Freshford Cottage Nursing Home

Freshford Cottage Nursing Home is a residential care home providing personal and nursing care to up to 20 people. The service provides support to older people who were living with a range of health care needs. Some people had memory loss associated with their age and physical health conditions. The service also provided care and support for people who were at the end of their lives. At the time of our inspection there were 17 people using the service.

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

People were not 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 support this practice.

The quality of the service was regularly monitored through audits, however we identified areas where further improvements were needed in relation to mental capacity and people’s records.

Staff understood how to support people safely, risk assessments provided further guidance about individual risks.

People were supported to have enough to eat and drink throughout the day. We identified that improvements were needed to the delivery of the lunchtime meals. The registered manager told us this would be addressed.

Staff received regular training and supervision and individual support was provided to ensure staff had the knowledge and skills to support people. People were supported to maintain and improve their health with support from health care professionals.

The home was clean and tidy throughout. Systems were in place to help ensure people were protected from the risk of infection. Staff understood safeguarding risks and procedures and knew what to do if concerns were raised. People were supported to receive their medicines when they needed them. There were enough staff, who had been safely recruited, working in the service.

People were happy living at the home. They told us staff were kind, they were given choices and able to do what they liked throughout the day. There was a positive culture at the service. People, relatives and staff were asked for their feedback through meetings, discussions and feedback surveys.

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

Rating at last inspection

The last rating for this service was good (published 16 March 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

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

We have found evidence that the provider needs to make improvements. Please see the effective 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.

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

Enforcement

We have identified breaches in relation to need for consent and good governance at this inspection.

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

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.

Freshford Cottage Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide nursing, personal care and accommodation for up to 20 older people, over 65 years of age, who have chronic physical health care needs, such as diabetes, and who also may be living with dementia. At the time of the inspection there were 17 people living at the home. The premises is a converted older building, with an extension to one side, on two floors. Lifts enable people to access their rooms and there are communal rooms on the ground floor, with access to the garden for people using walking aids and wheelchairs. Freshford Cottage Nursing Home is one of three care homes within the registered organisation.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

At the last inspection on 24 October 2016 the service was rated as Requires Improvement overall. We found that improvements were needed under key questions of safe and well led. We asked the provider to take action to make improvements to guidance for ‘as required’ medicines, the medicine administration records, daily records and quality monitoring of the care and services provided. This action has been completed and the rating for each key question and the overall rating for Freshford Cottage Nursing Home is ‘Good’.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. At this inspection we have made a recommendation that the provider seeks advice and guidance from a reputable source, about Accessible Information Standards (AIS) to ensure staff are aware of their responsibilities.

Staff managed medicines safely. Staff responsible for giving out medicines had attended training and their competency was assessed to ensure they understood ‘as required’ medicines and completed the medicine administration records. The provider had identified where improvements were needed in record keeping through the quality assurance system. Staff had been allocated to review care plans to ensure they were up to date. People, and their relatives if appropriate, had discussed their needs with staff; they were involved in writing their care plan and had signed them to show their agreement

The care plans were person-centred. They included people’s individual support and care needs and assessment of risk; with clear guidance for staff to follow to ensure safe and appropriate care was provided. For example, if people were at risk of falls or unable to move around the home independently, the most appropriate aid, such as a hoist or wheelchair, was recorded. Staff asked people how and where they wanted to spend their time and used the aids to assist people to and from the lounge or to sit comfortably in their own room. People took part in one to one and/or group activities of their choice. These included bingo, manicures, quizzes, trips into town shopping and the seafront and, there were with regular visits from external entertainers.

Staff were knowledgeable about people’s individual needs. Staff had attended essential training as well as additional training; such as dementia awareness. The registered nurses attended training to update and ensure their nursing competency. Observational supervision was provided on a day to day basis and formal supervision at regular intervals. This meant staff were aware of their roles and responsibilities and provided the care and support people needed and wanted. People were supported to eat a nutritious diet and drink sufficient fluids; meals were freshly cooked and snacks and drinks were available at any time. Staff monitored people’s health and people could access healthcare professionals and services, to maintain their health and well-being.

