Fairholme House

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 Good. At this assessment the rating has changed to Inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of 3 legal regulations in relation to person centred care, people’s safe care and treatment, and consent to care and treatment.

This service scored 33 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing, and communication needs with them.

Reviews of care planning documentation were not carried out with people or representatives, did not always reflect people’s current needs or take into consideration any changes in their health, care, or support.

Assessments did not consider the person’s health, care, wellbeing, and communication needs, to enable people to receive care or treatment to ensure the best possible outcomes. For example, risk assessments were not always in place, there was limited guidance in place for risk associated with people’s swallowing. There was limited guidance in place around people’s continence risks, information was not available to guide staff to ensure staff were able to identify and acted on risks around infections.

Where people required support with repositioning, assessment did not contain information about the risk, or mitigation such as how often people should be supported to reposition. Staff we spoke with were unclear of how often people should be supported to reposition. People’s care notes evidenced they were using equipment, which had not been included within people’s assessments. People at the home had no current pressure care concerns.

Assessments in place did not always have the correct scoring or information which could impact the support people receive. Peoples care records were not updated following incidents to mitigate the risk, this meant staff did not have the most accurate information to support people’s care needs. Staff told us they were not always updated if people’s needs changed.

People were put at increased risk as care plans and risk assessments were not person centred or accurate.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Some people were living with dementia however, the care environment was not always dementia friendly, as signage around the home was unclear. Care plans were not always detailed or reflective of people’s current needs, we found inconsistency in the provision of personal care.

People were offered a choice of meals and were mostly positive about the food. We heard "I get the best of food here, if I don't like it, I tell them, and they will change it. They're very good for me" and "The staff work well together, they tell me what's on the menu at lunchtime."

People’s dietary requirements were not always appropriately recorded in their care planning; however, kitchen records were kept up to date. We observed people received the correct dietary level. During observations, people were not always given a choice of what drink they would like, people had to wait to be supported by staff to eat their lunch. Staff did not interact or explain to people why they had to wait for their lunch. This caused visible distress to people. For those people who required a modified diet, food was not always presented in an appetising manner, and training was not always in place for IDDSI [The International Dysphagia Diet Standardisation Initiative] levels. IDDSI is a global framework which provides standardized terminology and definitions for texture-modified foods and thickened liquids used for individuals with swallowing difficulties.

There was limited evidence people were offered food and drinks on an evening, as there was no documentation in people’s care notes.

There was no evidence available of SALT [Speech and language therapist] referrals or guidelines within peoples care planning documentation. For one person, contact had not been made with professionals following an assessment where a SALT referral was identified. Following our inspection, the registered manager told us they had made this referral.

People were put at risk of harm and of not receiving person centred care.

The provider did not always work well across teams and services to support people.

Where people received care from a range of different services, there was limited documentation recorded to evidence this partnership working.

Systems in place to record and monitor accidents and incidents were not being used effectively. The service did not ensure essential information about people’s care was available as information was not kept up to date or reflective of people’s needs. Care planning documentation was not updated following incidents to mitigate risk, and information within assessments was not always accurate, which could impact when people moved between services.

The service had links with the local GP practice, district nurses visited the home. Staff communicated with each other via the use of a handover sheet. Some staff felt this level of communication worked well, whereas others felt it did not always work if staff been on leave.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice, and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People were not always supported in a person-centred way with their nutrition. We observed examples of people living with dementia who required support or encouragement to eat, waiting for support in order to eat their meals.

There was limited evidence within people’s documentation of partnership working with external healthcare professionals. Assessments documented people had not received any input with their oral care by professionals in many years. People were not supported to make dental appointments. The registered manager told us this is something they would look into. People we spoke with felt they needed limited input for the GP as they were well, and the service made appointments for people when needed.

People were not involved in regularly reviewing their health and wellbeing needs, and the service did not focus on identifying risks to people’s health and wellbeing early and on how to support people to prevent deterioration.

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, or they met both clinical expectations and the expectations of people themselves.

There were ineffective systems in place to monitor people’s care and treatment as there were limited audits in place to identify issues, therefore the service was unable to continuously improve people’s care and treatment.

Care planning audits were not thorough, feedback was not collected, there were no care note audits, walk arounds or observations carried out.

Falls, accidents, and incidents were not well managed. Records contained conflicting information regarding the frequency of incidents, what action staff took to safely help the person, as well as what action was taken in order to improve people’s outcomes.

There was limited guidance in place, or documentation to monitor and improve outcome, people were not asked for their feedback. People told us they were not sure who the manager was.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

People told us "The staff are kind, they are very considerate. They consider my privacy before they come in the room, they knock on my door." Staff provided good examples of how they would gain people's consent.

Peoples care planning information contained conflicting information about their ability to consent. When staff were asked about specific people, they stated that these people did not have capacity to make decisions about their care. These people had no supporting documentation in place to evidence their capacity had been assessed. .

The service was not always working in line with the principles of the Mental Capacity Act 2005. There was lack of evidence to demonstrate people had been involved in decisions about their care. Where people lacked capacity to consent, decisions had not always been made in people’s best interests as there were no best interests’ decisions in place.

Policies in place identified a two-stage process to assess people’s capacity, however it did not contain this process or any documentation to support with assessment. The service did not carry out Mental Capacity assessments for restrictive practices such as not being able to leave the building and sensor mats, Mental capacity assessment were also not in place for insulin, medicines, or people being supported to make decisions. Peoples care plans had been signed by the registered manager not the individual or their legal representative.

Not all staff had received appropriate training around capacity and consent. When talking with the registered manager, there was a general lack of understanding around the Mental Capacity Act, best interest decisions and supporting people with dementia.

This put people at increased risk of restrictive practices and not receiving person centred care.