Archived: Fairview House

Updated 8 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 2, 6 and 30 November 2017 and was unannounced. It was conducted by two inspectors on 2 and 30 November 201 and three inspectors on 6 November 2017. The inspection was prompted by information of concern about the standard of care being provided and the environment in which people were living.

This was the first inspection since the provider took over the operation of the service on 30 June 2017. Before the inspection, we reviewed information that we held about the service including notifications. A notification is information about important events which the service is required to send us by law.

During the inspection, we spoke with five people living at the home and four visiting family members. We were unable to speak with other people because of their level of cognitive impairment. We spoke with the provider’s nominated individual; this was a director of the provider’s company who had been nominated as the point of contact with CQC. We also spoke with the provider’s compliance manager, the registered manager, a covering manager from another home operated by the provider, nine care staff, a cleaner, an administrator, a maintenance person and a cook. We looked at care plans and associated records for 12 people, staff duty records, recruitment files, cleaning records, records of complaints, accident and incident records, and quality assurance records.

We observed care and support being delivered in communal areas of the home. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with a community nurse who had regular contact with the home and received feedback from managers and social care practitioners from the local authority’s safeguarding and commissioning teams. We looked at care plans and associated records for 12 people, staff duty records, recruitment files, cleaning records, records of complaints, accident and incident records, and quality assurance records. We also received feedback from the Clinical Commissioning Group (CCG) Medicines Management team, who conducted a review of medicines management in the home between the second and third days of the inspection.

Updated 8 June 2018

Fairview House 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 accommodation for 24 people. There were 22 people living at the home at the start of the inspection.

People are accommodated on two floors, with a third floor providing office accommodation. Six rooms had en-suite bathrooms. In addition, two larger bathrooms and a wet room were provided, together two lounges and a dining room.

The inspection was unannounced and was conducted on 2, 6 and 30 November 2017. It was the first inspection of the service since the provider took over the operation of the home on 30 June 2017.

There was a registered manager in place. 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 2008 and associated Regulations about how the service is run. The registered manager resigned between the second and third days of the inspection, with immediate effect. However, they remain legally accountable for the service at the time of the inspection and going forward until they have deregistered with CQC. The provider responded by bringing in a manager from one of their neighbouring homes to provide management cover.

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 so that there is still a rating of inadequate 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 within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

There were widespread and systemic failings identified during this inspection. The provider had failed to establish and implement clear working practices, policies, procedures or quality assurance systems. They acknowledged that they had no effective oversight of the service. Quality assurance systems were not robust. Where deficiencies had been identified, they had failed to take action to address these. For example, they had failed to address hazards identified in a fire safety risk assessment; and they had failed to ensure staff received appropriate training (having cancelled training that had been planned).

Not all staff were caring and compassionate. Some demonstrated a lack of respect for people and their property and did not treat people with consideration. Two people were not dressed appropriately to protect their dignity; and people were sometimes given other people’s clothes to wear.

We found significant concerns relating to health, safety and welfare of people. There were not enough staff to keep people safe and meet their needs and the situation deteriorated during the course of the inspection when the registered manager, a cook, a cleaner and several care staff resigned.

Areas of the home were not clean and infection control arrangements were inadequate. We found puddles of urine in two people’s rooms; beds and bedding covered in dried urine and faeces; and wet beds that had been made up for people to use. Laundry was backed up in the laundry, people’s commodes were not emptied or cleaned effectively and clinical waste was not managed safely.

We referred concerns relating to the cleanliness of the kitchen to the Environmental Health department of the local authority and they took action using their own powers.

Individual risks to people were not managed effectively. Pressure-relieving mattresses were not set correctly; a slide sheet was not available to support a person to reposition; a person was dressed in trousers that were too long and presented a trip hazard; staff did not have access to information or guidance about head injury monitoring; and not all staff had received fire safety training.

There was not a gas safety certificate in place and a subsequent check by a gas engineer revealed that the gas cooker was not safe and should not be used. As a result, staff were unable to prepare a choice of adequate meals for people.

Medicines were not managed safely. People did not always receive their medicines as prescribed, including antibiotics for chest infections. Two people were subsequently admitted to hospital with suspected chest infections. A further person did not receive an essential blood-thinning medicine on nine occasions. In addition, best practice guidance was not followed in respect of administration and recording practices.

Systems and processes used to investigate abuse or allegations of abuse were not operated effectively. We identified two instances where concerns met the threshold for reporting to the local authority, but this had not been done. During the course of the inspection, other allegations of potential abuse were identified by senior staff and were reported as required. These allegations have now been referred to the police.

Staff did not follow legislation designed to protect people’s rights. Conditions applied to authorisations to restrict people’s liberty were not followed and staff did not know which people were subject to restrictions.

We found staff had not received appropriate training for their role. Some staff had not completed moving and handling training, yet were using equipment to support people to move. Others were not up to date with essential training, including in subjects such as safeguarding, infection control and food hygiene.

Staff supported people to eat, but this was not always done in a safe or dignified way. People did not always have access to drinks and some staff did not know how to thicken drinks to an appropriate consistency to protect the person from choking. Although staff monitored people’s weights, action was not taken when one person lost a significant amount of weight.

Some adaptations had been made to create a supportive environment for people, but noise levels were sometimes excessive and the layout of the building created a bottleneck that prevented the free flow of people around the home.

People were usually supported to access healthcare, although we identified occasions when staff had failed to identify that people needed extra support or medical intervention.

Staff were not responsive to people’s needs and people did not always receive the care and support they needed. Some people appeared dishevelled and were not supported with their personal and oral care. People were left in uncomfortable chairs for extended periods.

People’s care plans had been developed with input from the person and their family members, but people were not consulted about all aspects of their care. Care plans encouraged staff to promote people’s independence, but had not been updated to reflect people’s current needs and were not being followed.

People were not supported to lead active lives through the provision of meaningful activities. The provider had cancelled some pre-planned activities and staff told us they did not have time to organise activities for people.

Record keeping practices were not adequate. Staff were disorganised and were not given clear direction, although they said they felt supported by the registered manager.

The registered manager told us they had not received any complaints, although feedback from the local authority indicated that family members had raised concerns with other staff. We identified that the provider did not have a complaints procedure in place. This was developed during the course of the inspection, although it was not communicated to people or their families.

Appropriate recruitment procedures were in place and followed. The registered manager had complied with the duty of candour requirements by notifying family members verbally and in writing when people had come to harm.

Some staff had received training in end of life care and people’s end of life wishes were recorded. A family member provided positive feedback about the end of life care provided to their relative.

After the first two days of the inspection we wrote to the provider detailing our concerns. On the third day of the inspection we found that action had not been taken and the care and support afforded to people had deteriorated. Due to the level of concerns we identified, we used our urgent powers to prevent any new admissions to the home. We are also considering what other regulatory action to take.

We liaised with the local authority who commission services