Fairby Grange

Fairby Grange provides accommodation and personal care for up to 27 older people. The service provides both permanent and respite support. There were 18 people living at the home on the day of our inspection.

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

Medicines had not always been stored at the correct temperature to ensure they were safe to use. Medicine administration record (MAR) charts for one person had not always been checked and signed off by two staff to make sure the MAR had been completed accurately according to the prescriber's guidance. The registered manager took immediate action to rectify this.

Risks to people had not always been identified to ensure staff had the guidance necessary to follow a specific plan to prevent harm. Risk assessments were not always in place to detail safe ways of working with some people with certain condition such as people prescribed blood thinning medicines. The registered manager took immediate action to rectify this.

We found that staff were not always adhering to government guidance on Covid-19. We observed some staff not wearing masks or not wearing them correctly in the service.

There were enough staff to meet people’s needs during the day. However, we found there may not be enough staff at night in case of fire evacuation. The provider responded by recruiting additional night staff.

The governance of the service was not robust enough. Although improvements had been made, we found areas that require further improvements.

Staff supported people and ensured they were safe. Staff recorded accidents and incidents and ensured preventative measures were implemented.

People received support with their food and fluid needs. One person said, “We get good food and offered choices. We get to choose a day before.” The home was adapted and designed in line with people’s needs.

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.

People were supported by kind and caring staff. Staff treated people with respect and ensured people’s privacy was maintained. People were treated with dignity.

People had access to a range of activities to suit their needs and preferences. People were encouraged to maintain relationships with relatives and new friendships in the home were promoted. For example, we met three ladies who told us, “Lovely here. We have made friends here.”

People felt included in the running of the home. Staff received regular supervision and took part in staff meetings. This meant they felt comfortable to raise any concerns or suggestions in relation to the care provided.

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 12 March 2020). The service remains requires improvement.

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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about incidents and accidents reporting, safeguarding, medicines, infection control, staff trainings, risk assessments and compliance with fire regulations. A decision was made for us to inspect and examine those risks.

This inspection was carried out to follow up on action we told the provider to take at the last 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 COVID-19 and other infection outbreaks effectively.

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 monitor the service and will take further action if needed.

We have identified two breaches in relation to, safe care and treatment; medicines management and robust monitoring of the quality and safety of the service.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Fairby Grange provides accommodation and personal care for up to 27 older people. The service provides both permanent and respite support. There were 26 people living at the home on the day of our inspection.

People's experience of using this service

Medicines were not always safely managed. Medicine administration record (MAR) charts contained gaps without any explanation. Liquid medicines did not have open dates to ensure that they were effective to administer. Medicines competency checks and audits carried out did not identify the shortfalls found at this inspection.

Risks were not always identified and assessed. Risk management plans did not always guide staff on how risks should be minimised. Accidents and incidents were not always appropriately recorded and investigated and learning from this was not always disseminated to staff. Care plans were not always updated to show a change in people needs. Internal audits were either not carried out or did not always identify the issues we found at this inspection.

People said they felt safe and that their needs were met. People were protected against the risk of infection. There were enough staff deployed to meet people’s needs in a timely manner.

Assessments were carried out prior to people joining the home to ensure that all their needs could be met. Staff were supported through induction, training, supervisions and appraisals. 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 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 did not support them in the least restrictive way possible and in their best interests. Their needs were accurately assessed, understood and communicated.

Staff were caring and respectful. People, including those living with dementia were offered a variety of stimulating activities on a regular basis. Information was available to people in a format to meet their specific communication needs. The service was not currently supporting anyone considered to be at end of life, but relevant information was recorded in their care plans.

People’s independence was promoted by staff. The provider worked in partnership with key organisations to ensure people's individual needs were planned. Annual surveys were carried out to obtain people’s feedback.

Rating at last inspection

The last rating of the service was good (published on 10 May 2017).

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 person-centred care, , safe care and treatment, and good governance.

Please see the action we have told the provider to take at the end of this report.

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 may also meet with the provider.

There was no registered manager in post at time of inspection. The registered provider had an acting manager in post that was going through the processes of becoming registered 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.

At our previous inspection on 14 March 2016, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities). These breaches were in relation to assessing individual risk of people living at the service, understanding of the Mental Capacity Act 2005 and appropriate records and quality monitoring systems. At this inspection, improvements had been made and the service was compliant with all regulations.

The registered provider had systems in place to protect people against abuse and harm. The registered provider had effective policies and procedures that gave staff guidance on how to report abuse. The acting manager had robust systems in place to record and investigate any concerns.

Risks to people's safety had been assessed and actions taken to protect people from the risk of harm. The environment was clean and tidy.

Medicines were stored securely and safely administered by staff who had received appropriate training to do so.

There was sufficient staff to provide care to people throughout the day and night. When staff were recruited, they were subject to checks to ensure they were safe to work in the care sector.

Mental capacity assessments were being carried out and these were decision specific. Staff and the registered manager demonstrated good knowledge of the Mental Capacity Act 2005. However, we found that one area had been missed. We have made a recommendation about this in our report.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people's freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005.

People were referred to health care professionals when needed. People’s records showed that appropriate referrals were being made to GP’s, speech and language therapists, dentists and chiropodists.

Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed.

People were being supported to have a nutritious diet that met their needs. People were supported to eat by suitably trained staff.

