Archived: Fairfield Care Home

Fairfield Care Home is a residential care home providing personal care for up to 21 adults. There were 14 people living in the home during our inspection visits. Two of those people were in hospital.

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

Medicines management was not consistently safe. We have made a recommendation about the management of some medicines.

Risks to people's safety and the environment were not always identified and mitigated and risk assessments did not always contain accurate information to help staff manage risk. A continuity plan was not in place to ensure people would receive safe, consistent care in the event of an emergency.

Governance systems to monitor the quality and safety of the service were inadequate. Completed audits and checks had not identified the concerns we found. This demonstrated lessons had not been learnt since our last inspection.

Enough staff were on duty to meet people’s needs. However, the provider could not demonstrate their staff were always recruited safely. Staff enjoyed their jobs, but they had not been supported to develop their skills and knowledge to provide high quality, safe care. Also, staff with no experience of working in a social care did not receive an induction that reflected nationally recognised induction guidance.

There had been a lack of consistent management and leadership at the service since 2015. Frequent management changes had impacted negatively on the quality and safety of care people received.

Whist people felt safe and were happy living at the home the standards of care they received had declined since our last inspection. People’s privacy and dignity was not maintained, and people’s personal belongings were not treated with respect. Staff knew people well but the language they used when they spoke about people was not always respectful.

Care was not always provided in line with people’s preferences and choices and care records did not consistently contain detailed information to help staff provide personalised care. Action was being taken to address this.

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.

Information about the service was not provided in a format all people could understand and more needed to be done to ensure the environment was dementia friendly. Improvements had not been made to the environment since our last inspection to make sure it was a nice place for people to live. Some areas of the home were not clean.

People had enough to eat and drink and had access to health professionals when needed to maintain their health and wellbeing. People had opportunities to feedback their views on the service they received. Recent feedback showed people were happy with how their home was run.

People were supported to practice their religions and people's end of life wishes were documented if they had chosen to share this information. People were satisfied with the social activities available. People and their relatives knew how to make a complaint. No formal complaints had been received since our last inspection.

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

Following our inspection, we notified the local authority commissioners about the areas of concern we

identified.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated

Activities) Regulations 2014. These were:

Regulation 10 Regulated Activities Regulations 2014 – Dignity and respect

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 15 Regulated Activities Regulations 2015 – Premises and equipment

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Regulation 18 Regulated Activities Regulations 2014 – Staffing

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 20 September 2018) and there was one breach of regulation. 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 improvements had not been made and the provider remained in breach of regulation.

This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for this service is inadequate and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel

the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within

this timeframe. If not, enough improvement is made within this timeframe and a rating of inadequate remains for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration if they do not improve.

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.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

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

Fairfield Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Fairfield Care Home provides care and accommodation for up to 21 older people. There were 19 people living at the home at the time of our inspection.

At our last inspection in February 2017 improvements were needed in three of the key questions we inspected these were Effective, Responsive and Well led and we identified one continued breach of the regulations. We rated the service Requires Improvement' overall.

We asked the provider to make improvements. They sent us an action plan which informed us the necessary improvements would be completed by July 2017.

During this inspection we found not all improvements had been made and sufficient action had not been taken in response to the breach in regulation. Lessons had not been learnt by the provider because quality assurance procedures were not effective to always keep people safe. The provider was heavily reliant on the registered manager to ensure the home was running effectively. The provider's lack of managerial oversight meant opportunities to drive forward improvement had been missed.

Also, additional areas where the home had previously performed well now required improvement. Therefore, the service continues to be rated as ‘requires improvement’ and continues to be in breach of the regulations.

The service is required to have a registered manager in post. 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 and associated Regulations about how the service is run. Since our last inspection the management at the home had changed. The previous registered manager had left their employment in April 2017. A new manager had been in post since June 2017 and registered with us in May 2018.

Enough staff were available to meet people's needs. However, the provider had not consistently followed their recruitment policy to ensure staff who worked at the home were of suitable character which placed people at potential risk. Action was being taken to address this shortfall.

