Fairlawn

Fairlawn is a residential care home providing personal and support to older people, some of who are living with dementia. The service can support up to 60 people. There were 55 people living at the home at the time of inspection.

People’s experience of using this service and what we found

Improvements had been made to planned staffing levels. The improvements had been sustained following our last inspection. There was a focus on recruitment and retention of staff at Fairlawn. People, their relatives and staff told us this had improved. There was a new manager who complimented the team already in place. There was confidence in the manager and the deputy manager.

Infection control procedures were in place to contribute to keeping people safe, these had been enhanced due to the Coronavirus pandemic. People, their relatives and staff were updated, and the provider ensured that they had additional oversight and offered increased support to the home.

People felt safe and their relatives were reassured. Staff had received training and knew how to recognise concerns and who to report them to, they felt confident the manager would act on any information of concern. There were systems in place to ensure lessons were learned and these were used to improve practice within the home.

Quality assurance systems were robust and were used to drive improvements. Staff felt proud to work at Fairlawn, felt appreciated and had confidence in and respect for their colleagues. People and staff felt involved in the home and were kept updated. The manager and deputy manager understood their responsibilities in their respective roles and worked with a variety of health and social care professionals to meet the needs of people living at Fairlawn.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 September 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 29 July 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fairlawn on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service

Fairlawn is a residential care home providing personal care to 57 older people. The service can support up to sixty people. On the second floor there is specialist care for people with dementia.

People’s experience of using this service and what we found

The service used a tool which assessed people’s dependency and calculated the number of staff required for each shift. There were fewer staff on duty than the tool suggested and we could not be sure that people’s needs were being met in a timely manner.

Staff and relatives told us improvements had been made since the last inspection. People told us they were happy, felt safe. Relatives said staff had a good understanding of their loved ones needs and preferences. Risks had been identified and measures put in place to keep people safe from harm. Medicines were managed safely and administered by trained staff.

Staff listened to what people wanted and acted quickly to support them to achieve their goals and outcomes. Staff looked to offer people solutions to aid their independence and develop their skills.

Staff were trained and skilled. They worked with people to overcome challenges and promote their independence. Equality, diversity and human rights (EDHR) were promoted and understood by staff.

People, professionals and their families described the staff as caring, kind and friendly and the atmosphere of the home as relaxed and engaging. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received pre-admission assessments and effective person-centred support. The service was responsive to people’s current and changing needs. Regular reviews took place which ensured people were at the centre of their support.

A new deputy manager, operations manager and director of residential care services had been recruited since the last inspection. Leadership was more visible and promoted good teamwork. People, professionals and staff spoke highly about the management and staff had a clear understanding of their roles and responsibilities. The registered manager, deputy manager and staff team worked together in a positive way to support people to achieve their own goals and to be safe.

Checks of safety and quality were made to ensure people were protected. Work to continuously improve the service was noted and the registered manager was keen to make changes that would impact positively on people's lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 February 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made.. However, enough improvement had not been made in all areas and the provider was still in breach of one regulation.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the deployment of staff at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is registered to provide accommodation and personal care for up to 60 older people. At the time of our inspection the service was providing residential care to 57 older people.

Fairlawn is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service was not safe. Systems and processes were not always operated effectively to protect people from abuse and improper treatment. Medicines were not always managed safely and people were not supported in accordance with the provider’s protocol following falls. This was a breach of the regulations

People were not protected from the risk of infection. The home was not clean and the fabric of the building was damaged in parts making cleaning difficult. Improvements were not always consistently followed or completed when things went wrong and lessons were learnt. This was a breach of the regulations.

Staff had not received supervision and appraisals. This was a breach of the regulations.

Systems to monitor and improve the quality of the service were not fully effective. A number of quality monitoring systems were in place including audits and monthly visits by the operations manager. While these activities identified some areas for improvement they did not always result in actions being taken to improve safety or quality. This was a breach of the regulations.

Two people’s DoLS authorisations had expired and applications had not been made in advance of the expiry date. This was due to a system failure. Staffing was not always arranged to ensure people’s needs were met. Professionals and staff told us there were not enough staff.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs and the people important to them. A complaints process was in place and people felt they would be listened to and actions taken if they raised concerns. People’s end of life wishes were known including their individual spiritual and cultural wishes. Feedback and observations of social and occupational stimulation within the home was mixed.

