Fairland House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Requires Improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Delays in reporting, incidents, accidents and safeguarding concerns over time could adversely affect people’s care and treatment and records need to be robust, so it is clear what actions have been taken and show how risks were being accurately monitored.

Lessons learnt were not effectively disseminated across the service. Staff could not give us any examples. However, the maintenance lead was able to tell us how lessons from other services and CQC assessments had led to changes in practice. Daily risk meetings were used to enable heads of department to focus on risks.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People were supported holistically to ensure their needs were met. We saw proactive working with other agencies and shortfalls being identified and addressed. Where care was not delivered correctly staff were supported to improve their practices and ensure they had the skills to meet peoples identified needs.

Our only concern was the robustness of care planning and risk assessments where the service had not always ensured a regular review of people’s needs to ascertain if the care plan was still relevant or required updating to flag unmet or changing needs. Care plans were being overhauled, however we found that care notes were quite generic which would make it difficult to extract key information. A key worker system or named carer had not been established for each person which could improve the ability to oversee and review people’s care.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Risk meetings and staff handovers ensured staff knew changes to people’s needs and weekly multi-disciplinary meetings helped to ensure a joined-up approach to meeting people’s needs. The manager was currently reviewing people’s needs to establish if their needs could be met within the service or if people needed additional funding or an alternative provision.

Staff received training to ensure they understood people’s individual needs and knew how to protect people in line with the policies such as human rights and adult safeguarding. People were protected from discrimination and actual avoidable harm due to management oversight and processes which identified risk and set measures in place to reduce harm where possible.

Lessons were learnt across the service but a delay in identifying and reporting accidents and incidents could put people at increased risk of continued harm. The manager worked with the local authority to record and report safeguarding concerns.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Proactive risk taking was promoted but we received a concern regarding self-administration of medicines and how a person was not initially supported to continue to be independent with this task. The home has since facilitated this. Some restrictive practice was identified for example: people needed assistance to use the lift so had to wait until staff were available, but we saw there were appropriate deprivation of liberty safeguards in place, (DoLS) and people were able to access the garden and trips out were organised.

Risk assessments were in place including robust manual handling plans. We found however more detail was required in terms of people’s distress behaviours and potential triggers. Some of the information was generic and did not clearly describe what the persons’ usual presentation was and what might cause increased anxiety. Staff described using high/low interventions, but it was unclear what this meant and some of the terminology used by staff was generic rather than descriptive such as ‘challenging’ which was not helpful in understanding behaviour.

Risks associated with falls were documented and analysed but we were concerned by the lack of accurate description and timely actions taken. For example, a person’s falls were described as mostly behavioural, but it was not clear from their falls history how staff distinguished between behaviour and accidental. Actions by staff were not consistently recorded to show what follow up actions or reviews had taken place. This included contact with other professionals, family or a review of their risk assessments and care plans. Some staff had recently identified a lack of confidence in reporting procedures although the new manager had been supportive in reviewing documentation and upskilling staff.

A relative did raise concerns about a family member having regular falls and asking for a re-referral to the falls team. Staff confirmed there was adequate lifting equipment in place to assist people off the floor and staff seemed well trained.

We also had concerns about weight loss over time, following a review of three months of data. We noted that recent weight loss was impacted by both flu and a stomach bug but found records ambiguous in terms of how much people had eaten and drank. Records stated, ‘ate all’, or ‘ate standard plate’ which was not sufficiently descriptive. People were referred to the GP when they had unintentional weight loss, but it was unclear if the chef and all the staff were proactive in encouraging regular snacking and nutritional choices. One family suggested not, and we observed on the day of our assessment a new flexible 24-hour menu had just been introduced but not fully implemented and people’s menu choice was restricted.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Improvements in the environment were noted, and we found clear maintenance and cleaning schedules in place. The standards of cleanliness were good and there were sufficient staff to ensure spillages were dealt with effectively. However, at the weekend there was a reduction of staff which could compromise standards. Continence products were readily available and there were no unnecessary odours in the service.

An electronic check in system ensured visitors were signed in and could be accounted for if evacuation was necessary. Fire procedures were robust, and staff could tell us what procedures were in place.

The maintenance person on site was highly organised and was able to show what systems were in place to oversee the safety of the premises and equipment. We did not identify any hazards other than a radiator cover coming loose which was rectified immediately. We also found flooring was raised in one room which could cause a trip hazard, and the bathroom upstairs had been out of order for some time which could impact on people’s experience of personal care.

We noted brief periods of time when people were left unsupervised which could increase the risk of accidents, and several people mentioned others coming into their rooms unsupervised. Regular checks were carried out by staff and where people’s needs were increasing this was communicated with other professionals and had resulted in additional funding and, or people moving to more appropriate services where nursing care was provided.

The provider mostly ensured that there were enough qualified, skilled and experienced staff. Staff had not always received effective support, supervision and development to help ensure they worked together well to provide safe care that met people’s individual needs.

Staffing levels had improved, and recruitment was robust. Immediately following our last assessment night staffing levels increased and there were always permanent staff on duty. However, the service continued to use regular agency staff and although continuity of agency was secured some agency profiles showed agency staff were relatively new to their roles with limited training and experience. Permanent staff did not feel able to always delegate to agency staff due to their lack of experience. Staff said shifts could be variable depending on who you were working with and some permanent staff lacked confidence. We discussed this with the manager, and this has arisen as several senior staff had recently come back to their posts and staff training and development had been impacted by a lack of management. Training statistics had recently improved and although some staff’s supervisions and appraisals had lapsed staff were receiving direct observations of their practice to ensure that they were deemed competent and able to evidence that they had understood their training.

Staff meeting minutes had highlighted concerns about staffs’ ability to lead a shift and delegate effectively as busy times of the day with medicines reportedly taking a lot of time to administer. The manager was working to support staff to develop their skills and senior staff all had additional qualifications relevant to their role.

Relatives told us there were more staff around and commented that staff were responsive to, “call bells,” and “Assisting relatives in and out of the building.”

We observed people getting their needs met in a timely way but raised concerns about the weekend when there were less staff working particularly ancillary staff and no activity staff which could impact on people’s experiences and safety. People were more likely to fall in their room at certain times of the day and although staffing had recently increased, we felt people’s dependency was generally quite high based on the data regarding their supervision levels, number of falls and behaviour. The manager was in the process of reviewing people’s needs to ensure staffing levels were appropriate.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We observed good standards of hygiene and knowledgeable staff who understood how to reduce cross infection. A recent outbreak had occurred, but the manager had worked with public health to ensure that cross contamination was reduced.

Relatives commented on cleanliness, one said, “Their room is always spotless.” Relatives commented on staff wearing gloves and aprons when appropriate and relatives said they were advised not to visit when there was an infection outbreak at the home.

The kitchen had recently been refurbished and floorings replaced. The kitchen awarded five stars by environmental health which was a significant improvement from the last assessment. People looked well cared for and clean.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Auditing of medicines helped to identify any shortfalls. Staff administering medicines were adequately trained and peoples medicines were kept under review with clear instructions about what and when to administer. Staff voiced concerns about how long medicines could take to administer which created the risk of medicines not being administered in line with the prescriber’s instruction. Senior staff were being supported to prioritise medicines and received additional training and recent medicine competencies.