Archived: Fairlawn Residential Home

We found the following examples of good practice.

Prior to the current lockdown the registered manager had been facilitating visits in a garden summer house. A Perspex screen divided the summer house for people and their relatives. During periods of lockdown the registered manager had sent emails about what activities people had done to keep relatives connected. There was also an iPad for people and relatives to have Skype calls.

Meal times were made more flexible to reduce the number of people in the dining room. Only two people ate at any dining table at one time and people could eat in the lounge or their rooms to further enable social distancing.

People were supported to go to essential healthcare appointments. For example, one person who had experienced an increase in falls attended an appointment to check a possible underlying cause. The registered manager said they had supplied the person with personal protective equipment (PPE) and transportation to reduce the risk of infection.

The registered manager told us they had reduced the number of healthcare professionals entering the service during peaks of COVID-19. For example, the registered manager said they had worked with the district nurse to support people with minor skin conditions. The district nurse dropped off dressings and provided guidance for the registered manager to carry out the care. Photographs were sent to the district nurse to review. The registered manager told us they had also reduced the risk of infection when the chiropodist visited by stationing them in one bathroom. Staff took people to the chiropodist to receive their care.

The registered manager had created an infection control booklet for staff to keep for easy reference. The booklet contained emergency action plans, hand washing techniques and correct PPE practice.

Further information is in the detailed findings below.

Fairlawn Residential Home is a ‘care home’. People in care homes receive accommodation and 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. Fairlawn is registered to provide accommodation and personal care for a maximum of 26 frail and elderly people, some of which were living with dementia. The service is a large extended property and people’s accommodation is provided over two floors with a stair lift available to support people to the upper floor.

There was a registered manager at the service. 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.

At the last inspection on 2 and 3 October 2017, we told the provider to take action to make improvements. This was because people, their relatives and staff told us there were not enough staff to meet the needs of those using the service. Additionally, we found shortfalls in the registered manager had not ensured that effective systems were in operation to monitor and improve the quality and safety of the service.

At this inspection we found there were enough staff deployed to meet the needs of people. Staffing levels had increased which had a positive impact on people using the service. The registered manager had improved quality monitoring procedures and audits, and had a better oversight of the quality of care being provided.

People were protected from the risk of abuse. Staff were trained in how to identify abuse and knew how to report it. Risks to people and the environment were assessed, recorded and staff took steps to minimise them. New staff were recruited safely in line with best practice and nationally recognised guidance. People received their medicines safely. Staff received training and had their competency checked regularly. People were protected by the prevention and control of infection. The registered manager took steps to learn from accidents, incidents and when things went wrong. They used information to help prevent future accidents.

People had their care and support delivered in line with current legislation and best practice guidance. Newly recruited staff received an induction which included training courses and shadowing more experienced staff. Other staff received refresher training that was built around those using the service. People’s nutrition and hydration needs were being met. People were involved in developing menus. Staff sought and followed guidance from health professionals if people had health conditions. People had access to health care and treatment. People’s needs were met by the design and adaptation of the premises. People were able to decorate and furnish their rooms as they wished. Staff were knowledgeable about the Mental Capacity Act (MCA) 2005, and worked in line with its principles.

Support was provided to people in a personalised way. Each person had their own care plan which had been reviewed taking into account their preferences and views. People were supported to take part in activities of their choosing. People said they knew how to make a complaint, and would do so if the need arose. Complaints were managed in accordance with the registered provider’s policy. People were supported at the end of their lives to have a dignified death. Their preferences were gathered and staff worked closely with health professionals.

The registered manager had the skills and experience to lead the service. The culture at the service was honest and transparent. Staff said they felt proud to work at the organisation. They had oversight of the daily culture in the service, which included the attitudes and behaviour of staff. People, their families and staff were encouraged to be engaged and involved in the service. There were links with the local community.

Fairlawn Residential Home is registered to provide accommodation and support to up to 26 older people. There were 21 people living at the service at the time of our inspection.

There was a manager in post who was registered with the CQC. 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.

Risks were managed effectively to ensure people’s safety and welfare. People were kept safe from abuse by staff who knew how to identify signs of potential abuse and were confident to respond appropriately. Staff used the safeguarding policy to guide them when reporting concerns and the registered manager investigated any concerns thoroughly.

Medicines were managed safely and effectively by trained staff. The registered provider had effective policies and procedures in place to help ensure the environment was kept safe and well maintained for the people living there.

