Archived: Fawnhope Rest Home

Fawnhope Rest Home is a residential care home registered to provide care and support for up to 19 people.

The service provides support to older people some of whom were living with dementia. The home is accessed over two floors by stairs and a stairlift. Accommodation was in an adapted building with a separate annexe. At the time of our inspection there were 7 people living at the home.

People's experience of using this service and what we found

Improvements had been made in the home since our last inspection. People had risk assessments in place for their care and support needs. The provider and registered manager had introduced a system to ensure these were kept up to date.

People told us they were happy and safe living at the home , supported to live well by staff who had the necessary information to keep them safe. A person stated, “The care staff here take care of me.” Another person told us, “I feel safe, I look after a lot of people and they look after me, I’m happiest in here.” A visiting health and social care professional commented, “[Person’s name] was able to report they felt safe at the home, was happy and was well fed.”

Assessments were completed and included risk of falls, support needed in a fire evacuation and specific risks from individual health conditions such as pain assessments. Physiotherapy guidance for contractures was in place. This is a tightening of the muscles, tendons, skin, and surrounding tissues that causes the joints to shorten and stiffen.

Repairs and cleanliness concerns identified at the previous inspection had been completed with further improvement works in progress. A staff member stated, “The repairs have been done, we are able to tell the nominated individual what we need, and they sort it.”

Infection control procedures were in place and continued to help keep people safe. There were enough stocks of personal protective equipment (PPE) and staff were wearing it in line with the current government guidance.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 January 2023). At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 12.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Fawnhope Rest Home is a residential care home registered to provide care and support for up to 19 people. The service provides support to older people some of whom were living with dementia. The home is accessed over two floors by stairs and a stairlift. Accommodation was in an adapted building with a separate annexe. At the time of our inspection there were 13 people living at the home.

People’s experience of using this service and what we found

Improvements were needed to ensure risks to people were properly assessed, and actions taken to reduce or remove them. Medicines were not always managed safely and the risk to people of avoidable infection was not always managed effectively. The environment was not maintained to an acceptable standard and repairs not always carried out in a timely manner. Routine utilities checks were not always carried out to ensure they were safe, such as, gas and water safety.

The management systems and processes within the home were either not established or did not operate effectively. The audits and monitoring had not identified the shortfalls found within this inspection.

Staff told us they received training and support. Training was mainly online, and some practical training had been arranged for moving, handling and basic life support. The registered manager told us they discussed training with staff in meetings. Staff were not always able to tell us about their training content; we have made a recommendation about staff training.

Observations we made and feedback we received told us the décor within the home was in places tired, worn and not suitably maintained. The provider told us there was no formal ongoing programme of refurbishment and redecoration. We have made a recommendation about the environment within the home.

Improvements had been made and people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff understood how to offer choice, and this was observed throughout the inspection. However, the documentation of assessments under the Mental Capacity Act 2005 were not always clear. The registered manager was in the process of transferring the assessments to local authority templates to make them clearer.

People and their relatives were happy with the care they received at Fawnhope Rest Home. There were enough staff planned on duty and recruitment was ongoing. Feedback we received told us staff were kind and caring. We observed some kind and respectful interactions between staff and people during the inspection. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We received positive feedback about the registered manager and the home worked well with a variety of health and social care professionals.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 December 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that there were acceptable staffing levels at all times. At this inspection we found the provider had acted on the recommendation.

Why we inspected

The inspection was prompted in part due to concerns received about the management of the home, staff training and the environment. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safe care and treatment of people and the management of the home. We have made a recommendation about staff training and the environment.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Fawnhope Rest Home is a 'care home'. Fawnhope Rest Home accommodates up to 19 people living with dementia and physical frailty. The care home accommodates people across two buildings. There is the main care home and a small two-bedroom annexe located through a garden. At the time of our inspection 12 people were living in the main home and no people living in the annex.

People’s experience of using this service and what we found

The lack of robust infection control practices placed people at risk of being exposed to infections. This included known risks associated with the current Covid-19 pandemic.