Relatives spoke positively about staff. Staff communicated with people in ways that were understood when providing support. People’s private information was stored securely and discussions about people’s personal needs took place in a private area where it could not be overheard.

People had complete freedom of choice on how they wanted to live their lives. Staff supported people to make choices and understood the importance of this.

The provider had ensured that there were effective processes in place to fully investigate any complaints. Records showed that outcomes of the investigations were communicated to relevant people. People and their relatives were encouraged to give feedback through resident meetings and yearly surveys.

The acting manager was approachable and supportive and took an active role in the day-to-day running of the service. Staff were able to discuss concerns with them at any time and know they would be addressed appropriately. The acting manager was open, transparent and responded positively to any concerns or suggestions made about the service. The provider carried out surveys to identify shortfalls with the service and took action as a result.

There was a registered manager in post. 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 registered manager was supported by a senior care staff to ensure the daily management of the service. The registered provider was present in the service most days during the week and was involved in the day to day management of the service.

This was the first inspection of the service under the provider’s registration, however the registered manager had continued to manage the service during the transition from the previous ownership to the current.

The registered provider had not ensured that risks to individuals were appropriately assessed and minimised, for example the risk of developing pressure wounds, malnourishment and falls. However, staff were responsive to changes in people’s needs and made referrals to health professionals as needed.

The registered provider had not ensured that staff and the registered manager fully understood and adhered to the principles of the Mental Capacity Act.

The registered provider did not have effective systems in operation for checking and improving the quality of the service. They had not identified shortfalls found in this inspection, for example in relation to managing risks and meeting the requirements of the Mental Capacity Act.

Generally staff promoted a person centred culture in the service, but some of the language that staff used reflected a culture that focussed on getting tasks completed more than a person centred culture. Staff referred to ‘doing’ people when they were talking about who they were going to assist with personal care and ‘feeding’ people rather than supporting them with their meals. The registered provider had spoken with staff about the use of appropriate language in a team meeting, but this had not ensured the required improvements.

The registered provider had not ensured accurate and complete records were maintained in respect of the running of the service.

Staff were trained in recognising the signs of abuse and knew how to refer to the local authority if they had any concerns. Systems were in place to protect people from abuse. Staff showed they understood the need to meet the emotional needs of people living with dementia as well as their physical needs.

There were enough staff employed, with the right skills and experience, to meet people’s needs. The registered provider ensured appropriate checks were made before new staff started work to ensure they were suitable to care for people.

People’s medicines were managed so that they received them safely. People had their health needs met by a team of health care professionals. Staff supported people to access the care they needed. Staff took necessary precautions to reduce the risk of people acquiring an infection in the service. We made a recommendation about the access arrangements for the laundry room.

The premises were clean, safe and well maintained and suitable for the needs of the people that lived in the service. The registered provider had given some consideration to the specific needs of people who live with dementia. Signs had been fitted providing people with guidance to bathrooms and living spaces and people had been supported to choose a picture for their bedroom door that would help them recognise their room. Risks within the premises had been assessed and minimised. Equipment used for the provision of care was appropriately maintained. Accidents and incidents were monitored and action taken to reduce the risk of them happening again.

Staff were provided with training appropriate to their roles and had the opportunity to complete a relevant health and social care qualification. Staff were appropriately supervised and supported to ensure they carried out their roles effectively and safely.

People were provided with sufficient food and drink to meet their needs. We made a recommendation about the availability of drinks and snacks and the arrangements for serving meals.

Staff were caring and kind in their approach and demonstrated compassion and patience when supporting people. Staff knew people well and knew information about their families and personal histories. A staff member told us, “Knowing about people’s lives and their past helps reduce their frustration when we are caring for them”. Staff provided reassurance to people who were distressed or disorientated in a warm way. People were enabled to stay in touch with family and friends.

People were involved in decisions about their day to day lives and their care. People’s privacy was respected and people were supported in a way that respected their independence. The staff promoted people’s independence and encouraged them to do as much as possible for themselves.

Most people received a personalised service that met their needs. However, we found that people who used the service for a period of respite did not always have a care plan developed within a reasonable timeframe. We have made a recommendation about this. Staff responded to people’s needs and requests in a timely way. We made a recommendation about ensuring that people can access their call bells at all times. The service provided a variety of social opportunities for people. People said they enjoyed the social opportunities and entertainment provided. The registered provider had improved the provision of activities recently to ensure the activities provided were personalised to individuals’ hobbies and interests.

People’s views were sought and acted upon. The registered manager sent questionnaires regularly to people to obtain their feedback on the quality of the service. The results were analysed and action was taken in response to people’s views. Regular residents meetings were held and the registered manager took account of people’s comments and suggestions. People knew how to make a complaint and felt confident to do so.

The registered manager provided clear and confident leadership for the service. The registered provider and the registered manager understood their legal responsibilities. They had notified the Care Quality Commission of any significant events that affected people or the service.

During this inspection we found three 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 also made a number of good practice recommendations as follows;

We recommend that the registered provider review the access arrangements for the laundry.

We recommend that the registered provider consider arrangements for making drinks and snacks readily accessible to people to allow them to access them without having to ask staff. We recommend that the registered provider review the arrangements for serving meals to ensure people are not waiting whilst others are eating.

We recommend that the registered provider review the systems in place for ensure that people can call for assistance if needed.

We recommend that the registered provider establish an appropriate timeframe for developing a care plan that identifies and meets the needs of people using the service for respite care.