Fairholme House

Fairholme House is a residential care home providing personal and nursing care for up to 22 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 17 people living at the service.

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

There had been significant improvements made to improve people’s outcomes. People told us they felt safe living at Fairholme House. Staff knew how to identify and report any concerns. Staffing levels had improved, and the home was using no agency staff. There were sufficient staff deployed to meet people's needs. The provider had safe recruitment and selection processes in place.

Risks to people's safety and well-being were managed through a risk management process. Medicines were managed safely, and people received their medicines as prescribed.

People had a pleasant dining experience which offered a variety of appetising homemade food choices available at times that suited people's preferences. The menu was overseen, and food prepared by an enthusiastic catering team who knew people’s needs very well. Staff supported people to maintain food and fluid intakes.

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. Staff had a particularly good understanding of when the principles of the Mental Capacity Act should be applied.

Provision of activities had improved, and people had opportunities to participate in meaningful activities and we saw evidence people were involved in choosing activities and following their hobbies.

The home was well-led by a new registered manager who was committed to improving people's quality of life. The registered manager had developed internally and knew the service well. The registered manager and the provider created a clear management structure and established a group of staff who worked well as a team. The provider’s oversight of the service had significantly improved. The provider had introduced effective quality assurance systems which were used to monitor the quality and safety of the service. Staff worked well with external social and health care professionals.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (Published 19 July 2022). 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 improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended the provider consider current good practice guidance on staff training, induction and supervisions and take action to update their practice accordingly. At this inspection we found the provider had acted on the recommendations and had made improvements.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

We carried out an unannounced focused inspection of this service on 31 May 2022. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment as well as good governance. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fairholme House on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Fairholme House is a residential care home providing personal and nursing care to up to 22 people. The service provides support to older people, some of whom living with dementia. At the time of our inspection there were 16 people living at the service.

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

We had received concerns of poor care. We found people’s medicines were not always managed safely due to poor stock control, a lack of guidance and staff competency assessment.

People were not always safe from the risk of fire due to a lack of staff training and knowledge and risk assessments not being in date.

The provider’s maintenance and monitoring systems were not always updated to maintain people's environmental safety.

The provider had no clear process of managing accidents and incidents and as such there were no lessons learnt. We found people’s records were not always up to date and some of them had conflicting information.

New staff received induction and training, however, the content could be improved. We have made a recommendation about staff induction.

There was a longstanding registered manager in post who had recently withdrawn their resignation following the departure of a newly recruited deputy manager. The provider told us they were in the process of restructuring the management team to ensure effective oversight of the home.

The provider had some quality assurance systems in place, however, these were not always effective. Audits of care and safety were not always completed consistently and had not identified the shortfalls we found. The provider did not have a formal system of regular engagement with people and relatives or of obtaining feedback on care, they relied on their open-door policy. This meant there was a missed opportunity to improve care based on people’s feedback.

Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place. There were sufficient staff deployed to meet people's needs. The provider was continuously recruiting for care, maintenance and activities staff posts.

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. Staff had a particularly good understanding of when the principles of the Mental Capacity Act should be applied. People were supported to meet their nutritional needs and complimented the food at the home.

People and relatives told us staff were caring. Staff did all they could to promote people’s independence and we saw examples of this. People had access to other healthcare services, ensuring a holistic level of support was provided. Staff worked well with external social and health care professionals.

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 good (published 11 January 2018)

Why we inspected

We received concerns in relation to staffing, recruitment, training, medicines management, records, activities, quality of care and management of the home. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the relevant key question sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fairholme House on our website at www.cqc.org.uk.

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 and Recommendations

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 as well as good governance at this inspection.

We have made a recommendation about staff induction.

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

Fairholme House is a residential care home providing personal care to 11 people aged 65 and over at the time of the inspection. The service can support up to 22 people.

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

We received information raising concerns about moving and handling practices, the cleanliness of the home, people not being reviewed when they have weight issues, storage of medicines and the registered manager and provider not addressing issues when they were brought to their attention.

We found people were being mobilised safely and relevant documents were in place to ensure staff followed these when supporting people. The kitchen and various rooms we viewed were clean and there was a cleaning schedule in place. Medicines were stored appropriately and safely. People’s weight was checked on a regular basis and where there were concerns external professional advice was sought. There was no evidence that issues brought to the attention of the registered manager and provider were not addressed. Staff were positive about the registered manager being approachable and listening to their views.

People and a visiting professional gave us positive feedback about the home. People confirmed the staff were kind and the registered manager was available to talk with.

