Archived: The Fairways

We last inspected The Fairways on 08 and 09 September 2016 when we rated the home inadequate overall and placed the home into special measures. We identified breaches of multiple regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following our last inspection we issued two warning notices in relation to breaches of regulations relating to the provision of safe care and treatment and good governance. This meant we sent a formal notice to the provider and registered manager that they must become compliant with the regulations by 22 October 2016 in relation to safe care and treatment, and 15 November 2016 in relation to good governance. The provider sent us an action plan to tell us the improvements they would make in order to become compliant with the regulations. At this inspection we found the provider had made significant improvements and they were meeting the requirements of the regulations.

The Fairways is a large detached house on a main road close to the centre of Flixton. There is a small car park at the front of the property. The home is registered to provide accommodation and personal care for up to 20 people. At the time of our inspection there were 20 people living at the home.

There was 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 provider had improved quality assurance and audit processes since our last inspection. We saw a wide range of audits were undertaken to help the provider monitor the quality and safety of the service. The findings of the daily and weekly audits were analysed for themes, and actions identified as to how the service could make improvements.

The provider had sought the opinions of people using the service and their relatives as to the strengths and areas for improvement the service had. The findings of questionnaires sent out were analysed and used to set targets for improvement.

People told us they felt safe living at the home. Staff were aware of how to identify and report potential safeguarding concerns.

Staff felt there were ‘pressure points’ in the day when staffing levels could be improved. However, staff did not feel this had an impact on people’s care. The provider had a process for considering how many staff were required, and during our inspection we saw staff were available to provide support to people whenever needed.

Staff had assessed risks to people’s health, safety and wellbeing. This included consideration of risks including falls, pressure sores, malnutrition and social isolation. There were plans in place for staff to follow to reduce risks, and we saw any equipment such as mobility aids or pressure sensors were in place as directed in people’s care plans.

Newly employed staff had been recruited following robust procedures to ensure they were suitable for the job role. The provider had recognised that historic recruitment procedures had not been robust, resulting in missing references and gaps in employment histories. The provider had carried out an audit of any required information that was missing and was taking action to satisfy themselves that staff remained suitable for their job roles.

A recent infection control audit had identified shortfalls in the prevention and control of the spread of infections. Issues included the lack of a separate laundry facility or bed pan washer. The provider had an action plan in place to address these concerns, and they showed us plans for works to provide a separate laundry and to purchase a bed pan washer. However, the works had not started at the time of the inspection, which the provider told us was due to them awaiting a re-inspection by CQC.

The provider had changed the way food was provided. Meals were prepared by a third party contractor and delivered to the home. People gave us positive feedback about the meals, and we saw people’s dietary requirements were being met.

Staff had received training in a variety of topics relevant to their job roles. The provider had identified some gaps in training provision and was in the process of booking additional training. We have recommended the provider reviews the scope of the training they have determined to be mandatory.

Staff had received supervision with a manager and felt supported, although formal supervision was infrequent. We have recommended the provider reviews best practice guidance in relation to supervision.

We found the home was well organised and there was a calm environment. Staff were attentive, and interacted positively and respectfully with people. The Fairways is located in an older building, and we found there was limited communal space or adaptations to make the environment more ‘dementia friendly’. However, relatives commented on the ‘homely’ feel of The Fairways.

We received consistently positive feedback from relatives and people living at the home about the staff and the service in general. Staff knew the people they supported well, and relatives were confident that staff were able to meet their needs. The service made appropriate referrals to other health professionals when further advice was required in relation to any health concerns.

Care plans were personalised and contained information on people’s preferences, likes, dislikes and personal history, although the level of detail recorded was variable. Relatives told us they were confident staff understood their family member’s preferences, and they told us they had been involved in developing care plans.

The home employed activities co-ordinators and a range of activities in and out of the home were provided. Staff had considered the need for activities and interaction with people who may be at risk of social isolation.

The home used an electronic care management system to make records of care provided and for care plans. Staff told us the electronic system worked well and they were able to find the information they needed when required.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We last inspected the service on 6 August 2014 where we found the service was meeting all of the regulations we reviewed at that time.

The home provides personal care and accommodation for up to 20 people, some of whom have a dementia related condition. There were 20 people living at the home at the time of the inspection.

There was a registered manager in place. She had worked at the home since the home opened in 1990. A registered manager is a person who has registered with CQC 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.

We spent time looking around the home and found shortfalls with the premises and infection control procedures. The nominated individual showed us their plans to build a 40 bedded care home on a nearby piece of land that they had recently purchased. They explained that people from The Fairways and their other home, The Knoll, would move into the new purpose built home. The new home was due for completion in April 2018. The manager and nominated individual told us that they were aware of the issues with the premises. They explained however, that due to the imminent build of the new care home; they did not want to undertake any extensive building work.

The manager explained that informal checks were carried out to monitor the quality and safety of the service since she and the directors were always available. No formal audits were completed in relation to care plans, the dining experience and health and safety. In addition, medicines audits did not highlight the shortfalls which we found. We identified multiple breaches of regulations, most of which had not been identified and actioned by the provider.

People and staff told us that there were sufficient staff deployed. There were two staff on duty at night. There was no evidence that night time staffing levels had been assessed to ensure that two staff were sufficient to evacuate people safely in an emergency. The manager told us that they had a staffing tool to help calculate staffing levels; however this had not been completed.

Most people told us that they felt safe. One person disclosed a safeguarding allegation to us. We spoke with the manager about this allegation and she referred it to the local authority safeguarding adults team. There was a safeguarding policy in place. It was not clear however, when the police would be contacted in allegations where it was suspected that a crime had been completed. Staff informed us that they had not witnessed any concerns and said they felt able to inform the manager if abuse was suspected.

