This inspection took place on 23 and 25 January 2018. The first day was unannounced.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.