Archived: 71 The Fremnells

71 The Fremnells is registered to provide accommodation with personal care for one person who has physical and learning disabilities. The person has lived as part of the providers family for many years and was living at the service on the day of our inspection. The provider was also the registered manager of the service and the premises was their own family home.

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

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

Improvements had been made to the provider's knowledge of the Mental Capacity Act 2005. A capacity assessment had been completed with the person’s involvement and agreement. The person was supported to have maximum choice and control of their lives and the registered manager supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager knew about safeguarding people from harm. Family members provided care as and when needed. No staff were employed so there were no recruitment procedures for us to review. Risk assessments were completed to ensure the person was kept safe whilst maintaining their independence. The premises were adequate for the person’s needs.

Effective infection control measures were in place to enable the person to remain well. The person’s medicines were well managed and administered correctly and in line with good practice.

Lessons had been learnt and changes made to improve the quality of the service for the person. The provider followed best practice guidance from professionals and undertook training relevant to their role and responsibilities. There was good communication and liaison with a range of health and social care professionals.

The care provided was person centred, responsive, respectful, inclusive, warm and caring. Information about the person’s needs was comprehensive, clear and reviewed as and when needed. The person was fully involved and made choices and decisions about their life. They enjoyed an active social life, utilising the local community and a wide range of opportunities.

The service was well led by a caring and knowledgeable registered manager. Quality assurance systems were in place. Checks such as health and safety of the premises, medicines, equipment and supplies were monitored regularly relevant to the needs of the service.

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

The last rating for this service was Good (published 3 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

A registered manager was 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.

71 The Fremnells is registered to provide accommodation with personal care for one person who has physical and learning disabilities. The provider applied to register the service so as to allow them to continue to offer care to one specific person to whom they had provided care services in the past. The person was living at the service on the day of our inspection. The provider is also the registered manager of the service and the premises is the registered manager’s own family home.

Improvements were needed to the registered manager's knowledge of and to records relating to the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Written assessments had not been completed to demonstrate that decisions taken were in the person’s best interests to ensure that their human rights were protected.

The registered manager was knowledgeable about identifying abuse and how to report it to safeguard the person they cared for. No staff were employed so there were no recruitment procedures for us to review. Risk management plans were in place to support the person and to keep them safe. There were also processes in place to manage any risks in relation to cross infection.

Medicines were safely stored, recorded and administered in line with current guidance to ensure the person received their prescribed medicines to meet their needs. Effective support for the person’s nutritional and healthcare needs was in place.

The registered manager was the main carer and they were supported by a family member. They ensured that the person was always accompanied and observed in line with their care needs. The registered manager had maintained their training to ensure they were skilled in supporting the person’s specific care needs. Care records included the person’s individual needs and reflected changes so that there was clear information on how to provide the care and support they required.

Dignity and privacy was respected. The person lived in a friendly and caring environment and their relationships were encouraged and supported. The person was supported to participate in social activities including community based events and to follow their own interests.

The registered manager monitored the quality of the service through their daily involvement in the person’s care and through effective communications with others involved in supporting the person.

Our inspection team was made up of one inspector. During our inspection visit we spoke with the person who used the service, a relative and the manager of the service. We also looked at records, including assessments, care plans, training records, audits and medication records. Prior to meeting the person who used the service, the manager explained the person's communication method. We saw that this was written down and was carried with the person when they were not in the service. We also used our observations to gather information. Below is a summary of what we found. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

Records contained detailed assessments of the person's needs and had been regularly reviewed. We saw that where any changes in the person's needs had been identified, the care plans and risk assessments had been updated.

Where people did not have the mental capacity to provide consent the provider complied with the requirements of the Mental Capacity Act 2005. The staff had received training in this area. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst no applications have needed to be submitted, proper policies and procedures were in place. The manager had been trained to understand when an application should be made, and how to submit one.

Systems were in place to make sure that staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

The person who used the service told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with the manager that they understood the persons care and support needs and that they knew them very well. A relative we spoke with said, 'The staff are very knowledgeable about how to support my relative; they encourage him to be as independent as possible.'

The person's health and care needs were assessed with them, and they were involved in developing their plans of care. Specialist dietary needs had been identified in care plans where required. The training that staff had received equipped them to meet the needs of the person who used the service.

Is the service caring?

The person was supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting the person. The person's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes. A relative we spoke with told us, 'We are very happy with the care that my relative receives. They always ensure that they are involved in making decisions about their life and the way they want to live it.'

Is the service responsive?

When the persons health needs had changed, the manager ensured that care plans and risk assessments were updated. If the person's needs changed then health professionals were involved in reviewing the care plans and risk assessments. Any training requirements were addressed immediately by the manager.

Is the service well led?

The service worked well with other agencies and services to make sure care was delivered in a joined up way. The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. As a result, the quality of the service was continuously improving.

The person's care plan contained an assessment of their support needs that identified the care and treatment required. These were reviewed by the person using the service, the provider and a team of healthcare professionals. Risks were managed when in the care of the provider but these had not been formally recorded. A relative we spoke with said, "The care my relative gets is excellent and they are very happy."

We found that the person living received suitable quantities of nutritious food and hydration. These had been assessed by a nutritionist so that they received the healthiest food options. The person using the service was supported appropriately at meal times.

The provider had received safeguarding training and refresher courses to enable them to protect the person using the service from abuse. They were aware of the procedures to follow and who to notify if an incident occurred. We found that the person was safeguarded from the risks of abuse.

Records held were accurate and contained information in relation to the care and treatment of the person using the service. These included a comprehensive care plan and documents in relation to training, equipment, medication and nutrition.

We looked at the care record and found it to be clear and informative and it covered all areas of both health and personal care and met the needs of the individual. The person using the service was treated with consideration and respect and involved in all aspects of their care and treatment. The plan also reflected likes and dislikes and the preferred activities and there was much variety and stimulation.

The equipment at the location was fit for purpose, all properly maintained and suitable for the needs of the individual and helped promote independence. The provider provided one to one care and had the relevant qualifications and experience to carry on the regulated activity.

Due to the daily supervision of the person using the service the carer was able to monitor the quality of service provision on a regular basis and therefore identified any areas for improvement at an early stage, taking action where appropriate.