purpose of the inspection was to establish if improvements had been made to people’s safety following enforcement action we had taken in June 2015. We found the required improvements had been made and that care was being provided in a safe way. You can read a summary of our findings from this inspection below.

Freegrove Care Home is a small residential care home located in a residential area of Lymington. The home is arranged over two floors and can accommodate up to 17 people. At the time of our inspection there were 13 people living at the home. The home supports people with a range of needs. Most people were quite independent and only needed minimal assistance. Some people were more dependent and needed assistance with most daily living requirements including support with managing their personal care and mobility needs. A small number of people being cared in the home were living with dementia and could display behaviour which challenged.

The home 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 and associated Regulations about how the service is run. The registered manager was in the process of applying to de-register and the registered provider was now in charge of the day to day management of the service.

We found that the registered provider had taken action to ensure that people had appropriate care plans and risk assessments which helped staff to deliver their care safely. Tools used to assess and monitor people’s risk of developing pressure sores or of becoming malnourished were being consistently used.

Arrangements were in place to ensure that people’s medicines were administered safely. Medicine audits were being effectively used to drive improvements and to ensure that people's medicines were being managed safely. Staff were only administering medicines when they had been trained to do so and their competency to do this safely had been assessed.

There were systems in place to reflect upon the nature and cause of incidents and accidents. These were reviewed by the registered provider to identify any trends or patterns so that remedial action could be taken which might reduce the risk of similar incidents happening again.

Food was being stored in line with guidance from the Food Standards Agency. This helped to ensure that people were not given foods that were unsafe or unsuitable to eat.

Arrangements were in place for dealing with emergencies which might reasonably be expected to arise from time to time. Each person had an personal emergency evacuation plan (PEEP) and there was a detailed business continuity plan which set out the procedures for dealing with a range of emergencies.

This report only covers our findings of the inspection on 25 September 2015. You can read the report from our previous inspections by selecting the ‘all reports’ link for ‘Freegrove Care Home’ on our website at www.cqc.org.uk.

We could not improve the overall rating for this service because to do so requires consistent good practice over time. We will consider whether it is appropriate to revise the overall rating awarded to this service during our next planned comprehensive inspection.

Inspection carried out on 11 and 12 June 2015

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

We carried out an unannounced comprehensive inspection at Freegrove Care Home on 22 and 23 January 2015. We found a number of breaches of the legal requirements and as a result we served four warning notices on the registered manager and registered provider requiring them to become compliant by 11 May 2015. The warning notices related to failings in how people’s care and welfare was managed, the cleanliness and infection control measures in place and the governance arrangements within the home. We had also found that staff had not maintained an accurate and complete record of the care and support provided to people using the service. We also issued five requirement actions. This was because the provider and registered manager had not ensured there were suitable arrangements in place for the safe management of medicines, for acting in accordance with people’s consent, safeguarding people from abuse and the risk of unlawful restrictions of their liberty. The provider and registered manager had also not ensured there were sufficient numbers of staff on duty at all times and that staff had received appropriate support, training and professional development. The provider sent us an action plan in relation to these breaches of the Regulations saying they would have made the required improvements by 31 May 2015.

We undertook an unannounced focused inspection on 11 and 12 June 2015 to follow up on whether the necessary actions had been taken to meet the warning notices and legal requirements. You can read a summary of our findings from this inspection below.

This report only covers our findings at the inspection on 11 and 12 June 2015. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Freegrove Care Home’ on our website at www.cqc.org.uk.

Freegrove Care Home is a small residential care home located in a residential area of Lymington. The home is arranged over two floors and can accommodate up to 17 people. At the time of our inspection there were 14 people living at the home. The home supports people with a range of needs. Most people were quite independent and only needed minimal assistance. Some people were more dependent and needed assistance with most daily living requirements including support with managing their personal care and mobility needs. A small number of people being cared in the home were living with dementia and could display behaviour which challenged.

The home 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 and associated Regulations about how the service is run.

We found that although some improvements had been made, we found that some Regulations continued to be breached.

Some people did not have appropriate care plans and risk assessments which helped staff to deliver their care safely.

