Fairhaven Lodge Also known as Dr Morgiana Muni Nazerali-Sunderji

Fairhaven Lodge is a residential care home providing personal care for up to 25 people, aged 65 and over who were living with dementia. At the time of our inspection, 23 people were living at the home.

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

The provider had made improvements to try to ensure people’s care was delivered safely. Staff were recruited safely and there were enough staff on duty to meet people’s needs. One person’s relative told us, “More full-time staff would be good, like many care homes in this climate of staff shortages. This does not stop the amazing professional care my mum receives.”

The registered manager had fostered a culture that was open and inclusive, and put people at the centre of the care they received. One person’s relative told us, “[Registered manager] is an asset. She cares for everyone and is hands-on.” Another said, “I have found Fairhaven and its staff to be excellent in looking after Mum, making her final years as comfortable as possible.” They went on to say, “I cannot think of anything to make me feel Fairhaven hasn’t been an excellent choice of care home for Mum, in fact I can’t recommend it highly enough.”

Medicines were managed safely, and staff kept the home clean and tidy. Staff managed risks well and had plans to follow in case of emergencies. The service had systems to protect people from the risk of abuse and improper treatment.

Governance at the service had improved. Staff understood their roles and responsibilities and worked well with external agencies to meet people’s needs. The provider monitored the quality of the service using a range of systems.

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.

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 23 March 2021) and there were breached of regulations. 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.

At our last inspection we made recommendations to the provider around calculating staffing levels, medicines competency checks and learning from adverse events. At this inspection we found the provider had acted on our recommendations and made improvements.

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.

We carried out an unannounced inspection of this service on 11 and 17 December 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe care and treatment, Fit and proper persons employed and Good governance.

We carried out 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. 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 Fairhaven Lodge 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.

Fairhaven Lodge is a residential care home providing personal care for up to 25 people, aged 65 and over who were living with dementia. At the time of our inspection, 13 people were living at the home.

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

The service was not always safe. We found risks related to infection prevention and control were not managed. Risks related to fire safety had not been suitably assessed and managed. Staff recruitment processes were not robust. We have made recommendations around calculating staffing levels, medicines competency checks and learning lessons when things go wrong.

The service was not always well-led. We found the provider’s quality assurance systems had not been operated effectively. Records relating to care and the management of the service were not always complete, accurate and up to date. This could have compromised the quality and safety of the service.

The management team were receptive to our feedback and were keen to make improvements to the service, responding promptly to our concerns. They took a positive approach to working with us and provided the information we requested.

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 6 June 2019).

Why we inspected

We carried out this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about infection control. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with infection control and quality assurance, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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 coronavirus and other infection outbreaks effectively.

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.

Fairhaven Lodge is registered to support a maximum of 25 older people who live with dementia. At the time of our inspection there were 17 people living at the home. Fairhaven is situated in St Annes close to the promenade and local amenities. Accommodation is provided on three floors with a passenger lift for people to access the upper floors. All bedrooms have en-suite facilities and there are multiple communal areas to support people’s social needs.

People’s experience of using this service:

Relatives told us they were reassured their family members were safely supported at Fairhaven. A relative said, “I know my relative's safe and very happy there.” The registered manager provided clear guidance to ensure staff understood their duty to report abuse or poor practice.

Relatives stated staffing levels were suitable to meet their family member’s needs. A relative said, “There's always enough staff. I like that the care staff only do care. It gives me more confidence in their expertise.” Staff stated they had good levels of training to underpin their knowledge and skills.

Staff followed correct procedures to ensure they administered people’s medicines safely. One employee stated, “Training is great, we always have to update it to make sure we know what we are doing.”

The management team completed risk assessments to guide staff to reduce the risk of unsafe care. Relatives said they were reassured their family members were safely supported at the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. A staff member told us, “My responsibility is making sure I am not taking anything away from the person when I am helping them. Making them feel like people, not pieces of furniture.”

The registered manager regularly assessed people’s nutritional needs to prevent the risk of malnutrition. A relative told us, “[My relative] was starving herself before, but now she's eating well and has been putting weight on.”

