This unannounced inspection took place on 20 June 2017. Freshfields provides accommodation and personal care to a maximum of 36 people, some of whom may be living with dementia. On the day of our visit there were 35 people using the service.

At our previous focused inspection on 22 July 2015, the service was meeting the legal requirements.

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.

The service was well led with evidence of effective quality assurance systems in place to ensure the quality of care delivered was monitored and continuously improved.

There were safeguarding systems in place which were known and understood by staff. Staff demonstrated an understanding of the incident and accident reporting procedure and were able to explain any learning that had taken place following some falls resulting in injuries.

People and their relatives told us they felt Freshfields was a safe place to live. They thought there were enough staff to meet people’s needs.

People told us their privacy and dignity was respected. They were involved in how the service was run and told us they were asked their views on issues such as meals and how they spent their time. They told us they were able to make a complaint if they were unhappy with any aspect of their care.

Care plans were person centred and were completed after consulting with people and their relatives. They included peoples religious, emotional and physical support needs and preferences.

People were enabled to maintain a balanced diet that met their individual needs. Food and fluid charts and regular weight checks were in place for people at risk of malnutrition.

Staff were supported by an approachable management team that ensured monthly staff meetings took place and supervision. There was a comprehensive induction and training program which ensured staff were up to date with practice and able to deliver evidence based care.

Recruitment systems were robust and included appropriate checks to ensure that only suitable staff were employed.

The service worked according to Mental Capacity Act to ensure that where people lacked capacity decisions were made in their best interests following appropriate guidance and involvement of relevant professionals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People’s needs were assessed and care was planned and delivered in line with their individual care plan. People we spoke with told us they were satisfied with the care and support they received. Comments included “the attention and help is extremely good” and “the staff have great friendliness and care.” We found that care plans and risk assessments were in place which set out how to meet people's needs in a safe way. People had access to health care professionals including GP’s and opticians.

We found that medications were stored securely and administered safely. The home’s physical environment was well maintained and various safety checks were carried out, such as checking fire alarms. Checks were carried out on staff before they began working at the service, including obtaining two employment references. The service had a complaints system in place and people we spoke with knew who they could complain to if they wished. One said “I would tell one of the workers if anything was wrong.”

We spoke to four people using the service who were all very pleased with the service they received and said the staff were all attentive and caring. Many people said that they had seen their health improve greatly after being at the home for a few weeks. One person said "I would recommend this place-everything is good."

We saw that staff treated people using the service with respect and care. Personnel and training records we reviewed showed that staff were suitably skilled and qualified.

The standard of food was good and people were encouraged to eat full meals, without being unnecessarily pressured.

The provider had an effective system in place to measure the quality of the service.

The people we spoke with were very happy with the care that they received. People said, “I am very happy with the care and nothing is too much trouble. Staff do whatever you want. They will bring you tea at any time of the day or night. They are kind and patient. The staff seem to get on well with each other and they have a laugh and a joke. No complaints, could not fault the place”. “It’s very good to have someone here when you need them. Everything is good, the staff are good. They look after you well”. “The girls are wonderful. I looked at lots of homes and thought Freshfields was the best. Everyone said the same. I would recommend it. They do all they can for you”.

Relatives we spoke with were also happy with the quality of the service. One said, “Staff have been very helpful. They spend time with my father, talk to him and take him out for coffee. He is happy with the food and said it’s a nice balanced diet. I have seen that there are enough staff to spend time chatting to people and there’s always a lot going on”. Another said, “This is an excellent home and my mum is well looked after. She was very ill earlier this year and they gave her good care and dedication and got her through it. I can only speak well of the service, staff are caring and it’s run very well”.

A healthcare professional told us, “The service is excellent and staff are willing to learn. They treat residents well and with respect. There is a good rapport and they do things above and beyond, particularly when supporting people at the end of their life”.

We visited this service on 10 and 11 November 2015 and found the provider was in breach of the regulation that related to medicines. People were not protected against the risks associated with the unsafe use and management of medicines. Systems were not in place to ensure that people safely received all of their medicines when they needed them. The provider sent us an action plan stating the steps they would take to address the issues identified.

We undertook this focused inspection on the 22 July 2015 to check that the provider had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Freshfields Residential Home on our website at www.cqc.org.uk.

Freshfields is a 36 bed care home providing accommodation and personal care for older people, including some living with dementia. Most of the 36 single bedrooms have ensuite facilities. There was a lift to each floor and accessible bathrooms to assist those with mobility difficulties.

At the time of the inspection 36 people were using the service.

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 and associated Regulations about how the service is run.

At this inspection we found that the provider had followed their plan and the legal requirement relating to medicines had been met. Systems were in place to ensure that people received their prescribed medicines safely and appropriately. Information was in place to ensure that staff knew how and when to administer medicines that were prescribed on an ‘as required’ basis or that should only be given under specific circumstances. Controlled drugs were securely stored and accurately recorded.