Freestones Residential Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 61 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People’s needs were not always accurately assessed and kept under review. For example, new needs and risks were not always identified and care plans were not reflective of people’s current needs and how staff were to meet them. People’s feedback regarding their involvement in their care was mixed. Although some relatives had been consulted this was not always reflected in their records. The quality of information and instructions was not always monitored to enable staff to provide person-centred care. People’s health was not always effectively monitored and action taken in response to changes, for example, bowel health. There was limited oversight and monitoring and there was room for improvement in this area.

People’s views about the activities and support to access health services was mixed. One person said, “I do see other professionals and staff helps me with organising that, like chiropodist, hairdresser every other week, GP if we are poorly, they will send somebody same day.”

During our inspection visit we observed the meal-time experiences. We observed staff provided appropriate support to people, for instance encouragement to eat and offered to cut food into smaller pieces.

Residents and relatives’ meetings were used to gather their views about the care and support, provided, activities and meals and feedback about this was mixed. A relative said, “I don’t recall any residents’ meetings as such, or any questionnaires or surveys, but what is often done is that manager comes and ask us directly is everything ok.”

Although people’s care records did not always reflect people’s hobbies and interests, we saw people spending time in the lounge watching tv, completing a jigsaw puzzle, colouring or napping. A person told us, “I tried a lot of new stuff, like new food, some new activities and the best of all I have new friends.” Another person said, "We played bingo, I can be busy with my crosswords, puzzles if I want to, my whole family loves coming for visits they say I am in holiday resort. They all say it is lovely place.” Relatives feedback about activities and stimulation was mixed. They included, “[Person name] enjoys the exercises as it keeps their arms, hands and fingers moving which helps with their condition.” Another relative said, “What can be done better is more stimulation for people who are in their rooms, sometimes when I come, she is with no hearing aid, and I am not surprised she is not responding to anything because she can’t hear them.”

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Monitoring systems were not always individualised, for instance everyone was on fluid intake monitoring charts and these were not completed consistently. Fluid intake and urine output were not always looked at, which increased the risk that dehydration or infection going unnoticed. This did not reflect person-centred practice and reduced the value of the records in medical emergency.

Staff told us the benefits of being a small care home meant communication was easier and they did not always have to wait for the daily handovers. Although staff were familiar with the needs of people, the lack of accurate and up to date care plans increased the risk to people not receiving the care they needed consistently.

People and relatives told us they received regular support from familiar staff who knew them well. A relative said, “Main asset here are some very good and experienced staff, who are here for very long time, and they offer personnel stability, which we as relative, like; they do know the job well.”

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

During our inspection visit we saw information displayed around in the service in different formats, such as easy read and pictorial, which enabled people to find their bedroom and the toilet. There was also information displayed about activities, safeguarding contacts and complaints procedures, accessible to people and visitors. There were photographs of staff which enable people to recognise the staff on duty.

People’s communications had been assessed and reflected in their care plan when they first moved to the service but was not always reviewed. The provider told us they would make information available in format suitable for information as required. They assured us as they moved to the electronic care system all information pertaining to individual people would be available in a format that they may understand. Relatives said they felt informed about appointments or incidents, although some said they would appreciate more regular updates about reviews.

Staff told us pictorial menus were available to help support people to choice a meal, if required. This demonstrated that effort was made to present information in an accessible way, particularly for people living with dementia or communication difficulties.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. The provider and staff did not always involve people in decisions about their care or tell them what had changed as a result.

People and relatives had been involved in the assessment and care planning process when they first moved to the service. However, for subsequent care review meetings there was no record of people or their relatives being consulted. This was raised with the provider who assured us record keeping would be improved as they move from paper records to electronic care system.

People and relatives were confident to speak with the provider if they had any concerns. The complaints procedure was clearly by the entrance. People and relatives knew how to raise a concern. Their comments included, “I don't have any complaints; if I did have something to say I may talk to one of the carers” and "[Provider] is approachable and willing to listen and make [Person name] stay as comfortable as can be.” The provider was open and responded to concerns without delay. They told us they had not received any complaints about the care home. The provider had also responded and provided assurance to the concerns CQC had received and referred to them about staffing, food and leadership.

The provider made sure that people could access the care, support and treatment they needed when they needed it. For example, pre-admission assessments were completed to ensure people’s needs were understood before moving into the service. This helped identify any equipment or adaptations required, such as mobility aids or pressure-relieving mattresses, so support could be arranged in advance. Staff understood the needs of people and how to support them.

People had access to healthcare and specialist services as needed. A relative said, “[Person name] has a lot of other professionals involved, haematology test, pacemakers check up every year, podiatry and haircuts every 3-4 weeks. Dentist is difficult to organise even for us.”

The provider told us they had a good relationship with the GP practice who visited the service weekly. Although any adjustments needed or support required was not always documented staff were aware what equipment was required in the delivery of care. Staff also knew people’s relative who needed to be informed about any appointments so they could attend or support their family member. Staff knew how to access emergency or out-of-hours medical advice when required.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

A relative said, “[Person name] likes the room as it has the same wallpaper they had at home, and the large window they can look out of.” Although people and relatives described the environment as ‘homely and comfortable’ there was no evidence that consideration had been given to people regarding the décor, furnishings, artwork. The environment was not always suited to the needs of people living with dementia; for example, different floor covering, with a mix of patterns and textures.

The provider and staff had completed training on the equality act and were confident to advocate for people to tackle discrimination or barriers. People and relatives told us there were no barriers to care or to access health care support. A relative told us,”[Person name] used to struggle walking but gradually she improved and now only uses walking stick which is fantastic achievement.”

People had access to health professionals when they needed. However, staff did not have the relevant guidance enable them to recognise symptoms and when a person may need ‘as required medicines. Instructions provided by health professionals were not always reflected in people’s care plans and monitoring records were not consistent or reliable in relation to potential risks. This did not reflect person-centred care and promoting positive outcomes for people. This was raised with the provider who assured us record keeping with be improved as they move from paper records to the electronic care system.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

At the time of the inspection, there was no one receiving end-of-life care.Where people had advanced decisions about dying, these included within care documentation. Relatives told us, “We've discussed [Person name] end of life care and they have got DNARCPR (Do Not Attempt Cardiopulmonary Resuscitation) in place - we don't want them going to hospital but to stay here where [Person name] is loved and cared for” and “We discussed what’s best for [Person name] and all the arrangement have been made. All the necessary paperwork was complete as we want them to remain at Freestones. The DNAR is in place, and the GP had completed a ReSPECT form too.”