Keychange Charity Fair Havens Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During this assessment we looked at 3 quality statements in the key question of safe. We found concerns in 2 of the 3 quality statements, where breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. The overall rating for this key question combines scoring from quality statements we looked at during this assessment and quality statements scores in line with findings from our last inspection, where the service was rated good. People did not always receive their medicines as prescribed, and medicines administration records were not accurately maintained. Care planning around people’s medicines did not always contain person specific instructions or information related to their health and medical conditions. Systems around the storage of medicines were not always in line with best practice. This was a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider failed to ensure they completed robust recruitment checks when employing new staff. This increased the risks that unsuitable staff may be employed to work with people. This was a breach of Regulation 19 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. After our assessment site visit, the registered manager took action to make immediate improvements to their medicines management and staff recruitment processes. They were able to demonstrate how they had reduced the main risks associated with the breaches in regulation detailed above. However, they still required time to evidence they had embedded good practice and were no longer in breach of regulations. No concerns were found in the quality statement of Safeguarding, which we looked at as part of this assessment. The provider had robust systems in place to help ensure people were kept safe from suffering abuse or coming to avoidable harm. Safeguarding incidents were reported and investigated appropriately.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe living at the service. They said that they felt reassured by knowing staff were available to provide support when needed. Comments included, “Oh yes, I feel very safe. They [staff] are very attentive”, “At night you know you feel safe as you see the night staff” and, “They [staff] look in on you all the time to make sure you’re alright."

Staff had received training in The Mental Capacity Act 2005 (MCA) and told us how they minimised any restrictions to people which were required to promote their safety. One staff member told us, “[The MCA is) There to protect people who may not have capacity [to make decisions about their care].”. Staff had received training in safeguarding and felt confident in identifying and reporting concerns about people’s safety and welfare.

There were effective processes in place to ensure safeguarding concerns were identified, reported and acted upon appropriately. We reviewed records of completed safeguarding alerts and found the registered manager had analysed concerns to look for trends and ways to reduce the risk of recurrence. The provider ensured that when people lacked capacity, decisions were made in their best interests. They demonstrated a clear understanding of the Deprivation of Liberty Safeguards (DoLS) and ensured it was only used when in the best interest of people.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they were happy with staff, telling us staff were kind and patient in their approach. Comments included, “Staff are brilliant” and, “Staff are very good. I’ve never seen a sign of impatience.” People told us that staffing levels at the home were good and they were attended to quickly when they requested staff help or assistance. Comments included, “When I call them they [staff] are always willing to help.” People told us that staff were competent and appeared well trained in their role. They detailed how staff supported them to safely mobilise around the home which helped them to remain active.

There was mixed feedback from staff as to whether they felt supported in their role. They told us there was sufficient training, but some staff felt they were unable to raise issues with senior leaders. The registered manager told us they had recently been away from the service to help at one of the provider’s other care homes. They felt this may have contributed to staff’s feedback about not always feeling supported in their role.

The provider did not always recruit staff in line with its recruitment policy. This meant that recruitment processes were not robust and in line with requirements set out in regulation. We reviewed 3 staff recruitment files and found each contained incomplete information. This included, missing reference checks from previous employment, incomplete work history and missing evidence that identification documents had been checked. For 2 staff, the provider could not evidence that a certificate from the Disclosure and Barring service (DBS) had been obtained prior to staff working with people. A DBS check contains a record of people’s criminal convictions and cautions. The registered manager had effective systems in place to monitor staff’s training needs and competence. Staff had received appropriate training relevant to their role. There were systems in place to assess and monitor staffing levels, to help ensure there were suitable numbers of staff to meet people’s needs.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People we spoke with said they were happy with the support they received in managing their medicines. Comments included, “Staff are very good. They give me my medicines every night” and, “They [staff] always make sure I take my tablets at night time." Although people's feedback about their medication was positive, due to the providers management systems and processes, people potentially have gone without their medicines as required, which reflected that their ‘lived experience’ was not always positive. We have commented further on this in 'Processes'.

Staff who were responsible for the administration of medicines were confident in carrying out their role. However, some staff told us that there could be improvements in the systems of ordering and returning of medicines to better ensure people had an adequate supply. Comments included, “I think the system needs to be better.” The registered manager was very responsive to feedback. After the second site visit, they demonstrated how they had made improvements to training, auditing, care planning, administration recording and systems to oversee the ordering and returns of medicines. This helped to reduce the risks which we identified at this assessment.

The provider did not always manage medicines in line with their policy or best practice guidance. This meant that people did not always receive their medicines as prescribed and medicines managements systems were not always safe. The systems around ordering and returning medicines were not robust, resulting in some people running out of their prescribed medicines due to a lack of supply. We reviewed examples where people had run low or out of their medicines. In some examples, the provider did not take all reasonable steps to source an emergency prescription which could have meant that people received their medicines as required. People’s care plans did not always contain detailed information about their medical conditions, such as Diabetes or Alzheimer’s. This meant it was not always clear how people needed support around these conditions and what staff should do to monitor their health. There was limited oversight into medicines management systems. The Completed audits we reviewed did not highlight issues found with medicines errors, medicines administration records and the management of controlled drugs which are subject to strict legal rules around their use. This put people at increased risk as there was a lack of oversight into how medicines management systems were operating at the service and mistakes were not always identified or addressed.