Archived: Fairfields House

The provider had sent us action plans telling us what action they intended to take to become compliant following our earlier inspections. On nutrition, the provider told us that they would be compliant by 31 January 2014. However, because of fresh concerns that were raised with us, it was felt that an early inspection was warranted before that date, due to our concerns for people's wellbeing.

Similarly with the safety and suitability of the premises, the target date was 30 April 2014. However, in the action plan, the only area that we were told would not be compliant by the date of our inspection was the replacement of a fire alarm panel, which the provider had planned to do during their next round of refurbishments in March/April 2014. As the fire panel did not relate to the concerns that had been raised with us about the safety of the building we decided that an early inspection was warranted before that date, due to our concerns for people's wellbeing.

Three compliance inspectors took part in this inspection and an independent nutritional advisor. We found that although there had been some improvement, further improvement was required.

We found that people's needs were assessed, but their care plans did not always reflect their needs. We found that improvements had been made in the way that people's nutritional needs were assessed and met; if people were identified as having lost weight they were being referred to the dietician. However, staff were not always aware of people's nutritional needs.

The provider had taken action to make improvements to the safety of premises, but still needed to carry out work to satisfy the environment health agency that the building was safe. We saw that the service needed to take more precautions to protect people from Infection.

There was not always enough qualified, skilled and experienced staff on duty to meet people's needs.

We found that the provider had failed to properly assess the risk to people's health and welfare and did not have systems in place for them to monitor the quality of the service they provided.

During our inspection we found that the provider had failed in their duty to protect the people who used the service and others, because they failed to assess the risk of fire within the service, and to take action to protect people from it. They also failed to monitor cleanliness and infection control within the service.

We were told by an anonymous person that the heating in the service was not working properly and that some of the communal areas and bedrooms were cold. Two of the rooms reported to be cold were people's bedrooms, who chose not to leave their bedroom during the day. This meant that people might be at risk from developing hypothermia.

This concern was not founded, because the service recognised that they had problems with the heating and were taking action to keep people safe and to get the heating system repaired. However, this outcome 10, safety and suitability of premises, outcome 5, meeting nutritional needs and outcome 16, assessing and monitoring the quality of service provision had previously been found not compliant because of concerns we had during our previous inspection of 11 September 2013. This means that these outcomes will remain not compliant. We will be assessing whether the service has taken sufficient action to become compliant in these outcomes at a later date.

We had also received information that concerned us and made it necessary to reconsider our judgement of how this service supported people with their nutritional needs. During past inspections people had told us that they were unhappy with the choice of meals they were given, the quality of the cooking and the quantity they were given. The service had taken action but the dietitian who supported this service had since voiced concerns about the way they supported those people who were nutritionally vulnerable.

We found that care plans did not always contain accurate information, did not always reflect people's dietary needs and did not give staff proper guidance around meeting those needs. We also saw that the staff had not received training around supporting people with their nutritional needs.

We saw that improvements had been made in the way that the service managed records and that supervision and training was taking place.

On 22 April 2013 we found that the planning and delivery of care failed to reflect published research evidence and guidance issued by professional and expert bodies as to good practice. We also saw that care plans were not always updated to reflect people's changing needs.

During this inspection we saw care plans had been updated and that the pressure sore risk assessment tool (Waterlow) and the malnutrition universal screening tool (MUST) were being used.

We talked with three people who used the service. They told us that they were comfortable and liked living there. One person told us, 'I'm comfortable here.' Another person, who had previously told us that meals were repetitive, said that, 'There have been changes to the menus and we get more choice now.'

One person told us that they had a problem keeping their bedroom door open. They took us to their room to show us how they used a stool to keep it open. We noticed other fire safety infringements. When this was brought to the attention of the provider they took immediate action to maintain fire safety within the service.

We found that the planning and delivery of care failed to reflect published research evidence and guidance issued by professional and expert bodies as to good practice in relation to the care and treatment of some of the people who used this service.

We found that people's nutritional needs were being met, but people told us that they were given limited variety and choice in their meals. There were no processes in place for recording and monitoring nutrition intake, and fluid charts had not been properly completed.

We saw that staff were not supported through supervision and that they did not receive adequate training essential for caring for older people.

During our last inspection of this service on 1 August 2013 we found that the systems in place were not effectively assessing and monitoring people's nutritional intake, because they were not completed properly. On this occasion we found that the service had still not maintained the records effectively.