Fairfield Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. We identified issues with the accurate assessment and recording of people’s needs. Care plans we reviewed failed to clearly assess and document individual needs. For example, one person’s dementia diagnosis was described inconsistently, minimising its impact. Another person’s mobility and fall risk were not reflected in their emergency planning. These gaps may lead to ineffective care delivery and missed opportunities for intervention. Staff told us their concerns about water jugs not being refilled regularly. One relative told us, "The care they give is as good as anywhere." Anotherrelative said, “They seem to be very well experienced about [Name]’s needs and the care they require.” However, some relatives told us although needs were generally met some areas could be improved. For example, one relative said, “They work well with [Name] but I think they could encourage them to sit out of bed more. But [Name] does not have a comfortable chair.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. Professional partners reported the provider follows external professional advice, including treatment plans. In the care plans we reviewed there was limited evidence of people and/or their loved ones being involved. We observed people did not always have access to nutritious food which reflected their preferences. We noted some people were spending extended periods in bed throughout the day. One person told us, “I don't get out at all. It is depressing. They don't get me up. Sometimes they leave me lying in bed all day. They don't support me to bathe." We found some people were not supported to bathe in line with their preferred method. At the time of the assessment, refurbishment work was underway to install additional bathing facilities, including a bath, which were not previously available in the home.

The provider did not always work well across teams and services to support people. We observed staff working well together to support people. However, the feedback we received from staff was mixed. Comments included, “The staff are lovely to work with,” and “All staff work well together. We are a very good team, including the manager and deputy manager.” However, other staff members told us there is tension amongst the staff team. They described a lack of shared responsibility and uneven workload distribution. One staff member said, “We are given the tasks out of our job role in addition to our other jobs which is hard.” Leaders told us this perception may have been influenced by ongoing service improvements and the introduction of a new electronic care planning system, which temporarily created additional work as staff adjusted to new processes. Feedback from people and their relatives on care coordination was mixed. One person had seen external professionals, while others were unsure or unaware of coordination efforts. A relative told us how they felt coordination had improved following incidents such as falls or seizures, though was unsure about any involvement of external services. They said, “They always have somebody on the corridor and someone in the day room; and the staff nurse who oversees everything.” Another relative said their loved one had not yet needed multi-agency support but expected good coordination if required.

The provider did not always actively support people to manage their health and wellbeing, promoting independence, choice, and control. Some people and their relatives told us about poor nutrition and a lack of stimulation.We observed people were given small portion sizes. For example, one person was served only one piece of cheese on toast for their evening meal, and another was served a fried egg and a scoop of mashed potato. Leaders told us these meals were served in line with people’s individual preferences at the time of the assessment. However, we received feedback from some people and staff that food variety and portion sizes could be improved.We observed a person requesting an extra helping of custard, which was provided according to their preference. Some people told us they can request additional portions, and these are provided when available. One person said, “I don't get out. No one talks to me. They just leave me here. The bread is thin. The food is not healthy. It is a waste of time telling them as nothing gets done." Another person told us, “The food is poor. Unhealthy. Sometimes we get tinned fruit but mostly it is just cake and custard." Some relatives noted oversight with food choices. One relative reported informing the provider their family member disliked certain foods; however, these continued to be served to them. Some members of staff told us nutritional training was minimal, with reliance on informal advice from catering staff. Some staff members expressed concerns about food quality, small portion sizes, and poor variety of meals. Comments included, “Food choices for residents are poor,” “Requests for alternative meals are denied,” and “Portion sizes are small.” We observed some people remained sitting in the lounge all day. Some members of staff told us they were concerned about people left sitting in communal areas for long periods, increasing the risk of pressure damage. Some staff mentioned call bells and requests for help were sometimes ignored, particularly on the upstairs floor. However, we observed call bells were answered within a reasonable time frame.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and consistent, and they met both clinical expectations and the expectations of people themselves. Professional partners told us there was consistency in care quality and positive people’s outcomes. However, the documentation inconsistencies we found within people’s care plans made it difficult to monitor outcomes. For example, one person’s mobility status and support needs were contradictory within their care plan. In another example we found wound care records showed discrepancies in healing timelines. Staff told us care plans lacked sufficient information and did not reflect people’s needs. One relative raised concern about staffing levels and the care their loved one receives. They said, “[Name] needs to move and get their mobility back, but they have not got the staff to help so they just sit all day.”

The provider did not always ensure people were fully informed about their rights around consent, nor consistently respect these when delivering person-centred care and treatment. While leaders demonstrated a proportionate approach to restrictions, including the use of Mental Capacity Act (MCA) assessments and least restrictive options, there were inconsistencies in practice. Consent to care was generally recorded within people’s care records, and we saw examples of staff seeking verbal consent before carrying out tasks. Records included capacity assessments and best interest decisions where required. However, some staff’s understanding of the MCA and Deprivation of Liberty Safeguards (DoLS) was limited. Documentation within care plans and emergency planning contained contradictory guidance about capacity and consent, creating uncertainty for staff about whether to act under best interests or seek consent. For example, in one person’s care plan it stated both that they may not be able to communicate decisions, and that staff should gain verbal consent. There were unclear escalation protocols and guidance for staff on best interest decision-making in emergencies.We found the covert administration of medicines was not always carried out in accordance with documented authorisations, as required under the MCA.