Archived: Fazakerley House Residential Care Home

We found the following examples of good practice.

Visitors to the service were screened for symptoms of COVID-19 prior to being invited inside, to help prevent the possible spread of any infection. Family visits were pre-arranged and took place in a comfortable, dedicated area designed and equipped to keep people and others safe. The area was thoroughly cleaned in between visits.

A family member told us, “Staff have been amazing. They have communicated with me during COVID and kept me up to date with everything, I can’t fault them in any way.” People told us they felt safe living at the service and staff told us they felt safe at work.

Staff had received up to date IPC training and had access to up to date policies and procedures to manage any risks relating to the COVID-19 pandemic. There was clear signage located around the service providing advice and guidance on things such as handwashing techniques, social distancing and disposal of domestic and clinical waste. Staff had a good understanding of current IPC practices.

Staff had access to a good supply of appropriate personal protective equipment (PPE). PPE was used and disposed of safely. People told us staff always wore a face mask and used, additional PPE when delivering personal care.

People living at the service, staff members and visitors were tested for COVID-19 in line with current guidance and a record of tests carried out at the service was kept.

There were two staff members appointed as infection prevention and control leads. They kept up to date with current IPC guidance and best practice and shared any updates across the staff team.

Fazakerley House accommodates up to 45 people across two separate wings, each of which has separate adapted facilities. There were 38 people using the service at the time of the inspection.

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

At our previous inspection in July 2018 the service was in breach of Regulations. At this inspection we found enough improvement had been made and the provider was no longer in breach of regulations.

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.

Medicines were now safely managed. Medication rooms were now kept locked when unattended by staff and medicines were now dispensed and administered to people at the right time. People told us they received their medicines on time.

The environment and mobility equipment were now safe and clean. More regular checks were now carried out on both the inside and outside of the environment and mobility equipment and any risk identified was acted upon promptly.

Care was now planned based on people’s needs and choices with clear outcomes recorded. Records in place to monitor aspects of people’s care and support were now completed as required to reflect people’s needs and the care provided. Records which contained personal information about people was now stored away when not in use and accessible to staff on a need to know basis.

The providers systems for monitoring the quality and safety of the service were now carried out at the required intervals and more effective in identifying and actioning areas for improvement.

Safe recruitment processes were followed for selecting staff and there was the right amount of suitably skilled and qualified staff to safely meet people’s needs. People felt safe living at the service. Staff understood their responsibilities for safeguarding people from the risk of abuse and for reporting any health and safety concerns. Accidents and incidents were reviewed, and lessons were learnt to help reduce further occurrences.

Staff received the support and training they needed for their role. Staff received regular support from their line manager and they attended regular staff meetings. Staff told us they felt well supported, valued and listened to. People received the support they needed to meet their dietary and healthcare needs.

People’s care and support needs were planned in a personalised way. People had developed good relationships with staff who understood their individual preferences and care needs. Adaptations and signage were in place to assist people with their mobility and orientation. Plans were in place to replace carpets with more suitable flooring in corridors on the ground floor.

People and family members told us that staff treated them well and were respectful, kind and caring. People were involved in making decisions about their care and they felt listened to.

The service promoted a positive culture that was person-centred. The registered manager was described by people, family members and staff as approachable and supportive.

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 (published July 2018). The service has improved to good.

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.

The last inspection of the service was carried out in July 2016 and during that inspection we found a breach of regulation 9, person centred care. Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to make the required improvements.

During this inspection we found improvements had been made, however we found breaches of regulations 12, 15 and 17. This was because; medication was not always managed safety and parts of the premises and equipment were unclean and unsafe. In addition the quality monitoring processes failed to identify and mitigate risks to people.

Fazakerley House is a ‘care home’. 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. Fazakerley House accommodates up to 45 people who require personal care. At the time of the inspection there were 43 people using the service. The service provides accommodation over two floors.

The service had a registered manager. 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 management of medication was not always safe. On the first day of inspection the medication room was unlocked with no staff present. There were items of pre-dispensed medication in pots on top of a cabinet which posed a risk to people who may have entered the room. We raised this at the time with a senior member of staff and they immediately locked the door to the medication room.

Parts of the environment and items of personal equipment were unclean and unsafe. An outside patio and a wooden summerhouse which people used were littered with weeds, cigarette ends and general waste, including used disposable gloves. Cigarette ends had been disposed of in a plastic bin which also contained used tissues and sweet wrappers, posing a fire risk. Items of personal equipment including wheelchairs and stand aids were heavily stained with food debris, dust and spillages. This increased the risk of the spread of infection. The patio and summerhouse were cleaned and made safe on the first day of inspection and by the second day of inspection personal equipment had had been cleaned.

