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 Inadequate. At this assessment the rating has changed to 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 58 (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 ensure people's care and treatment were effective because they did not consistently involve people in discussions about their care, and documentation did not always contain adequate up to date information or guidance.

People gave mixed feedback about their involvement in care planning. One person told us, “They [staff] have not asked me about how my care is, but I would be very happy for them to do that.”

Care plans and risk assessments covered a range of areas, including pressure care, urinary tract infections, nutrition, hydration, falls, medicines and equipment. However, records were not always accurate, relevant or sufficiently detailed to guide staff.

The provider did not always maximise the effectiveness of people’s care and treatment by assessing and reviewing their care. For example, some care plans contained information which did not reflect people’s current needs accurately or when people may require equipment to support them.

Guidance for staff was not always detailed enough to ensure care was delivered consistently. Whilst staff demonstrated a good understanding of people's needs, care plans were often task focused rather than person centred. Records did not always clearly describe how people's medical conditions affected their daily lives or how care should be adapted to meet their individual needs and preferences.

The provider did not always ensure care and treatment was delivered in line with current evidence-based guidance. Whilst people generally received effective support to maintain their health, nutrition and wellbeing, care plans and risk assessments did not always provide staff with clear guidance to manage identified health risks consistently and safely.

Information was not always available for staff about how to manage people’s needs consistently and effectively. Records showed blood glucose and blood pressure monitoring was undertaken where required. However, care plans did not always explain why monitoring was needed, expected parameters, or the action staff should take when readings fell outside normal ranges. For example, low blood glucose readings were not always rechecked following intervention, and guidance relating to high and low blood glucose levels was limited.

We found inconsistencies in care records relating to people's dietary needs. For example, records contained conflicting information about the texture of modified diets and did not always include clear risk assessments or professional guidance.

Staff told us staffing pressures occasionally affected mealtime support.

Staff knew people well and supported their nutritional needs effectively. People were offered regular drinks and snacks, received meals which met their dietary requirements and spoke positively about the food provided. Records also showed positive outcomes, including weight gain for people previously identified as being at risk of weight loss.

The provider worked effectively with other teams and healthcare services to support people and ensure continuity of care. Systems were in place to share relevant information when people's needs changed or when support from external professionals was required.

There were systems in place to improve communication and the coordination of care. Health and safety meetings took place regularly, with actions identified and documented. One person told us, “They [staff] go around and get headache tablets or painkillers or call the doctor.” Formal handover meetings took place between staff and were documented to ensure important information about people's care and wellbeing was shared consistently.

The provider had introduced daily checklists and key worker arrangements to support oversight of people's needs and promote continuity of care. These measures helped ensure staff worked together effectively.

The provider did not always support people to manage their health and wellbeing to maximise their independence, choice and control.

People were not always involved in regularly reviewing their health and wellbeing needs. Comments from people included, “I have seen the care plan, but I’ve not been involved in any changes. I feel it is something I need to have an input to” and “I don’t think they [staff] have asked me about things here.”

Relatives told us they were kept informed about important changes to people's health and wellbeing. One relative told us, “They phone to say the GP has been in, antibiotics have been prescribed and the GP will phone me around decision making.”

Staff encouraged people to make choices and maintain their independence. Staff supported people to decide where they wanted to spend their time and provided assistance in ways which promoted independence whilst maintaining safety.

However, staff told us people were not always supported to engage in meaningful activity and could spend extended periods sitting in wheelchairs. We were told there were occasions when planned activities did not take place, which may limit opportunities for people to remain active and support their overall health and wellbeing.

The provider monitored people's care and treatment, however, there was inconsistent evidence available to demonstrate how outcomes were reviewed to identify areas for improvement.

The provider supported staff through clinical review meetings. These meetings discussed areas such as weight management, wounds, falls, infections and other clinical risks. These evidenced improvements in people's weight following nutritional interventions. Where issues were identified, these were discussed and addressed. For example, concerns about nutritional supplements not always being consistently provided were identified through review processes and action was taken to improve practice.

However, governance and oversight systems were not always effective in demonstrating how identified actions were followed through and monitored. For example, meeting minutes highlighted concerns relating to bed rail and mattress checks which required further work, but records did not always identify the improvements required, who was responsible or how progress would be reviewed.

There were gaps in care planning and staff guidance. For example, some people had blood pressure monitoring in place. Care records did not clearly explain why this was required, what readings were considered outside of normal parameters or what action staff should take in response to elevated results. Although some high readings had been recorded, guidance regarding escalation and ongoing monitoring was not available. In addition, staff had not received training relevant to this aspect of care.

This meant the provider could not always be assured care and treatment were delivered consistently, in line with best practice, or outcomes were being effectively monitored and acted upon.

The provider told people about their rights around consent and respected these when delivering person centred care and treatment.

People were supported to make choices about their care and treatment wherever possible. We observed staff offering people choices, including where they wished to eat their meals.

The provider had systems in place to assess people's capacity to make specific decisions, and staff had a good understanding of people's abilities and the decisions they were able to make independently. Staff were able to clearly describe how one person was supported to make choices about their personal care and how they remained involved in tasks they were able to complete themselves.

Staff sought people's consent before providing support. For example, staff asked people whether they were happy to be assisted when moving between chairs and wheelchairs. However, on some occasions staff did not always seek consent in a person centred way, instructions were given rather than people being actively involved in decisions about their care.

People gave mixed feedback about how consent was sought. One person told us, “They [staff] don't ask as they just do it, but that's ok.” A relative told us, “They speak to [person] as if [person] can understand.”