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 Inadequate.

At this assessment the rating has changed to Good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 68 (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 had taken steps to develop a more open and responsive culture within the service, and people, relatives and staff spoke positively about some improvements.

Staff described the management team as approachable and willing to listen to concerns. One member of staff said, “No complaints at all, little things I ask to be done are done.” Another told us, “Since the new manager has been in, everything we have felt we needed, they have agreed to and got it done.”

Staff told us they felt able to raise concerns and share ideas for improvement. Staff demonstrated an understanding of equality, diversity and human rights and were committed to providing compassionate care.

The provider had inclusive leaders who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders were and had taken steps to improve the quality of care and the culture of the service.

Staff spoke positively about the support they received from the management team and told us they felt listened to. One member of staff said, “Yes, very well, she listens and supports us with everything we need. Every day we have a 10-to-15-minute quick meeting to discuss how work is going, what we need and what we are lacking in training and equipment.”

People, relatives and staff spoke positively about the visibility of leaders. Comments included, “I have them come and chat to me. I know [owners], they come and talk to us,” and “I do know the manager, and she does come round and chat to me, very nice.”

People and relatives were positive about the management of the service. One relative told us, “It is well managed because it feels like a family.” Another said, “I have no grumbles about the place at all, it is well run.”

The provider fostered a positive culture where people and staff generally felt able to speak up and have their views heard. Staff told us they felt able to raise concerns and make suggestions.

Staff told us the management team was approachable and encouraged them to share ideas and contribute to improvements within the service. One member of staff said, “She [manager] encourages us to give opinions on things that should be done. Yes, I speak up.”

Staff also described opportunities to raise concerns and provide feedback through meetings and informal discussions with management.

Staff recognised individuals had different levels of confidence when speaking up. One member of staff explained although they did not always attend meetings due to night shifts and family commitments, they still felt able to share ideas and feedback with management.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff came from a range of backgrounds and worked together to meet people's needs. Staff communicated effectively and supported each other as a team.

Staff had opportunities to attend meetings, supervision sessions and training to support their development and engagement within the service. Staff told us they felt supported by their colleagues and management team.

The provider had established a range of governance and quality assurance systems to monitor the safety and quality of the service. Whilst these systems had identified some areas for improvement and supported positive changes, they were not always effective in identifying and addressing the concerns found during this inspection.

Governance processes had not consistently identified or addressed all areas of concern. We found issues relating to care planning, recruitment records, staff training, and record keeping that had not been recognised through the provider's own quality assurance systems. Inconsistencies within care records had not been identified, meaning the provider could not always be assured records were accurate, up to date and reflective of people's current needs.

Although audits and monitoring checks were completed, actions arising from these were not always clearly documented. Managers were able to describe improvements and action taken, however, records did not consistently evidence timescales for completion, follow-up actions or how improvements had been monitored to ensure they were embedded and sustained.

The provider sought feedback from people, relatives and staff through surveys and meetings. However, systems for analysing and responding to feedback were not always robust, and it was not always clear how comments and suggestions had been used to drive improvement.

Despite these concerns, the provider had made progress since the previous inspection and demonstrated a willingness to improve. The management team responded positively to feedback and took prompt action to address issues identified during the inspection. However, further work was needed to ensure governance systems were fully effective in identifying concerns, driving improvement and sustaining good outcomes for people.

Leaders routinely reviewed key aspects of care quality and safety, including people's health needs, accidents and incidents, infections, weight loss and environmental issues. Records showed these reviews had led to some improvements, such as changes to the environment, mealtime experiences and the monitoring of people's wellbeing. Systems were also in place to oversee staff supervision and meetings. Staff spoke positively about efforts to improve record keeping, 1 member of staff told us, “The manager trying to improve the paperwork and documentation.”

The provider worked in partnership with a range of healthcare professionals and services to support people's health and wellbeing.

People told us they had good access to healthcare support when needed. One person said, “I do see the GP and the district nurse come in.” A relative told us, “The bonus of being here is that [person] can see a GP which is more than [person] could at home.”

Staff made referrals and sought advice from GPs, district nurses, dentists and other healthcare professionals when people's needs changed. This helped to ensure people received coordinated care and treatment and supported continuity of care.

Resident meetings showed people were consulted about things going on at the service and were given opportunities to share their views about day-to-day life within the home. The provider had also attempted to re-establish links with the local church following the cessation of church services due to changes in local clergy.

The provider had systems in place to support learning and improvement, including clinical reviews, staff meetings, supervision, audits and feedback surveys. However, these processes were not yet embedded to drive continuous improvement.

Processes in place resulted in positive changes within the service, including environmental safety checks and monitoring of people's health needs. Where incidents had occurred, additional equipment checks had been introduced to promote people's safety. However, systems to support continuous learning and improvement were not always fully effective, as incidents reviewed had not always identified important missing information to continuously improve learning.

Concerns raised through staff and relative surveys were not always clearly analysed, and records did not consistently evidence how the provider had responded.

Shortfalls identified during the inspection relating to care planning, training, recruitment and record keeping, had not always been identified, limiting the provider’s ability to drive improvement. Whilst the provider had made progress since the previous inspection and showed a willingness to learn and improve, further work was needed to ensure learning was embedded and used consistently to improve outcomes for people.

Staff meetings included discussions about lessons learned, record keeping, communication and person-centered care. Staff were reminded of the importance of supporting people to make choices about their daily lives, such as when they wished to go to bed, rather than relying on established routines.