Fairmile Grange

We found the following examples of good practice.

Policies and staff practice were in line with the latest government guidance ensuring people, visitors and staff were protected from catching or spreading infection. Visiting arrangements for a designated person were through an appointment system and arrival checks included a rapid result COVID-19 test carried out by trained staff. Following a negative test result visitors were provided with Personal Protective Equipment, (PPE), handwashing facilities and were escorted to their relative.

Changes to the layout of the building included creating a safe visiting area in a room with its own external door. A full size clear screen divided the room into two halves and had been installed with microphones. This meant people could have additional family and friends, other than one designated person, visit them. The premises and equipment were visibly clean and cleaning products had been changed to meet current requirements. Cleaning schedules had been reviewed in response to COVID-19 and changes had included increased cleaning of touch points.

Staff had completed Infection Prevention and Control training, including the safe putting on and taking off of PPE. Staff competency checks were regularly carried out to ensure best practice. PPE was available throughout the home and stock levels ensured at least 28 days’ supply.

Staffing levels were flexible and responsive to changing needs of people. This included being able to provide one to one support to a people when their cognitive ability impaired their understanding to self-isolate or socially distance from others.

People and staff were participating in both the COVID-19 testing and vaccination programmes. People were involved in decisions and had their consent obtained for testing and vaccination in line with legal requirements.

Fairmile Grange is a residential care home that was providing nursing and personal care to 50 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

People and their families consistently described the care as safe. Staff had been trained to recognise and report any suspected abuse, discrimination or poor practice. Records showed us when potential concerns had been identified they had been reported appropriately to the relevant agencies. People had their risks assessed, monitored and reviewed and actions taken to minimise avoidable harm were the least restrictive to ensure people’s freedoms and choices were respected. Staff recruitment checks, including a criminal record check, had been undertaken to ensure suitability to work with vulnerable adults. Staffing levels were flexible and responsive to people’s changing needs.

People had their medicines ordered, administered, recorded and disposed of safely by trained staff. When a medicine error had occurred, staff were honest and transparent and ensured the appropriate actions were taken to ensure the persons safety and enable lessons to be learnt. Working with other health professionals such as occupational therapists enabled better health outcomes for people. Records showed us people had access for planned and emergency health care including opticians, dentists and audiologists.

Staff completed an induction and on-going training and support which enabled them to carry out their roles effectively. Opportunities for professional development included diplomas in health and social care and opportunities to undertake the registered nurse associate training at a local university.

We observed people receiving kind, compassionate care and having their privacy, dignity and independence respected. People and their families consistently spoke positively about the staff team providing examples of their kindness and patience. Staff were knowledgeable about people’s individual communication skills which meant they were able to ensure people were involved in decisions about their day to day care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Pre-admission assessments had been completed with people to gather information about their care needs and choices. The information had been used to create person centred care plans that reflected people’s spiritual, cultural and lifestyle choices and were reviewed with people and/or families on a regular basis. People had an opportunity to be involved in end of life care planning which included any cultural requirements. Feedback from families described kind, dignified care at the end of a persons’ life.

People, their families and staff spoke positively about the management changes in the home and describing staff morale as high due to good communications and teamwork. We observed an open, honest culture where staff felt able to express their views and opinions and told us they felt appreciated in their roles. Leadership was visible, promoted person centred care and met legal reporting requirements.

Quality assurance processes were effective in identifying, monitoring and reviewing areas requiring improvement ensuring continued and sustainable improvements. People, their families and the staff team had opportunities to be involved and engaged in developing the service through regular meetings, newsletters and social events. Feedback was used to reflect on practice and improve the outcomes for people. A complaints process was in place and people and families felt they would be listened to and any necessary actions taken by the manager.

Rating at last inspection: At our last inspection carried out on 23, 24 and 25 January 2018 the service was overall rated as requires improvement. Our report was published on 13 April 2018.