There was a supervision and appraisal system in place. Informal supervision sessions were sometimes carried out but these were not always documented. Staff told us they received sufficient training. We noted that there were some gaps in training provision. The manager told us that the local authority had stopped delivering training. She said they were currently working with other providers to source further training.

There was a lack of evidence that people had consented to their care and support.

We checked whether people’s nutritional needs were met. People and relatives spoke positively about the meals at the service. However, we identified shortfalls in the provision of meals for those people who required a pureed diet. There was a lack of choice and all items of food were blended together which did not appear appetising and meant the individual flavours of the meal could not be experienced. The cook had not undertaken specific training in the provision of modified textured diets. In addition, it was not always clear what advice had been sought from relevant health care professions to ensure that people’s diets were appropriate.

Although staff informed us that people’s needs were met in a person centred way, some people informed us that at times, care and support was based on routines which were not always person centred such as bathing and getting up in the morning.

The provider used a computerised care management system to plan and review people’s care and support. This system reminded staff when reviews of care plans and risk assessments were due.

People told us that their social needs were met. A new activities coordinator was due to start working at the home the week after our inspection. We saw photographs of activities which people had historically taken part in, such as pet therapy and arts and crafts.

There was a complaints procedure in place. No one with whom we spoke had made any formal complaints.

The registered manager and nominated individual were very open and transparent throughout the inspection process and acknowledged the concerns we raised. They were aware of the issues with the premises, especially in relation to the sluice/laundry area and lack of storage.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found seven breaches of the Health and Social Care Act 2008. These related to person-centred care; dignity and respect; need for consent; safe care and treatment; staffing; meeting nutritional and hydration needs and good governance. 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.

As part of this inspection we spoke with three people using the service, two relatives of people using the service and two carers as well as the deputy manager. We observed staff interacting with people throughout the day. We reviewed records relating to the management of the home which included care plans for four people, staff training records, policies and quality audits.

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records that we looked at.

Is the service safe?

We saw that an assessment of people's needs had taken place before people had gone to live at the home and was followed by a comprehensive risk assessment after people had moved to the home. This meant that care for people was planned to ensure their safety. People had been involved in planning their care and consented to the care they received. Staff knew how to deal with emergency situations. There were enough staff to meet the needs of people using the service. Staff had been supported to receive appropriate training to care safely for the people living in the home. Staff understood mental capacity to consent issues. CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes. No DOLS applications had needed to be submitted to the local authority but a manager understood how and when to do so. Records were managed safely. Overall we found that the service was safe, although current staffing numbers were not based on an analysis of people's needs and might not support any increase in the dependency of people using the service.

Is the service effective?

The service was effective. People told us that they were happy with the care they or their relatives received and felt that all their needs had been met. A person said that the staff, 'Know what I like and don't like. They can't do enough for me.' A relative said, 'All my worries were gone when (they) came here.' It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Care plans reflected assessed risks, were reviewed and updated regularly.

Is the service caring?

The service was caring. A person told us that all of the carers were caring and a relative said they could tell they cared by, 'The way they do things for people.' We spoke with carers who knew people's needs and spoke affectionately about the people they cared for. We observed them interact with different people in a kind and gentle way, using humour where appropriate.

Is the service responsive?

The service was responsive to the changing needs of people using the service, to comments and suggestions and to recommendations made in external safety reports. A person told us that when they had first come to live at the home, they had made several suggestions which had been acted on. An example was about the way that their drinks were served. We saw that assessments of people's needs resulted in care plans that carers read and updated if people's needs changed. The care plans helped staff to know the needs and care that individual people required. Carers told us that the managers were responsive to suggestions about any new training. A training manager told us about discussions that had taken place about potential changes in the policy and procedure concerning future DOLS applications for people who lack the capacity to consent: this was in response to a recent court judgment.

Is the service well led?

People said the manager was, 'Very nice', and that they cared about people who lived in the home and about the staff. A relative said that both the manager and deputy manager were very good. A carer said the manager was, 'Nice and very supportive.' The manager was supported by a training manager and senior staff at a second home of the provider's. The service had a system in place to monitor and assess the quality of the service. Staff were supported to complete an induction program and on-going training to meet the needs of people living at the home. Records were accessible, relevant and legible, stored safely and destroyed confidentially after an appropriate time period.

The detailed evidence supporting our summary please can be read in our full report.

We noted that bathrooms and toilets were well signed and close to rooms on each floor.

During the inspection we sampled six care files. We found that the files were well organised and person centred and contained where appropriate a mental capacity assessment.

Detailed assessments of care needs and assessment of risk had been undertaken and were updated monthly including mobility, manual handling, nutrition, dependency and falls risks.

We found the environment was safe and suitable for the people using the service with all relevant checks being completed.

We found a robust audit process was in place to monitor all aspects of care at The Fairways and the opinions of people living in the home, their relatives and visiting professionals were sought via annual questionnaire's.

Staff we spoke with were able to demonstrate a thorough understanding of safeguarding concerns and what action to take if they had any concerns.

We found that staff received appropriate training to allow them to carry out their roles.

People told us; 'I Like it here its home from home'. I am happy to be here, they look after me well'. 'The staff are great, the food is good I am happy here'.

A relative told us; 'My X is new here but has settled well the staff look after her well'.

Staff told us; 'I've been here for years, I really enjoy the work and the people both living here and staff are great'.

We spoke to two members of staff who told us they were well supported at work, had regular training, and had opportunities to undertake further training to increase their knowledge.

Records indicated that people's care needs were regularly assessed, and people were involved in planning their own care. We saw that medication was kept secure and no discrepancies were found in the records of in the medication we looked at.

We saw that people were offered regular drinks and had a choice of food. If they were at risk of malnutrition their food and fluid intake was monitored.