Fairleigh House

Fairleigh House is a care home providing personal and nursing care to up to 7 people. The service provides support to people with complex learning disabilities, autistic people and people with physical disabilities. At the time of our inspection there were 6 people living at Fairleigh House.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: Medicines were not always managed safely, and improvements were needed to ensure processes for storing people’s medicines were robust and effective. Environmental risks had not been fully mitigated. Staff provided kind, caring, person-centred care and support. Staff communicated with people in ways that met their needs. People living at the home each had unique and complex health needs and staff knew people and understood risks to people.

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

Right Care: There were sufficient staff deployed to meet people's needs and wishes. A small number of agency staff were used to cover staff vacancies. Wherever possible the same agency staff were used which provided people with a consistent approach. People received person-centred care that promoted people's dignity, privacy and human rights. Staff recognised and responded to changes to individual's needs. We saw staff treated people with kindness and patience. People had access to meaningful activities and care plans were person centred.

Right Culture: The provider did not always operate effective systems to monitor the quality of the service they provide. Audits were not comprehensive and had failed to identify shortfalls in relation to risks to people's safety, medicines management and the use of PPE. People were at the heart of what the service did. Relatives and staff told us there was an open and positive culture at the service.

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

Rating at last inspection

The last rating for this service was good (published 16 August 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the safety and quality of care provided to people. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

We have assurances that the issues identified are being acted upon by the management team and a pro-active response was taken during the inspection process to start addressing the areas of concern.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management, approach to health and safety, training of staff and the quality and assurance systems in place at this inspection.

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.

Fairleigh House is a residential care home providing personal care for six people with autism. The home is a large detached building. Five people had their own room and shared the bathrooms, kitchen and two lounges. One person lived in their own independent flat on the lower ground floor of the house.

Fairleigh House is registered to be able to support for up to seven people. The registered manager told us there were no plans to use the seventh room at the home. The six people currently living at Fairleigh House had lived together for many years and it was felt a new person moving was not in their best interests.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were extremely well supported by a stable, dedicated staff team who knew people, their needs and how they communicated very well. People were observed to be very comfortable with members of staff.

Clear, detailed person-centred plans were in place which identified people’s health and wellbeing support needs and how staff should meet these needs. Risks had been identified and guidance provided in how to manage these risks.

Where people may have behaviour described as challenging, clear guidance was in place in how staff should distract and support people to reduce their anxieties and make sure they were safe. These clearly identified what physical restraint could be used and that it was only to be used as a last resort.

People had a full itinerary of weekly activities, including walking, canal trips and drives in their own transport. People were also involved and active within their local community, using local shops and leisure facilities. People were encouraged and supported to complete the tasks they were able to do.

The number of incidents of challenging behaviour was low at the service due to the regular planned activities and routines and stable staff team who could identify the signs a person was becoming anxious and were able to distract them to de-escalate the situation.

There were enough staff on duty to meet people’s needs. Staff were safely recruited and well trained. Staff were very positive about the induction, training and support they received. The provider encouraged staff development and progression.

Staff were recruited with the activities people did in mind. Staff were provided with walking boots and weather proof clothing, so they could support people to go out in all weathers.

People received their medicines as prescribed. Information was in place to identify how people would non-verbally communicate if they needed an over the counter medicine, such as pain relief.

A quality assurance system was in place to monitor the service. Monthly audits and safety checks were completed.

People were supported to maintain their health and nutrition. Fairleigh House had access to the providers Central Support Team (CST) for specialist advice on behavioural support and speech and language.

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

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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

Rating at last inspection

The last rating for this service was outstanding (published 16 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

We last visited the service on 4 August 2014 where the provider was found to have met all the regulations we inspected.

Fairleigh House provides support and personal care for up to seven people with learning disabilities. There were seven people living at the home at the time of our visit. There were five single rooms, a semi-independent flat on the top floor and an independent flat on the lower ground floor.

There was 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 person we spoke with and relatives told us that the service was exceptionally caring. Staff were highly motivated and demonstrated a clear commitment to providing dignified and compassionate care and support. Staff used creative and inclusive ways to make sure that people had accessible and tailored methods of communication.

