Archived: Fallowfields Residential Home

People were happy living at Fallowfields. They told us their needs were met in a personalised way by staff who were competent, kind and caring.

Individual and environmental risks were managed appropriately, which meant people were kept safe from avoidable harm. Medicines were managed safely and people received all their medicines as prescribed.

People’s rights and freedoms were upheld. People were empowered to make all their own choices and decisions. They were involved in the development of their personalised care plans that were reviewed regularly.

A robust quality assurance system helped the management continually seek and implement improvements that would benefit people. Staff felt listened to and worked well together.

The service met the characteristics of Good in all areas. More information is in the full report.

Rating at last inspection:

The service was rated as requires improvement at the last full comprehensive inspection, the report for which was published on 18 July 2017.

About the service:

Fallowfields is a residential care home that was providing personal care to five people aged 65 and over at the time of the inspection.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

A registered manager was not in place at the time of the inspection, although the manager had applied to be registered with CQC and their application was being processed. 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.

This comprehensive inspection was carried out to check on the service’s progress in meeting the requirements made as a result of the previous inspection in August 2017. During that inspection we identified that risks to people were not always managed appropriately, a hoist was not fit for purpose and quality assurance processes were not operated effectively.

Following the inspection in August 2016, the providers sent us an action plan detailing how they would become compliant with the regulations. At this inspection, we found action had been taken, but further improvement was still required.

There were appropriate procedures in place to manage medicines safely. However, staff did not always follow these correctly and did not take action when storage temperatures were too low for some medicines.

There were enough staff deployed to meet people’s needs, although the deputy manager was covering night shifts, due to staff shortages, and staff were task-orientated during the mornings. However, the manager was in the process of recruiting more staff.

Most people received effective care that met their needs. However, records did not confirm that two people received the specific support they needed. Further improvements had been made to the environment, although noise levels were intrusive and the use of the dining room for staff training was not appropriate.

People were complimentary about the food and their dietary needs were met. People were encouraged to drink well; however, the recording of people’s fluid intake was not always accurate and action was not always taken when records indicated they had not drunk enough.

People said they were treated with kindness and compassion. We observed many positive interactions between people, although some staff, at times, did not show consideration for people in the lounge.

Providers are required to conspicuously display their CQC performance ratings on their website and within the home. The rating from the previous CQC inspection was clearly displayed at the entrance to the home, but was not displayed on the providers’ website. When we pointed this out, the provider took the website offline until the matter could be rectified.

Quality assurance processes had improved and had led to some improvements. However, they were not always effective and needed further time to become fully embedded in practice; for example, they had not identified that the medicines procedures were not being followed correctly by staff.

Staff acted in an open and transparent way when people came to harm. However, the manager did not always provide written information to the relevant person following an accident.

Individual and environmental risks to people were managed appropriately. People were supported to take risks that helped them retain their independence and avoid unnecessary restrictions.

People felt safe at Fallowfields and staff knew how to identify, prevent and report abuse. Safe recruitment processes were followed to help ensure only suitable staff were employed. Staff were suitably trained and appropriately supported in their role.

People were supported to maintain friendships and important relationships. Their privacy and dignity were protected. People were encouraged to remain as independent as possible and were involved in decisions about the care and support they needed.

People received care in a personalised way according to their individual needs. Care plans were informative and staff encouraged people to make as many choices as possible about how and where they spent their day.

Activity provision had improved and people had access to a wide range of individual and group-based activities; these had been tailored to people’s interests and were meaningful to them.

The providers sought and acted on feedback from people and their families. There was an appropriate complaints procedure in place and people knew how to raise concerns.

People and their relatives had confidence in the management of the home. The providers, the manager and staff were responsive to feedback and demonstrated a shared commitment to working hard improving the service. They were receiving support from external social care professionals to develop. Staff enjoyed working at the home and spoke positively about the management.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

A registered manager was not in place at the time of the inspection, although the manager had applied to be registered with CQC and their application was being processed. 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.

At our last inspection, in June 2015, we identified the providers were not meeting all fundamental standards of quality and safety. We issued warning notices requiring the providers to become complaint with regulations relating to the safe care and treatment of people; staffing arrangements; and quality assurance systems. We also issued requirement notices relating to person-centred care; the need for consent; and the suitability of the premises.

At this inspection we found some improvements had been made, but the providers were still not meeting all fundamental standards and people’s safety was compromised in some areas.

Although people told us they felt safe at Fallowfields, we found staff had not received up to date training in how to protect people from abuse and they did not always report incidents of abuse to the local safeguarding authority.