Risks associated with the environment and people’s needs had not always been safely assessed, monitored and mitigated.

Although improvements had been made in relation to people receiving their medicines in a safe way, improvements were needed with medicine records. We have made a recommendation about this.

There was a mixed view about staffing levels in the service. We have made a recommendation to the provider to review their staffing levels.

People and relatives described Fawnhope as a safe place to live. Staff had a good understanding of safeguarding procedures. Staff were recruited safely.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff told us they were supported by regular training and supervision. People were supported to access other healthcare services in a timely way. Adaptations had been made to the home to meet the needs of the people living there.

Quality assurance systems had not always been effective in identifying the concerns we found at this inspection and bringing about improvement.

Staff were positive about the management of the service and told us the registered manager was very supportive and approachable.

The registered manager demonstrated a willingness to make improvements and during the inspection began reviewing their systems and process to ensure the service consistently provided good, safe, quality care and support.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (11 November 2019). There was one breach of regulation in relation to regulation 18 (Notifications) of the Care Quality Commission (Registration) Regulations 2009. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fawnhope Lodge Rest Home on our website at www.cqc.org.uk.

At this inspection enough improvement regarding regulation 18 had been made and the provider was no longer in breach this regulation. However, we identified three new breaches of regulations in relation to providing safe care and treatment, consent and governance. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

We will describe what we will do about the repeat requires improvement in the follow up section below.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Safe, Effective and Well-led Key Questions which contain those requirements. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe, Effective and Well led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, consent and governance. Please see the action we have told the provider to take at the end of this report

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress.We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Fawnhope Rest Home is a care home. Fawnhope Rest Home is registered to provide accommodation and personal care for up to 19 people, some of whom were living with a dementia related condition. The care home accommodates people across two buildings. There is the main care home which accommodates up to 17 people and a small two-bedroom annexe located through a garden. At the time of the inspection there were 15 people living in the home.

People’s experience of using this service and what we found

People and their relatives told us they thought the service was safe. The quality and safety of the service had improved for people since our last inspection.

At our last inspection we found that the administration and storage of medicines was not managed safely. Although the management of people’s medicines had improved, more robust processes were required to prevent errors occurring.

Providers are required to inform CQC about various incidents and events which occur within the home. The provider had failed to ensure that incidents and accidents were reported to CQC as required.

Risks to people were managed and people were protected from the risk of abuse. There were suitable systems for ensuring the home was clean and equipment was safe for use. Staff were recruited safely, and there were sufficient numbers of staff to keep people safe. Staff had received appropriate training and support to enable them to meet people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, consent had not always been sought where needed.

People's care plans contained detailed information about them and their care and support needs to help staff deliver personalised care. The management team reviewed the care and support provided to people to make sure it continued to meet their needs.

People and their relatives told us they thought the staff were kind and caring. The staff team knew people well and we observed positive interactions. One relative told us, “It's homely here, the manager and staff are very nice and helpful. I visit every day and always feel welcome.”

The provider had improved people’s wellbeing by ensuring there was an activities coordinator who provided meaningful activities. People were supported to access their community and participate in person centred activities.

The registered manager had systems and processes to monitor quality within the home, but these had not always identified the shortfalls we found. Action plans had been developed to address on-going improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 27 September 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

The service remains rated requires improvement, but the Commission acknowledges improvements have been made. This service was rated requires improvement both at the last inspection and at this inspection. At this inspection we found improvements had been made but the provider was still in breach of regulations, and improvements were still required.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fawnhope Rest Home on our website at www.cqc.org.uk.

Enforcement

At this inspection we have identified one breach in relation to failing to notify CQC of significant events. Please see the action we have told the provider to take at the end of this report.

Follow up

We will ask the provider to complete an action plan following this report being published to detail how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Fawnhope Rest Home is registered to provide accommodation and personal care for up to 19 older people including people who may be living with dementia or other mental health conditions. Fawnhope Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of our inspection there were 16 people living at the home, 14 of whom were accommodated in a converted and extended residential building with a shared lounge and dining area. Two people were accommodated in a separate annexe. At the time of our inspection they chose to have their meals and daytime activities in the main house. There was an enclosed garden.

