This inspection took place on 11 and 12 October 2016 and was unannounced.

Freshfields is a care home providing support for up to 35 adults with physical disabilities. The building has single rooms as well as single self-contained rooms with bathroom and kitchen areas. It also has 2 bungalows within the grounds, close to the main building. Communal space in the building includes a dining area, lounges, activities areas and outside garden space. Freshfields is located in Formby, within walking distance of local shops, pubs and the beach and is close to a local railway station.

During the inspection, there were 33 people living in the home.

A registered manager was in post. 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. We asked people their views of how the home was managed and feedback was positive. Staff told us the registered manager was, “Approachable” and that they could raise any issues with them and were confident they would be listened to.

People we spoke with told us they felt safe living in Freshfields. All staff we spoke with were able to explain types of abuse and how they would report any concerns and we found that appropriate safeguarding referrals had been made.

We looked at the systems in place for managing medicines in the home and found that these were managed safely. Staff had completed training in relation to safe medicine administration and had their competency assessed.

The care files we looked at showed staff had completed risk assessments to assess and monitor people’s health and safety and that measures had been put in place to minimise risks. The safety of the environment was also assessed and regular maintenance checks were completed to ensure the building and equipment remained safe.

Although the home was safely maintained, we found that older parts of the building were in need of some refurbishment and the registered manager told us this was planned and due to commence in January 2017.

We looked at how staff were recruited within the home and found that most safe recruitment practices were followed. People living in the home were involved in the recruitment of staff. We looked at how the home was staffed and found that there was adequate numbers of staff on duty to meet people’s needs.

Supervisions and annual appraisals had not been completed in line with the Leonard Cheshire policy, which states that staff should receive a minimum of four one to one supervision sessions per year and an annual performance review. Staff were supported in their role through an induction and on-going training to help ensure they had the knowledge and skills necessary to support people effectively.

The service was working within the principles of the Mental Capacity Act 2005 (MCA). DoLS applications were made appropriately and people’s consent to care and treatment was sought.

When asked about the food available, people told us they always had a choice of meal and feedback regarding meals was positive. There was also a coffee bar available where people and their relatives could make their own drinks whenever they wanted one.

People living at the home told us staff were kind and caring and treated them with respect. We observed people’s dignity and privacy being respected by staff in a number of ways during the inspection and interactions between staff and people living in the home were warm and relaxed.

Care plans were written in such a way as to promote people’s dignity. Staff were guided to listen to people, seek consent and promote independence where possible. Care files included information on what was important to the person, what they wanted to achieve and what the staff needed to know in order to support them e

We last inspected Freshfields Care Home in August 2014. At that time, we found people were not protected from the risks of unsafe or inappropriate care and treatment because records were unclear and not maintained. Additionally, there was a lack of formal and consistent processes in place to support staff in their role and help them to deliver effective care. During this inspection, we checked to see whether improvements had been made. We found the provider to be compliant. Records were being maintained and staff were being supported appropriately in their roles and responsibilities.

Our inspection was carried out unannounced. As part of the outcomes we looked at we followed up on one area that the home needed to make improvements in following our last inspection in December 2013. The inspection helped answer our five questions:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

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

Is the service safe?

People told us they were treated with respect and dignity by the staff. They told us care was good and if they had any medical issues that needed monitoring, or to be followed up, this was arranged. People told us they felt safe and well cared for.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

We discussed the issues around the people’s consent to the care they received. The home had some supporting policies and information around mental capacity and consent to support people who may not be able to make decisions about their care or treatment. The registered manager showed an understanding of the Mental Capacity Act 2005 [MCA] which is the legislative framework for the decision making process regarding people who may lack mental capacity.

Some care records we saw were unclear, difficult to easily find information and had not been updated as changes to people’s care occurred. We have asked the provider to take action to meet requirements.

Is the service effective?

People’s health and care needs were assessed. Specialist dietary, mobility and equipment needs had been identified in care plans and assessments.

People told us that staff asked them about their care and they felt involved. This was reflected in the care documentation which showed that people had been involved in the assessments and care planning process. Assessments and care plans indicated people had been involved in decision making.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, “The staff are very kind and helpful’’, ‘’There’s always something going on here. There’s plenty of company – nothing could be improved’’, “Staff are great. They treat people like human beings’’, ‘’Disabled access is very good – I can get anywhere I want to go’’, ”We do different sorts of activities. It’s very good. We get to choose whether we join in.’’

People said staff did everything needed to support them with their day to day living.

We observed staff continually working to support people with all aspects of care. We observed staff communicating and interacting well whilst supporting people.

People’s preferences and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

We saw that people were supported to complete a range of daily activities and this included support with social activities. Social activities were organised on a daily basis on the day unit which formed part of the home. People living at Freshfields were free to join in if they wished.

Following our last inspection in December 2013 we had made a compliance action [requirement] that the service needed to respond to and address. This concerned the complaints process being used in the home and how the service responded to complaints. We found that the service had responded and made the improvements needed.

Is the service well-led?

The service had a quality assurance system. This included both internal and external audits by senior managers. The system of audits had identified areas that needed improving and there were plans to address these. The information helped support management decisions and objectives for the service.

When we spoke with staff they told us that generally staff morale was low at the present time and there were a number of issues that they felt needed addressing. Care staff told us there was a lack of consistency from senior managers in the home as well as nursing staff who led various shifts. Care staff felt there was a negative culture where there was a lot of criticism if something went wrong but a general lack of positive support. We found there was a lack of consistent and formal processes in place to support staff in their role and help them to deliver effective care. We have asked the provider to take action to meet requirements.

We found that people who used the service were treated well and with dignity and respect. Care plans and people we spoke with confirmed they had been involved in discussions and reviews regarding their care and treatment plans. They were involved in and able to have their say in how services were provided through residents meetings.

People who used the service told us they were satisfied with the care and support given to them. They said:

“I love it here, I am spoilt rotten”,

“I really like it here; the nurses are kind and look after me well”.

“I am treated well and with respect, I am allowed a certain amount of freedom and independence to do what I want within safe limits”.

Care and support plans identified people’s needs and how their needs were to be met. Risk assessments and care plans were seen to be individualised and covered all aspects of a person’s needs. Risk assessments and care plans had been completed in full and reviewed.

People were protected from the risks of abuse as staff were trained and knowledgeable in safeguarding vulnerable adults. Staff were suitably trained and supported to provide care to people who used the service.

We found concerns with the management of complaints. We found that systems for dealing with complaints were not used appropriately and were not effective.

We spent time with several people who lived in the home. We looked at what choices people could make and observed if they were treated with respect. We looked at their involvement in how the service was organised and how much they were included in planning and reviewing the care they received.

We were shown how people who lived at Freshfields made choices about their meals and activities. A choice of food was available for breakfast and lunch and whilst one evening meal was prepared alternatives could be arranged. One person told us, "Its not a problem if I want a different meal or just fancy a snack."

People who lived at the home said staff supported them well. We saw there was good communication when staff carried out care. They said the staff knew how to support them appropriately and safely. This showed the home was responsive to people's care needs. One person told us, "The staff know exactly how to help me."

We received positive comments about the staff from people who lived at the home as well as a relative we spoke with.This helped evidence the staffs competency and approach to care.