Fallowfield

Fallowfield is a care home providing personal and nursing care for up to 25 people. At the time of our inspection there were 23 people living at the service. Fallowfield is a nursing home set in a Victorian mansion within large landscaped gardens. They provide nursing care and support to people with nursing needs.

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

People’s medicines were not always safely managed. Risks to people were assessed and documented, however, risk assessments and care plans were not always updated to reflect changes in people’s needs and some lacked detailed guidance for staff on how best to manage people’s needs and risks. Management staff completed regular audits of the service and had identified the issues we found in this report; however, we were not assured that appropriate actions were taken in a timely manner to address these issues and this required further improvement. Staff knew how to support people to keep them safe. Appropriate recruitment checks took place before staff started work and staff were deployed effectively throughout the home. There were systems in place to monitor, investigate and learn from incidents and accidents. There were procedures in place to reduce the risk of infections and staff followed good standards of infection control and hygiene practices.

People’s needs were assessed when they moved into the home to ensure they were safely met. Staff had the skills, knowledge and experience to support people appropriately. Staff were supported through induction, training and supervision. People were supported to maintain a healthy balanced diet and had access to health and social care professionals when they needed them. Health and safety checks were carried out of the premises and equipment to ensure they were safe. The home environment was clean and tidy, and the design of the premises met people's needs. 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.

People and their relatives were consulted about their care and support needs. People were supported to participate in a range of activities and events within the home. Relatives were free to visit people if they wished without any unnecessary restrictions. Staff understood the importance of working within the principles of the Equality Act and supported people in meeting their needs. There was a complaints procedure in place and people were confident their complaints would be listened to and acted on. The registered manager and staff worked in partnership with health and social care professionals to plan and deliver an effective service to people. People’s views were taken into account to help drive service improvements.

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 28 January 2021).

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.

Enforcement and recommendations

We have identified two breaches of regulation in relation to safe care and treatment and the safe management of medicines. We have made a recommendation in relation to the providers quality audits and checks ensuring action plans are implemented to monitor actions taken to address issues identified.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Fallowfield is a 25 bed care home with nursing care home for older people. There were 22 people using the service at the time of our inspection.

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

Since the last inspection, the service had made considerable improvements in relation to risk assessments, maintaining care documentation and ensuring people were treated with dignity and respect. However at this inspection, we found improvement was needed in relation to some areas of medicines management.

There were enough staff available to meet people’s care and support needs. The provider had appropriate arrangements to help prevent the spread of Covid 19. There were procedures in place to prevent visitors to the home from spreading infection at the entrance and on entering the premises. The provider had accessed regular testing for people using the service and staff and shielding and social distancing rules were compiled with. All staff had received training on infection control and specific training relating to COVID 19.

The service worked in partnership with healthcare professionals to embed improvements and deliver an effective service. Positive feedback was received about the service from relatives and staff.

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 Requires Improvement (published 9 June 2020).

Why we inspected

We received concerns in relation to infection control and staffing. As a result, we undertook a focused inspection to review the key questions of safe, caring responsive and well-led only.

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 requires improvement to good. This is based on the findings at this inspection.

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.

Fairlight and Fallowfield is a care home made up of two units, a nursing unit and a residential unit in adjoining buildings; Fairlight is the residential unit and Fallowfield the nursing unit. The care home accommodates up to 55 people in total. There were 40 people aged 65 and over living there at the time of the inspection.

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

Supplementary records of people’s care showed people were not consistently being checked in relation to repositioning, hourly checks and fluid intake. Call bell risk assessments were not in place for people who lacked capacity. Some aspects of medicines were not managed safely. There was no record of the checking of expiry dates and the same medicines for different people was being stored together. There were instances where people were not treated with respect and privacy ensured. Care plans lacked detail on how people should be supported appropriately. There were systems in place to assess and monitor the quality of the service provided. However, these were not always effective and did not identify the shortfalls found during this inspection.

We have made a recommendation about care planning guidance in relation to supporting people’s needs.

The service had safeguarding procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks had taken place before staff started work and there were enough staff available to meet people’s care and support needs. The service had procedures in place to reduce the risk of infections. Accident and incidents were recorded and acted upon. Any lessons learnt were used as opportunities to improve the quality of service.

People’s care and support needs were assessed when they moved into the home. Staff were supported through training, regular supervision and annual appraisals of their work performance. 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.

People’s independence was promoted. People and their relatives had been were involved in decisions about their care.

People were supported to maintain relationships and engage in activities they enjoyed. The home had a complaints procedure in place. People were supported to make decisions about their preferences and choices for their end of life care.

The manager and staff worked in partnership with health and social care providers to plan and deliver an effective service. The service took the views of people and their relatives into account through meetings and care review meetings.

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 24 June 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last eight consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, dignity and respect, and good governance.

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.