Individual risks to people were not always managed appropriately. Additional measures needed to keep people safe were not always documented and staff did not know how to adjust special mattresses to meet people’s individual needs.

Staff had not received essential training to equip them for their roles and demonstrated a lack of knowledge in the way they supported people. Some staff were using equipment, such as stand-aids they had not been trained to use. Staff had not been trained to calculate the body mass of people who could not stand on scales, so could not identify whether people had lost weight. New staff did not follow a structured induction training programme.

Suitable arrangements were in place for managing medicines. However, staff had not received refresher training, they did not always record when they applied topical creams to people and action was not taken when storage temperatures dropped below safe levels.

Safe recruitment procedures were not always followed, as essential pre-employment checks were not always completed to make sure staff were suitable to work with people at Fallowfields.

Environmental risks were managed effectively and arrangements were in place to deal with emergencies, although not all staff understood the systems for opening fire doors. Some improvements had been made to the environment, although further work was needed to support people living with dementia.

Staff did not always follow legislation designed to protect people’s rights. They were not aware of conditions that should have been applied to one person, to safeguard their freedom.

People were satisfied with the food. They were encouraged to drink often and supported them to eat and drink when necessary. However, records of what people had consumed were not always accurate.

People told us they were cared for with kindness and compassion and we observed positive interactions between people and staff. However, staff were not always discreet and sometimes lacked insight into people’s communication needs.

New arrangements were being introduced which would give people more choice about when they had baths and showers. Activity provision had improved, although it was not always meaningful.

People received care and support in a personalised way and staff responded promptly to their changing needs. However, care plans were not always up to date and did not always reflect the care and support that people had received.

Quality assurance arrangements were still not adequate. They had not identified any of the above concerns and this had led to continuing breaches of regulations. The providers did not tell us about three significant incidents as required. Management arrangements were not robust as the training and knowledge of the providers and the manager were not up to date.

In other ways, the home had an open culture. People and staff said the manager and the providers were approachable; they notified relatives when significant incidents occurred; the previous inspection report was available and had been discussed with people; and visitors were always welcomed.

There were enough staff to meet people’s needs. They understood their roles and worked well as a team. People’s privacy was protected; confidential information was held securely and people could choose whether they received personal care from a male or a female care worker.

All areas of the home were clean and staff followed appropriate infection control procedures. People were supported to access healthcare services and they were seen regularly by doctors and other healthcare specialists.

People were involved in planning their care and relatives were kept up to date with any changes in people’s health. The providers sought and acted on feedback from people and there was an appropriate complaints procedure in place.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We identified breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

A registered manager was not in place at the time of the inspection, although the manager had applied to be registered with CQC and their application was being processed. 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.

This comprehensive inspection was carried out to check on the service’s progress in meeting the requirements made as a result of the previous inspection in March 2016. Following that inspection, the service was rated inadequate and placed in Special Measures. This meant we started to use our enforcement powers to monitor and check the service. We had identified that staff did not always respond appropriately to allegations of abuse; risks to people were not managed effectively; safe recruitment practices were not followed; staff were not suitably trained and did not follow legislation designed to protect people’s rights; staff did not always communicate effectively with people; action to address previous failures had not been completed; quality assurance systems were not effective; and the providers did not always notify CQC of significant events.

Following the inspection in March 2016, the providers sent us an action plan detailing how they would become compliant with the regulations. At this inspection, we found action had been taken, but further improvement was required.

The providers, the manager and staff demonstrated a shared commitment to making the necessary improvements. A new quality assurance system had been introduced, but this had not yet become embedded in practice and had not picked up the concerns we identified.

For example, whilst most individual risks to people were managed effectively, we found measures were not always taken to protect people from the risk of pressure injuries and a hoist used to support people to transfer between chairs was not fit for purpose. Also, some risk management processes were over-protective and did not support people’s freedom or empower them to retain their independence.

Staff were not always aware of people’s dietary needs and one person was not receiving a suitable diet. The amount people drank was not always recorded accurately and action was not always taken when people did not drink enough.

Staffing arrangements were not robust, especially during the mornings when people were being supported to get up and have breakfast. People’s medicines were managed safely, although the recording of topical creams was not always accurate.

Entries in people’s care plans showed they were not always treated in a considerate way and staffing shortages meant staff were sometimes task-orientated. However, at other times staff interacted positively with people and people said staff treated them in a caring way.

People were satisfied with the meals they received and were given help to eat when needed. However, menu choices were not offered in a way that was supportive of people living with dementia.

