Fairland House

Fairland House is a residential care home, providing personal care and support for people over 65. The service can support up to 34 people. At the time of our inspection there were 29 people using the service.

Fairland House is an adapted building split across two floors, with access via a lift or a staircase. All rooms have en-suite bathroom and shared facilities. The service benefits from large secure gardens for people to use.

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

The care environment was visibly clean, although some areas of the home were tired and required modernisation, the service had a development plan in place for improvements to the environment.

Some aspects of medicines management required improvement. These had been addressed by the time we gave feedback at the end of the inspection.

Daily records were not kept up to date and this had not been identified by quality monitoring processes.

Staff were not always clear on their role, people felt there could be more staff to support them.

New online quality monitoring systems were in place providing oversight of the service, however these require further embedding and development to ensure effective monitoring of the service.

Safeguarding procedures were in place, and staff had received training to protect people from abuse. Action had been taken to learn from incidents that had occurred to reduce the risks of reoccurrence.

People were involved in planning and reviewing their support needs. Care plans were shaped around people's preferences and support needs. This included positive risk taking.

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.

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

Rating at last inspection and update

The last rating for this service was good (Published 29 February 2020)

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.

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.

Recommendations

We have made a recommendation in regard to the quality assurance monitoring systems.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Fairland House is a residential care home providing personal care and accommodation to 31 people aged 65 and over at the time of the inspection. The service can support up to 34 people.

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

Improvements had been made since our last inspection to the safety of the home. Risks in relation to people’s safety had been assessed and managed well.

The governance systems had been reviewed and were more robust. This ensured the quality of care people received was regularly monitored and improved where necessary. There was good leadership in place and the registered manager and provider demonstrated they were keen to learn and drive improvement within the home.

The registered manager’s knowledge regarding the care standards required had improved, as had the support and direction given by the provider. However, we did find a shortfall in this knowledge in relation to the types of incidents the Care Quality Commission needed to be notified of. We have therefore made a recommendation for the registered manager to review the relevant regulations.

There was an open culture within the home. People had a voice and were listened to and they were respected as individuals. They 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 staff were kind, caring and compassionate. They took time to get to know the people they supported to ensure that care was delivered in line with their needs, preferences and routines. The staff had received a variety of training which was reviewed regularly, to ensure their practice remained safe and their knowledge up to date.

There was an awareness of social isolation and people were encouraged to participate in activities that were of interest with them. Relatives and friends were free to visit at any time. Good links with the community had been established to facilitate people’s wellbeing.

People received a good choice and variety of food and drink. They were supported with their healthcare needs. Good links had been established with the relevant services such as the GP surgery, dentists and district nursing teams. Staff worked well with these professionals, including at the end of people’s lives to ensure they received care that met their wishes and preferences.

When something had gone wrong, such as an accident, the provider had processes in place to ensure learning occurred. Relevant parties such as the person involved or their relative, had been included in the investigation and offered an apology where necessary.

Rating at last inspection and update

The last rating for this service was Requires Improvement (published February 2019). 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 been made and the provider was no longer in breach of regulations.

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.

Fairland House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Fairland House is registered to accommodate up to 34 people. Care is provided over two floors. There are communal areas that people can reside in along with space for dining on the ground floor. At the time of our inspection visit 29 people were living in the home, eight of whom were living with dementia.

The last manager to be registered with CQC at this service de-registered in August 2018. A new manager took up post but then left the service. The current manager started in November 2018. They are not currently registered with CQC but they have made an application to do so. A registered manager is a person who has registered with the 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. Since the last inspection the nominated individual of the provider who has overall responsibility for monitoring the quality of care provided had also changed. They also commenced this new role in November 2018.

At the last inspection of Fairland House, we rated the home overall as requires improvement. This was because people had not always received care that was safe or effective to their needs and systems in place to monitor the quality of care had not been robust. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective and well led to at least good.

At this inspection we found that the provider continued to be in breach of two regulations of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for the home therefore remains as requires improvement. This is the third consecutive inspection that the home has been rated as requires improvement. This demonstrates a lack of learning and consistent drive for improvement to ensure the quality of care reached an overall rating of good.

Not all risks to people’s safety had been assessed and therefore mitigated. Most staff used good and safe practice but some did not. These factors placed people at risk of avoidable harm.

