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 requires improvement. At this assessment provider had made some improvement and was no longer in breach of regulation. However, the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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 mostly made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs had been reviewed prior to transitioning records to the new digital care system implemented. Records showed people’s needs were assessed prior to moving to the service. People and their relatives had been involved in reviewing their care plan and risks.Care plans were detailed providing clear instructions to enable staff to meet people’s needs effectively.

Most people and relative told us the regular staff provide care needed. However, one person felt this was not the case when an agency staff supported them. A relative also told us, “I think [Person name] hair washing could be more regular and a bit more with their hands.”

Feedback was mixed regarding involvement in ongoing care planning and reviews. Some relatives reported being regularly involved, while others said they had not been involved beyond the initial assessment. However, people’s records reflected discussion and contact with family regarding changes to care needs and reporting actions taken when there were any health concerns.

People’s daily care intervention and the care notes reviewed contained gaps and quality of recording was not always consistently completed to demonstrate care needs were fully met. For example, personal hygiene needs and oral health. This made it more difficult to assess if planned care was effective.

The provider did not always deliver people’s care and treatment with them, in line with good practice guidance and what was important and mattered to them. For instance, key information about people had not been completed enabling staff to know what was important or that matter to individuals in relation to their lifestyle, family and how they wished to be cared for.

Recognised assessment tools were used, including the Malnutrition Universal Screening Tool (MUST) to identify risks of malnutrition and Waterlow assessments to assess the risk of developing pressure sores. Care plans provided staff with clear guidance on managing identified risks, supporting people's health and wellbeing. However, assessments and care plans did not consistently demonstrate how people's wishes and preferences had been considered.

Staff understood people's dietary needs and preferences, and information about allergies and modified diets was readily available. Staff prepared modified meals and thickened fluids correctly, and most people and relatives felt action taken when concerns arose.

Feedback about food was mixed. While some people and relatives were satisfied with the quality and preparation of meals, others felt there was limited choice and variety, for instance one relative told us there was sausages on the menu three times a week in the form of hotdogs, sausages with mash and toad in the hole. Staff told us alternatives meals were available despite the menu displayed only showed one main meal and dessert option for lunch and supper, which reduced opportunities for people to exercise choice.

We observed meals were served individually and not everyone seated at the same dining table received their meal at the same time. Staff responded promptly to requests for condiments as these were not readily available.

Some improvements had been made following the introduction of digital care records. However, inconsistencies and gaps in recording were identified and although these issues had been highlighted through audits, improvements had not been sustained. This reduced assurance that people's health risk and needs were consistently monitored and responded to promptly.

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.

People and relatives felt staff sought medical advice when needed. A relative told us, “When [Person name] had a sore under [area on the body], they sorted it out with cream. When they had blood in their urine, and this was cleared up with antibiotics.”

Staff also described good teamwork and told us they supported each other to meet people’s needs.

Staff worked with a range of health and social care professionals, including GPs, district nurse team and other professionals. Referrals were made when people needed additional assessment or support, including to the dietitian.

Staff understood how to respond to changes in people’s health and told us they reported concerns to senior staff so advice and support could be sought from appropriate healthcare professionals.

The provider did not always support people to manage their health and wellbeing, so people could not 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.

People were supported to access healthcare services when needed. Staff recognised changes in people's health and sought advice from GPs and other healthcare professionals. Referrals and appointments were arranged as required, and there were regular visits from the GP and nurse practitioner to monitor people's health. A relative told us, “The opticians are arranged here. The doctors would be arranged by staff, but dentistry; I don’t know what would happen if [Person name] has toothache.”

However, people were not always supported effectively to maintain their health and wellbeing. Although care plans provided guidance, records relating to continence care and personal hygiene were not always completed consistently, reducing assurance that people received the support they needed. In addition, refusals of care were not always recorded, limiting opportunities to identify patterns, review risks, and adapt care accordingly.

Staff were aware of people's dietary needs and preferences. However, feedback on food quality and menu choices was mixed, with some people reporting limited options, reducing choice and access to a varied and balanced diet.

We saw some positive examples of engagement, including staff spending time with people looking at books and an external activities coordinator providing an hour a week of physical activity, which some people enjoyed. However, opportunities for meaningful activity were limited for some people. One relative told us, “There is quite a lot of isolation, not really any stimulation.” We observed people spending long periods watching television, napping, or waiting for visitors, which increased the risk of social isolation and reduced opportunities to maintain their interests, wellbeing, and quality of life.

The provider monitored people’s care and outcomes. However, records were not always reliable enough to demonstrate that people’s needs and expectations were consistently met or that actions taken had improved outcomes. For instance, people's involvement in reviewing their care and support was not always evident, reducing assurance that decisions reflected their wishes and preferences.

There was limited feedback from people about how staff monitored their health and wellbeing to promote good health. A relative told us staff responded promptly to changes in the person's health, was investigated and successfully treated with antibiotics.

The digital care system enabled staff to monitor people’s health, wellbeing, and care, and care plans and risk assessments had been reviewed, and people's weights were measured. However, monitoring was not always effective in assessing whether care achieved positive outcomes. Records relating to personal care, hygiene, and continence were sometimes incomplete and did not always demonstrate appropriate review or escalation. For example, staff documented a person had been repositioned in bed but did not always record the new position.

We also found staff did not always recognise or escalate risks associated with constipation, and similar issues were identified in medication records. Although the quality lead was responded promptly when the concerns were raised, this demonstrated that further action was needed to strengthen oversight and monitoring.

A relative told us staff responded promptly to changes in the person's health, was investigated and successfully treated with antibiotics.

Overall, the provider had introduced systems to monitor people’s care and outcomes, and there were examples of positive improvements. However, monitoring did not always result in clear actions or demonstrate that improvements had been effective. Further work was needed to embed these systems into practice and ensure monitoring information was consistently used to evaluate care, drive improvement, and achieve positive outcomes for people.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

The provider had made sufficient improvements to address the issues we identified at the last assessment of the service. People's records included mental capacity assessments (MCA) and, where people lacked capacity, decisions were made in their best interests with involvement from relevant people and professionals. DoLS applications had been made where required and any conditions were being met.

Staff training records showed most staff, including the provider, had completed Mental Capacity Act (MCA) 2005 training and they demonstrated an understanding of consent.

People told us they were able to make choices about how they spent their time and that staff respected their wishes. A relative told us staff used their knowledge of their family member's preferences to support decision-making when they were no longer able to make simple choices.

We observed people were generally supported to make decisions about their day-to-day care. However, this was not always effective. For example, when a person living with dementia appeared unsure about a meal choice, staff did not use picture menus or other communication aids to help them understand the options and make an informed decision. This reduced the person's opportunity to exercise choice and control over their care.