There was a registered manager in place. 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 previously inspected Fawnhope Rest Home on 24 and 25 May 2016 and rated the home as Good. We found a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) 2014, Premises and Equipment. This was because the provider had failed to adequately assess risks associated with fire safety as not all actions required by Hampshire Fire Service had been completed. At this inspection we saw that the fire risk assessment was complete and any issues identified had been actioned. The provider was no longer in breach of this regulation. However, we found that the provider did not have robust arrangements in place to ensure all staff could act appropriately in the event of an emergency. We have made a recommendation about best practice fire safety guidelines.

We also found other breaches of regulations at this inspection.

The administration and storage of medicines was not managed safely. This had not been identified by the service because effective checks had not been undertaken.

There was not a robust quality assurance process in place. Audits to assess the quality of service provision were ineffective in identifying some of the improvements needed. Action plans were not developed to ensure improvements were made.

Not all complaints received had been recorded to show how the complaint had been managed and that the complaints procedure had been followed. We have made a recommendation about the management of complaints.

Care plans did not contain information that was always reflective of people’s current needs. There was conflicting information in some people’s care plans.

Staff sought verbal consent from people, before providing support, but did not always follow legislation designed to protect people’s rights when making decisions on their behalf. Care plans did not have mental capacity assessments in place.

Some activities were provided for people; however, the provision of activities did not always meet people’s emotional, social and psychological needs. Feedback about staffing levels was mixed and we observed that people spent long periods of time without engagement from staff. We have made a recommendation about the determination of staffing levels.

Feedback about the food on offer was positive and people were given a choice. Where people needed support to eat, this was given in a dignified way. However, people did not have their fluid intake adequately monitored.

Some risk assessments were not reflective of people’s current needs and this documentation needed improvement to ensure clear guidelines were in place for staff to follow. However, we saw that measures had been put in place to address and reduce risks for people.

Most care plans in place were person-centered and included details about people's life histories and what was important to them. People were supported by staff that knew them well.

The home was visibly clean and staff used protective equipment when needed. Staff were seen to follow infection control procedures except for one time during our inspection.

People were complimentary about the staff. All interactions we observed between staff and people were positive. Staff promoted people’s privacy and dignity and encouraged people to remain as independent as possible.

Staff displayed good knowledge on how to report any concerns and could describe what action they would take to protect people from harm. Accidents and incidents were recorded and monitored to determine if any trends were occurring.

Safe recruitment processes, including pre-employment checks had been followed.

During our inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

Fawnhope Rest Home is registered to provide accommodation and personal care services for up to 19 older people, and people who may be living with dementia, a learning disability or other mental health condition. At the time of our inspection there were 16 people living at the home. They were accommodated in a converted and extended residential building with a shared lounge and dining area. One person was accommodated in a separate annexe intended for people with greater independence. At the time of our inspection they chose to have their meals and daytime activities in the main house. There was an enclosed garden.

There was a registered manager in place. 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.

Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided. However the provider did not always make sure that required maintenance to the building and equipment was arranged in a timely manner. They had not completed maintenance actions identified in a fire safety audit. The provider relied on informal systems of management in some areas.

The provider had arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely. Recruitment processes were in place to make sure only workers who were suitable to work in a care setting were employed. Arrangements were in place to store medicines safely.

Staff received appropriate training and supervision to maintain their skills and knowledge. Staff were aware of the need to gain people’s consent to their care and support. Staff were aware of the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They did not apply to anyone living at the home at the time of our inspection.

People were supported to eat and drink enough to maintain their health and welfare. They were able to make choices about their food and drink, and meals were prepared appropriately where people had particular dietary needs. People were supported to access healthcare services, such as GPs and community nursing teams.

People told us they had caring relationships with their care workers. They were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people’s individuality, privacy, and dignity.

