9 May 2023
During an inspection looking at part of the service
Fairfield View is a residential care home providing personal care for up to 54 people. The service mainly provides support to older adults and people living with dementia. At the time of our inspection there were 38 people using the service. Care is provided across two units, with 'The Elms' providing specialist dementia support. People have their own bedrooms, some of which are ensuite. Communal spaces including bathrooms, living spaces and a secure garden were available.
People’s experience of using this service and what we found
Systems of governance and oversight had been introduced but were not currently being effectively used to ensure the safety and quality of the home. We found information used for oversight of people’s needs, including dietary information and wound care was not being accurately maintained. Systems to ensure people received the correct care had either not been implemented or was not being used effectively. Communication and involvement of people using the service had improved, although further work was needed. Staff needed further support to understand and develop in their roles, in order to support the governance processes within the service.
People's needs, and risks were not always being safely managed in relation to modified diets and skin integrity. Medicines were not always being safely managed. Safe recruitment of staff was being completed and there were generally enough staff to support people. Environmental improvements were found, and plans were in place to address shortfalls. Action to address most, but not all safety issues had begun. Equipment had been obtained to promote better infection prevention and control but some areas of the home including furniture and shared bathrooms needed further work.
People did not always have accurate and up to date needs assessment information. Oversight of needs and guidance in handover records and care plans was sometimes inaccurate or inconsistent. Observations and records did not assure us that people’s needs were being consistently met. People's view of the food was mixed, and it was not clear that people were having their dietary needs met. Improvements to the environment had begun but further work was needed to ensure shared and frequently used areas, such as communal bathrooms were suitable for use. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service were in place to support good practice. Staff felt well supported and training was available. Further work to support staff to complete and understand all aspects of mandatory training was needed.
People’s care plans had been developed, but further work was needed to ensure these were accurate, completed and person centred. An activity worker began at the home during the inspection and staff tried to support people to engage in activities where time allowed. However, people told us they were bored, and we observed there was a lack of stimulation.
People and families spoke positively about the staff, and we observed kind and caring interactions. People's dignity was respected, and choice was generally, but not always promoted.
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 inadequate (published 08 November 2022) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection as part of the multi-agency meeting approach, to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
Enforcement
We have identified breaches in relation to the management of individual risk; the management of medicines; the provision of person-centred care; knowledge, training and skills of staff; and systems for management and oversight of the service.
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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.