There were insufficient numbers of staff to ensure that the needs of people were being met. The service did not use a systematic approach when determining the number and skills of staff required. Safe recruitment practices were carried out by the provider to ensure people were only supported by staff who were suitable to work with the people living in the service. Staff received training to help equip them with the right skills and knowledge to support the people in the service. The registered manager supported staff with regular supervision, but appraisals of staff performance did not take place. We have made a recommendation about this.

People were supported to have the 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 were happy with the food provided, and were supported to have a nutritious diet that met their needs. Communication between the kitchen and care staff was good. People were supported to have regular and appropriate access to health care professionals such as the dentist, optician, chiropodist and the GP.

People who used the service spoke highly about the caring nature of staff. Staff knew people well and were able to take this into account when providing care and support. Relatives told us they were happy with the support provided, and with the caring nature of staff. People and their relatives were involved with the planning of care. Relatives were kept up to date with any changes, incidents or concerns involving their loved ones.

People at the service had access to a range of activities, but these were not always tailored to the interests of the people using the service. We have made a recommendation about this. People and their relatives were positive about the input from the activities coordinator. Where people could not attend communal activities, individual sessions were provided.

The registered manager was seen to be open and transparent and welcomed comments and input from staff, people using the service and their relatives. There was a complaints procedure in place. Outcomes of investigations were shared with relevant people.

The registered manager was not carrying out any structured quality assurance of the care and support provided at the service. A new procedure was being developed at the time of the inspection.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. The home could accommodate 26 people and, when we visited, there were 25 people who lived in the home. People who lived at the home had a range of needs including dementia.

We spoke with three people living in the home and with two of their relatives. We looked in detail at three care plans. The manager was on holiday at the time of our inspection and so we spoke with the provider, the senior staff member who was the team leader, another staff member, the administrator, chef and an activities co-ordinator.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The home conducted assessments to ensure the right level of care was available and staff were guided in their work by detailed care plans. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Staff were trained and competent to deliver a safe level of care. This meant people were receiving a safe service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found that staff had received appropriate training and frequent supervision to ensure that their skills were up to date and appropriate to meet the needs of the people who lived at the home. This included regular updates in areas such as manual handling, first aid and fire safety. In addition, there was additional training in areas such as dementia.

Staff used effective practices, for example, to prevent falls. We also found care staff sought advice, where appropriate, from senior staff and from other health care professionals. The home provided an effective service.

Is the service caring?

We saw that the staff offered a caring service for people living in the home and that they were considerate and sensitive. One person who lived in the home said, "I like it here, I am very happy".

One relative we spoke with said, "The staff we have seen have been caring and considerate.'

Is the service responsive?

We saw that staff responded promptly to call bells and helped people with eating, drinking and moving about the home. We found evidence in the care plans that staff contacted appropriate healthcare professionals when required and informed relatives of any changes.

The provider invited and listened to feedback and made changes where they were reasonably practicable. Recent changes had included different arrangements for personal correspondence and changes to the menu. People we spoke with said they enjoyed the food and drink and we saw that the food they received suited their individual needs. The provider was responsive to the needs of people living in the home.

Is the service well-led?

The home was well managed with a qualified team of professional care staff. The staff we spoke with said that they felt supported in their work.

There was also an annual survey to take feedback and suggestions from people who lived in the home and their relatives. Feedback from the relatives we spoke with was positive and the people who lived in the home told us they were happy with the care they received.

People were asked for their consent before care was given.

People received care and support that was well planned and sensitively delivered.

People received the medicines they needed when they needed them.

People were supported by staff who had received appropriate training.

Effective quality assurance procedures ensured that people were provided with a good service.

Overall we found that this service was safe, effective, caring, responsive and well-led and had achieved compliance with all the standards we inspected. We have made some comments that the provider may find it useful to note to make sure that the home continues to provide a good service.

We also saw that staff supported and gently encouraged people to eat and drink at their own pace. One person who used the service said "The food was good and we get lots of choices."

People's needs were assessed and peoples likes and dislikes were identified including, the time they like to get up and go to bed, what they like to eat and drink.

We saw that evidence that a safe staff recruitment procedure was in place. We saw that staff received regular training and updates. All staff had received safeguarding training and policies and procedures were in place.

Staff we spoke to told us that they received regular supervision, people said they felt that the homes training programme enabled them to carry out their role competently and that the management team was supportive and accessible.

We saw the provider regularly assesses and monitors the quality of the service provided to protect people who used the service from the risk of inappropriate or unsafe care and treatment.

Monthly audits are carried out reviewing key areas such as care plans, risk assessment, medication, accidents, incidents, compliments and complaints, fire safety and the building environment. Appropriate actions are taken to address any concerns and identify areas of good practice.