The provider involved people in the care assessment and care planning processes. Care and support were based on plans which took into account people’s needs and conditions, but also their abilities and preferences. Care plans were updated as people’s needs changed, and were reviewed regularly. People were able to take part in leisure activities which reflected their interests. Group activities and entertainments were available if people wished to take part.

The home had an open, friendly atmosphere in which people felt able to make their views and opinions known.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to take at the end of the full version of this report.

This is a summary of what people told us and what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and comfortable in the home. One said 'It is like a new family.' A visitor told us, 'I know [my partner] is safe and warm.' We saw people being supported in a way that took into account their safety and welfare.

The service had appropriate risk assessments in place. These were written to ensure people's safety and welfare when receiving personal care. There was a contingency plan to cover foreseeable emergencies, and general risk assessments to do with the environment people lived in. Procedures were in place to control and reduce the risk of the spread of infection.

Is the service effective?

People told us that they were satisfied with the care and support they received. One said, 'They look after you marvellously.' Another said, 'I would not want to be anywhere else.'

We found people's care and support were based on thorough assessments and detailed and personalised support plans. Staff were supported to deliver care to the required standard by appropriate training and a system of appraisal and supervision.

Is the service caring?

We observed support being delivered in a caring manner. Staff were aware of people's family histories, hobbies and interests and engaged with them about these subjects. Staff checked regularly that people were comfortable and offered frequent hot and cold drinks between meal times. They encouraged and praised people and facilitated their independence where possible.

Staff we spoke with were motivated to provide quality care. They had a thorough knowledge of people's needs and how they preferred to have their care delivered.

Is the service responsive?

People and their relatives told us they had been involved in the care planning process, and that people's views and preferences were taken into account. The service responded to changes in their needs or circumstances. Care plans were reviewed and updated regularly.

The service had systems in place to ensure the care provided was appropriate to peoples' changing needs. There were enough staff to respond to people's needs as they arose. A visitor told us, 'If you ask them for something they do it straight away.'

Is the service well-led?

Staff told us they were supported to deliver care and support to the required standard and they were able to get advice if they needed it. They said if they raised concerns with the manager or senior staff, they were dealt with and resolved.

Systems were in place to regularly assess and monitor the quality of service provided. Risks were assessed and appropriate action plans were in place. There were processes in place to review and learn from incidents, accidents and complaints.

We spoke with a nurse who visited the home regularly. They told us 'The manager is great, but the home needs input generally', referring to the cleanliness of the home and the practice of some staff, which they had not raised with the manager.

We spoke with the provider, the manager, the improvement coordinator, all five care staff on duty and the chef. We found that there was conflict amongst the care staff and individuals and as a consequence we received varying views about the service. For example one of the care staff told us there was 'good teamwork ' it's not cliquey', while another said 'the management needs to wake up'. A third staff member told us 'People feed off (the staff) negativity'.

We reviewed care records for three people and observed practice. We found that people experienced effective care because their needs were assessed and reviewed.

People could choose from a varied menu and had the support they needed to help them eat and drink.

People were protected from the risks of unsafe management of medication because there were effective systems in place.

Staff did not receive suitable training and this presented a risk to people using the service.

Comments included. 'They look after me well and they help me. The helpers are very kind and the food is nice.'

For each person living in the home there was a detailed, person centred plan of care in place that included people's individual needs and wishes. The plans also contained clear information regarding staff supporting people's emotional wellbeing.

In order to meet people's individual needs, the home's staff worked with a variety of healthcare professionals including district nurses and mental health teams. We were shown that advocates and specialist consultants were used where appropriate.

People were protected from risk of abuse or harm by there being safeguarding polices and procedures in place and by staff knowing how and when to use them.

Evidence we saw showed us that people were supported by a caring, experienced staff team. The staff team were well supported and trained.

People had their social needs assessed and had access to a range of activities and outings.

There was a regular cycle of quality audits undertaken to ensure that the home was kept under review.

Comments from four family members that spoke with us included. 'They always make us very welcome; staff are very good and always let us know if our relative is poorly.'