Archived: Farehaven Lodge

Farehaven Lodge is a service that is registered to provide accommodation for up to 40 older people, some of whom are living with dementia. Accommodation is provided over two floors and there are stair lifts to provide access to people who have mobility problems. At the time of our visit 28 people lived at the home.

Farehaven Lodge had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

We previously inspected Farehaven Lodge on 2 November 2016 and found the provider failed to identify medicine errors and take appropriate action. This was a breach of Regulation 12 of the Health and Social Care Act 2008 Regulated Activities Regulations (HSCA RA) 2014 Safe care and treatment. We also found governance systems were not always effective. This was a breach of Regulation 17 of the HSCA RA Regulations 2014 Good governance.

At this inspection we found the provider had made progress and was no longer in breach of Regulation 12. Whilst governance systems did prompt improvement we found other areas of care delivery that were not consistently to the standard expected detailed in the regulations. We issued a repeated breach of Regulation 17. We also issued a breach of Regulation 18 HSCA RA Regulations 2014 Staffing, a breach of Regulation 15 HSCA RA Regulations 2014 Premises and equipment and a breach of Regulation 9 HSCA RA Regulations 2014 Person centred care.

The provider did not ensure sufficient numbers of staff were appropriately deployed to meet peoples’ needs at all times.

The provider did not ensure CQC were notified about incidents of possible abuse.

The provider did not ensure Farehaven Lodge was consistently meeting fire safety requirements.

People were not always supported to engage in meaningful activities and were often left without stimulation.

Further improvement was required to enable people living with dementia to navigate throughout the home safely and effectively.

Staff were aware of people’s individual risks and were able to describe the strategies in place to keep people safe.

Staff knew each person well and had a good knowledge of the needs of people.

Staff received supervision and appraisals were on-going, providing them with appropriate support to carry out their roles.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. Appropriate arrangements were in place for people who were subject to DoLS.

Food menus offered variety and choice. The chef prepared meals to meet people’s specialist dietary needs.

Where possible, people and relatives were involved in care planning.

Staff supported people with health care appointments and visits from health care professionals.

Care plans were amended to show any changes and they were routinely reviewed every month to check they were up to date.

People knew who to talk to if they had a complaint. Complaints were passed on to the registered manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person, their relatives, and where appropriate other health and social care professionals.

The provider had appropriate arrangements in place should people require end of life care.

We issued four breaches of the Health and Social Care Act 2008. You can see what action we took at the back of this report.

Farehaven Lodge is a service that is registered to provide accommodation for up to 40 older people, some of whom are living with dementia. Accommodation is provided over two floors and there are stair lifts to provide access to people who have mobility problems. There were three lounges on the ground floor and a dining room that people could choose to spend their time in. At the time of our visit 28 people lived at the home.

Whilst a person is named on our register as being the registered manager, this person was no longer working at the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. A new manager had been appointed and started working in the home on 19 September 2016. They advised us they would be making an application to become the registered manager. Throughout the report we refer to this person as the manager.

Following our last inspection on 4 and 5 August 2015 requirement notices were issued for breaches in Regulations11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered person had not ensured appropriate application of the Mental Capacity Act 2005. They had not ensured that identified risks associated with people’s care had been appropriately assessed and plans developed to mitigate such risks. Service user records were not always up to date and systems to assess and improve the quality of the service were not always effective in driving improvements.

At this inspection improvements had been made. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the provider had suitable arrangements in place to establish, and act in accordance with people’s best interests if they did not have capacity to consent to their care and support. The manager understood their responsibility with regard to Deprivation of Liberty Safeguards (DoLS) and they had applied for authorisation under DoLS to ensure people were protected against the risk of being unlawfully deprived of their liberty. They were no longer in breach of Regulation 11 however we have made a recommendation that the provider review the system used to ensure best interests decisions are clearly documented and guidance for staff about authorised DoLS are referenced in care plans.

Improvements had also been made to the management of risk and the plans of care for people. Care records contained information to guide staff about the management of risk associated with people’s needs. Staff were knowledgeable of people’s needs and the support they required. The provider was no longer in breach of this element of Regulation 12. However the management of medicines needed to be improved. Multiple occasions were found which showed staff had signed to say medicines had been administered but this had not happened. This was a breach of Regulation 12.

Systems were in place to monitor and assess the quality of the service provided. Some records required further work to personalise them and ensure they were accurate and reflected people’s needs. The manager had identified this need and developed and action plan to address this as well as other areas which required improvement. However, as the manager was new to the service they needed time to make the changes and embed these.

People felt safe and staff knew their roles and responsibilities in safeguarding people.

Thorough recruitment checks were carried out to check staff were suitable to work with people. Staffing levels were mostly appropriate to meet people’s needs, although we have made a recommendation that the provider review the tool used to assess staffing levels and ensure this includes the night time period. Staff were supported to develop their skills through training and the provider supported staff to obtain recognised qualifications. Supervisions for staff had improved and the manager had met with almost all staff on a one to one basis. They had plans to undertake appraisals and plan training for 2017.

People’s views on the choice of food were varied and the manager had identified the need to review the menus and choices available. Peoples intake was monitored and when additional health professional input was needed this was sought. Staff supported people to ensure their healthcare needs were met.

People told us the staff were kind and caring. No one had any concerns and said they were happy with the care and support they received. Staff respected people’s privacy and dignity and used their preferred form of address when they spoke to them. Observations showed that staff had a kind and caring attitude.

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

There was limited communication with people because of their care needs. Consequently, we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This included looking at the support that is given to them by the staff. We spent 35 minutes observing people and staff together at the early evening meal time. We saw people had positive experiences. Staff were observed to help people who needed it. People were observed enjoying the meal and the contact they had with other people during the meal.

We looked at care records and found the home carried out an assessment of prospective resident's needs before they were admitted to the home. Care plans were recorded and gave guidance for staff on how they supported people. The home assessed whether people had capacity to make decisions about their daily lives and there were records where the home had to make decisions on behalf of those who lacked capacity (best interests decisions).

The home had policies and procedures regarding the safeguarding of vulnerable. We found that staff were trained in the safeguarding of vulnerable adults.

The home used a staff dependency assessment tool for determining staffing numbers. We found the home had sufficient numbers of staff to meet the needs of those accommodated.

The home used a number of checks and audits of its own performance including satisfaction surveys completed people who lived at the home.

One person told us "it is a wonderful home, staff are so helpful". Others told us how good the service was.

Both relatives that we spoke with said that "staff were attentive to the needs of their Aunt". They said that the home was "the best that they found in the area" and that they were very happy with the service.

People we spoke with said they felt safe in the home and said they were confident that staff would respond appropriately to any concerns they raised. People told us the manager regularly asked them how they were.

All of the care staff working at the home have completed National Vocational Qualifications (NVQ) at level 2, 3 or 4.