CQC report explained · a nursing home
What the CQC found at Freshfields
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Medicines were given as prescribed and on time. Risks were assessed, staffing was sufficient, recruitment was safe, and infection prevention arrangements were suitable.
- Effective?
- Good
- Care plans reflected people's current needs, staff training had improved, and the home followed the Mental Capacity Act principles. People were supported with healthcare, food and drink.
- Caring?
- Good
- People were treated with dignity and respect and were encouraged to remain as independent as possible. Feedback from people and relatives was consistently positive.
- Responsive?
- Good
- Care was personalised and people were involved in their care plans and daily choices. Activities, community trips and communication support were available.
- Well-led?
- Requires improvement
- Leadership and governance systems had been overhauled and were identifying shortfalls better. However, more time was needed to show that the revised practices were sustained.
What inspectors found, July 2023
Rated Good and no longer in special measures; care improved greatly, but well-led remains Requires Improvement while changes are being embedded.
Inspectors visited on 20 and 21 June 2023. The first day was unannounced and the second was announced. They spoke with people, relatives and staff, observed care, and checked care plans, medicines, training and quality records.
The home had made major improvements since the previous inspection. Medicines were given safely, risks were assessed, care plans were rewritten, staffing was more stable, and people received care from staff who knew them. Inspectors also found kind and respectful care, personalised support, activities, and good communication.
All four care questions were rated Good. Well-led was rated Requires Improvement because the new systems had not been in place long enough to show that improvements would last. The overall rating changed from Inadequate to Good, and the home left special measures.
Safer medicines
Medicines were administered as prescribed and on time. Checks for storage temperatures and records for insulin, patches and creams had improved.
“At this inspection records evidenced that people received medicines as prescribed and on time, this was further evidenced by peoples' feedback.” from the report
Stable staffing
There were enough staff to meet people's needs promptly. The home had reduced its reliance on agency staff, so people were more likely to be supported by familiar staff.
“Since the last inspection, the reliance on agency staff had reduced. Some experienced staff had returned to the service.” from the report
Personalised care
Care plans had been rewritten around people's needs and preferences. People said they were involved in planning their care and could choose how their day was arranged.
“Peoples' care plans, which had been re-written since the last inspection, were person centred and written in a way which was sensitive and considerate to the specific needs and choices of the person.” from the report
Kind and respectful care
Inspectors saw respectful care, and people and relatives gave consistently positive feedback about staff's kindness, patience and understanding.
“People and their relatives provided consistently positive feedback about the care and support provided by staff” from the report
Activities and choice
People could take part in activities at the home or in the community. The home also offered one-to-one activities for people who preferred to stay in their rooms.
“People enjoyed both on site activities and trips into the community, to help people feel a sense of belonging and avoid any feelings of social isolation.” from the report
Improvements need to last
needs fixingThe home had introduced new audits, records and leadership arrangements, but inspectors said they needed more time to see that these changes were firmly established and sustained.
“We were assured the registered manager had improved standards of care, however, further time was required to evidence and embed revised practices.” from the report
- 01How are you checking that the new care records and risk assessments remain accurate and complete?
- 02What audits now check that medicines are given on time and stored safely?
- 03How do you monitor whether staffing levels remain sufficient and how often are agency staff used?
- 04What evidence can you show that the improvements in leadership and governance have continued since this inspection?
- 05How are residents and relatives involved in reviewing care plans and suggesting activities or changes?
This was a follow-up inspection checking action from the previous inspection, including the Regulation 12 Warning Notice and infection prevention and control; it covered all five key questions, but the report says the visit was to follow up on earlier concerns. This explanation was written from the published report of 12 July 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2023
Rated Inadequate and placed in special measures; inspectors found serious problems with medicines, staffing, risk management and person-centred care.
This was the home’s first inspection since the new provider registered it. The inspection was unannounced and took place on 14 November 2022. Inspectors spoke with people, relatives and staff, and reviewed care plans, medicines records, recruitment files and management records.