Although people’s care was planned based on assessments carried out, some people’s care plans lacked information about how their needs were to be effectively met. Some people’s care plans did not clearly demonstrate what was the expected outcome for the person and there was a lack of monitoring of some people’s care.

The environment was equipped with aids and adaptations such as handrails and a passenger lift to help people move about safely and independently. However, there was a lack signage and stimulus for people living with dementia, such as items and focal points to support reminiscence. We were provided with information regarding plans to develop the environment.

People’s dignity and confidentiality was not always respected. Staff used dirty equipment to help people with their mobility and safety and an outside area which people accessed was unattractive. People’s confidentiality was not fully protected as files containing personal information about people were left in communal areas. Staff did however approach people in a kind and compassionate way and they used their knowledge of people to provide them with comfort and reassurance at times they were upset.

The approach to care planning for some people was person centred in that their care plans took account of the person’s views and preferences about how their care was to be provided. Work is in progress to ensure that each person’s care is planned using this approach. Staff responded to people’s needs in line with their care plans.

The registered providers quality assurance framework was not always effective. Checks carried out on the environment, equipment and care records failed to identify and mitigate risks to people which we found during our inspection. Records of daily checks carried out on the environment and equipment did not accurately reflect the findings. Although the concerns had been actioned by the second day of inspection, a consistent approach is needed to ensuring risks to people are identified and mitigated.

People told us they felt safe living at the service and that they would tell someone if they were worried about anything. Staff had access to training and procedures for safeguarding people from abuse. They knew the different types of abuse and how to report any safeguarding concerns. Allegations of abuse had been reported to the relevant agencies.

The recruitment of staff was safe. Applicants were subject to a series of checks prior to an offer of employment being made. This included checks on their criminal background, previous work history, skills and qualifications. There were sufficient numbers of suitably skilled and experienced staff deployed across the service to meet the needs of people and keep them safe.

Staff were provided with training and support for their role. New staff were provided with induction training which was linked to the Care Certificate. All staff were required to complete annual refresher training in topics linked to the Care Certificate as well as other topics relevant to their role and people’s needs. Staff received support through one to one supervisions and staff meetings.

People’s mental capacity had been assessed and plans put in place to guide staff on ensuring people’s rights were protected within the law. Records demonstrated that best interest decisions were made with the involvement of people and relevant others.

People’s nutritional and hydration needs were assessed and planned for. People were given a choice of food and drink which was prepared in accordance with their likes, dislikes and dietary requirements. Food and fluid intake was monitored for people where this was required. People commented positively about the provision of food and drink.

People received appropriate healthcare to meet their needs. People accessed healthcare services as and when they needed to, including their GP, dieticians and community nursing teams. Records were maintained for each person detailing the contact and input from external healthcare services.

Fazakerley House provides accommodation for up to 45 older people. The service is located in the Prescot area of Knowsley. Accommodation is provided over two floors. Bedrooms located on the first floor can be accessed via a stair case or passenger lift. There were 44 people using the service at the time of our inspection.

The service has a registered manager who was registered with the Care Quality Commission in January 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.

The last inspection of the service was carried out in June 2014 and we found that the service was meeting all the regulations that were assessed.

Improvements are required to ensure people receive all the care appropriate to their needs. People received the care and support they needed with their physical and healthcare needs from the right amount of staff, however there was not always enough staff to meet people’s social needs. People and family members told us that staff were often too busy and did not have much time to sit and socialise with people Opportunities for people to take part in meaningful activities was limited. This was because the activities co-ordinator only worked for part of the week and care staff were required to carry out domestic tasks as part of their role leaving them little time to engage with people.

Some fire doors leading to people’s bedrooms did not fit properly into the recess which posed a risk to people’s safety in the event of a fire. The registered manager acted upon this immediately by arranging for the door closures to be adjusted. The door to a bathroom which was used to store items of equipment was wide open. This posed a trip, slip and fall hazard to people. The registered manager locked the door immediately and instructed staff to keep it locked at all times.

The registered provider had a safe and fair recruitment and selection policy. Applicant’s suitability to work at the service was assessed based on information which they were required to provide. This included details about their previous employment history, skills and experience. In addition applicants underwent a series of pre-employment checks on their character before employment was confirmed.

