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Fairlight & Fallowfield Requires improvement

We are carrying out a review of quality at Fairlight & Fallowfield. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 8 January 2019

During a routine inspection

This inspection took place on 8 and 9 January 2019 and was unannounced. Fairlight and Fallowfield is a ‘care home’. People in care homes receive accommodation and nursing, or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 55 people, across two joined buildings or units with adapted facilities, one of which focuses on residential care, and the other on nursing care. There were 52 people living at the home at the time of our inspection

At the last inspection on 22, 23 and 24 November 2017 we had found some improvement was required because sufficient staff were not always deployed to ensure people received prompt support when required. We also found that some environmental risks were not consistently managed safely at the service, call bell response times were not monitored effectively and notifications were not consistently submitted to CQC, where required. The home was again rated Requires Improvement overall for the fifth successive occasion since 2015. As part of our methodology for services repeatedly rated Requires Improvement we met with the provider on 26 January 2018 to discuss their improvement action plan to discuss what they would do to improve the key question safe and well led to good.

At the last inspection in November 2017 there was no registered manager in post. At this inspection there was an experienced registered manager who had registered as manager at the home since May 2018. 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.

At this inspection we found all the areas we had identified as requiring improvement at the last inspection had been addressed. However, we found the quality of other aspects of care and support was not effectively monitored and managed to ensure other specific risks to people’s health and safety were identified and assessed. We found two breaches of regulation as the systems to ensure oversight of risks in relation to the premises and people’s dietary needs was not always effectively managed to reduce possible risks to people. The issues we found had also not been identified by the provider’s own quality assurance systems.

You can see what action we have asked the provider to take in respect of one breach of regulation at the back of the full version of this report. However, full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded

Other aspects of the governance of the home also required some improvement. There were no regular infection control audits or checks carried out on the care provided at night. Some issues identified were not always addressed promptly. While there was informal discussion and regular handovers between shifts; there was an absence of visible processes such as meetings to aid communication and oversight of the home. People’s views about changes to the service were not always consistently sought.The service has again been rated Requires Improvement for the sixth time.

Improvements were required as although there were systems in place for the monitoring and investigating of accidents, incidents and safeguarding; there was no clear system to ensure trends or learning was consistently identified. We also found some improvements were needed to ensure people’s diverse rights were identified, respected and supported and to evidence people and their relatives’ involvement in the care review process.

People and their relatives told us they felt safe at the home. Staff understood how to safeguard people and

Inspection carried out on 22 November 2017

During a routine inspection

This inspection took place on the 22, 23 and 24 November 2017 and was unannounced. Fairlight and Fallowfield is a ‘care home’. People in care homes receive accommodation and nursing, or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 55 people, across two joined buildings, one of which focuses on residential care, and the other on nursing care. There were 48 people living at the home at the time of our inspection.

At the last comprehensive inspection in February 2017, we asked the provider to take action to make improvements to address deficiencies in staff training. We conducted a focused inspection of the service in June 2017 to follow up on further issues we had identified during our February 2017 inspection relating to poor risk management, following which we asked the provider to take action to make improvements to address concerns relating to the management of pressure relieving equipment at the service. We also took enforcement action following that inspection, serving a warning notice on the provider and registered manager, requiring them to address concerns we had identified with their systems for monitoring the quality and safety of the service. These actions have all been completed.

At this inspection we found improvement was required because sufficient staff were not always deployed in a way that ensured people received prompt support when required. We found further areas of improvement were required to ensure environmental risks were consistently managed safely at the service, call bell response times were monitored effectively and to ensure notifications were consistently submitted to CQC, where required.

The service did not have a registered manager in post. 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. The current service manager was in the process of applying to become the registered manager.

Risks to people had been assessed, and staff acted to manage identified risks safely. People were protected from the risk of abuse, because staff were aware of the types of abuse that could occur and the action to take in reporting any concerns they had. Medicines were stored, recorded and administered to people safely. Staff were aware of the action to take to ensure people were protected from the risk of infection. Staff were also aware to report any accidents or incidents and records showed that any accidents that had occurred at the service had been followed up to reduce the risk of repeat occurrence.

The provider followed safe recruitment practices when employing new staff. Staff received an induction when they started work at the service, and were supported in their roles through a programme of training and regular supervision, which included an annual appraisal of their performance.

People were supported to maintain good health. External healthcare professionals confirmed that staff worked in partnership with them to ensure people received consistent support across different services. People were also supported to maintain a balanced diet and told us they were happy with the layout and decoration of the home. 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.

People confirmed staff treated them with care and consideration, and that their privacy and dignity were respected. Staff involved people in day to day decisions about their care. People had care plans in place which reflected their individual needs and preferences. The servi

Inspection carried out on 12 June 2017

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of Fairlight & Fallowfield on 07, 08 and 09 February 2017 which resulted in our taking enforcement action. We served warning notices on the provider and registered manager in respect of a breach found of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. We took this action because people using the services risk assessments were not always up to date and action had not always been taken where risks had been identified to ensure their safety was maintained. We also found risks associated with the environment were not safely managed.