Staff had not completed all the training they needed to although the manager was aware of this and some overdue training had been booked. Activities for people to participate in to stimulate their wellbeing had declined but this was being addressed. People’s views were being sought to improve this area.

The premises would benefit from some improvements to help people living with dementia orientate themselves. We therefore recommend the provider consults appropriate guidance in this area to make the necessary improvements.

The current manager in post demonstrated a passion to learn and people and staff told us improvements had been made since the manager had started working in the home. New systems had recently been put in place to drive this improvement but these were not currently all effective or embedded to ensure that risks to people’s safety were consistently managed well. People, relative and staff views about the care provided had been sought and the manager was using this feedback to help improve the quality of care people received.

People were very happy living in the home and they were provided with support by staff who were kind and caring. People were treated with dignity and respect and they had built caring relationships with the staff.

People received enough food and drink to meet their needs and they had been involved in making decisions about the care and support they received. Their needs and preferences were met and their consent was always sought before any care took place. They were given full choice and control over their care.

Systems were in place to protect people from the risk of abuse and staff used good practice to protect people from the risk of the spread of infection. When people became unwell, the staff acted quickly to ensure they received the appropriate medical advice.

There was a system in place to capture and investigate any complaints or concerns that had been made and the manager demonstrated that they learnt from any incidents that occurred. Good links has been and continued to be, developed within the local community for the benefit of people living within the home.

Staff were very happy working at the service. They felt supported, told us their morale was good and could develop and complete qualifications within care.

There was an open culture in the home. People and relatives could approach the staff or manager whenever they wished and were listened to and their opinions respected.

During our last inspection in December 2016, we found four breaches of Regulations. These had been in respect of Regulations 9, 11, 12 and 17. This was because some people’s needs and risks to their safety had not been adequately planned or managed. There had been a lack of clear guidance in place for staff to follow to help them provide people with safe and appropriate care. Also, consent for people’s care had not always been sought in line with relevant legislation and the provider’s governance systems had not been effective at monitoring the quality of care people received.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Responsive and Well Led to at least good. This was not received at our first request but was sent after a further letter was issued to the provider regarding the matter.

At this inspection we found that improvements in certain areas had been made. However, the provider remained in breach of Regulations 12 and 17. This was because we found that some risks to people’s safety had either not been assessed or managed well. The provider’s governance systems had again failed to adequately monitor the quality of care people received and therefore, to drive the required improvements needed. In addition, we found two breaches of the Care Quality Commission (Registration) Regulations 2009 as the provider and registered manager had failed to notify us of some incidents that had occurred which they are required to do by law.

Fairland House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 34 people over two floors. At the time of the inspection, there were 27 people living in the home.

A registered manager was working at the home. A registered manager is a person who has registered with 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.

People’s medicines were not consistently managed well and staffing levels were not always in line with the provider’s requirements. Most staff used good and safe practice but some did not consistently do this for the benefit of the people living in the home.

Staff had not completed all of the training they needed to complete although the registered manager was aware of this and was booking the relevant training. People’s risk assessments did not all contain sufficient guidance for staff on how to mitigate risks to their safety.

Activities for people to participate in had declined recently. This was because the staff member who was responsible for this area had recently left the home. Again, the registered manager was aware of these areas and was actively working to improve them.

The people we spoke with were happy living in the home. They received care that was based on their individual needs and preferences. They were treated as individuals and were empowered to make decisions and take risks in relation to their own care. Their diverse needs were adhered to and respected. This was the culture that had been embedded in the home and the staff and management in the home were passionate that people should receive this type of care.

People were provided with care and support by kind and caring staff who treated them with dignity and compassion. This included as they reached the end of their life. Staff were mindful about people’s rights to privacy and ensured this took place.

The management and staff engaged people in the running of the service and took action to make improvements where these had been suggested. There was an open culture where people and staff felt able to raise concerns without fear of recrimination.

Systems were in place to protect people from the risk of abuse and any incidents or accidents that took place were fully investigated and learnt from to reduce the risk of them re-occurring. The staff team worked well with other services to provide people with the care they required. This included supporting people to access relevant healthcare services to help keep them well.

People received enough food and drink to meet their needs. They had plenty of choice of food and were supported to eat and drink if this was required. People’s consent to their care was always sought before any care was given. Where people lacked capacity to consent, the staff acted in line with relevant legislation to ensure they acted in people’s best interests.