Most people felt safe living at the home and procedures were in place to protect people from harm. Staff had received training to support them to understand their responsibilities to report any witnessed or allegations of abuse. However, the provider was not keeping us informed of events, such as allegations of abuse that they are required to inform us about.

Risk assessments identified potential risks to people's health and wellbeing. Risks were regularly reviewed and staff demonstrated a good knowledge of how risks were to be managed.

People received their medicines when they needed them from trained staff. However, checks of people’s medicines had not identified a series of issues. We found medicine administration records were not completed as required. People's creams did not have the date they were opened or the date when they should be discarded recorded. Also, we could not be sure staff checked people's medicine was correct before administering them.

Staff understood the provider’s emergency procedures and the actions they needed to take in the event of an emergency. Incidents and accidents that happened at the home were recorded and analysis of incidents was completed to reduce the risk of reoccurrence.

Maintenance and safety checks carried out at the home were not always effective to keep people safe. Staff understood their responsibilities in relation to infection control but improvement was required to ensure infection control practices were consistently followed.

The design of the building supported people to live comfortably however, people told us it was difficult to gain access to some areas of the garden. Action was being taken to address this and plans were in place to refurbish some areas of the home.

The provider was working within the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible.

New staff had received effective support when they had started work at the home. People thought the staff were well trained and staff spoke positively about the on-going training they received.

People’s needs were assessed before they moved into the home and people had been involved in planning their care. People’s care plans contained detailed information about their preferences and daily routines which supported staff to provide person centred care.

People told us staff were caring. Staff knew people well, they were responsive to their needs and knew what was important to people. People’s right to privacy was respected and people were encouraged to remain independent.

People's religious and spiritual needs were respected. Staff received training to support them to treat people as individuals.

The quality of social activities had improved since our last inspection which supported people to maintain their hobbies and interests. People were involved in planning meaningful activities.

People knew how to make a complaint and felt comfortable doing so. The provider and registered manager encouraged feedback from people, their relatives, visitors and staff which was used to drive improvement.

People were happy with how the home was run. Staff felt supported by the registered manager and regular team meetings were held which gave staff the opportunity to discuss any issues of concern and ideas for improvement.

We found one continued breach 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 the report. We also found a breach of Regulation 18 Care Quality Commission (Registration) Regulations 2009.

Fairfield Care Home is a residential care home which provides care for up to 21 people and supports some people who live with dementia. There were 19 people who lived at the home at the time of our inspection visit.

When we inspected Fairfield Care Home on 6 February 2015 we identified a breach of regulation in relation to how the provider monitored and assessed the quality and safety of the service provided. At that time the home did not have a registered manager. The management of the service had been inconsistent and we found some actions identified for improvements at our previous inspection on 18 September 2014 had not been taken. We asked the provider to send us an action plan of how they would address the issues we had identified.

We returned to Fairfield Care Home on 17 September 2015 and we identified a continued breach of regulation in how the provider monitored and assessed the quality and safety of the service provided. At this inspection we found that improvements had not been made and the provider continued to be in breach of this regulation. We met with the provider and issued a warning notice to become compliant with the regulation.

On 5 January 2016 we completed a focussed inspection of Fairfield Care Home to see if improvements had been made to address the issues identified within the warning notice. We found that some action had been taken to improve how the service was led, however further improvements were required and the home continued to be in breach of this regulation.

The provider had undergone changes in the management team at the home. At the time of this inspection on 15 February 2017 the service had a registered manager in post. 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. The registered manager had been registered with us since October 2016.

In addition to there being a new manager in post, there have also been changes to the deputy manager and senior care staff. Staff felt the new registered manager was open and supportive to them. However, not all felt the provider was as supportive, and felt they had not listened to their concerns about the service when they had been raised. At times, the provider’s oversight into improvements required to the service people received was ineffective.

Staff knew the importance of seeking consent when providing care to people, but did not have in-depth knowledge of the principles of the Mental Capacity Act. Where people had been diagnosed as having a condition which impacted on their capacity to understand, there were assessments to determine what decisions the person could make, and what needed to be made in their best interest. Deprivation of Liberty safeguards were in place for people whose reduced capacity had meant their liberty had been restricted, however these were out of date and had not been re-applied for.

