Freestones Residential Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. The service was in breach of legal regulation in relation to people’s consent to care and treatment.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs were assessed prior to moving to the service. The care developed were basic and they did not always contain the necessary information to instruct staff on what care and support to provide, for example, to manage risks of falling and skin integrity. Record keeping was not clear or consistent and we were not assured people’s current needs were assessed and care plans reflected how staff were to meet their needs.

People told us their care needs had been discussed with them when they first moved to the care home. A person said, “Usually one of the staff or [Provider] will ask me if everything's ok with how staff support me, and so far, it’s been ok.” A relative said, “We've been involved in a meeting to review [Person name] care as their dementia has worsened, just to make sure we're happy they are getting the care they need. However, care records did not always demonstrate people’s needs had been discussed with them. This was important as care plans should be developed collaboratively, focusing on what matters most to the person. We could not be assured reviews of care needs remained effective and relevant. The provider acknowledged any consultation with relatives were not always recorded. They assured us once the new electronic care system had been implemented; it should address this issue.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

Risks to people were assessed using evidence-based screening tools. They included the malnutrition universal screening tool (MUST) to assess a person’s individual risk of malnutrition and Waterlow for people at risk of developing pressure sores. Staff had reviewed the risks most months. However, one person’s risk remained high which required a referral to the district nurse for further assessment but there was no record to indicate this. Staff told us the provider had made the referral, but there was no record of this, and the care plan had not been updated to reflect instructions from health professionals for staff to follow.

Staff were trained to provide evidence-based care, but the care plans did not always have the correct guidance to support people with needs related to pressure area care, catheter care or hydration needs. Monitoring records were not always completed fully, accurate or reliable. This limited assurance that appropriate care and support was delivered in line with evidence-based guidance. These concerns were raised with the provider to address.

People’s dietary needs had been assessed.The designated staff member with responsibility for preparing meals was aware of people’s dietary requirements, but not all staff were aware of a people with allergies. There was no information displayed to indicate people’s dietary requirements and allergens. This was raised with the staff member and the provider. They acted promptly and ensure dietary requirements and allergen information was displayed.

Despite the shortfalls found, staff aware of people’s food preferences. We observed staff prepared thickened drinks correctly and encouraged people to have regular drinks.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff told us communication between staff was good. Staff were able to explain which professionals were involved in people’s care. However, the care plans did not always include specific instructions provided by health professionals.

Feedback from professionals was positive. Comments included, “When visiting Freestones the residents always appear content and well kempt. Communication between myself the care home staff and the manager, is overall satisfactory” and “Should a patient fall the Gp or advance nurse practitioner is usually notified regarding the extent of the fall, whether they were reviewed by EMAS or AE department or whether any follow up action is required from the surgery.”

People told us they could access health care services as required. A person said, “I do see other professionals and staff help me with organising that, like chiropodist, hairdresser every other week, GP if we are poorly, they will send somebody same day.” A relative told us, “Last time [Person name] was seen by the GP was when they had a water infection and they prescribe antibiotics for them.”

The provider supported people to manage their health and wellbeing, so people could always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Most people told us they enjoyed the choice of meals provided. Their comments included, “My food comes like mashed; I can’t swallow that well, but even mashed it taste very good” and “Roast dinner is good here, but fish is very thin and it’s not like in fish and chips shop but it’s alright to eat and I do eat that meal.” A relative said, “We had a long chat about everything with manager and immediately they started to provide gluten free food for them.” There was a rotating seasonal menu and always a choice of meals each day. The meals prepared including fortified and textures options where a person had swallowing difficulties.

People’s records were not always completed consistently or accurately, for instance the food and drink consumed, and urine output for people with a catheter. This meant potential health risks may not be identified in order to access appropriate medical advice and treatment. It was not always clear how people were supported to be involved in decisions about their health, care and healthier lifestyle choices, and there was room for improvement in this aspect.

People told us they were supported to attend routine health screening and flu vaccinations. Relatives also told us that staff kept them informed when their family member was unwell. People’s records also confirmed when they were by the GP or the district nurses. During our inspection visit the optician was conducting eye health checks.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

People and relatives felt staff had had a positive impact on their quality of life and wellbeing. However, system to monitor care interventions and improve outcomes for people was not always effective. Records had not always been completed consistently to provide oversight.We found instructions from the district nurses in relation to pressure area care and catheter care was not always reflected in people’s care plans. The monitoring records were not completed consistently to enable staff to identify potential risk and deteriorating health. For example, staff did not always record how much urine was emptied from catheter bag or it was recorded in different places. Records showed everyone was placed on fluid monitoring without a known risk of dehydration, but these were not completed consistently. There were no fluid intake targets or monitoring to ensure people had had enough to drink to stay hydrated. The audit process and provider oversight was inconsistent and there was no record if action had been taken. We brought these concerns to the attention of the provider to address.

The provider did not tell people about their rights around consent or respect these when delivering care and treatment.

The provider and staff had received training in the Mental Capacity Act (MCA) 2005 and understood the importance of people’s consent. However, the provider was not working within the MCA principles. Mental capacity assessments and best interest were not completed robustly, ensuring the person or their relative or relevant professionals had been consulted. Decision specific assessments were in some instances grouped together such as care and finance. We found capacity assessments and best interest decisions were not completed where people were cared for in bed and bedrails were used to prevent them from falling out of bed. Where best interest decisions had been completed these were not correct. Despite staff trained in this area, some staff did not fully understand and were not supported to complete assessments were people lacked capacity. This supported the feedback we received from a professional with responsibility to carry out best interest assessments.

Deprivation of Liberty Safeguards (DoLS) is a legal framework that protects people who lack the mental capacity to consent to care and treatment.Where people had a DoLS authorised, with or without conditions, these were not reflected in the person’s care plan. Conditions attached to the DoLS were not all met for people such as best interest decision required for the use of bed rails, medication and modified diet. This meant people were at risk of abuse and undue restrictions had been placed on their lives.

The provider had not submitted notification to CQC when a person’s DoLS had been authorised by the local authority. This demonstrated the provider was not meeting their legal responsibility as a registered person.

People were aware of their rights around consent and told us staff sought their consent and respected their wishes. A person said, “Carers are well trained to ask us for permissions before trying to do anything, but if they know us well that might not be needed.”