Inspectors found that medicines were not always given as prescribed or at the right time. Some medicines were not stored securely or at safe temperatures. Risk assessments and care records were incomplete, staffing levels were sometimes too low, and agency staff did not always receive a proper induction.
People were not always supported in line with the Mental Capacity Act. Their needs and preferences were not always reflected in their care. Inspectors also found kind interactions, clean surroundings, suitable food choices and some positive activities. The manager returned after the inspection and provided evidence of some immediate improvements, but the overall rating remained Inadequate.
Kind interactions
Inspectors saw staff speaking kindly and compassionately to people during support. Volunteers had also built positive relationships with people.
“We observed positive interactions between staff and people during our visit. Staff spoke to people in a kind and compassionate manner when providing support.” from the report
Clean surroundings
The home appeared clean and hygienic. Staff had protective equipment and followed the visiting procedures described in the report.
“The home appeared clean and hygienic; staff responsible for the cleanliness of the home completed records to evidence tasks completed.” from the report
Food choices
People could choose their food and drink and were supported to have a varied and healthy diet. Most people said they enjoyed the food.
“People could choose their food and drink and they were supported to eat a varied and healthy diet.” from the report
Some action after inspection
The manager and provider responded to inspectors’ feedback. They supplied evidence that some care plans and risk assessments had been improved after the visit.
“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.” from the report
Medicines were unsafe
seriousSome people did not receive medicines as prescribed or at the right times. One person missed seizure medicines for three consecutive days and experienced an avoidable seizure.
“People did not always receive their prescribed medicines due to lack of stock and medicines were not always administered at the right times.” from the report
Risks were not properly managed
seriousCare plans and monitoring records did not always explain or record how identified risks should be managed. This included risks linked to medical conditions, skin, diabetes, food, drink and repositioning.
“Failure to assess, monitor and manage identified risks, placed people at risk of avoidable harm.” from the report
Staffing and agency induction
seriousThere were occasions when staffing numbers were below the provider’s assessed safe level. The home relied heavily on agency staff, who did not always know people’s needs or receive an effective induction.
“We could not always be certain that enough staff were deployed to meet people's needs in a timely manner and keep them safe.” from the report
Consent and liberty safeguards
seriousCapacity assessments were missing or did not explain their conclusions. Some restrictions were used without the required DoLS authorisations.
“The lack of completed or accurate capacity assessments meant we could not be certain that consent for care had been obtained from the right people or that the service was acting in people's best interests.” from the report
Personalised care was missed
seriousSome people did not receive care that matched their needs or preferences. One person had not had a requested shower since 26 October 2022 because the required specialist chair had not been obtained.
“People did not always receive person-centred care based on their needs or preferences.” from the report
Weak oversight
seriousThe home’s checks did not identify all the problems found by inspectors. Communication with relatives had also deteriorated, and some relatives did not feel listened to.
“Governance systems had failed to drive necessary improvements to the safety and quality of care provided.” from the report
- 01How are you making sure every person receives their prescribed medicines at the correct time and that medicines are stored securely and at safe temperatures?
- 02What are the current staffing levels on each shift, and how do you make sure agency nurses and care staff know each person’s needs before they start work?
- 03Which care plans and risk assessments have been updated since the inspection, and how do you check that staff follow them?
- 04Have all required capacity assessments and DoLS applications now been completed and reviewed?
- 05What has changed since the inspection to make sure personal care, mobility support and individual activities reflect each person’s preferences?
This was an unannounced comprehensive inspection covering all five key questions, including infection prevention and control under Safe. This explanation was written from the published report of 11 January 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Freshfields
4 rated inspections over 7 years: the service has held its Good rating throughout.
- July 2023Goodcurrent ratingup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2023Inadequatedown from GoodSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2016GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- July 2019
Registered with the Care Quality Commission on 31 July 2019.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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38 live-in carers within about an hour of Sefton
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,270 a week. 34 can care for a couple. 11 years' experience on average.
“He developed a close affinity with Terence, spending time talking with him before he retired to bed and looking after his needs during the night.”
“It was clear that she genuinely cared and her warm approach really helped put our minds at ease.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.