People were relaxed and happy with the care and support they received. Relatives were complementary about the care provided for people and the support they received from staff. People were treated with respect; their independence was promoted and people were supported to make decisions in their best interests. Staff had received training in Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice. Accidents and incidents were recorded and audited to identify any trends and action was taken to minimise the risk of these re-occurring.

People said they felt safe and a relative told us their family member was, “Safe and secure, no worries.” Staff had attended safeguarding training; they knew how to protect people from harm and they told us what action they would take if they had any concerns. Effective recruitment procedures were in place and there were sufficient staff working in the home to support people. Checks were completed to ensure new staff were safe to work in the care sector and references were obtained before they started work. The home was clean; the environment and equipment was well maintained and emergency procedures were in place to support people if they had to leave the building.

Feedback was continually sought from people, relatives and staff. People were encouraged to share their views daily as they talked to staff and at regular residents meetings. In addition, yearly feedback questionnaires were given to people, their relatives, staff and visiting health professionals. Staff attended staff meetings and were encouraged to put forward suggestions and complete the yearly staff surveys. Staff said they were happy working at Freshford Cottage Nursing Home and felt involved in decisions to improve the service.

The home provides support and care for up to 18 people with nursing and personal care needs. There were 17 people living at the home at the time of the inspection. Some people had complex needs and required continual nursing care and support, including end of life care. Others needed support with personal care and assistance moving around the home due to physical frailty or medical conditions such as diabetes, and some people were living with dementia.

The registered manager was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.’ A manager had been appointed prior to the inspection. They told us they

would be applying to register as the manager of the home with CQC.

The inspection took place on 24 October 2016 and was unannounced.

At the comprehensive inspection on 28 September and 2 October 2015 the overall rating for this service was requires improvement. The inspection found improvements were required in relation to providing safe care and treatment for people at risk, record keeping and assessing and monitoring the service provided and, there was no registered manager in place.

The provider sent us an action plan and told us they would address the issues by 14 January 2016.

During our inspection on 24 October we looked to see if improvements had been made and a manager had been appointed. We found improvements had been made, the provider was now meeting the regulations, and a registered manager was in place although further work was needed to ensure systems were embedded into practice.

A quality monitoring and assessing system had been developed and had identified some areas where improvements were needed. However, further work was required to ensure the system picked up the areas we found in the inspection; including the gaps in medicine records, limited information in the daily records and signage in people’s rooms. The provider had a monitoring system in place that had identified areas where improvements were needed and, offered on going support to develop a robust system.

Risk assessments had been completed as part of the care planning process and staff demonstrated how they guided them to support people safely to move around the home and reduce the risk of pressure damage and falls. Staff had attended safeguarding training and demonstrated an understanding of what action to take if they had any concerns.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People said the food was good, they were offered choices and staff were observant and took action if people lost weight. Activities were provided each weekday afternoon and people enjoyed participating in these.

Relatives and visitors were welcome at any time and felt involved in decisions about the support and care provided.

A complaints procedure was in place. This was displayed on the notice board near the entrance to the building, and given to people, and relatives, when they moved into the home. People said they did not have anything to complain about, and relatives said they were aware of the procedures and who to complain to, but had not needed to use them.

We also took information from other sources to help us understand the views of people who used the service, which included resident meeting minutes.

The people we spoke with told us they were happy with the care they received and with the staff team. One person who used the service told us, 'The care here is very good. I can't fault it. They look after me well.' Another person commented, 'The staff are good. If you want anything they will get it for you. It's first class.'

The people who used the service were in safe and secure premises that promoted their wellbeing.

We saw that the equipment used to meet the needs of the people who used the service was suitable for its purpose, well maintained and used correctly and safely.

We saw evidence that the provider had an effective recruitment and selection procedure in place to ensure that staff were qualified to do their jobs.

The provider had also ensured that sufficient numbers of staff with the right skills and abilities were employed to meet the needs of the people who used the service.

We also saw that care plans, staff records and other records relevant to the management of the home were accurate, fit for purpose and held securely.