We have made a recommendation about helping people in care homes access activities that will improve their health and social wellbeing.

People had been involved in assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People had their eating and drinking needs understood and met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. People were supported to have choice and control of their lives.

People, their families and professionals described the staff as caring, kind and friendly and the atmosphere of the home as warm and inviting. People could express their views about their care and felt in control of their day to day lives. People had their dignity, privacy and independence respected.

People’s, professional’s and staff’s feedback on the management at the home was positive. They described them as, approachable, supportive and professional.

During our inspection we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the registered provider to take at the back of the full version of the report.

The service had a newly appointed manager in place who had applied to the Care Quality Commission to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People’s nutritional needs were assessed to make sure they received a diet in line with their needs and wishes. We observed the midday meal being served in two dining areas of the home. Staff made sure that people received any specialist diets they required including soft textured food and were clear about who required support to eat and when. However the deployment of staff meant that not all people were able to be supported individually or received their meal whilst still hot. We addressed our concerns with the manager, who said they would review the deployment of staff at mealtimes with immediate effect.

Safe procedures had been followed when recruiting new staff. Checks and references had been carried out before a new staff member started working in the home. This meant that new staff were suitable for the job they had applied for and there was a robust recruitment process in place.

New staff completed an induction programme which gave them the basic skills to care for people safely. New staff were also able to shadow more experienced staff. One new member of staff said they had been given time to read policies and procedures at the providers head office, and had been able to shadow other staff for a number of weeks. They said. “The induction was good and gave me confidence to support people, I had someone with more experience to guide me for the first couple of weeks”.

The manager, deputy manager and staff knew the importance of safeguarding the people they supported. Staff told us, and records seen, confirmed that all staff received training in how to recognise and report abuse. Staff spoken with had a clear understanding of what may constitute abuse and how to report it. All were confident any concerns would be fully investigated and action would be taken to make sure people were safe.

Care plans were personalised to each individual and contained information to assist staff to provide care in a manner that respected needs and individual wishes. Risk assessments which outlined measures to minimise risks and keep people safe were held in people’s care plans.

Safe systems were in place to protect people from the risks associated with medicines. Medicines were managed in accordance with best practice. Medicines were stored, administered and recorded safely. Health professionals were routinely involved in supporting people with their health and wellbeing.

People saw healthcare professionals as required, for example the GP, district nurse, chiropodist and dentist. Staff supported people to attend appointments with specialist healthcare professionals in hospitals and clinics. Staff made sure when there were changes to people’s physical wellbeing, such as changes in weight or mobility, effective measures were put in place to address any issues.

On the day of the inspection there was a calm and happy atmosphere throughout the home. Staff were kind and interacted with people in a friendly and respectful way. People’s needs were assessed and care was planned and delivered in line with their individual care plan.

The provider had a complaints procedure the operation manager told us if a complaint was to reach the written stage it is responded to within the specific time scales as detailed within Care South Complaints Procedures.

People's needs were regularly reviewed. Each care plan we looked at had been reviewed and updated when the person's needs had changed. For example, one person was very unwell and there was a short term care plan in place, detailing the action staff needed to take to ensure the person was comfortable and pain free.

People were supported at meal time. We observed staff supporting people who could not eat without assistance. Staff were respectful, sitting beside people, engaging them in conversation and helping them with their meal at their own pace. One person told us, ' I prefer to eat on my own.' Another person told us the food was, 'excellent'.

There were cleaning schedules to maintain standards in the home. We were told by domestic staff that during the week different sections of the home were thoroughly cleaned.

People told us that staff responded quickly when they used the call bell. One person told us, 'staff are always thoughtful' another person said ' staff always support me the way I prefer'. One person said ' staff are marvellous'

Monthly audits were completed to monitor quality.

We found people were provided with a choice of suitable and nutritious food and drink. One person told us "we have a choice of menu which is very nice". Three fluid charts we saw were completed fully by staff protecting people from dehydration. However we saw that the charts did not have an individuals' target food intake written upon them and there were no specific amounts of food consumed recorded on the chart. People therefore would not be protected against the risk of inadequate nutrition.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There was an effective complaints system available. Comments and complaints were responded to appropriately