Why we inspected: This was a focused inspection to follow up on the enforcement action we had taken at the comprehensive inspection in January 2019. It was to see if the provider now met the regulations in the key questions Is the service safe? And Is the service well led? We were also aware of a notifiable safety incident which was being investigated under safeguarding at the time of the inspection and which raised questions about care and treatment provided to people following a fall.

Following the last inspection and the sixth repeat overall Requires Improvement rating we had met with the provider and registered manager with representatives from the local authority on 13 March 2019 to discuss their overall rating and how they might make improvements to meet the regulations. They had provided us with an improvement plan. The inspection was also to review the progress of the improvement plan where it fell under the key questions of safe and well led.

People’s experience of using this service:

We found that some improvements had been made and actions taken in respect of some concerns identified at the previous inspection in January 2019. However, other areas had not been acted on or, where they had this had not been in a robust and effective way. We found there was a continued breach of regulations in the way the home was run. There was an absence of effective systems to provide oversight over risks to people following accidents and incidents and in relation to possible risks at the service identified at the last inspection, which had not been fully addressed. There was an absence of effective oversight to ensure adequate records of people’s care were maintained.

We also found the provider and registered manager had not met the requirements of the duty of candour regulation which require registered persons to act in an open way following a safety incident about how such incidents have been responded to.

We had mixed feedback from people and relatives about the way the service was run. There was no system to ensure regular checks were carried out on people in their rooms or that staff received and understood communication at handovers or from staff meetings. The service did not proactively seek to include relatives at residents’ meetings. Audits and checks were not always effective at identifying issues.

There were no effective systems to assess and review required staffing levels. We have made a recommendation for the provider to seek suitable guidance on deciding appropriate staffing levels.

People told us they felt safe and looked after. Medicines were safely managed. There were effective recruitment measures in place. The management of people’s dietary risks which had been a concern at the previous inspection had improved and communication about these risks was more effective. Kitchen staff had received appropriate training in relation to possible choking risks.

Not all key questions were considered at this inspection and the service remains rated Requires Improvement overall. This will be reviewed again at our next comprehensive inspection.

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

Rating at last inspection: Requires Improvement report published 12 March 2019.

Enforcement: Full information about The Care Quality Commission's (CQC) regulatory response to more serious concerns found in inspections and appeals is added to reports after any representation and appeals have been concluded.

Action we told provider to take: For further information please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: Following this inspection we wrote to the provider outlining the concerns we had about the management of aspects of the service and asked for a report of actions they would undertake to address the issues found.

We will continue to monitor this and other information and intelligence we receive about the service closely. We will return to re-inspect in line with our inspection timescales for Requires Improvement services or earlier if we have information about new concerns.

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 where to report any concerns to. Some risks to people were identified and assessed appropriately. There were arrangements to deal with emergencies. People were protected from the risk of infection and the environment was clean. Medicines were managed safely. There were enough staff to support people and meet their needs. Effective recruitment practices were in place to reduce the risk of unsuitable staff.

People’s needs were assessed before they went to stay at the home to ensure these could be met. People were supported to have enough to eat and drink and to have access to a range of health professionals when required.

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. People gave consent to the care and support they received. There were systems in place which ensured the service complied with the Mental Capacity Act 2005. (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves.

Staff received suitable training and support. People and their relatives were positive about the home. They told us staff were kind, respectful, caring and treated them with dignity. People were consulted about their care and support needs and provided with information about the service.

People had a care plan that recorded their current care and support needs. People’s needs for stimulation and social interaction were recognised with a range of activities provided. People’s needs at the end of their lives were recognised and planned for. People and their relatives were aware of how to raise a complaint and we saw these were responded to appropriately.

People relatives and staff were positive about the way the home was run. Some aspects of the quality monitoring of the services did work to identify and address issues. Staff liaised with other organisations to communicate about people’s care and support needs.

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 service offered a range of activities for people to engage in, and we saw plans in place to increase the level of one to one activity support for people who were unable, or did not wish to take part in communal activities. The service provided appropriate care and support to people at the end of their lives.

People and relatives were aware of how to make a complaint and expressed confidence that any issues they raised would be addressed by the manager. The provider had systems in place to gain the views of people about the service with a view to driving service improvements. People, relatives and staff spoke highly of the manager, and told us there service had improved in recent months. Staff were aware of the responsibilities of their roles and told us they worked well as a team, focussing on providing people with good quality care and support.

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.

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 addressed.

Staff supported people to take part in a range of activities and to maintain the relationships that were important to them. People and staff told us they felt the service was well managed. Staff spoke positively about the working culture at the service and told us they enjoyed good support from the management team and their colleagues.

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 up to date with people's conditions and day to day needs.

People and staff told us that the service well led and there was a positive culture with in the service which focused on good team work. People were able to express their views about the service through regular residents meetings and an annual survey and we saw action had been taken to make improvements to the service in response to feedback.

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.

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.