There were staff vacancies and regular agency staff were used as and when this was necessary. The registered manager worked alongside staff to help ensure people were safely supported. The registered manager was finding it challenging to carry out all the managerial duties and this was discussed during the inspection with the provider. Plans were underway to develop a new role to support the registered manager.

We looked at the preparedness of care homes in relation to infection prevention and control. We found the following examples of good practice in relation to infection control. People could see visitors safely either in the garden or in a designated room. Visitors took a COVID-19 test and their temperatures were taken to minimise the risk to people and staff. Staff had a good supply of personal protective equipment (PPE) to help protect the people they were supporting.

Further information is in the detailed findings below.

Rating at last inspection The last rating for this service was good (published 11 January 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about storage of medicines, the cleanliness of the home, how people at the service were being kept safe and how the registered manager and provider responded when issues were brought to their attention. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well led section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fairholme House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good. However at this inspection the service had improved their rating in responsive to outstanding.

The service was extremely responsive to people's individual needs and preferences and staff worked flexibly and often went the extra mile to ensure people lived as full a life as possible. People's care plans were centred on their wishes and needs and continuously kept under review.

The registered manager and staff went to exceptional lengths to deliver person centred care that recognised people as unique individuals. The involvement of relatives, other organisations and the local community was at the very heart of how activities at Fairholme House were planned to ensure people were stimulated and had their needs met.

The service continued to provide safe care to people. Staff had received training in safeguarding adults and understood their responsibilities to identify and report any concerns. The provider had safe recruitment and selection processes in place, these included completing checks to make sure new staff were safe to work with vulnerable adults.

Medicines were managed safely and people received the medicines as prescribed.

People's care plans contained risk assessments which included risks associated with peoples care. There were sufficient staff to meet people’s needs.

People continued to receive effective care from staff who had the skills and knowledge to support them. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to maintain good health.

People continued to benefit from caring relationships with staff. Staff supported people with kindness and compassion. Staff respected people as individuals and treated them with dignity and respect. People were involved in decisions about their care needs and the support they required to meet those needs.

The service continued to be well led by a registered manager and care provider who were open, honest and transparent. The registered manager continually monitored the quality of the service.

On the day of our visit 21 people were using the service. They were supported by four care workers, an activities co-ordinator and two kitchen workers.

People we spoke with told us they liked living at the home and that care workers always asked permission before helping them. One said "I think it is a very good home. They care for me and ask what I need. They always ask me before I get assistance". Another said "they ask for my permission every time".

We spoke with three care workers and talked to them about consent to care. One said "I knock on the door first then ask if it is ok to help them, we always offer choices". Another said "We treat people individually and I try to get to know them. I always ask, some need coaxing but I always check first".

We found that people were safe from abuse, or the risk of abuse because the provider had taken appropriate steps to protect people. People told us they felt safe and all the care workers we spoke with new what to do if they suspected abuse was occurring.

We looked at the provider's records and saw they were held securely, maintained and up to date. Care plans were person centred and fit for purpose including fluid and food records.

People we spoke with said they were happy living at Fairholme House. One said 'everybody is kind and cheerful'. A relative told us 'the general atmosphere is quite happy. I've never heard anything other than pleasantries'. People told us they were enabled to maintain their independence. One said 'I just do what I want to do'.

Before people received care, for example the use of bed rails, it was not clear that the service had sought their consent. Where people did not have capacity to consent the provider had not always acted in accordance with the legal requirements.

Staff told us they felt well supported in their role and enjoyed their jobs. One member of staff said the support was 'Very good. You can approach (the registered manager) or senior staff at any time'.

We observed that people were cared for in a clean, hygienic environment. Staff were able to clearly describe their responsibilities for cleaning and infection control.

Risks were managed across the service through appropriate risk assessments and the views of people who used the service were regularly sought.

Peoples' records were not always up to date. For example, food and fluid charts had not been consistently completed to evidence that people, identified as at risk from malnutrition, had consumed enough food and fluid.

We found people were treated with dignity and respect. People told us 'this is home from home 'and 'I couldn't be in a better place '.

We found care was delivered safely. People told us they 'felt safe' in the home.

Staff were supported and trained to deliver good care. One person told us 'the staff are good here, they definitely know what they are doing'.

People told us they had no complaints about the quality of care the service provided. One person told us 'I would speak to the manager if I had any complaints but I don't have any'. People knew how to complain if they had a concern, a relative we spoke with told us 'I know who to complain to but I have never had to'.