Fairholme

We found the following examples of good practice.

¿ Systems were in place to prevent people, staff and visitors from catching and spreading infections.

¿ Additional cleaning of all areas and frequent touch surfaces was being carried out regularly.

¿ People were supported to understand the pandemic and the need for infection prevention and control (IPC) measures, such as staff wearing face masks.

¿ Staff participated in a regular testing programme.

¿ Staff wore appropriate PPE and the service had ample PPE supplies.

The inspection took place on 23 October 2017 and was unannounced.

We previously inspected Fairholme in September 2016, at which time the service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the inspection of September 2016 we identified that the provider did not always have in place safe procedures regarding medicines and that bathrooms and communal areas were in need of refurbishment. At this inspection we found the provider had ensured all necessary action had been taken to ensure medicines administration was safe and that areas of necessary refurbishment had taken place. At our inspection of September 2016 we rated the service as requires improvement. Following this inspection we rated the service as good.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

Premises had been improved, with two bathrooms refurbished, communal flooring recovered and people’s rooms decorated. The service was clean throughout. Maintenance of the building was well managed with a dedicated maintenance team covering this service and two of the provider’s other services.

People who used the service told us they felt safe and no relatives or professionals we spoke with raised concerns. Staff had been trained in safeguarding and were confident in how to identify potential abuse and how to report it.

There were sufficient staff on duty to keep people safe and meet their needs.

Pre-employment checks of staff were in place, including Disclosure and Barring Service checks, references and identity checks, to help ensure unsuitable people were not employed.

The ordering, storage, administration and disposal of medicines was safe, with improvements made in the recording of controlled drugs. Staff demonstrated a sound knowledge of people’s medicinal needs.

Risk assessments were in place to ensure staff knew how to protect people against the risks they faced, whilst also encouraging them to take some positive risks.

People had access to primary healthcare such as GPs, nurses and specialists, and got the support they needed. Staff liaised well with external professionals.

Training for staff was up to date and comprehensive, covering mandatory areas such as safeguarding, health and safety, moving and handling and fire safety, as well as areas specific to people’s developing needs, such as dementia awareness.

Staff received regular supervision and appraisal meetings and confirmed they were well supported and empowered.

People told us the new chef provided a range of high quality healthy meals. The chef planned a new cookery course for people to encourage more independence and we saw people who used the service interacted well with him.

The premises were well adapted. People used the varied lounges and calm spaces to suit their mood and the open kitchen/dining area was popular.

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. One person who used the service was moving on to more independent living on the day of our inspection and the registered manager and deputy were keen for other people to achieve similar outcomes.

The atmosphere at the home was at times relaxed, at times vibrant, with people who used the service feeling at home. People who used the service, relatives and external stakeholders told us staff were caring and treated people in a dignified manner that respected their individuality.

Person-centred care plans were in place and bi-monthly residents’ meetings took place, whilst reviews of care plans involved people who used the service or people who knew them best.

There were a range of in-house activities although take-up was varied. People who used the service told us they were content although some relatives felt more could be done to encourage people’s independence.

All people we spoke with, relatives and staff spoke positively about the impact the registered and deputy manager had made, and we found them to work well as a team. The culture was one of empowerment and confidence amongst staff, and homeliness amongst people who used the service. The registered manager had ensured people’s needs were well met and had clear plans for supporting people to become more independent in future.

Fairholme is a care home with accommodation for up to 22 people who require personal care, some of whom are living with mental health problems. At the time of our inspection 20 people were receiving a service.

We previously carried out a comprehensive inspection of this service on 8 February 2016.

Breaches of legal requirements were found because the provider did not have effective systems to ensure the care and treatment of service users was appropriate, met their needs or reflected their preferences. The quality assurance system was not effective in monitoring the quality and safety of the service provided to service users.

After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of the regulations relating to person centred care and good governance.

As part of this comprehensive inspection we checked that they had followed their plan to confirm that they now met the legal requirements.

We found the assurances the registered provider had given us in the action plan had been met.

Care plans had undergone redevelopment and people had been included in their care planning. Care plans and risk assessments were reviewed monthly as a minimum or when a change in need took place.

The provider had developed a quality assurance process to obtain the views of people, other health care professionals, relatives and staff. Questionnaires were sent to people who used the service and were in being returned. The manager had a system in place to analyse responses received.

At this inspection we found there were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, specifically medicine management and premises and equipment.

