Fairmount

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

People told us they felt safe and happy at the home. Staff understood how to safeguard people from harm or neglect. The home monitored any accidents and incidents to respond swiftly and identify learning.

Risks to people were identified and safely managed. There were enough staff to meet people’s needs and the home had effective and safe recruitment procedures in place.

Medicines were safely managed and infection prevention and control measures were effective.

Staff received a range of training to help them support people effectively. Staff received equalities and human rights training and people’s diverse needs were assessed and supported.

People were supported to maintain a healthy balanced diet and they had access to health care professionals when they needed them.

Staff asked people for their consent before they provided care or support. 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.

There was a warm and friendly atmosphere at the home. People were positive about the care they received and told us the way staff supported them was respectful and encouraged their independence.

People had a personalised plan for their care and were supported to enjoy a range of activities to engage them and reduce isolation. The staff worked with health professionals to ensure people’s end of life care needs were considered and met

People and their relatives told us the home was well managed and that the culture of the service was person centred. The provider had an effective system of oversight to ensure the quality and safety of the service was maintained. Staff told us they enjoyed working at the home and felt well supported.

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 requires improvement (report published 22 February 2021)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

You can read the reports from our previous inspections, by selecting the ‘all reports’ link for Fairmount on our website at www.cqc.org.uk.

Follow up

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

Fairmount residential care home is a care home service that accommodates 38 older people across two floors in one adapted building. The home specialises in caring for people living with dementia. There were 18 people using the service at the time of our inspection.

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

Since the last inspection, the service had made considerable improvements in relation to assessing risk, medicines management person centred care and good governance.

There were enough staff available to meet people’s care and support needs. The provider had appropriate arrangements to help prevent the spread of Covid 19. There were procedures in place to prevent visitors to the home from spreading infection at the home. The provider had accessed regular testing for people using the service and staff and shielding and social distancing rules were complied with. All staff had received training on infection control and specific training relating to COVID 19.

The service worked in partnership with healthcare professionals to embed improvements and deliver an effective service. Positive feedback was received about the service from relatives and staff.

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 Inadequate (published 5 May 2020) and there were multiple breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person centred care and good governance.

We also carried out an unrated inspection on 12 August 2020.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 13 May 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fairmount on our website at www.cqc.org.uk.

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.

Fairmount residential care home is a care home service that accommodates 38 older people across two floors in one adapted building. The home specialises in caring for people living with dementia. There were 19 people using the service at the time of our inspection.

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

During the inspection, improvement was still needed as discrepancies were found in relation to people’s repositioning, hourly checks and fluid intake. Medicines were managed safely, and people received their medicines as prescribed. However, improvement was needed with recording as some records had not been countersigned and any follow up was not recorded. There were systems in place to monitor the quality and safety of the service. However, improvement was still needed in relation to record keeping.

There were enough staff available to meet people’s care and support needs. The provider had appropriate arrangements to help prevent the spread of Covid 19. There were procedures in place to prevent visitors to the home from spreading infection at the entrance and on entering the premises. The provider had accessed regular testing for people using the service and staff and shielding and social distancing rules were compiled with. All staff had received training on infection control and specific training relating to COVID 19.

A new manager was in post since the last inspection, they and the director of care worked in partnership with healthcare professionals to embed improvements and deliver an effective service. Positive feedback was received about the service from relatives, staff and healthcare professionals.

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 Inadequate (published 5 May 2020).

Why we inspected

We undertook this targeted inspection based on the rating of the last inspection and whistleblowing concerns we received about the service. We wanted to check the impact of this on the service and ensure people were safe.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified continued breaches of regulations at this inspection because not enough improvement had been made in relation to assessing risks, medicines management and maintaining accurate and complete records in relation to people’s care.

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.

Fairmount is a care home service that accommodates 38 older people across two floors in one adapted building. The home specialises in caring for people living with dementia. There were 35 people using the service at the time of our inspection.

People's experience of using this service Medicines were not safely managed. Medicine Administration Records (MAR) were not always completed in full to demonstrate people had received their medicines as prescribed. Staff had not recorded opening dates of medicines where required to ensure they remained safe for use. Unlabelled medicines were found in the medicines trolley. People’s monitoring charts including food and fluid charts, repositioning charts and records relating to personal care were not always completed to help ensure people’s safety.

