Fairview

About the service

Fairview is a residential care home providing personal care for up to 10 people with a learning disability and mental health conditions. At the time of the inspection there were 9 people living at the service.

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

Right Support:

People received safe care and they were supported by staff who knew how to protect them from harm. Staff supported people to take their prescribed medicines and to access healthcare services.

Staff were aware of people's individual risks and plans were in place to minimise these while maintaining people’s independence.

Recruitment of staff was safe and robust. We saw that pre-employment checks had been completed before staff could commence work.

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.

Right Care:

There was a relaxed atmosphere in the home where staff were respectful and supportive in their interactions with people.

Where people required support with personal care this was provided in a discreet way and promoted people’s dignity and privacy.

People were given choices about the way in which they were cared for. Staff listened to them and knew their needs well.

Right Culture:

Staff demonstrated a positive person-centred attitude to their work and promoted people’s rights and independence.

Staff were proactive in ensuring people had equal access to services.

Staff told us they enjoyed working at the service and we saw they had formed good relationships with people they supported.

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

Rating at last inspection

The last rating for this service was good (published 19 December 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ Information and guidance was provided to all visitors when visiting the home which specified the processes in place to facilitate safe visits. All visitors were screened for symptoms of COVID-19 and were provided with Personal Protective Equipment (PPE), and required to take a test at the door to prove their negative status. This enabled the service to protect people, staff and visitors.

¿ The service had an open garden area with separate access to allow safe visiting. At the time of the inspection, non-essential visiting to the home was restricted due to cases of infection recently reported within the home.

¿ The service ensured all staff received appropriate training, support and guidance throughout the pandemic period. Observation and reflective practices were used to assess staff competency and enhance their learning and development.

¿ Staff were observed to be wearing PPE in line with government guidance and the providers policy. There were adequate PPE supplies in the service. The home was clean and tidy and staff had systems to ensure all areas, particularly shared bathroom areas were regularly cleaned and care staff were documenting cleaning being carried out within the home. Frequently touched surfaces of the home for example handrails and door handles, were continuously being cleaned.

¿ The service monitored and screened people living at the home and staff daily for any signs or symptoms of possible infection. This enabled the service to take immediate action if anyone was identified with symptoms of COVID-19 to prevent and minimise the risk of transmission.

¿ People and staff had access to regular COVID-19 testing as per government and Public Health England guidance. People and staff had been offered vaccination and guidance was in place to promote the uptake of the vaccination programme, particularly amongst the staff team.

¿ New admissions to the home was completed in line with COVID-19 guidance. People were only admitted following a negative COVID-19 test result.

¿ There was an infection control policy and contingency plan in place that had been updated as guidance had changed. At the time of the inspection, there had been a recent outbreak and healthcare professionals had continued to provide clinical support to people as required. Areas for learning and improvement had been identified from the outbreak and had been adopted since the outbreak.

¿ The provider worked pro-actively to ensure that they worked in line with the most current guidance and directives. All information was shared with all staff through regular meetings, handovers and hand-outs.

¿ Handwashing, sanitising, and PPE stations were located throughout the home. However, toilet facilities did not have a sink with water located within the same room. If the bathrooms located nearby were in use by others, people would not have immediate access to handwashing facilities. The registered manager told us the service will be undertaking refurbishment in the coming year and they will explore the installation of more hand washing facilities throughout the building.

Further information is in the detailed findings below.

At our last inspection on 20 February 2017 although the service was rated ‘good’ overall, there was a breach of the regulation in relation to safe care of service users as the service did not always have risk assessments in place to guide staff when providing care.

Fairview 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 registered to provide care for up to10 people. On the day of the inspection there were nine people living at the service. They varied in age, with a variety of learning and health disabilities.

The service had a 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

At this inspection we found there were risk assessments in place for people for the majority of risks. The main risk assessments for moving and handling and, for example, skin integrity were in place. More specific personalised risk assessments, for example behaviours were in place on some care records but not for all people who needed them.

Medicines were in the main safely managed but the staff had adopted some practices which were potentially unsafe but these were remedied on the day of the inspection.

Care records were comprehensive and up to date. The registered manager told us they would streamline care records as it was not always easy to find the most up to date information.

People told us staff were kind and we saw this was the case. People told us the food was good and they enjoyed the activities at the service.

People had good access to health care and health professionals as needed.

Staff told us they found the registered manager approachable and they enjoyed working at the service as part of the team. Training and supervision took place in key areas. Staff recruitment was safe.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Quality audits were undertaken by the registered manager in a number of key areas but there were no provider audits taking place at the time of the inspection. Following the inspection the provider sent us an updated quality assurance framework and told us they would begin audits at the service.

The service had a 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

Risk assessments had been completed for most people. However, for some people risk assessments did not provide information on how to mitigate identified risks to ensure people were safe at all times. After the inspection the registered manager sent us evidence to demonstrate that the information had been included to mitigate identified risks.

There were systems in place for quality assurance. We discussed our concerns with risk assessments which had not been identified in the audits we saw with the registered manager, who assured us that risks were being identified and the quality assurance process would be made more robust to include how to mitigate identified risks.

Medicines were being managed safely.

Staff had the knowledge, training and skills to care for people effectively. Staff received regular supervision and support to carry out their roles.

Staff sought people's consent to the care and support they provided. People's rights were protected under the Mental Capacity Act 2005. Deprivation of Liberty safeguarding application had been made for people that, due to their own safety, required supervision when going outside.

People had the level of support needed to eat and drink enough, and to maintain a balanced diet. People were able to access healthcare services and attend routine medical appointments and health monitoring with staff support.

Staff encouraged positive, caring relationships with the people who lived at the home. Systems and procedures were in place to encourage and facilitate people's involvement in decisions that affected them.

People were treated in a respectful and dignified manner by staff who understood the need to protect people's human rights.

Activities in the home were tailored to suit people’s individual needs and preferences.

People received care that was shaped around their individual needs, interests and preferences. Care plans promoted a person-centred approach, and staff made use of these.

People found the registered manager approachable and had confidence in their ability to act on things. Staff felt well supported by the manager.

We identified a breach of regulation relating to risk management. You can see what action we have asked the provider to take at the back of the full version of this report.

Peoples' needs were assessed and care and treatment delivered in line with their individual plan of care. The care records examined by us contained evidence that the care needs of people had been assessed.

The provider had taken reasonable steps to identify the possibility of abuse. They provided us with examples of what constituted abuse and were aware of action to take when responding to allegations or incidents of abuse.

Staff told us they were able to perform well in their roles because they received support from their manager. They told us that they felt able to approach their manger with their concerns, knowing they would be acted upon.

We reviewed the records of some people who used the service. We observed that all plans of care contained detailed information relating to people's care and treatment.

The registered manager had taken steps to ensure the premises were being maintained appropriately. We found that staffing levels were sufficient for the needs of people who use the service. The provider had an effective system in place to regularly assess and monitor the quality of service that people receive. This meant that people were protected and received safe care and treatment.