We conducted this unannounced focused inspection of the service on 12 June 2017. At the inspection we looked at aspects of the key question 'Is the service safe?' This report only covers our findings in relation to the focused inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Fairlight & Fallowfield' on our website at www.cqc.org.uk.

Fairlight and Fallowfield is a home providing nursing care and residential support for up to 55 people in the London Borough of Bromley. At the time of our inspection there were 42 people living at the home.

The service had a new registered manager in post who had registered in the time since our last inspection. 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.

At this inspection we found a continuing breach of regulations because whilst the provider had taken action to address all of the issues identified in the warning notices, we could not be assured that pressure relieving equipment in place for one person was safe for use. Following the inspection we wrote to the provider with regards to this issue and they confirmed the action they had subsequently taken to ensure the equipment was safe for use.

We also identified a further breach of regulations because effective systems were not in place to monitor and mitigate the risks associated with the use of pressure relieving equipment and because records relating to people’s care and treatment were not always complete and accurate.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Inspection carried out on 7 February 2017

During a routine inspection

This inspection took place on 07, 08 and 09 February 2017 and was unannounced. Fairlight and Fallowfield is a home providing nursing care and residential support for up to 55 people in the London Borough of Bromley. At the time of our inspection there were 44 people living at the home.

There was a registered manager in post at the time of our inspection although they told us they no longer had day to day responsibility for the management of the service. The current manager was in the process of applying to become 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 2008 and associated Regulations about how the service is run.

At our last inspection we found a breach of regulations because risks to people's health and safety around the use of certain equipment had not always been assessed and action had not always been taken to ensure risks were safely managed. Following the inspection the provider sent us an action plan explaining how they would address these concerns. However, whilst we found that the provider had made improvements to the specific areas identified at the previous inspection, at this inspection we identified breaches of regulations because risk assessments had not always been reviewed on a regular basis and action had not always been taken where people were at risk to ensure their safety was maintained. Environmental risks were not always safely managed and sufficient action had not always been taken to ensure the risk of infection was safely controlled.

We also found breaches of regulations because staff were not always up to date with their training in areas considered mandatory by the provider, and because the provider’s systems to monitor the quality and safety of the service were not always effective in driving improvements. Additionally, whilst the provider sought feedback from people at residents meetings and through regular surveys, residents meetings were not always conducted on a quarterly basis, in line with the management team’s expectations, and survey results had not always been considered by staff to help drive improvements at the service. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People were protected from the risk of abuse because staff knew the signs to look for and action to take if they suspected abuse had occurred. The provider followed safe recruitment practices and there were sufficient staff deployed within the service to meet people’s needs. Medicines were stored securely and administered safely. We also found accurate records were maintained regarding the receipt, administration and disposal of people’s medicines.

Staff sought consent from the people they supported and involved people in day to day decisions about their care and treatment. The provider worked within the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to ensure any restrictions on people’s freedoms were lawful and minimised. People were supported to maintain a balanced diet and to access a range of healthcare services when required. Staff were supported in their roles through supervision and an annual appraisal of their performance.

People received care that was caring and compassionate. They told us their privacy and dignity were respected. People had been involved in developing and reviewing their care plans. The care people received met their individual needs and preferences. The provider had a complaints policy and procedure in place and people expressed confidence that any issues they raised would be

Inspection carried out on 2 February 2016

During a routine inspection

This inspection took place on 02 and 03 February 2016 and was unannounced. At our last inspection in December 2014 we found a breach of regulations because records relating to decisions made on people’s behalf when they lacked capacity themselves did not always clearly demonstrate that the provider had followed the requirements of the Mental Capacity Act 2005. At this inspection we found that improvements had been made to meet the requirements relating to consent.

Fairlight and Fallowfield is a home providing nursing care and residential support for up to 55 people in the London Borough of Bromley. At the time of our inspection there were 45 people living at the home. There was a registered manager in post at the time of our inspection. 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.

At this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because risks to people's health and safety had not always been assessed and action had not always been taken to ensure risks were safely managed. You can see the action we have asked the provider to take in response to this breach at the back of the full version of this report.

Staff were supported in their roles through regular supervision and an annual appraisal of their performance. They received an induction when they started work for the provider and completed training in a range of areas which gave them the skills to undertake their roles effectively. There were enough staff available to meet people's needs although people had mixed views about the use of agency staff within the service. The provider undertook appropriate recruitment checks on new staff before they started work.

Medicines were safely stored but improvements were required in the recording of administered medicines and to ensure people consistently received their medicines as prescribed. People were protected from the risk of abuse because staff were aware of the potential signs to look for and the action to take if they suspected abuse had occurred. Staff sought consent from people when offering support and the service worked within the requirments of the Mental Capacity Act 2005 (MCA) but improvement was required to ensure that conditions placed on people's Deprivation of Liberty Safeguards (DoLS) were met.

People were supported to maintain a balanced diet, although, their views on the food on offer at the service were mixed. People had access to a range of healthcare professionals when required and visting healthcare professionals told us that staff made appropriate referrals promptly when needed. We observed caring and friendly interactions between staff and people. People's privacy was respected and they were supported to make decisions about their care and treatment.