In October 2016 the home was visited by a community pharmacist team who identified a number of issues in the way medicines were stored, audited and administered. The registered manager had worked with the pharmacist team at addressing the issues raised.

The provider did not have an effective infection control system in place that protected staff and people who used the service from the risk or spread of infection.

There were enough staff to meet people’s needs. Risks to people’s health and well-being were known by staff, and written risk assessments and care plans had up to date information to support staff in their knowledge of people. Pre-employment checks were completed to ensure, as far as possible, that people employed to support people living in the home were of good character.

Staff had received training which the provider had deemed necessary to meet people’s specific individual needs or ensure their safety.

Since the registered manager was employed in September 2016 no complaints had been received. There was no record of complaints prior to this time so we were unable to identify if they had been addressed appropriately through the provider’s complaints policy and procedure.

People enjoyed the meals provided and people who required support to eat and drink were getting sufficient support to maintain their health and well-being.

Limited activities were available to people in the home and the registered manager had identified this as an area to improve.

Individual staff members were kind and attentive to people. However, due to demands on their time, staff interaction with people was mostly when supporting people with care tasks. Friends and relatives could visit the home at any time during the day and evening.

During this inspection we found the service to be in breach of one 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 the report.

After the comprehensive inspection, we met with the provider and they wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused unannounced inspection on 5 January 2016 to check that they had followed their plan and improvements had been made. At this inspection we found some improvements had been made, however further improvements were required in order for the provider to be fully complaint with this regulation.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Fairfield Care Home’ on our website at www.cqc.org.uk.'

Fairfield Care Home is registered for a maximum of 21 people offering accommodation for people who require nursing or personal care. At the time of our inspection there were 16 people living at the service.

A requirement of the service’s registration is that they have 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There was no registered manager in post and there had not been since April 2013. The previous manager had left in August 2015 after six months in the role. A new manager had been in post since September 2015. At this inspection they told us that they had submitted an application in October 2015, however, this had been returned as it was incorrectly completed. No further application had been submitted as the provider and manager were awaiting for some further background checks to be completed for the application and told us this was near completion. The manager told us they were fully intending to resubmit their application to us.

At this inspection we found that some improvements had been made, however the provider continued to be in breach of this regulation. At times the quality and safety of care people received remained unsatisfactory.

The provider had displayed their last inspection ratings as is the legal requirement to do this, however on the day of our visit, these were not legible. The manager was aware of the notifications they were required to send us, however we had not received all of these.

Learning and development opportunities remained limited for staff. The manager had made some changes to improve this and further plans were in place.

Protocols for medicines given ‘as required,’ were now in place, however these required some further updating.

Care records and risk assessments had been reviewed, however did not always contain relevant information to support people. There was not always enough staff available to support people at times they required.

The manager and staff had some understanding of the principles of the Mental Capacity Act 2005 (MCA). Mental capacity assessments had been completed however were not personalised. Some people at the service were being deprived of their liberty and the appropriate applications had not been made.

Some quality monitoring audits had been undertaken. There were no audits in the area of infection control and we saw some areas of concern in relation to this during our visit.

People and staff told us they could raise concerns with the management team who were approachable. Staff felt more supported in their roles and there were now some opportunities to discuss any issues or concerns they may have. Staff meetings were now being held monthly.

People had some opportunities to be involved in the running of the service and offer their views and opinions. However, there were no formal meetings taking place for people or their relatives. People knew how to complain and no further complaints had been made since our last visit.

Fire drills had now been carried out. Accidents and incidents were recorded and analysed. Emergency plans were now in available.

Some improvements had been made to the premises since our last visit and more were planned.

We found a breach 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 the report.

We set a compliance action in relation to these areas and received a report from the manager that told us what they intended to do to achieve compliance.

We followed up on this area of non compliance by undertaking an inspection on 18 September 2014. During this inspection we spoke with some people who lived in the home and members staff on duty including care and cleaning staff. We also looked at cleaning records available and observed cleaning in five bedrooms. We found that some improvement had been made since our last visit, but the service remained non-compliant in this area.

