Archived: Fairholme

We had received concerns in respect of staff not adhering to PPE protocols which had the potential to put people at risk from the Covid-19 virus. The registered manager acknowledged some staff had removed face masks to have their photograph taken during the Christmas period. The manager had taken action to reinforce the requirement for staff to wear face coverings at all times. This was being closely monitored and additional testing had taken place.

We found the following examples of good practice.

The registered manager was communicating with people, health professionals, staff and family members regularly. This was to make sure everyone understood procedures and precautions being taken, and how to keep people safe during the current Covid-19 outbreak. The registered manager worked with the care staff team to ensure infection prevention and control measures were followed.

The registered manager and other senior staff provided training to ensure staff knew how to keep people safe during the COVID-19 pandemic. There were effective measures in place including the provision of PPE for staff and people visiting the service. This ensured people living and working at Fairholme had access to additional support. For example, medical and emotional support.

We observed there were effective procedures in place to support staff to follow current guidance on infection prevention and control in order to help people to stay safe. The registered manager ensured staff and people who used the service understood why the measures were in place.

The registered manager was supported by the providers, and other health professionals, including GP’s. Regular communication took place and there was a named professional designated to support the service.

When people were required to isolate, notices were available to alert staff to what was required, and what PPE was to be worn before entering the room. Systems were in place for additional checks to take place to ensure people’s wellbeing.

The service had put plans in place to effectively manage any outbreak using designated staff to prevent the risk of the virus spreading to others.

Staff helped people to stay in touch with family and friends through phone and video calls. The service had a safe visiting system, which was coordinated and meant visitors did not need to walk through the service to reach the visiting area. Appropriate PPE and screens were in place to safely support visits.

Further information is in the detailed findings below.

Fairholme Nursing Home is a ‘care home’ that provides nursing care for a maximum of 60 adults, with a range of health care needs and physical disabilities. At the time of the inspection there were 48 people living at the service. 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.

Fairholme is situated in the town of Camborne. It is a purpose built service on two floors. All rooms were single occupancy. There was a passenger lift serving the upper floor. Two lounges and a dining room were situated on the ground floor. There were additional quiet areas for people to use.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance. Training was provided to all staff with regular updates provided. The registered manager had a record which provided them with an overview of staff training needs.

The service had sufficient staffing levels in place to provide support people required. People told us staff were responsive and available when they needed them.

Staff had been recruited safely, received on-going training relevant to their role and supported by the registered manager and team leaders. They had the skills, knowledge and experience required to support people in their care. Staffing levels were sufficient to meet the needs of people who used the service.

Risks in relation to people’s daily lives were identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible.

Accidents and incidents were being recorded and reported and any lessons learned were shared with staff. The service learned by any mistakes and used this as an opportunity to raise standards. There was a culture of openness and honesty and staff felt able to raise concerns or suggestions.

Staff were supported by a system of induction, training, supervision and appraisals. Staff received training relevant for their role and there were good opportunities for on-going training support and development. More specialised training specific to the needs of people using the service was being provided. For example, dementia care and clinical nutrition support.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

Care plans were well organised and contained personalised information about people’s needs and wishes. Care planning was reviewed regularly and whenever needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted.

There were a range of quality assurance arrangements at the service in order to raise standards and drive improvements. For example, audits to ensure quality in all areas of the service was checked, maintained, and where necessary improved.

All levels of staff engaged with all stakeholders of the service. People’s views were taken into account through regular communication and surveys. The results of the most recent survey had been positive.

There was a system in place for receiving and investigating complaints. People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe? People told us they felt safe. Systems were in place to help the manager and staff members learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

Fairholme alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Fairholme had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). This helped to ensure that people's needs were met.

Is the service effective? People's health and care needs were assessed with them, although people were not involved in writing or reviewing their plans of care. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people's needs.

Specialist dietary needs had been identified where required. Care plans were up-to-date.

We saw that there was good liaison and communication with other professionals and agencies to ensure people's care needs were met.

Is the service caring? We spoke with people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, 'He's a nice boy, they all are' and 'I enjoy being here, the staff are wonderful'. When speaking with staff it was clear that they genuinely cared for the people they supported.

People's preferences and interests had usually been recorded although the quality of life histories was variable.

Fairholme had regular support from the GPs from the local GP practices and other visiting health professionals. This ensured people received appropriate care in a timely way.

Is the service responsive? Many people who lived at Fairholme had complex health needs and were either not able, or chose not to join in group activities. The care records did not always evidence the lifestyle of these people, or show that they were routinely offered one-to-one or group activities, although the manager told us action was being taken to remedy this.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led? Fairholme had a new manager, who had only been in place for approximately three weeks, but people told us they had confidence in the manager, the providers and the staff.

We saw minutes of meetings held with the staff and the people that lived at Fairholme. This showed the management consulted with people and staff to gain their views and experiences and improve support for people who lived at the service.

The service had a quality assurance system, and staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

People experienced care, treatment and support that met their needs and protected their rights and people were protected against abuse because the provider had appropriate arrangements in place.

There was sufficient, appropriately skilled and experienced, staff on duty to meet people's care needs. People were protected by the home's robust recruitment procedures.

Records were legible, up to date and stored securely, although not all required records were available for inspection.

People told us they felt they had enough to do to keep occupied, they confirmed there were activities provided and they could choose whether to participate or not. People told us they were happy with the care provided.

During our inspection, we found people’s privacy, dignity and independence were respected and people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People experienced care, treatment and support that met their needs and protected their rights, people were protected against abuse because the provider had appropriate arrangements in place and staff were well supported and trained.

The providers had systems in place to monitor the quality of the service provided at Fairholme.

We looked at the care planning and found that this had not improved since our last inspection on the 8 October 2012. The care plans did not direct, inform or guide staff, this meant that staff were not aware of how to provide care to individuals in a consistent manner. A consultant had been employed to implement new systems to improve the service.

The recruitment process had improved and we saw that all pre-employment checks had been gained prior to the person commencing employment.

Since our last inspection in October most of the staff had received training in areas such as safeguarding and pressure area care.

The system for monitoring the quality of service had not improved since our previous visit. The providers had sought advice from “consultants” in order to implement a new system to ensure that there will be an effective system in place.

We looked at documentation on care planning and found that this did not inform, direct or guide staff, this meant that staff were not aware of how to provide care to individuals in a consistent manner.

We were told that the home had recruited a number of new staff. Training for the staff was not delivered effectively .One member of staff explained that she had received four hours induction training when she started, the member of staff felt that four hours was not sufficient to cover all the mandatory training as it was 'a lot of information all at once'.

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive and the provider did not have an effective system in place to identify, assess and manage risks.