Archived: Fremington Manor Nursing and Residential Home

The home is a large manor house with a purpose built extension. At the time of the inspection there were 36 people living at the service.

We found the following examples of good practice.

There was an outbuilding with a shower where staff changed and put on their personal protective equipment (PPE) before entering the main building.

Outside each person’s room there was a box with PPE, disinfectant and bags for disposal of used PPE. These boxes were checked throughout the day to ensure staff had ready access to the right equipment.

Additional space had been allocated to ensure staff were able to take breaks and keep within social distancing rules. Chairs were removed and tape placed on the carpet to show the distance between seats.

Additional cleaning regimes had been implemented. This included more regular cleaning of touch points such as door handles, keypads and handrails.

Staff had received training and support to work safely in a pandemic, such as Covid-19. Where staff needed to isolate due to a positive test or exposure to someone else with a positive test, they were continued to be paid.

There were clear risk assessments in place to ensure those staff who were more vulnerable from Covid- 19 had a protective plan in place. This included workers who had underlying health conditions, pregnant team members and those from an ethnic background.

The staff team said they had been very well supported by the management team and provider. Staff had received gift certificates for their continued hard work. Staff had access to one to one supervision or independent counselling if needed.

People were being supported to isolate in their rooms due to an outbreak. Staff were making additional comfort visits to ensure they were cared for.

The activities team continued to provide support to people and the provider had given additional funds to ensure peoples’ social needs could be met. For example, they had purchased an extra-large TV so people could take part in Zoom quizzes.

Fremington Manor Nursing and Residential Home accommodates a maximum of 60 people. People’s conditions varied, but the service placed a strong emphasis on end of life care and working collaboratively with local palliative care services.

The building comprises the original manor house with a purpose-built extension. There were 40 people resident at the time of the inspection.

The inspection took place on 9 and 10 January 2019 and was unannounced.

At our last inspection we rated the service good. At this inspection we found the standard of service had further improved and we have rated it as outstanding.

Why the service is rated outstanding.

People using the service were the priority at Fremington Manor Nursing and Residential Home. People received care, treatment and support tailored to their individual needs and of a very high standard.

A community hospice nurse said of the end of life care at the service, “(The service) puts patients first. There is nothing too much for patients. The registered and deputy managers have a deep commitment to palliative patients.”

There was exceptional commitment to meeting people’s diverse needs. This had included those associated with beliefs/faith, age and gender. The service continually researched information. This knowledge helped them provide empathy, in particular where people’s choices were in opposition to evidence based practice, such as pain and infection management.

The service was very caring because of the total commitment of staff to people’s welfare. People said staff were very kind. Staff expertly managed difficult, and sometimes embarrassing, situations putting the person at ease and upholding their dignity. Privacy and dignity were fully promoted.

The management understood the importance of valuing staff, all of whom spoke very positively about their work and praised the registered manager and provider organisation. There were robust systems for ensuring a safe and high standard of service. Any concern was promptly dealt with, openly and honestly and with a view to continual improvement. People’s, and staff views were always considered. Staff supervision ensured staff received the support they needed and any change at the service was managed expertly, listening to staff views throughout.

People received a high standard of care and treatment. One health care professional said, “The (staff) are second to none.” Staff praised their training, which fully equipped them for their work. External health care expertise was sought appropriately.

People had an in-depth assessment of their needs and wishes. Care plans enabled staff to understand important aspects of the person they were caring for. Risk was well managed in the least restrictive way possible.

People were fully protected through robust recruitment, staffing, infection control and management of the premises. Medicines were expertly managed for people although we have made one recommendation, based on one person’s records. All risk was effectively assessed and managed, in least restrictive ways.

Adaptation suitable for meeting people’s needs in a safe way was available where possible. All necessary equipment was in place to promote people’s independence and maintain safety. There were robust arrangements should an emergency occur, such as a fire.

People’s legal rights were understood and protected. Where people lacked capacity to make informed decisions these were made in their best interest.

People received a healthy and nutritious diet. There was a lot of choice of food and any negative feedback was followed up with the intention of meeting people’s preferences. Food and fluid intake concerns were properly managed.

The service fully met their legal obligations and kept themselves appraised of changes in legislation and good practice.

Fremington Manor Nursing and Residential Home is registered to provide accommodation with nursing or personal care for up to 60 people. The service is intended for older people and is divided into two units within the main building; a residential unit for people with a lower level of care need and a nursing unit for people with a higher level of care need. Each area has its own staff team. During our visit, there were 54 people living at Fremington Manor.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.

People lived in a home where they were relaxed and comfortable. The atmosphere was homely and friendly and people told us they liked living there. Their comments included, “The whole place is good … kitchen, laundry, gardener… I am in danger of leaving someone out … I just want to say it is very good” and “I think this service is outstanding. I can’t fault it. The staff are all very caring. I consider it a real privilege to be here.” Two relatives said, “It is the best … the attitude of all the people here … people are looked after well and I don’t want to leave anyone out” and “It’s the ambience here and the attitude of staff … staff are friendly and encourage conversation … people are spoken to like a member of the family … they don’t lose their identity.”