Improvements had been made to the environment and the cleanliness of the premises but there were still further areas that required improvement.

The provider had employed additional staff and reviewed the staffing structure. However, people and staff continued to tell us that there were times when there was insufficient staff to meet people’s needs and keep them safe.

We could not be assured that the recruitment practices operated by the provider were safe as the provider had not performed all of the required checks before new staff members started work.

The management of people’s medicines required further improvement before we could judge this to be safe.

The provider had not demonstrated that they were having due regard to the Mental Capacity Act 2005. When a person’s capacity to make decisions about their care was in doubt, mental capacity assessments had not always been completed.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. The provider and registered manager had not taken action to identify all of the people who might require applications for Deprivation of Liberty Safeguard authorisations.

Staff had received additional training, but the provider could not demonstrate that all staff had received appropriate training before they were involved in moving and handing interventions and the administration of people’s medicines. We were concerned that this could result in people receiving unsafe care.

Some improvements had been made to the quality assurance systems, but there were still areas of concern. It was not clear how audits were being used to drive improvements and incidents and accidents were not being properly reported and investigated.

Improvements had been made to ensure that people were protected from the risk of abuse. Staff were having regular supervision which helped to ensure they were able to carry out their roles and responsibilities effectively.

Interactions between staff and people who used the service demonstrated that staff knew people well. People told us that staff were kind and caring.

We found a number of on-going breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 22 & 23 January 2015

During a routine inspection

At an inspection on 29 July 2014, we asked the provider to take action to make improvements to how they managed the care and welfare of people, the cleanliness and infection control measures used within the home, staff recruitment, quality assurance processes and records. The provider sent us an action plan which said that they would ensure mental capacity assessments were completed when necessary and that staff would receive mental capacity training. They said that each care plan would be reviewed monthly and would evolve to be more person centred. The action plan stated that a health and safety audit would be implemented and hand washing products distributed around the home. They stated that relevant checks would always be completed in the future when new staff were employed. They told us that these actions would be completed by 31 October 2014.

We carried out this unannounced inspection on 22 and 23 January 2015 to see if the required improvements had been made.

The provider and registered manager were still not meeting the required standards in any of the areas where concerns had been identified in July 2014. In addition, we found that the provider and registered manager were failing to meet the required standards in a further six regulations.

Freegrove Care Home is a small family owned residential care home located in a residential area of Lymington. The home is arranged over two floors and can accommodate up to 17 people but at the time of our inspection there were 12 people living at the home. The home supports people with a range of needs. Most people were quite independent and only needed minimal assistance. Some people were more dependent and needed assistance with most daily living requirements including support with managing their personal care and mobility needs. A small number of people being cared in the home were living with dementia and could display behaviour which challenged.

The home 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 and associated Regulations about how the service is run.

The provider and registered manager had not taken proper steps to ensure that each person was protected against the risks of receiving unsafe or inappropriate care as people did not always have accurate and detailed care plans and risk assessments which helped staff to deliver their care safely. People’s records did not always contain enough information about their needs to ensure that staff were able to deliver responsive care.

Recruitment procedures were not safe. The provider had accepted Disclosure and Baring (DBS) certificates issued by previous employers without first carrying out their own checks to ensure that these did not reveal any new information of concern about potential new workers. Appropriate references and employment histories had not been obtained for one person.

The provider did not have appropriate arrangements in place for effective prevention and control of infections. Whilst people told us the home was kept clean, we found that two rooms had an unpleasant odour. Staff were not always using protective clothing such as gloves and aprons and relevant guidance was not always being followed in respect of food storage and the disposal of contaminated waste.

The provider and registered manager had not ensured there was an effective system in place to assess and monitor the quality of the service. We identified concerns in a number of areas. These issues had not been identified by the provider or registered manager.

When a person’s capacity to make decisions about their care was in doubt mental capacity assessments had not always been completed. We were not able to see that appropriate best interests consultations had been undertaken.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care home. The provider and registered manager had not made any applications for Deprivation of Liberty Safeguard authorisations; even though some people were not free to leave the home unsupervised and were subject to a high degree of observation.