Why we inspected: This was a planned inspection based on the previous rating. At our last inspection we found a breach in regulation as actions in place to minimise avoidable harm to people were not always being followed. Medicines had not always been stored, administered or recorded safely. We asked the provider for an action plan detailing how they would improve the service to a rating of ‘Good’ and checked these actions at this inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

The home had a manager who had been in post four months at the time of our inspection. During our inspection they became the 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.

Fairmile Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide care for up to 80 people. At the time of our inspection there were 50 people in the home some of whom were living with a dementia. The home provides accommodation over four floors. Rooms have en suite shower facilities. Communal facilities include specialist bathrooms, lounge, kitchenette and dining rooms, quiet social areas and an accessible garden.

People had not always been protected from avoidable harm as actions in place to minimise risks to people had not always been followed. One person had a high risk of falls and needed to have their walking aid in reach and an alert pad on their chair. We found this had not happened. We observed another person have a fall and they were lifted off the floor by care staff instead of using moving and transferring equipment. This meant people were at risk of avoidable injuries.

Medicines had not always been stored, administered or recorded safely. We observed a medicine trolley left unlocked and unattended potentially providing access to vulnerable people. Topical cream administration was not consistently happening in line with prescriptions meaning people were at risk of deteriorating skin conditions. Protocols for administering medicine as required for mood management had not been followed which meant that people could be having unnecessary medicines.

People had person centred care and support plans that had been developed in line with current good practice guidance and were stored securely on a computer database. Care workers and agency care staff had limited access to information held on the computer which meant people were at risk of not receiving consistent person centred care

People had the opportunity to develop end of life care wishes. Reviews took place regularly and at times included people, families and social and health care professionals.

People at risk of malnutrition had their weight, food and fluid intake monitored. Measures to reduce risks such as fortified foods, high calorie drinks and referrals to a GP were in place. People had their eating and drinking needs met including special diets and allergies. Meals were well balanced and appetising with plenty of choice. Some people were at risk of skin damage. Pressure relieving equipment was in place and being used correctly. People were protected from avoidable risks of infection as staff had been trained in infection control and food hygiene. Staff understood how to recognise abuse and the actions needed if abuse was suspected. Interactions between people and staff was respectful and respected people’s individuality.

People were supported by enough staff to provide safe care. Processes were in place to manage high sickness and absence levels, staff retention and more clarity and efficiency with the staffing rota and staff deployment. Staff had been recruited safely including checks that they were suitable to work with vulnerable adults. Staff had completed an induction and on-going training which provided them with the skills to carry out their roles and continue with their professional development.

People were supported to access both planned and emergency health care when needed. Working relationships with other professional agencies meant that people were receiving positive experiences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and their families described the staff as caring, kind and courteous. If people were anxious staff spent time offering emotional support. Staff had a good understanding of people’s interests and this meant that staff could talk with people about things that interested them. Activities took place in groups and also individually reflecting a person’s interests or hobbies. People had their communication needs understood which meant they could express themselves and be supported to make choices about their day to day life’s. People’s privacy, dignity and independence was respected which enabled people to express their individuality. A complaints policy was in place which people and their families were aware of and felt able to use if needed.

Staff had not always felt involved in decisions that impacted on their roles and responsibilities. Systems had been introduced to improve communication such as general staff meetings, daily heads of department meetings and a newsletter. Resident, relative and staff meetings had been held to share information, receive feedback and discuss changes in the service.

When the registered manager took up their post they made us aware that they found statutory notifications had not always been sent to CQC and then sent us the missing information. A statutory notification is a legal requirement for the provider to inform CQC of certain situations as part of their oversight of care provision. This meant that CQC had not received information to support their monitoring of the service in a timely manner.

Quality assurance processes were in place and actions plans were in place and completed in a timely manner when areas for improvement had been identified. Information gathered from feedback from external monitoring visits, audits and accident and incident reports had been shared with staff as a learning opportunity to reflect on practice.

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.