People we spoke with told us they were satisfied with the cleanliness of the home. "It's lovely and clean", "My room gets a clean every day" and "It's not necessary to clean my room every day but it gets done all the same," were comments made.

We did not detect any offensive odours during our visit and the home appeared clean and tidy.

Care and cleaning staff had been provided with infection control training to ensure they were aware of the national guidelines for infection prevention.

Care staff were aware of the need to follow appropriate guidelines when dealing with people's laundry to prevent the risk of infection.

Practices used in the process of cleaning peoples bedrooms did not protect them from the risk of infection via cross contamination.

The evidence we collected helped us to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People we spoke with told us they felt safe. One person we spoke with said: 'Oh yes, the staff are ever so good here and look after me."

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager was able to describe when an application should be considered and who should be involved in the process. We saw records that showed a number of staff had received training in mental capacity. The registered manager was aware of the recent High Court judgement that may have an impact of future applications and had received further training in this area.

The home was clean and tidy with no apparent odours. However, we identified staff did not always follow infection control guidelines when required. We have asked the provider to send us an action plan informing us of how this issue will be addressed.

People told us if they needed anything repaired or replaced, this had been done with minimal delay. We saw maintenance records that confirmed repairs had been undertaken promptly.

We found equipment was maintained and regularly serviced. We found the provider carried out regular fire checks and ensured people and staff knew what to do in the event of an emergency.

Is the service effective?

People had an individual care plan which explained what their needs were. People and relatives told us they had been involved in the care assessment and their contributions were listened to. Risk assessments were regularly reviewed and identified current risks.

We found staff had received the necessary training that enabled them to provide suitable and appropriate care for people.

Is the service caring?

People were supported by staff who provided care at people's preferred pace. Staff were kind and attentive and responded appropriately to people's requests.

Staff promoted individual choice and supported people who wanted to remain as independent as possible. We found individual wishes were taken into account.

Is the service responsive?

People received help and support from other health professionals when required, such as doctors, opticians, speech and language therapists and district nurses.

People were supported to participate in activities inside and outside of the home. At the time of our inspection people participated in a game of indoor skittles and dominoes.

The service had systems in place to monitor the care provided to people. This included reviews of people's care records.

Staff said they had a handover at the start of each shift to update them of any changes in people's needs since they were last on duty.

Is the service well led?

The service worked alongside other health care professionals and agencies to make sure people received the care they required. We spoke with relatives who confirmed outside health professionals had provided care and support to their family members.

The service had an effective system in place that assured the quality of service they provided. The service completed regular checks and sought the views of people who used the service. The service also gained the views of staff and we found the service listened and acted upon these views.

People's care records and other records were accurate, available and completed.

The manager had been in post at Fairfield for ten weeks and had already made significant changes in the way the service was provided. We could see that improvements had been made throughout the home. For example, documentation and records were very well organised. Care plans had been rewritten involving the individual and their families. Recruitment of staff was underway and staff training was now taking place.

Furniture and fittings had been reorganised to make the communal areas more welcoming and comfortable. Dining room tables had been rearranged to make more space in the room. Tables were nicely laid with tablecloths, runners and napkins. Condiments were available and flowers in pretty vases decorated each table.

The whole atmosphere in the home had changed for the better. Staff were smiling, people living there were happy and engaged in conversations and activities, and visitors to the home were made very welcome.

People told us they were very happy living at the home and were well cared for.

We inspected Fairfield Care Home again in September 2012 and found the provider had not made the necessary improvements. We issued a warning notice to the provider and manager requiring them to become compliant with Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 by 19 October 2012 or we would take further action to make sure that they achieve compliance.

We undertook an unannounced inspection on 22 October 2012 to check whether the provider complied with our warning notice. We met and spoke with 10 of the 11 people using the service.

We spoke with the provider, manager, care staff and two care workers. We also spoke with a care business consultant the provider had employed to advise on improving the care planning systems in the home. We looked in detail at the care records for three people. We looked at some of the other records relating to people's welfare, such as weight monitoring records.

We found evidence of improvement. Risks to people's health and welfare were identified and appropriate action was taken to minimise the risks. This meant the provider had complied with our warning notice.