We observed staff treated people as individuals and understood their different personalities. A relative told us, “For someone who has [my relative’s] level of understanding and communication to spontaneously saying she is happy is incredible.”

The registered manager discussed people’s wishes in relation to how they wanted to be supported. A relative stated, “The care is definitely bespoke here.”

The management team checked everyone’s views to assess the quality of care. A relative said, “I can't praise them all enough. They do a difficult job for sure, but hats off to them.” The registered manager completed audits to check the service maintained people’s safety and welfare.

Rating at last inspection:

At the last inspection the service was rated good (published 10 December 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any issues or concerns are identified we may inspect sooner.

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

At the last inspection on 29 October 2015 we asked the provider to take action to make improvements because we found breaches of legal requirements. This was in relation to poor management of medicines and consent and capacity. The provider sent us an action plan saying they would meet the legal requirements by 15 January 2016. During our inspection visit on 16 November 2016 we found these actions had been completed.

Fairhaven Lodge is situated close to both the sea front and the centre of St Annes. The service can accommodate a maximum of 25 people whose primary care needs are those of persons who live with dementia. Accommodation is provided on three floors. A stair lift is installed to support people with mobility problems to gain access to the upper floors. Most bedrooms have en-suite facilities. There is space at the front of the home for parking and a small, enclosed rear garden. At the time of our inspection visit there were 18 people who lived at the home.

There was a registered manager in place. 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 2008 and associated Regulations about how the service is run.

Although a number of people had limited verbal communication and were unable to converse with us, we were able to speak with seven people who lived at the home. We also spoke with one person visiting their relative. People told us they were happy and well cared for and felt safe living at the home. Comments received included, “They look after me really well the staff are very kind.” And, “I am very happy here and feel safe.”

We observed staff providing support to people throughout our inspection visit. We saw they were kind and patient and showed affection towards the people in their care.

We saw people who lived at the home were clean and well dressed. One person visiting the home said, “[Relative] is always immaculately dressed when I visit them. This pleases me greatly as they always took pride in their appearance. They look so happy when I visit.”

Staff spoken with and records seen confirmed training had been provided to enable them to support people who lived with dementia. We found staff were knowledgeable about support needs of people in their care.

We saw the service had an induction training and development programme in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

We found sufficient staffing levels were in place to provide support people required. This included staff supporting people to hospital appointments. We saw staff members could undertake tasks supporting people without feeling rushed.

We looked at the recruitment of three recently appointed staff members We found appropriate checks had been undertaken before they commenced their employment confirming they were safe to work with vulnerable people.

Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the service had responded promptly when people had experienced health problems.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

We found equipment used by staff to support people had been maintained and serviced to ensure they were safe for use.

We found the registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

People who were able told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. Comments received included, “I love the food we get plenty of choice.” And, “I like the homemade cakes. They are lovely.”

People told us they enjoyed the activities organised by the service. These were arranged both individually and in groups. We saw a variety of activities organised throughout our inspection visit and these were well attended.

The service had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were happy and had no complaints.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys and care reviews. We found people were satisfied with the service they received. Comments received from people’s relatives included, ‘I have always been delighted with the care given and fully support the work that the manager and her all her staff carry out effortlessly.’ And, ‘Very happy with the care. All the staff are lovely.’

Although some residents had limited verbal communication due to a dementia condition, we did receive positive comments from people about the service. Three of the residents we were able to speak with said, 'Great food, we are lucky to have a good cook here.' Also, 'The staff are so helpful always willing to listen when you are down a bit. They are really wonderful.'

During our inspection we looked at care records and undertook a tour of the building. A relative we spoke with about the home told us the building was always clean and never had any offensive odours. They also told us the staff were helpful, polite and knew how to support people who had dementia. One aid, 'They do keep the place clean. Also the staff are so helpful. The only thing is it could do with doing up a bit.'

Staff told us they felt supported, had regular meetings with their manager, and their training was kept up to date. Staff training records we looked at confirmed this.

Prior to our visit we contacted the Lancashire contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.