The person with whom we spoke and relatives described the responsiveness of staff as "outstanding." Staff found inclusive ways to meet people's needs and enable them to live as full a life as possible. An extremely creative activities programme was in place to help meet people's social needs.

People were actively encouraged to give their views and raise concerns or complaints. Various inclusive and effective feedback systems were in place to obtain people's views.

People told us that they felt safe living at the service. There were no ongoing safeguarding concerns. Medicines were managed safely. We checked medicines administration records and noted that these were completed accurately.

Checks were carried out to ensure that applicants were suitable to work with vulnerable people. This included obtaining written references and a Disclosure and Barring Service check [DBS]. People told us and our own observations confirmed that there were sufficient staff deployed to meet people’s needs.

Staff followed the principles of the Mental Capacity Act 2005. The manager was strengthening the service's records with regards to the documentation of any decisions relating to mental capacity to ensure that it was clear how the MCA was followed.

People’s nutritional needs were met and they had access to a range of healthcare services.

There was an effective system in place to monitor the quality and safety of the service. Various audits and checks were carried out. Actions were taken when any deficits in standards were identified. We looked at the maintenance of records. We saw that care files were stored securely. The manager was able to locate all records we requested promptly.

There was evidence that people and staff were involved in the running of the service. Feedback systems were in place to obtain people's views. Meetings and surveys were carried out. Staff told us that morale was good and they enjoyed working at the service.

The manager had submitted notifications to CQC in keeping with their obligations under the Care Quality Commission (Registration) Regulations 2009.

One inspector carried out the inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

Is the service safe?

We saw people were being cared for in an environment which was safe and clean. There were enough staff on duty to meet the needs of the people living at the home. A member of the management team was on duty on each shift and available on call in case of emergencies. Processes for the prevention and control of infection were in place. For health, safety and security reasons, visitors were asked to sign in and out.

The people we spoke with who used the service told us they felt safe. One person said 'I like it here.'

We saw training records and certificates which showed staff had received training to enable them to meet the needs of the people who used the service. This helped ensure the people who used the service were supported by staff who had the necessary skills and experience. We saw staff rotas which showed appropriate numbers of staff were on duty each shift.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). The aim is to make sure people in care homes and hospitals are looked after in a way which does not restrict their freedom inappropriately. We saw that one person had been the subject of a DoLS authorisation. The authorisation had been reviewed appropriately and restrictions were no longer necessary. Several members of staff had received training about the Mental Capacity Act and Deprivation of Liberty Safeguards so they understood when an application should be made and how to submit one.

Is the service effective?

People's health, social and care needs were assessed with them and they were involved in writing and reviewing their care plans. Specialist needs had been identified in care plans, for example, ways to communicate. Care plans were reviewed every year and when necessary due to changing needs.

From the training records we viewed we found staff had received training to enable them to meet the needs of the people who used the service. Discussion with staff and examination of records confirmed a programme of training was in place so all members of staff were kept up to date with current practice.

The people we spoke with told us they were happy with the care they received and said their needs were met. They spoke positively about the staff who supported them. From what we saw and from speaking with staff it was clear they had a good understanding of the care and support needs of the people who used the service.

Is the service caring?

People we spoke with told us they liked living at the home. Comments included 'I like it here.'

We saw the staff showed patience and gave encouragement when they were supporting people so people were able to do things at their own pace and were not rushed.

Is the service responsive?

The records we saw confirmed people's preferences and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to activities which were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We saw documentary evidence which showed the service worked well with other agencies and services to make sure people received their care in a joined up way.

From speaking with staff we found they had a good understanding of the home's values. They told us about their roles and responsibilities and they were clear about these. We saw quality assurance processes were in place to make sure the provider monitored the care provided and made improvements where necessary. For example, meetings were held with people who used the service so that they had the opportunity to express their opinions.

Comments were mainly positive and people stated 'My family member is well looked after' and 'My family member is happy in his routine'. However some people stated that in their opinion, changes in staff could disrupt the continuity of care for people living at Fairleigh House.