Fairholme House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Inadequate. At this assessment the rating has changed to Good.

This meant people were safe and protected from avoidable harm.

This service scored 66 (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 promoted a positive and open culture that supported safety. Staff were encouraged to raise concerns and understood the importance of reporting incidents and safety events.

People told us they felt listened to by staff and their concerns and requests were acted upon. One person said, “I know they [staff] do listen to me because if I needed anything, they would get it.” Another person told us,“Yes, yes they listen to me and get things I ask for.”

Staff told us there was a culture of openness and effective communication within the service. Handovers took place at the beginning and end of each day, and staff were required to read and confirm they had understood key information. One staff member said, “There is always an open conversation with seniors, and we know what's going on.”

Systems were in place to investigate incidents and identify opportunities for learning and improvement. However, incident records did not always contain sufficient detail regarding how people were supported following a fall. We discussed this with the management team, who acknowledged the need for more comprehensive recording to provide a clear audit trail. However, staff we spoke with demonstrated an understanding of the action required in the event of an accident or incident. Staff described the steps they would take to ensure people remained safe.

The provider worked with people and healthcare professionals to establish and maintain safe systems of care, however records were not always reflective of people’s needs which could impact people’s care.

People told us they could access healthcare support when needed. One person said, “If I need the doctor, I can see them here.” Staff worked with external professionals to monitor people's health and wellbeing and support continuity of care.

A hospital transfer pack was in place and supported the sharing of information when people moved between services. However, records did not always provide staff with sufficient information to support people safely and consistently. For example, moving and handling plans did not always specify the type of equipment required for transfers. Records contained limited information about what people could do independently and where support was needed. This meant the provider could not always be assured people would receive consistent support in line with their assessed needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, and discrimination. The provider shared concerns quickly and appropriately.

People told us they felt safe living at the service. One person said, "Oh yes, I feel very safe, I've been very fortunate, people are kind."

Safeguarding concerns had been referred to the Local Authority. The provider maintained clear records of safeguarding investigations and actions taken. Action plans detailed the required actions, who had been informed and the measures taken to reduce risk and support people's safety.

Staff demonstrated a good understanding of safeguarding and their responsibilities to protect people from harm. Safeguarding contact details were readily available throughout the home. Staff were aware of how they would escalate concerns externally. One staff member said, “If the manager didn't take action, I would call safeguarding.”

The provider did not always work effectively with people to understand and manage risks. Although risks relating to people's health and wellbeing, including skin integrity, nutrition and environmental factors, were assessed and monitored, risk assessments were not always person centred or regularly reviewed with the person.

Guidance was not always sufficiently detailed to support consistent care. For example, falls and mobility assessments did not always include detail about how people’s health conditions contributed to their risk of falls or affected their mobility. Care plans directed staff to refer to mobility plans and falls risk assessments; however, these were not always in place, or there was limited information about the support staff were required to provide.

Whilst body maps and skin inspection records were completed, records did not always clearly demonstrate what actions had been taken in response to identified bruising, redness or skin tears. As a result, it was not always evident how concerns had been followed up and monitored. We discussed this with the provider and were assured action had been taken.

Relatives told us they were consulted about care and treatment decisions and kept informed of changes to people's needs. One relative said, "The pressure sores on [person's] heels have been sorted and [person] has an air mattress now. The GP looks in on [person] and phones me about making decisions. Sides [bed rails] on the bed were fully discussed with me. I feel [person] is safe."

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Recent improvements had been made to the environment, including the installation of safety gates on stairways, refurbishment of bathrooms and improvements to storage areas. Communal areas and people's bedrooms and bathrooms were clean, accessible and free from unnecessary clutter.

The provider carried out regular environmental and health and safety checks to identify potential risks. Records showed routine walkarounds, fire door checks, and daily health and safety inspections were completed. Where issues had been identified, the provider took action to address them.

Fire safety equipment was in place and maintained, fire drills were undertaken and staff had completed relevant fire safety training. The provider ensured equipment was regularly checked, serviced and maintained to support the delivery of safe care. The home was clean and free from unpleasant odours.

The provider did not always ensure there were enough suitably qualified, skilled and experienced staff to meet people's needs. Whilst systems were in place to support staff development, including supervision and competency checks, we identified gaps in training and missed opportunities for further role-specific learning.

People gave mixed feedback about staffing levels. One person told us, “There are enough staff; most of the time there is somebody about when you are sitting here.” Another person said, “They do need more carers sometimes, I have to wait a bit.”

Staff responsible for delivering activities had not received activities training and were regularly required to support with people’s personal care. This reduced the time staff had available to provide planned activities and meaningful engagement for people. Following the inspection, the provider took action to ensure staff received further activity training.

Staff generally felt staffing levels were sufficient for the number of people living at the service and spoke positively about teamwork. Staff told us they worked together effectively during periods of staff shortage to ensure people's care needs continued to be met. However, staff acknowledged staffing pressures could impact on the delivery of activities.

Recruitment processes were not always robust. Not all staff files contained evidence of the full range of pre-employment checks, including proof of identity, up-to-date Disclosure and Barring Service (DBS) information and comprehensive interview records. While the provider was strengthening recruitment systems, records did not consistently demonstrate safe recruitment practices had been implemented.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns.

Infections were tracked appropriately, an outbreak management folder was in place, which demonstrated the provider used relevant external guidance to support infection prevention and control practices.

People spoke positively about the cleanliness of the home. One person told us, “My room is very clean, lovely and clean. The cleaners are nice.”Staff told us infection prevention and control practices had improved, commenting the home was cleaner and staff regularly sanitised equipment and maintained cleanliness in people's rooms, bathrooms and laundry areas.

The provider managed medicines safely and in a way that met people's needs and preferences.

People spoke positively about the support they received with their medicines and told us they had confidence in staff. One person said, “I'm well looked after. They [staff] put creams on to stop me getting sore. I take pills in the morning and in the evening. They bring me the tablets and make sure I take them and they don't go until I have.”

People's care and medicines records contained information about how they preferred to take their medicines, which helped staff to administer medicines safely and effectively.

Staff completed competency assessments to ensure they had the knowledge and skills required to manage and administer medicines safely.

Medicines management processes were in place, medicines and prescribed treatments were administered as intended.