People were involved in the planning of their care and care plans were person centred. There were a range of activities on offer for people to enjoy and the feedback from people about the activities offered was positive. People were aware of how to make a complaint and told us they were confident that staff would address any concerns they had promptly and effectively.

Senior staff undertook audits in a range of areas in order to monitor the quality and safety of the service and we saw action had been taken in response to audit findings. However, some improvement was required to the frequency at which people's care plans were audited to ensure the process was sufficiently robust to identify potential issues promptly.

The service held regular staff meetings to ensure staff were aware of the requirements of their roles and staff handover meetings were conducted between each shift so that staff we kept

Inspection carried out on 8 December 2014

During a routine inspection

This was an unannounced inspection which took place on the 8 December 2014. At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.

Fairlight & Fallowfield provides nursing and residential care for older people within two separate sections of the home. The home is located in Chislehurst, Kent and at the time of our inspection there were 47 people using the service.

During our inspection we found that the provider had breached a legal requirement in relation to consent. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were not always recorded appropriately. Medicines bottles, packaging and boxes were not labelled appropriately with the date of opening recorded. This meant that medicines administered may not be safe and fit for use. We have made a recommendation about the management of some medicines.

Mental capacity assessments were not always effective and sufficient in detailing the outcome of assessments conducted and the involvement of people using the service. Care plans did not always show consideration had been given to restrictions on people’s liberty or if decisions were made in their best interests.

The provider had safeguarding policies and procedures in place to guide best practice. Staff were aware of the provider’s safeguarding policies and procedures and how to report their concerns appropriately.

We observed there were sufficient numbers of staff to ensure that people were kept safe and well. Records showed staffing levels were analysed by establishing the dependency levels and needs of people using the service.

Safe and appropriate staff recruitment procedures were in place to ensure that staff were suitable to work with people using the service. Required checks were conducted before staff were allowed to work at the home.

Staff were supported appropriately and offered guidance on best practice through regular supervision and annual appraisals. Staff received regular supervision with line managers every six to eight weeks.

People were supported to maintain good physical and mental health and had access to health and social care professionals when required.

Staff displayed kindness, compassion and respect toward people using the service and addressed people by their preferred names. Staff asked people's permission before providing any care and support.

Care records demonstrated that staff supported people to access community services and practice their religion or cultural needs. They showed that people and their relatives had been consulted about how they wished to be supported and were involved in decisions about their care and support.

We observed that staff were responsive to people’s needs and in cases where people were not able to vocalise their choice or when they required support, staff communicated using methods suited to individuals.

The provider’s had a complaints policy and procedure in place. People using the service and their relatives told us they would know who to speak with and how to make a complaint if they needed. People told us they felt confident in making a complaint.

The provider had systems in place to evaluate and monitor the quality of the service provided although they had not identified the issues we found at the inspection. They regularly surveyed people’s views through quality assurance satisfaction surveys and regular residents meetings that were held to provide people with an opportunity to provide feedback on the service.

Inspection carried out on 17 December 2013

During a routine inspection

The home is in two separate sections which provide nursing and residential care. This visit covered mainly the nursing care half of the home as we had received some concerning information about the level of care provided to people.

People and family members we spoke with told us they were happy with the care provided at the nursing home. One person told us "the staff are marvellous.” One relative we spoke with said, “they (staff) spend time with the people and are very respectful.” Another relative said, “best possible care I can think of.” Another relative we spoke with said they visited twice daily and had never seen any untoward incident. “Staff welcome everyone with a smile.” “I am kept informed and the staff listen and act on our suggestions.”

At our inspection we found that people’s needs were suitably assessed and they received appropriate care based on their needs. Staff received suitable support and worked with other health and social care professionals to ensure people using the service received safe and effective care. People’s care records were up to date and secured safely.

Inspection carried out on 14 January 2013

During a routine inspection

People we spoke with said that the staff were caring and friendly. They were happy with the care provided at the home. One relative we spoke with said, "we couldn’t have been in a better place." Another relative we spoke with said, the staff were very caring. An external care professional who visited the home often and we met on the day said as far as they were aware the care home staff provided very good care to the people living at the home.

On our inspection we found that the people who used the service were involved in their care planning and received personalised care and support. Staff received support and training in different aspects of care and demonstrated an understanding of safeguarding of vulnerable adults and how to raise concerns. The provider undertook checks to monitor the quality of care.

Inspection carried out on 15 March 2012

During an inspection to make sure that the improvements required had been made

People we spoke with told us they were happy and satisfied with the service. They told us they were well looked after and the staff were friendly and supportive. One person we spoke with said, “there was nothing to criticise”.

Inspection carried out on 11 May 2011

During an inspection to make sure that the improvements required had been made

People told us that they were happy with the care at the home.

Inspection carried out on 26 January 2011

During a routine inspection

People told us that the home was well maintained. We met relatives of some of the people who live at the home. They said that they were happy with the care at the home.

However, on our visit we found a number of concerns with the care being provided at the home. For these areas we have asked for immediate improvement.