Whilst people told us they felt safe living at Freegrove Care Home, we found that people were not adequately protected from abuse. The provider’s safeguarding policy was not fit for purpose as it did not contain relevant information about how and to whom staff should report allegations of abuse. Safeguarding training was not always being updated regularly and some staff demonstrated a poor understanding of safeguarding. We asked the provider to make an urgent referral to the local Adult Services safeguarding team as we were concerned about how some aspects of one person’s care was being delivered.

People’s medicines were not managed safely. The provider and registered manager had not ensured that there were appropriate arrangements in place for the obtaining, recording, handling, safe keeping, safe administration and disposal of medicines.

The programme of training needed to be further developed to ensure that staff continued to receive all of the essential and relevant training required to carry out their roles and responsibilities effectively. Staff had not received supervision in line with the frequency determined by the provider.

Staffing levels required improvement. Target staffing levels were not always met and staffing levels were not always sufficient to meet people’s needs in a timely manner.

Whilst information about people’s dietary requirements was recorded in their care plans, staff were not always aware of these which increased the risk of people being offered inappropriate foods. A range of nutritious food was provided but there was limited choice. People told us, however, that they could always ask for an alternative and this would be provided. People told us the food was of good quality and tasty.

People spoke positively about the care provided by the staff as did their relatives. One person described the staff as “My saviours”. A relative said, “They are exceptionally kind and loving”.

People said they had no concerns about the leadership of the home. People felt they were listened to and told us that the registered manager and provider were attentive and often spent time talking with them and knew their needs well.

People knew how to make a complaint and information about the complaints procedure was included in the service user guide.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which now corresponds to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 29 July 2014

During an inspection in response to concerns

We brought forward a scheduled inspection of Freegrove Care Home (the home). This was because we had received anonymous concerns alleging the welfare of people at the home had been compromised. We found no evidence to substantiate the specific allegations.

At the time of our visit 14 people were accommodated at the home and we spoke with nine of them in order to hear about their experiences of living at the home. We spoke with two visiting relatives and the friend of people who lived at the home. We also contacted another relative by telephone. This was to hear what they thought about the standard of support people who lived at the home received.

We spoke with four members of staff as well as the home's registered manager in order to hear what they had to say about how the home functioned.

We contacted two local GP surgeries and the community nursing service to obtain their opinions about the care people received at the home. We received a response from one GP.

We gathered evidence against the outcomes we inspected to help answer our five key questions.

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found.

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

Is the service caring?

A GP who visited the home told us they had high regard for the home. They said “I observe residents being treated with care and dignity, and most importantly as individuals”.

People’s fundamental rights to privacy, dignity choice and independence were respected and their views were taken into account in the way the service was provided and delivered in relation to their care.

Is the service responsive?

People told us they were confident they could speak to the home’s staff or manager if they were unhappy with any aspect of the service they received. They told us they believed any concerns they had would be addressed and “put right if possible”.

We saw care staff did not make assumptions but always asked people what support they wanted and what choices they wanted to exercise. They also anticipated the needs of some people by checking with them frequently to see if they required help and support.

Is the service safe?

Risks to people's welfare had not always been comprehensively assessed and plans put in place to ensure their needs were appropriately met and risks to their safety were managed properly.

The home’s manager was not aware of recent changes to the criteria about the circumstances that could constitute a deprivation of a person's liberty under Mental Act 2005, Deprivation of Liberty Safeguards. This meant arrangements for the support of some people who lived at the home could result in them having their rights denied unlawfully.

People were not properly protected from the risk of infection because appropriate guidance had not been followed.

People were not protected from the risks of unsafe or inappropriate care and treatment because information about them was not always complete and accurate.

Is the service effective?

Risks to peoples welfare had not been always been comprehensively assessed to enable plans to be put in place to mitigate them. The care and support people received had not been planned in a way that reflected relevant guidance, fully ensured their safety and welfare and protected them form unlawful discrimination.

Is the service well led?

The provider did not have comprehensive or robust arrangements in place for checking and monitoring the quality of their service and for identifying, assessing and managing risks to the health, safety and welfare of people using it.