People lived in a pleasant home that was nicely decorated and had access to a secure garden area that they could freely use when they wanted to. The staff were clear that this was people’s home and treated it as such with respect and care. The home was clean and systems were in place to protect people from the risk of the spread of infection.

Good links with the community had been established for the benefit of people living in the home and these were being further enhanced.

The service provides accommodation and care for up to 34 older people. At the time of our inspection there was no registered manager in post. The owner had appointed a manager and they had been in post approximately three weeks and were supported by a deputy manager, senior staff and a full complement of staff. They told us they intended to apply for registration with the Care Quality Commission.

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.

In summary we found that people were well cared for by staff that were familiar with their needs and responsive to their wishes. People gave us positive feedback about their experiences and the staff that cared for them. The environment was clean and well maintained and refurbishment was on-going. A lift had been installed in the last few weeks. Prior to this a stair lift was in situ.

The manager was newly in post and already identified what they needed to put in place to ensure the smooth running of the service. Staffing levels were being maintained but occasional agency staff were being used to cover long term sickness. Staff were also being deployed to cover gaps in the rotas which effectively reduced the amount of care hours being provided. For example care staff were doing laundry and activity staff doing care hours. This impacted on people’s experiences.

We have made a recommendation about the use of a dependency tool to establish people’s needs which will help determine how many staff are required.

Staff were aware of people’s needs but people’s records did not clearly reflect their needs or provide information about how risks were to be effectively managed and monitored. It was evident that because staff knew people they were quick to refer concerns to other health care professionals but in terms of accountability. There were not clear records of the care given in accordance with people’s needs.

We have made a recommendation about information required in an emergency. Do not attempt pulmonary resuscitation. DNAPR.

Staff promoted people’s well-being and offered them meaningful choice. However we were not assured that the service always assessed capacity in line with the Act or always acted in a person’s best interest as there was very little recorded in people’s records about capacity, risk taking and promoting choice. The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements. People’s capacity to give consent had been assessed and decisions had been taken in line with their best interests. DoLS applications had been appropriately submitted to the local authority. We have identified a breach.

Servicing and auditing of equipment and premises were in place to ensure safe systems of work but these were not sufficiently robust.. We found records of accidents, incidents, falls and occurrences in place but no clear overview of these to help determine patterns and trends over time.

There were systems in place to ensure people received their medicines as prescribed and staff were trained to administer them. Minor concerns were identified, which we will comment further upon in the main body of the report and were being addressed by the staff.

We have made a recommendation about keeping records together in terms of people's medicines and risks associated with administration.

Staff recruitment processes were adequate but staff records had not been clearly audited in the past and gaps in record keeping meant we could not see if all the necessary checks were in place for all staff This was being addressed by the new manager. The same applied to staff training and supervision of practice. Records were not up to date but training was being refreshed and schedules were in place for future training and supervision.

People’s health care needs were monitored and promoted. People had sufficient to eat and drink but the monitoring of this was poor.

People’s records were not always up to date and we have made this a breach of the Health and Social Care Act 2008. The manager is aware and is working with their staff to improve upon this situation?

The service had a lack of effective systems to monitor the effectiveness and safety of the service it provide to individuals and the service as a whole. This has been identified as a breach of the above Act.

There was excellent engagement with health care professionals but less so with the wider community or with people and their families in terms of their preferences of care.

We found several breaches 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 this report.

We found that people who used the service understood the care and treatment choices available to them. People who used the service were also given appropriate information and support regarding their care or treatment.

We reviewed six sets of care records and found that people's needs were fully assessed. Care and treatment was planned and delivered in line with people's individual care plans. The care records showed us that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

As part of our inspection we spoke with six members of staff and found that there were enough skilled, experienced and qualified to staff to meet people's needs. We found that there was regular assessment and monitoring of the service and effective systems in place to reduce the risk and spread of infection.

We saw that people received appropriate care and support according to their personal needs. Risk assessments were regularly updated and advice was provided to staff members about how to provide care and support to people living at the home.

People were protected from the risks associated with medicines. We saw that medicines were stored safely and appropriately dispensed and recorded.

We saw that people living at Fairland House were supported by suitably qualified, skilled and experienced staff members.

There was an effective complaints system in place, and people knew how to make a complaint if they felt they needed to.