We found anomalies in the stock balance recording for one person’s medicine. The medicine administration record (MAR) did not contain the amount of medicine received in the last medicine delivery cycle. There were gaps in recording for one medicine on the MAR.

We found on one person’s MAR, the dates and amount of medicines received were not always recorded. For example, diazepam was recorded as being delivered but no amount, olanzapine receipt was dated but no amount received was recorded.

Where a person was self-administering their own inhaler, the date they were issued with a new inhaler was not recorded on their current MAR. Previous MARs showed that staff had recorded when a new inhaler had been issued. This meant that the service’s recording process in relation to medicines had not been followed correctly or consistently.

The recording process for returning controlled medicines had not been followed. Controlled medicines for one person had been returned to the pharmacy but the service’s controlled medicine record book had not been signed by the collecting pharmacy. The service’s general returns medicine book had been signed by the collecting pharmacy.

The medicine audit process had failed to identify short falls in medicine management.

This was a breach of Regulation 12 (Safe care and treatment) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Some areas within the premises appeared tired and in need of updating, the furniture in people’s rooms was stained and in need of replacing. The provider had a plan of refurbishment but this did set specific dates for completion. This meant the provider had failed to ensure suitable arrangements for maintenance of the premises and equipment.

This was a breach of Regulations 15 (Premises and equipment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had not ensured results from health and safety audits where actioned within specific timescales. The audits that the management team were completing had failed to identify the shortfalls in meeting the requirements of all the necessary regulations. We have made a recommendation that the service seek advice and guidance to enable them to create systems and processes to respond appropriately and without delay where quality or safety is being compromised.

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 manager has recently submitted an application to the Care Quality Commission for registration but this was rejected due to inaccuracies. The application had recently been resubmitted but had not been validated at the time of the inspection.

People told us they received their medicines at the right time. The medicine room was clean and tidy. Staff responsible for administering medicines had received competency checks.

People were complimentary about the service and made positive comments. They were happy with the care and support they received. One person said, “I am happy here, the staff are canny (Nice).” Another person said, “I’m part of a family here.”

Recruitment practices at the service were thorough and safe. Staff training was up to date and staff received regular supervision and appraisal. We looked at current and recent staffing rotas for the service. There were enough staff employed to make sure people were supported appropriately. People told us they felt the service had the correct level of staff supporting them.

Staff had an understanding of safeguarding and whistleblowing and told us they would speak to management if they had any concerns. They felt confident that management would listen and act on any concerns they raised.

Systems were in place for recording and managing safeguarding concerns, complaints, accidents and incidents. People told us they knew how to make a complaint. On person told us, “Oh I would make a complaint, no bother, [manager] is great.” Another person said,” I have nothing to complain about but I would speak with staff, they do listen.”

The registered provider had procedures in place in case of an emergency. People had personal evacuation plans (PEEPs) in place. A business continuity plan had been developed so staff knew what to do in an emergency. Health and safety checks were carried out to ensure the service was safe for people and staff. Checks included gas and electrical safety checks.

People’s health needs were regularly monitored and assessed. The service contacted other health care professionals when necessary, such as GPs and dieticians. People accessed community health care by way of attending dentist and optician appointments.

People said they were involved in their care and how they were supported. One person told us, “I don’t like doing my plans but I know it’s important so I am involved.” Another person said, “I have ambitions and speak to the staff about these to see if I can do things.”

People were supported to have a healthy varied diet. A snack station was available for people to help themselves to hot and cold drinks and snacks. One person told us, “We help plan the menu but can have something different if you want to.”

Staff understood the Mental Capacity Act 2005 (MCA) where people lacked capacity to make a decision and the Deprivation of Liberty Safeguards (DoLS) to make sure any restrictions were in people’s best interests. DoLS authorisations were in place for people who required one.

People engaged in a variety of organised activities. Group activities and one to one sessions took place and the service facilitated day trips. We saw records of recent and future planned outings.

People told us they would feel confident to approach the staff or manager if something was wrong. Resident meetings were held and a recent survey had been undertaken to gather feedback and opinions about the home and the service.

People felt the management in the home was open and honest. One person told us, “[Manager] and [deputy manager] are great, it is so much better now.”

People had individual bedrooms which allowed privacy. We saw personal effects on display such as pictures and ornaments. We found some bathroom areas had been recently decorated and new carpets laid. Supplies had been purchased to start decorating people’s bedrooms. We viewed evidence of quotes for improvement work which the manager had obtained for head office.

Fairholme is a residential care home and provides personal care for up to twenty-two adults with mental health needs.