Improvements had been made to the environment, although further work was planned. The conservatory still became too hot in the summer; corridor lights were repeatedly turned off, meaning people would not be able to see where they were walking; handrails were not easily seen and people’s access to the stairs was not controlled for their safety.

Staff had received additional training in legislation designed to protect people’s rights. Decisions were made in the best interests of people and verbal consent was sought before staff provided care and support. However, legislation designed to protect people’s freedom was not followed consistently.

The providers had become more involved in supporting some people to take part in activities outside the home and staff told us they ran activities in the evenings. However, activities for some people were not always meaningful and the frequency was variable. The provider’s action plan said this would be addressed by the end of October 2016.

All but one staff member understood the action to take in the event of a fire. Fire safety systems were tested and maintained regularly. People felt safe at Fallowfields and staff knew how to identify, prevent and report abuse.

Clear recruitment processes were in place to help ensure only suitable staff were employed. Staff were suitably trained and were positive about the support they received from management.

Staff supported people to build and maintain relationships. They protected people’s privacy and made sure confidential information was kept securely.

People were involved in planning and reviewing the care and support they received. Care plans were comprehensive and helped ensure people’s individual needs were meet in a personalised way.

The provider sought and acted on feedback from people, relatives and professionals. People were happy living at Fallowfields and thought it was well-run. The manager was being supported to develop their skills and was responsive to feedback during the inspection.

There was an open and transparent culture where visitors were welcomed. CQC were notified of significant events and the ratings from our previous inspection were prominently displayed. People were supported to access healthcare services when needed and staff had a good working relationship with healthcare professionals.

We identified breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

We undertook this focused inspection on 9 May 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report covers our findings in relation to those requirements and two related key questions; Is the service safe? And Is the service well-led? You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Fallowfields Residential Home on our website at www.cqc.org.uk

Fallowfields Residential Home is a care home that provides accommodation for up to 22 people including people with dementia care needs. There were 15 people living at the home when we visited. The home is based on two floors, connected by a passenger lift, in addition to a basement where the kitchen and laundry are located. There was a choice of communal rooms where people were able to socialise and some bedrooms had en-suite facilities.

A registered manager was not in place at the time of the inspection, although the manager had applied to be registered with CQC and their application was being processed. 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.

Medicines were managed safely and systems were in place to help ensure people received their medicines as prescribed. Staff knew how to protect people from the risk of abuse. There were enough staff to meet people’s needs and safe recruitment processes were followed.

Risks, including environment risks to people, were managed appropriately and staff responded appropriately to concerns about people’s safety. People were supported in a way that helped them retain their independence and avoid unnecessary restrictions.

People were happy living at the home and had confidence in the management team. There was a clear management structure in place; staff understood their roles and worked well as a team.

All staff demonstrated a shared commitment to providing a homely environment and delivering high quality care. The service had an open culture where visitors were welcomed and staff enjoyed positive working relationships with other professionals.

There was a comprehensive quality assurance system in place aimed at continual improvement. The providers sought and acted on feedback from people to further enhance the service.

This inspection followed comprehensive inspections in August 2014, June 2015 and March 2016. These inspections led us to follow our enforcement pathway. At each of the inspections since March 2016, we have noticed improvement in response to following our enforcement pathway and the provider is no longer in breach of any of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We will continue to monitor the provider to ensure that improvements are sustained.

During this visit we found the service had refurbished parts of the home and had introduced a cleaning regime. Medicines were properly recorded, and administered in accordance with guidance issued by the Royal Pharmaceutical Society.

We spoke with two people using the service and two family members of people who were unable to communicate with us. We also looked at three care plans. We found people were involved in decisions about their care and were treated with dignity and respect. One person told us, 'Staff are always discreet and sensitive'.

We spoke with the manager and three members of staff. They demonstrated a good understanding of people's care needs. An external health professional we spoke with said, 'There are no problems, they do everything we ask them to do and staff are always available'.

We saw people were provided with a choice of suitable and nutritious food and drink. A family member told us, 'They get good square meals each day and they look appetising'.

We looked at three staff files and saw appropriate checks were conducted before staff started work. There was an effective complaints system available and the service responded positively to comments made.

We observed that staff were courteous and where necessary consent was obtained, for example prior to providing care and support. Care plans were individual and other necessary records were well maintained. We saw that staff had received relevant training and support.

We found that people were not protected from the risk of infection. There were no policies, procedures or risk assessments in place to manage and monitor the prevention and control of infection, and the laundry rooms lacked hand washing facilities.

We also found that the process used for administering medicines put people at risk of not receiving the correct medicine, and we saw that some medicines were not stored safely.