Archived: Fairview House

At our previous inspection in November 2016, we identified three breaches of regulations. The provider had; failed to assess and mitigate risks to the health and safety of people using the service effectively; failed to ensure that the premises and equipment used by people were clean and properly maintained and failed to ensure that sufficient numbers of suitably qualified, competent and skilled staff were deployed in order to meet their needs. At this inspection we found action had been taken and all these areas had been addressed.

People, their families and staff all felt that there had been substantial improvements in all areas of the service over the last six months. These improvements included staffing levels; the atmosphere; the cleanliness of the home; the level of care provided and the overall running of the service.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and their families told us they felt the home was safe. The risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks in the least restrictive way.

Accident and incident records were clear and detailed and these were reviewed daily to see if any immediate action was required and monthly to identify any patterns. This enabled the registered manager to identify any actions necessary to help reduce the risk of further incidents.

Risks posed by the environment had been assessed and were being managed appropriately. There was a clear and detailed cleaning schedule in place, which domestic staff and care staff worked to, and daily spot checks were completed to assess the cleanliness of the home.

There were sufficient staffing levels to meet the needs of the people which enabled staff to engage with people in a relaxed and unhurried manner. Staff received an induction into the home, appropriate training and supervision to enable them to meet people’s individual needs.

Staff and the registered manager were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and assessments of their competence. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

People were supported to have enough to eat and drink and staff supported people, when necessary, in a patient and friendly manner.

Staff developed caring and positive relationships with people, were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs.

There was an opportunity for families to become involved in developing the service and they were encouraged to provide feedback on the service provided both informally and through an annual questionnaire. They were also supported to raise complaints should they wish to.

People’s families told us they felt the home was well-led and were positive about the registered manager who understood the responsibilities of their role. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the home.

The home 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 2008 and associated regulations about how the service is run.

At our previous inspection in December 2015, we identified a breach of regulation as the provider had not displayed their CQC performance rating as required. At this inspection we found action had been taken; the rating was displayed prominently on the premises and on the provider’s website.

People’s safety was compromised in some areas. The risks of people falling were not managed effectively. There was no clear policy or procedure in place to protect people with a history of falls; advice from specialists was not always followed and use was not made of equipment that could monitor people’s movements. The registered manager did not analyse the incidence of falls, so could not take remedial action to reduce them.

People told us there were not always enough staff deployed to meet their needs. On the morning of the first day of our inspection, there were not enough care staff and people did not receive the necessary support with their care needs. When additional staff arrived later in the morning, the atmosphere calmed and people were attended to promptly. Staff told us, and the duty rotas confirmed that the staff shortages had been common in recent weeks.

A cleaner was supporting the care staff, but this had had a knock-on effect with their work. We found some people’s bedrooms smelt of urine as the floors had not been mopped; one person’s sheets were badly stained and another person’s mattress was spattered with a brown substance. Instead of being changed, the mattresses had been turned over and made ready for the person to sleep on.

Staff knew how to prevent, identify and report abuse. However, money kept on behalf of people was not stored securely and put people at risk of financial abuse. We discussed this with the registered manager who took immediate action to store it securely.

There was a clear management structure in place, but responsibilities had not been delegated to senior staff. This put a heavy burden on the shoulders of the registered manager who did not have the time to take an overview of the service or identify and implement the necessary improvements.

The registered manager was not supported to access advice or guidance from their peers, so were not up to date with current practice, such as the requirements around the duty of candour regulations. Consequently, they had not provided written information to the relative of a person who had sustained a serious injury during a fall. Links had not been developed with community groups and people were not supported to leave the home and access the community.

Regular checks were conducted to make sure the building was safe for people and there were arrangement in place to deal with foreseeable emergencies. There were appropriate arrangements for managing medicines. Pre-employment checks were conducted to help ensure staff were suitable to work at the home.

Sttaff were skilled and suitably trained. New staff completed a comprehensive induction programme and all staff were suitably supported in their roles by the managers.

Staff followed legislation to protect people’s rights and freedoms. They sought consent from people before providing care or support.

People praised the quality of the food. Their dietary needs were met and staff provided people with appropriate support at lunchtime to help ensure they ate and drank enough. Staff monitored people’s weight and took action if they started to lose unplanned weight. People could access healthcare services and were referred to doctors and specialist nurses when needed.

People were usually cared for with kindness and compassion. Staff interacted with them in a positive way. They spoke about people warmly and demonstrated a detailed knowledge of them as individuals. They were skilled at communicating with people living with dementia.

Staff protected people’s privacy and involved people in the care planning process. They kept family members up to date with any changes to their relative’s needs.

Arrangements were in place to help ensure people experienced a comfortable, dignified and pain-free death. Staff had received training in end of life care and, following feedback from relatives, had signed-up to refresh this training by completing an extended course at a local college.

People received personalised care and support that met their needs. Care plans had been developed which provided staff with information about how to meet people needs. People were encouraged to make choices about every aspect of their daily lives and had access to a range of activities within the home.

The provider sought and acted on feedback from people. There was an appropriate complaints procedure in place and people knew how to make a complaint.

A quality assurance process had been developed. This had identified and addressed some areas that needed improvement. The provider promoted the value of dignity, which staff worked to.

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 looked at six care plans and related records of care. We saw they provided comprehensive information and gave detailed instructions on how staff should provide support to people.

We used a variety of methods to help us understand the experience of people using the service. We spoke with three people, spoke with two family members and observed care and support being delivered.

During the lunchtime meal we saw people were supported appropriately and according to their individual needs. We saw some members of staff ate at the same time as people they were supporting, which made the mealtime a social occasion and encouraged people to eat well.

We found people's needs were known and met. One person told us, 'I'm well looked after'. A family member said, 'I've no complaints, they look after (my relative) well'. We spoke with the manager and four members of staff. Each demonstrated a good understanding of people using the service, their individual preferences and the care and support they required.

We saw staff interacting positively with people. We heard staff checking that people were happy to accept care and support before it was delivered.

Family members told us their relative's needs were met. One family member said, 'Staff are lovely, they do look after them'. Another told us, 'I can't fault any of the care here'. However, we found methods used to support people to eat did not promote independence or encourage a good dietary intake.

We found people were cared for in a clean, hygienic environment. Effective systems were in place to reduce the risk and spread of infection. Two visiting health care professionals told us they were satisfied with the standard of cleanliness in the home.

Staff received appropriate training and professional development. They were supported to gain relevant qualifications.

The provider was responsive to comments made by people using the service and staff. Improvements had been made as a result.

We visited the home again on the 2 January 2013. On this occasion we found that care was being delivered effectively and medicines were being managed safely. We also spoke with three people and four family members who were visiting. They all told us they were happy with the care provided. One person said, 'Staff are very good and very helpful'.

Care plans were person centred and contained comprehensive information about how care should be provided. We spoke with six members of staff, including the manager. They demonstrated a good understanding of the care needs of people. We saw this being delivered effectively, although not all staff had an understanding of how to support people appropriately with eating.

We also spoke with two community health care professionals who praised the care that was delivered. One said, 'They are very proactive and always take our advice'. Recruiting and selection procedures were effective and showed that the provider conducted all necessary checks before people started work.

People's personal medical records were accurate and fit for purpose. Staff records and other records relevant to the management of the service contained the necessary information and were accessible.