Freshfields - Care Home with Nursing Physical Disabilities

Freshfields Care Home with Nursing Physical Disabilities (Freshfields) provides accommodation and nursing and/or personal care to up to 35 people. At the time of our inspection there were 23 people living at the home.

The service is purpose built and all accommodation and facilities are ground floor level.

People's experience of using the service and what we found

The service had made significant improvements since our last inspection. Systems and processes had been overhauled to address the breaches of regulation and to help improve the safety and quality of care provided. Further time was required to evidence these improvements were embedded through sustained governance.

Medicines were managed safely. People received their medicines as prescribed by staff who were competent to administer them.

Risks to people's health, safety and well-being were assessed and care plans had been re-written to ensure staff had access to information about how to manage people's identified risks and support them in a safe way.

Since the last inspection, the reliance on agency staff had decreased, a more stable team structure was in place. People received care by staff they knew and who were familiar with their needs and preferences. There were enough staff on duty to meet people’s needs in a timely manner.

Staff were recruited in a safe way and underwent an induction to help prepare them for working at the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Consent for care and support was being obtained in line with the principles of the Mental Capacity Act (MCA) 2005.

People's needs were assessed and planned for in line with best practice. Staff had access to information about how to support people based on their current needs, helping to ensure people received care based on their individual needs and preferences.

Since the last inspection, improvements had been made to the environment to help better support people with dementia or cognitive impairments to navigate the home.

We received consistently positive feedback from people and their relatives about the care and support provided by staff.

Governance systems had been overhauled to ensure they were effective at identifying issues and driving necessary improvements to the quality and safety of the service.

Since the last inspection, the former registered manager had returned to the service and had been instrumental in taking the appropriate action to address the issues we found. They and the provider had worked closely with the Local Authority to make positive changes and enhance the daily living experience of people using the services of Freshfields.

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

Rating at last inspection

This service has been in Special Measures since 10 January 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. This also included to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met (in relation to using medicines safely.)

We also looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from inadequate to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Freshfields Care Home with Nursing Physical Disabilities on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Freshfields provides accommodation and nursing and/or personal care to up to 35 people. At the time of our inspection there were 27 people living in the home.

People's experience of using the service and what we found

Medicines were not managed safely. People did not always receive their prescribed medicines due to lack of stock and medicines were not always administered at the right times. Medicines were not always stored securely and staff did not always ensure medicines were stored within safe temperature ranges.

Risks to people's health, safety and wellbeing had not always been assessed and staff did not always have access to information about how to manage people's identified risks and support them safely. Staff did not always complete records required to monitor people's identified risks; this meant we could not always be certain staff were following guidance regarding people's care and support needs.

There were not always enough staff on duty to support people safely, in addition there was a high usage of agency staff; including nurses. This meant people were not always receiving care that was person-centred. Safe recruitment processes were followed, however we could be certain that agency staff were being provided with an induction or necessary information prior to working at the service.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Capacity assessments were not always completed or did not always provide a rationale for the outcome of the assessment; this meant we could not be certain consent for care was being obtained in line with the principles of the Mental Capacity Act (MCA) 2005. Authorisations to lawfully deprive people of their liberty had not always been applied for where required.

People's needs had not always been assessed or planned for in line with best practice and staff did not always have access to information about how to support people based on their most current needs.

People did not always receive care that was based on their individual needs or preferences. This was because of the staffing issues identified and the lack of accurate or detailed information available to staff to support people.

We have made a recommendation about the design of the environment. The service design and decoration did not always support people with dementia or cognitive impairments to find their way around or staff unfamiliar with the service, find people's rooms.

Family members spoke positively about the regular staff who worked at the service but told us the standard of care had reduced following the manager's resignation and the high usage of agency staff.

Governance systems in place had not always been effective at identifying issues and driving necessary improvements to the quality and safety of the service.

Following our visit to the service, the manager returned to their role. They, and the provider were responsive to our feedback and took immediate action to address some of the issues we found. The manager provided evidence of some improvements made to people's care plans and risk assessments. People and family members provided positive feedback about the manager.

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

Rating at last inspection

This service was registered with us under the new provider on 31 July 2019 and this is the first inspection.

Why we inspected

This comprehensive inspection was prompted in part due to concerns received about medicines management and staffing levels. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found evidence the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well-led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management, risk management, mental capacity act 2005, staffing, person-centred care and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.