Inspection carried out on 7 January 2014

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

We spoke with six people who use the service and a relative, three members of staff, the registered manager and the service provider. We looked at care and support records for five people who used the service and other records relevant to the management of the service. We saw that improvements had been made to ensure that staff received appropriate training, professional development, supervision and appraisal, so that they were able to deliver care and support safely and to an appropriate standard. The provider had taken steps to ensure that the systems in place to regularly assess and monitor the quality of service that people received were effective. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. All of the above improvements will need to be embedded in practice and sustained.

A person who used the service told us: “The staff are very kind, I am happy with how I am treated. If the carer has a problem or doesn’t understand something she goes to a senior member of staff for advice”. Another person said: “The staff are lovely, they look after us and treat us very well”. We saw that staff interacted with and supported people using the service in a patient, caring and respectful manner.

Inspection carried out on 9, 10 May 2013

During a routine inspection

We spoke with five people who used the service, who spoke positively about the care they received. One person said: “It’s not home, but they’re lovely people”. Another person told us: “They’re good here and the food is lovely”. Three of the people we spoke with said they wished there was more to do. We saw that people were assisted to take their medicines in ways that maintained their dignity and independence.

We spoke with three members of care staff, who told us that they felt supported to do their jobs and were confident about being able to meet the needs of people using the service. However, other evidence did not support this. Staff were not receiving appropriate training, professional development, supervision and appraisal to ensure that they were able to deliver care and support safely and to an appropriate standard.

Whilst the management were accessible to people using the service, visitors and staff, there were no formal quality assurance mechanisms for regularly seeking and acting on the views of people using the service or their representatives. The systems in place to regularly assess and monitor the quality of service that people received were not always effective. We saw that the available records were kept securely and could be located promptly when needed. However, people were not protected from the risks of unsafe or inappropriate care and support because records were not always accurate and appropriately maintained.

Inspection carried out on 26 November 2012

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

We spoke to people using the service but their feedback did not relate to these standards. We saw evidence of the steps that had been taken by the provider to ensure that there were effective systems in place to reduce the risk and spread of infection. A detailed cleaning schedule was in place and was being adhered to by staff and monitored by the management. Staff had received training updates in infection prevention and control (IPC) and a member of staff we spoke with demonstrated their understanding of the IPC procedures.

We saw that the provider had taken action to ensure that people using the service were protected from the risk of scalding. A general risk assessment for water temperature throughout the home had been carried out and a programme of putting temperature control valves on all hot water taps within the property had been completed, in line with the provider’s action plan.

Inspection carried out on 3 July 2012

During a routine inspection

We spoke with one of the people using the service, their relative and another visitor. The people we spoke with confirmed that their, or their relative/friend’s care and support needs were being met and that they were treated with respect. The person using the service said that they were “well cared for” and told us that staff responded promptly if they or other people required assistance. They said that they had no complaints about the service. A visitor we spoke with said that their friend was settling in and was “happy here”.

The person we spoke with who used the service told us that they felt safe living in the home. They and their relative said they were satisfied with the standard of cleanliness in the home. However, other evidence did not support this and we have asked the provider to take action.

We were not able to speak with all of the people using the service because of their complex needs, which meant they were not able to tell us about their experiences. We therefore spent some time observing the care provided and people’s interactions with staff. We saw that people were spoken with and supported in a respectful and professional manner and were able to move around the house as freely and independently as possible. We observed that people received individual support when they required it.

Inspection carried out on 27 July 2011

During an inspection in response to concerns

People we spoke with told us that the service was meeting their needs and confirmed that staff respected their privacy and dignity. Many of the people using the service were not able to verbally communicate with us. We therefore spent time observing the care provided and people’s interactions with staff. We observed staff supporting people in ways that upheld their dignity and promoted their independence as much as possible. Staff we spoke with had a good understanding of the needs of people who use the service and interacted positively with them.

People told us they were satisfied with the standard of cleanliness in the home and confirmed that staff carried out cleaning tasks regularly. They said they could ask questions or raise any concerns at any time and that the management and staff would listen and respond. They told us they had no complaints about the service.

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