Fairland House

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Currently we did not feel the service was working collaboratively with people using the service or placing them at the centre of their care. Greater collaboration was needed with relatives to keep them informed and involved and to be partners in care. Greater community presence would enhance people’s experiences. The service was not well led and did not have effective systems and processes to identify and drive positive change within the service. There was limited engagement with people using the service, staff or relatives to collate their feedback on how things could improve and put them at the centre of their care. Staff were not adequately supported to develop their professionalism and be able to deliver safe, effective care. The provider had consistently failed to deliver high standards of care through robust management and staff development. This has meant people have had variable experiences of care. Incidents within the service could be avoided or reduced if effective incident management and learning from incidents had been in place. Risks from the environment, infection control risks and risks from poor record keeping had all recently been identified by the local authority and CQC rather than the provider which meant that had inadequate processes for their quality assurance. We were assured that the current manager team would be able to bring round effective change but until this is embedded the service requires further improvement.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although there was a new management structure in place. There were issues when staff had raised concerns previously that these weren’t listened too. Concerns around poor staffing levels especially at night and well-being checks. When we asked a staff member how they would cope in the event of a fire they said, “I would be stuck with 2 of us on, we would see where the fire is on the fire panel and have to wait for help.” This raised concerns about staff not being listened too with concerns that had a high risk with them. When this was discussed with new management team it was addressed promptly, however there were concerns in the delay of this being addressed from the provider level of the lack of oversight. The staff felt very supported from the new management team and were looking forward to the change within the service.

There was no clear strategy within the service of lessons learnt and lack of communication between departments. There was an Action plan in place, but this didn’t capture all the actions/ concerns in the environment and there was no evidence of this been shared with the staff. There was confusion over electronic handovers and paper handovers on the onsite assessment and this could lead to miscommunication, duplication of actions of failure to meet actions. This raised concerns with the provider of the lack of oversight within the service and their opportunity for the wider sharing of the visions and strategies within the organisation. There were discussions about holding future management meetings to resolve this issue.

During our site visit we identified concerns about the way the management and leadership of this service had been managed over time which had led to a decline in standards and poor general oversight. The local authority raised some serious concerns before the provider took some decisive action and put into place a stronger management team. It was this management team that identified shortfalls with the service and not the provider. As a response to concerns an action plan was put into place but we identified that this did not always carry across actions or show what actions had been taken to resolve things. It also didn’t show how surveys and meetings were used to identify wider concerns with the service from the perspective of people using the service and their relatives. Management had not been open and transparent about the failures of the service. The current management team were visible, available, honest, and realistic about their journey of improvement. The area manager told us they had reviewed their recruitment process to ensure they were employing people with the right skills who could take this service forward and be where it needed to be. They had been taking support and advice from the local authority to improve the service. Pockets of poor practice had not been identified due to poor oversight and a lack of effective auditing, but this was improving and there was a focus on upskilling staff.

We weren’t assured that the processes in place were evidence of this. There were no engagement surveys to people using the service, that visited the service or that worked there. There wasn’t evidence of regular meetings held. There was no lessons learnt in the environment from incidents that occurred and no evidence of encouragement for people to bring their ideas forward. The was no evidence of a complaints procedure and when we asked the provider of any complaints, we were informed there was none.

The service employed a diverse work force, but we were mindful that processes needed to be in place to ensure staff were supported with individual disabilities and circumstances such as a stress risk assessment and lone working risk assessment. Processes also needed to be strengthened to ensure the whole staff team have the skills to manage their work loads in line with their job descriptions and support to work effectively. Appraisals were not used which would give the staff the opportunity to discuss how to grow both personally and professionally and bring their best selves to work. The recruitment process could be reviewed, and staff files audited to iron out any missing documents which we found as part of our audit. By strengthening the recruitment, induction, and support for staff hopefully retention would improve.

We identified a breach of regulation 17: Good governance of The Health and Social Care Act 2014. due to wide spread concerns and failures. Leaders were very responsive to our feedback both on the day of the site visit and following our visit addressing any concerns we had, and the concerns raised by the local authority. They were mindful of what was needed to improve the service and had made a good start. We were mindful of the need to stabilise the service implement and embed the changes and recognized this would take time. Their priority had been to improve staffing, improve safe practices around medicines and increase their presence and availability around the service. The area manager was in regular contact with the service and the provider was giving the manager autonomy to manage. Upskilling staff was yet to be done which would greatly enhance the levels of care provided.

The service has not been well managed or well led and has retained a requires improvement for well led and other actions have been taken both by CQC and the local authority to bring about improvement at the service. The overarching quality and governance systems had not been particularly robust, and the oversight has been poor. People have lived in accommodation with inadequate numbers of staff and in a building which has been unsafe. Staff have been trained but the training has not enabled staff to carry out their role safely. For example, in practice staff are trained to know what actions they should take in event of a fire, but we found risks associated with fire poor. Inadequate numbers of staff meant safe evacuation would have been unachievable in the past and this had not been identified by the provider. Poor standards of cleanliness could result in spread of infection placing people at risk. Poor standards of care were cited by relatives and records of weight management showed unexplained variation in weight. However recent records showed a more stable pattern of weights. Falls, accidents and incidents were poorly recorded, and lessons were not learnt across the home or wider provider services.

Currently we do not feel that the service were working collaboratively with people using the service or placing them at the centre of their care. Greater collaboration was needed with relatives to keep them informed and involved and to be partners in care. Greater community presence would enhance peoples experiences.

When onsite there was no concerns with partnership working between the service and external stakeholders. Referrals were put through in a timely manner to meet the needs of the people using the service. There was evidence that the manager had autonomy, experience and a willingness to work with partner agencies.

When speaking to staff and leaders we weren’t assured that there was a process of reflection and lessons learnt following incidents. We weren’t assured how effective the training was. When we spoke to staff and asked what they had been able to implement into the service following any training they had received, they couldn’t demonstrate anything they had learnt. When we spoke to the provider, they had informed us they were planning to implement in house training to address this issue. When we spoke to staff, they were unsure on when they last had an appraisal or a supervision. When we spoke to the manager about these concerns, she informed us that she was aware and had planned to carry out supervisions/appraisals with every staff member in the setting.