There were safe systems in place for managing people's medicines. Medication was stored safety in dedicated rooms which were clean and tidy. Each person had a medication administration record (MAR) and a medication information sheet detailing their prescribed medication and any instructions for use. People received their medication on time by staff who had received the appropriate training and competency checks. When required people had accessed healthcare professionals such as GPs and district nurses.

People told us they liked the food and had plenty to eat and drink. Peoples’ nutritional and hydration needs were appropriately assessed and planned for. People received the support they needed to eat and drink and appropriate referrals were made on behalf of people to dieticians and speech and language therapists.

Care plans contained good information about people’s needs and how they were to be met and they were reviewed regularly and updated with any changes to people’s needs. Daily records which were maintained showed what care and support people had received and that staff had responded appropriately to any concerns about people’s health and wellbeing.

People’s privacy, dignity and independence was respected and promoted. People were approached in a kind and caring way and they were encouraged to do whatever they could for themselves. People’s bedrooms were personalised, clean and tidy and they were offered a key to their rooms and a lockable facility for their personal possessions.

Staff received training and support that helped them meet people’s needs. Training was made available to staff on an ongoing basis and their progress and knowledge was checked regularly to make sure they benefited from the training. Staff attended one to one meetings with their line manager and regular group meetings were held enabling staff to discuss their work, training and development.

Information about how to make a complaint was made available to people, their family members and visitors. People and family members said they would not be afraid to make a complaint if they needed to and they told us that they were confident they their complaint would be listened to and acted upon.

The service was managed by a person who people, family members and staff described as approachable and supportive. There was an open culture whereby all were encouraged to speak openly about any matters relating to people’s care and support. There were effective communication systems across all departments which helped to ensure people received consistent care and support to meet their needs.

Checks on the quality of the service were regularly carried out to make sure people received safe and effective care. Improvements needed were highlighted during checks and clear action plans were put in place and acted upon promptly to improve the service people received. However checks on the environment failed to identify some safety concerns, the registered manager acted upon these immediately and put measures in place to minimise risks to people's safety.

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 found appropriate care plans and risk assessments in place. These were sufficiently detailed, individualised to each person and reviewed regularly with the involvement of the person and relevant others. Staff provided care and support in a warm, polite and respectful way. Staff had a good understanding of the needs of the people who used the service and they knew how to respond to any concerns they had about a person’s health or wellbeing. Staff told us the staffing arrangements during meal times did not always meet the needs of people who used the service. Regular checks on people’s care and welfare were carried out to ensure people received safe and effective care.

Is the service effective?

People told us they were happy with the care provided and their needs had been met. Our observations and discussions with staff showed they were knowledgeable about the people they supported and records we viewed showed people had received the right care and support. People told us; “They know me well and are lovely with me" and "I feel as though I am part of a big family."

Is the service caring?

Staff spoke with people in a caring and compassionate manner. When people became anxious and upset, staff dealt with the situation calmly and were attentive to people's needs. People were valued and their privacy, dignity and independence were respected.

Is the service responsive?

We saw that before a person moved into the home, an assessment of their needs and abilities was undertaken. Care plans showed how the needs of the people who used the service were to be met, including how to manage any risks. Regular reviews of each person's care took place and any changes which were needed were quickly responded to. People's personal preferences such as their preferred routines were understood and respected. People were given the opportunity to put forward their views about the service and any changes suggested by them were listened to and acted upon. People told us they knew how to complain and felt confident that their complaint would be listened to and dealt with in the right way. One person commented, “I have raised concerns in the past and they were sorted right away.”

Is the service well led?

Staff and people who used the service spoke highly of the manager and said they were listened to when concerns or suggestions were made. We saw audits of various aspects of the service's operations such as medication management, care planning, people's finances and the homes environment had been regularly carried out. Where concerns were identified, processes were in place to enable appropriate changes to be made.

We spoke with five people and their relatives. They were very positive about the staff and care at Fazakerley. Their comments included:

"The staff are very good."

"The staff have time for you."

"I could see my care record if I wanted to."

'Sometimes I get a bit bored."

"The staff are alright.'

We found that the service operated an effective recruitment and selection process. All the staff we spoke with were positive about working at Fazakerley House. Records relating to the care, staffing and the management of the service were accurate and fit for purpose.

Service users spoke positively about the staff that worked there in terms of how their needs were met.

People living in the home appeared relaxed and comfortable in their surroundings and they told us they felt safe living at Fazakerley House.