Fairholme House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

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 leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to governance of the service.

This service scored 32 (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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

We observed staff providing care focused tasks which were not identified or challenged by the registered manager. The culture of the home was not always person-centred. We have reflected throughout this report, that people’s basic care needs were not always being met adequately or in line with their preferences.

The service did not provide a safe and homely environment, promote a culture of safety to ensure the approach of staff was in line with the principles of dignity and respect. Therefore, had not created a culture where the team worked well together and learnt from incidents which meant people did not receive good care. Staff felt there was limited guidance from the registered manager.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Leaders had not always supported staff to deliver safe and effective care which met people’s needs and improved their outcomes. The registered manager had failed to act on the issues impacting people, staff and the service in a timely manner, and had not identified the shortfalls found during inspection. Staff told us although the registered manager was approachable, they were not visible. Staff did not feel confident concerns raised to managers would be dealt with.

There were no daily walkarounds in place to identify the concerns found on inspection. The registered manager told us they would implement these following the inspection.
 

People did not always feel they could speak up and their voice would be heard.

Staff members expressed a lack of confidence in the registered managers ability to act on concerns raised. Although staff felt able to speak up to leaders, they did not always feel any action was taken.

The registered manager did not carry out staff surveys to collect feedback or experiences. A suggestions box had recently been implemented for staff and visitors to use; however this did not collect specific areas for staff to report on in order to improve the service. The suggestion box had not yet been utilised, and staff had not yet received any feedback.

Where concerns had been raised by staff in supervision, documentation regarding the seriousness of the concerns and the detail was not available. There was no indication these had been followed up on. After the inspection, the provider told us they were now documenting concerns raised by staff and the action taken.

The provider valued diversity in their workforce. The provider employed a diverse staff team, including different ethnic backgrounds and genders.

We received mixed feedback from staff in relation to how much they enjoyed working at the home and how supported they felt in their job. Staff told us they did not feel supported in their jobs.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The registered manager had not been effective in identifying the areas of improvement in the home environment to reduce the risk of people injuring themselves.

The registered manager did not have an overview or insight of the service. Audits in place did not identify concerns we found during our assessment in relation to safe care and treatment, training, medicines management, safeguarding, person centred care, IPC and good governance.

The registered manager did not check the quality of audits, or daily note records. There were no action plans in place to ensure actions from audits could be monitored and implemented.

The systems in place to record and monitor accidents and incidents at the service were not being used effectively to ensure actions were taken in a timely way and lessons were learnt.

This put people at increased risk of harm due to the failures in effective oversight.

The provider did not always understand their duty to collaborate and work in partnership, to ensure people received a seamless service.

We found some people had not been appropriately referred to external professionals. Where people had been referred to healthcare professionals, there was limited information to evidence their advice had been followed.

The service had a falls analysis in place. This analysis indicated people were having more than one fall a month, peoples care plans were not updated following this, and outcomes and recommendations were not recorded.

Professionals we spoke with told us “Staff are very engaged, open and willing to share information, learn how best to support residents who are experiencing distress and feedback outcomes (good and bad) - this is one of the care homes who really appreciate a psychosocial approach to support their residents.”

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

The lack of effective systems and management meant there was no drive to improve the safety of efficacy of the care and support being delivered. Risks were not identified or actioned to ensure people were safe, there was no focus on improving the safety for people and reducing the risk of injury.

Where lessons learnt were in place, the actions and learning from this, had not been implemented.

The registered manager did not have oversight into how care was delivered. This meant opportunities to analyse and review accidents and incidents for themes and trends did not occur. Learning was therefore not identified and consequently not shared with staff. This meant improvements to the service and the care people received were not considered or implemented.