Staff were not always kind or caring. We saw one person was left to sleep instead of being encouraged to eat their lunch. Staff did not always treat people with dignity and did not always ask for their consent before supporting them. The provider’s systems to assess and monitor the quality of the service were not effective as they had not identified the issues we found at this inspection.

People said they felt safe and that their needs were met. Risks were identified, and risk management plans were in place to manage these safely. People were protected against the risk of infection. Assessments were carried out to ensure people's needs could be met. Accidents and incidents were appropriately managed and learning from this was disseminated to staff. Sufficient numbers of suitably skilled staff were deployed to meet people’s needs.

Assessments were carried out prior to people joining the home to ensure their needs could be met. Staff were supported through induction, training and supervisions. People were supported to have 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 supported to eat a healthy and well-balanced diet. People had access to a variety of healthcare professionals when required to maintain good health.

People’s independence was promoted. Based on observation, we saw that information was available to people in a range of formats to meet their individual communication needs if required. The service was not currently supporting people who were considered end of life, but if they did relevant information would be recorded in their care plans. The provider worked in partnership with key organisations to ensure people's individual needs were planned.

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 of the service was requires improvement (published on 19 July 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to, dignity and respect, safe care and treatment and good governance.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will ask the provider to complete an action plan to show what they will do and by when to improve to at least good. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner. We will also meet with the provider.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Fairmount is a care home service that accommodates 38 older people across two floors in one adapted building. The home specialises in caring for people living with dementia. There were 29 people using the service at the time of our inspection.

People's experience of using this service

Medicines were not safely managed. Medicines were not always administered in line with the prescriber’s directions. Risks to people were not always assessed or reviewed and the provider did not always have appropriate risk management plans to guide staff on how to keep people safe. For example, staff were not provided with up to date guidance for one person who was at risk of choking. On the first day of inspection we saw the person choke whilst eating their lunch

Accidents and incidents were not analysed to determine trends or themes and share any learning with staff. Where people were at risk of malnutrition and dehydration, food and fluid charts were not completed and/or monitored. People and their relatives were not always involved in planning their care needs. Care plans and risk assessments were not always updated when there was a change in people’s needs and there was not always updated guidance in place for staff to follow. The provider's quality monitoring systems were not effective. Internal audits did not identify the issues we found at this inspection.

People said they felt safe and that their needs were met. There were enough staff to meet people’s needs in a timely manner. People were protected against the risk of infection. Assessments of people’s needs were carried out prior to them moving to the home to ensure their needs could be met. People's rights were upheld with the effective use of the Mental Capacity Act 2005. 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. Their needs were accurately assessed, understood and communicated.

Staff training was up to date. Information was available to people in formats that met their individual communication needs. Staff were supported through regular supervisions. Regular staff and resident meetings were held to obtain people’s feedback. The service was not currently supporting people who required end of life care support, but relevant information was recorded in care plans so this was available when people required this support. Recruitment checks were robust, and the suitability and competence of staff had been assessed appropriately and recorded.

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 Inadequate (published 22 August 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person-centred care, dignity and respect, safe care and treatment, premises, staffing and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will ask the provider to complete an action plan to show what they will do and by when to improve. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

At our last inspection in February 2017 we found breaches of legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care plans and risk assessments were not always completed or updated and did not always provide clear information and guidance for staff on how to safely manage risks identified. Personal evacuation plans were not always completed to ensure people would be safely evacuated in the event of an emergency. People's food and fluid charts and Malnutrition Universal Screening Tool (MUST) were not always adequately completed or monitored. Not all staff had DBS checks carried out before they started work. Best interests meetings were not always carried and decisions documented. Following that inspection, the provider wrote to us to tell us the action they would take to address our concerns.