The service did not have a 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.

The registered provider had breached regulations 9 and 17 of the Health and Social Care Act 2008. This was because most people’s care plans did not reflect their current needs and preferences. People’s needs had not been reassessed prior to developing new care plans. Some areas of the service had been neglected due to a lack of leadership within the home.

People said they were well supported. One person said, “It’s great now, it is very well changed. I am happy here, I don’t want to move.” Another person commented, “It’s alright, not bad. I want to stay here if I can.” A third person told us, “We are well cared for.” People were treated with respect by kind staff who knew their needs well.

People using the service and staff told us the service was safe. One person told us, “Yes I feel safe, there are staff.” Another person said, “I feel really safe because I can always get help if I need it.”

Staff showed a good understanding of safeguarding adults, including how to report concerns. There had been two safeguarding concerns raised about the service. One of these was still on-going at the time of our inspection. The registered provider had not made the required statutory notification to the Care Quality Commission.

Incidents and accidents were logged and the outcome of the investigation was recorded.

Recruitment checks had been carried out to check staff were suitable to work with vulnerable people. Staffing levels were sufficient to meet people’s needs in a timely manner. One person told us, “The staff are there if you want them.”

Medicines were managed and stored safely. People received their medicines from competent staff. One person commented, “I always get my medication on time.” Medication administration records (MARs) accurately accounted for the medicines administered to people.

The registered provider had procedures in place to deal with emergency situations. For example, people had personal evacuation plans (PEEPs) and a business continuity plan had been developed. Health and safety checks were carried out to help keep the building safe for people to use. These included checks relating to electrical safety and fire safety.

Cleanliness of the building had been neglected. One person commented, “The building is alright. They haven’t got a cleaner, so I don’t think it gets done enough. It could be a bit cleaner. We need a proper cleaner to get stuck in.”

Staff said they were well supported. Although appraisals were overdue, staff said they had regular one to one supervision. Records confirmed staff had completed the training they required. New staff had the opportunity to shadow more experienced staff to develop their knowledge and experience. One staff member told us, “I shadowed someone for a few weeks, the staff were really great.”

The registered provider followed the requirements of the Mental Capacity Act 2005 (MCA), including the Deprivation of Liberty Safeguards (DoLS). Staff knew how to apply the act to support people with making their own decisions. DoLS authorisations were in place for people who needed one.

People were supported to have a healthy varied diet. One person said, “The meals are good. You can have what you want. You just tell the cook and he makes it for you.”

The home was in need of refurbishment with tired and worn fittings and furnishings. Some mattresses needed replacing.

Records showed people had input from a range of other health care professionals, such as GP’s and specialist nurses.

People said they felt involved in how they were supported. One person told us, “I have a care plan, they ask me about it and it went in the care plan.”

People said there were plenty of activities to take part in, such as bingo and going away on trips in the summer.

People knew how to make complaint but said they had no concerns about their care. One person said, “Complaints, I know what to do. I just go to the managers. I have no complaints, not really.”

People had opportunities to give their views about the service, through regular residents’ meetings and questionnaires. The most recent feedback from May 2015 was mostly positive.

People felt the home mostly had a positive atmosphere. One person told us, “People get on together.”

An action plan had been developed following a serious safeguarding incident at the home. Improvements were progressing and were being monitored by the local authority. However, the action plan lacked definitive time scales to show when the registered provider expected the improvement to be completed. The area manager had carried out a comprehensive audit of the service. Actions identified included redecoration and continued improvements to people’s care plans.

We saw the registered manager and she told us how she had involved people and their relatives in reviews about the care service. We saw there were now regular checks of care records; to make sure the service was meeting people's needs in the right way.

We saw care records had been reviewed so they were accurate and up to date. We saw the support plans about each person's care were detailed and how they were regularly reviewed so they showed people's well-being and whether there had been any changes.

We spoke with some people in small groups sitting in the lounge. They told us they were happy with the service provided by the staff. One person said "The are really pleasant and supportive".

We saw how staff were friendly with service users interacting informally. One person we spoke with confirmed he was satisfied with the care he received and had no concerns although he feels now is the time for him to move on to a less supported environment. Other people we spoke with said they liked the care staff particularly the person in charge and her deputy and how they were made them feel at ease.

We had concerns about how the service was not designed around the needs of the people who lived there. Care records were up to date however the daily entries made were identical over many years. The home had systems in place to regularly check the quality of the care and other services such as catering, the environment and fire safety.