Staff knew people well and cared for them as individuals. People received care suitable for their needs and with generally enough staff on duty. An agency was used to cover any gaps in the staff rota. Staff were safely recruited, trained and enjoyed their work. Two people said, “It’s top notch here …. staff are all lovely” and “I am very happy here … they look after me well.” Staff felt supported by management and felt part of a team. They had a good understanding of safeguarding and knew how to recognise the different types of abuse. They knew the correct action to take and who to report any concerns to.

Each person had a care plan with suitable risk assessments in place. Care plans included key information and were up to date. Health and social care professionals were involved in people’s care and their advice acted upon. Good working relationships had been developed with the local GP surgery. Mental capacity assessments had been carried out and applications made to the local authority if people were deprived of their liberty.

People received their medicines in a safe way. Improvements and new systems were put in place to make sure people received their medicines safely.

People were very positive about the food and enjoyed varied, nutritious and appealing meals. Relatives comments included, “The food is so good”, “The food is amazing” and “Have you seen the food … it’s wonderful.”

.

Staff recognised the importance of family and friends who were welcomed at all times. A friend said, “We ordered ‘tea for three on the lawn’ recently and it was absolutely brilliant.” A relative said, “I have nothing but praise. They really look after people well. We are always made welcome. Very good service.”

People lived in a home which was maintained and decorated to a high standard. There were large grounds for people to sit and relax in.

There was a complaints policy and procedure in place with information about how to raise concerns or complaints. All complaints were dealt with appropriately and people informed of the findings. The service had received a high number of thank you and compliment letters which gave very positive and kind comments about the staff and service.

There were systems in place to monitor the quality of the service and any issues identified were acted upon and resolved.

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the days of our inspection there were 51 people living at Fremington Manor. The inspection was completed by two inspectors. We brought forward this planned inspection as we had received some information of concern from a relative of a person living at the service. We had also received a notification from the service about one person who had developed some pressure damage to their skin since being at the service.

The summary is based on conversations with 14 people living at the service, eight relatives and 18 staff. We looked at records of people's care and quality monitoring systems used with the home. We also spent time observing how care and support was being delivered to people.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe because there were sufficient staff with the right skills to meet people's assessed needs. We observed care being provided in a way which showed staff understood the needs and risks of people they were caring for. Where risks for people's health had increased, professional support had been requested. The person who had developed pressure damage had been referred to tissue viability specialist nurse team and their wounds were healing. We saw documentation to show, staff were now instructed to check and record their action in relation to pressure care at least two hourly.

We found the service kept people safe by providing a clean and well maintained environment. Staff used person protection equipment (PPE) such as gloves and aprons and we observed hand washing at appropriate times to help reduce the risk of infection and keep people safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw the service had used these safeguards appropriately to protect and uphold people's rights.

Is the service caring?

People we spoke with gave very positive views about the care and support they received from staff. Comments included ''Staff are very attentive, I couldn't wish for better'' and ''Staff are wonderful. I couldn't praise them enough, they are all 100% fantastic, caring, patient, cheerful. They make sure they spend time with you, which is really important.'' All our observations showed staff providing care and support in a kind and respectful way.

Is the service effective?

We found the service was effective because care and support was being well planned and delivered by a staff group who understood people's needs and wishes. Where people's needs highlighted the need for specialist equipment such as pressure relieving cushions or mattresses, these were provided and their effectiveness was monitored.

Is the service responsive?

We found the service was responsive to people's needs and wishes. For example, where people's healthcare needs had changed, their GP and other healthcare professionals were contacted quickly for advice and support to enable the service to provide the right care, support and treatment.

We heard how the service looked at meeting people's social and emotional needs, through regular activities and trips out, as well as their activities person spending one to one time with people who preferred to spend time in their own rooms or were unable to get out of their bed due to poor health.

Is the service well-led?

We found the service was well led by a manager who knows the people who live at the home and her staff group. People we spoke with knew who the manager/matron was and said they were confident in her ability to manage the service and to deals with any concerns or worries they may have.

The views of people who live at the home, their families and staff were taken into account when reviewing the quality of the care and support provided. People were asked to complete questionnaires, attend meetings and were asked for feedback via one to one meetings. We also saw the company were completing their own quality audit to include all aspects of the service.

People we spoke with told us that they were happy with the care and support provided. Comments included ''staff are very good, the home is nice and clean and I feel safe and well cared for.'' ''The staff are all very good. I really couldn't ask for better.''

We saw that there was a robust medication system in place, using electronic bar coded information. There were sufficient skilled and experienced staff and we observed care and support being delivered in a kind and respectful way.

Care was well planned and included a variety of social events and activities that encouraged people to remain engaged and involved in their surroundings.

Systems were in place to review and monitor the quality of care and services provided. This included seeking the views of people living at the home as well as staff.