At this inspection, we found that the provider had addressed the individual concerns identified at our last inspection. However, we found further breaches of legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were not enough staff deployed to meet people's needs. There were not enough hoists to meet people’s needs in a timely manner. Risks to people had been assessed and minimised, but risk management plans did not list the equipment required and used to mobilise people. People were not always protected from the risk of infection as individual hoist slings were not used when mobilising people. Processes were in place to monitor the quality of the service but these were not always effective as they did not identify the issues we found at this inspection.

Fairmount provides accommodation and personal care for up to 38 older people and specialises in caring for people living with dementia. There were 29 people using the service at the time of the inspection. 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.

There was a registered manager in place, who was on leave at that the time of this inspection. The deputy manager and area manager were available on the day. 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.

People told us they felt safe. There were appropriate adult safeguarding procedures in place to protect people from the risk of abuse. Staff understood the types of abuse that could occur and were aware of the action to take if they had any concerns. Staff knew about the home’s whistleblowing procedure and told us they would use it if required. The home recorded accidents and incidents acted on them in a timely manner. Medicines were stored, administered and managed safely. Appropriate recruitment checks were carried out before staff started work to ensure that they were suitable.

Staff received appropriate training and were supported through supervisions and appraisals so that they were effectively able to carry out their roles. The registered manager and staff understood the requirements of the Mental Capacity Act 2005 (MCA). People were supported to have 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. Staff told us they asked for people’s consent before they provided care. People were supported to have enough to eat and drink and had access to healthcare professionals when required to maintain good health.

People told us staff were kind, caring and respected their privacy, dignity and independence. People were involved in decisions about their daily care needs. People were provided with information about the service when they joined in the form of a 'service user guide' so they were aware of the services and facilities on offer.

People's needs were assessed prior to moving into the home to ensure their needs could be met. Care plans were reflective of people's individual care needs and preferences and care plans were reviewed on a regular basis. There were a variety of activities available for people to enjoy and participate in. People were aware of the home’s complaints procedures and knew how to make a complaint. People's cultural needs and religious beliefs were recorded and they were supported to meet their individual needs. Where appropriate people had their end of life care wishes recorded in care plans.

People and staff were complimentary about the registered manager and people and their relatives were provided with opportunities to provide feedback about the service.

Fairmount Residential Care Home provides accommodation and personal care for up to 38 people older people and is situated in the London Borough of Bromley. At the time of our inspection there were 31 people living at the home.

Fairmount Residential Care Home was taken over by a new provider in October 2016. There was a registered manager who had been in post since December 2016. 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 this inspection we found two breaches of legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Care plans and risk assessments were not always completed or updated and did not always provide clear information and guidance for staff. Personal evacuation plans were not always completed to ensure people would be safely evacuated in the event of an emergency. People’s food and fluid charts and Malnutrition Universal Screening Tool (MUST) were not always adequately completed or monitored. Best interests meetings were not always carried and decisions documented. Not all staff had DBS checks carried out before they started work. Although the provider had introduced and carried out a number of internal audits since taking over the service, not all shortfalls identified had been followed up and addressed at the time of the inspection. The provider only took over the service five months will ago and has assured us that all actions identified would be followed up as soon as possible. You can see the action we have asked the provider to take in respect of this breach at the back of the full version of the report.

Safeguarding adult’s procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

We saw staff training except for MUST training was up to date. Staff received supervision, appraisals and training appropriate to their needs and the needs of people who they supported to enable them to carry out their roles effectively. There were processes in place to ensure new staff were inducted into the service appropriately.

The registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005(MCA) and Deprivation of Liberty safeguards (DoLS). Staff asked people for their consent before they provided care.

People had access to a range of healthcare professionals in order to maintain good health. People were treated with kindness and compassion and people's privacy and dignity and confidentiality was respected. People were supported to be independent where possible such as attending to some aspects of their own personal care.

Staff were knowledgeable about people's individual needs. People's religious beliefs were recorded to ensure that staff took account of people's needs and wishes.

People were involved in their care planning and the care and support they received was personalised and staff respected their wishes and met their needs. People knew about the service's complaints procedure and said they believed their complaints would be investigated and action taken if necessary.

Regular resident and staff meetings took place and people’s views had been sought about the service.

People and staff told us they thought the service was well run and that the registered manager was supportive.