Archived: Fairfield View

Fairfield View is a residential care home providing personal care for up to 54 people. The service mainly provides support to older adults and people living with dementia. At the time of our inspection there were 38 people using the service. Care is provided across two units, with 'The Elms' providing specialist dementia support. People have their own bedrooms, some of which are ensuite. Communal spaces including bathrooms, living spaces and a secure garden were available.

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

Systems of governance and oversight had been introduced but were not currently being effectively used to ensure the safety and quality of the home. We found information used for oversight of people’s needs, including dietary information and wound care was not being accurately maintained. Systems to ensure people received the correct care had either not been implemented or was not being used effectively. Communication and involvement of people using the service had improved, although further work was needed. Staff needed further support to understand and develop in their roles, in order to support the governance processes within the service.

People's needs, and risks were not always being safely managed in relation to modified diets and skin integrity. Medicines were not always being safely managed. Safe recruitment of staff was being completed and there were generally enough staff to support people. Environmental improvements were found, and plans were in place to address shortfalls. Action to address most, but not all safety issues had begun. Equipment had been obtained to promote better infection prevention and control but some areas of the home including furniture and shared bathrooms needed further work.

People did not always have accurate and up to date needs assessment information. Oversight of needs and guidance in handover records and care plans was sometimes inaccurate or inconsistent. Observations and records did not assure us that people’s needs were being consistently met. People's view of the food was mixed, and it was not clear that people were having their dietary needs met. Improvements to the environment had begun but further work was needed to ensure shared and frequently used areas, such as communal bathrooms were suitable for use. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service were in place to support good practice. Staff felt well supported and training was available. Further work to support staff to complete and understand all aspects of mandatory training was needed.

People’s care plans had been developed, but further work was needed to ensure these were accurate, completed and person centred. An activity worker began at the home during the inspection and staff tried to support people to engage in activities where time allowed. However, people told us they were bored, and we observed there was a lack of stimulation.

People and families spoke positively about the staff, and we observed kind and caring interactions. People's dignity was respected, and choice was generally, but not always promoted.

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 inadequate (published 08 November 2022) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection as part of the multi-agency meeting approach, to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified breaches in relation to the management of individual risk; the management of medicines; the provision of person-centred care; knowledge, training and skills of staff; and systems for management and oversight of the service.

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.

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 work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

Fairfield View is a residential care home providing personal care for up to 54 people. The service mainly provides support to older adults and people living with dementia. At the time of our inspection there were 50 people using the service.

Care is provided across two units, with ‘The Elms’ providing specialist dementia support. People have their own bedrooms, some of which were ensuite. Communal spaces including bathrooms, living spaces and a secure garden were available.

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

Systems for oversight were not effective at all levels of management. The provider had not ensured sufficient oversight of the home to identify areas of concerns or ensure the registered manager had the systems, resources and support to maintain oversight of the quality of care. It was not clear how people were engaged in driving improvement across the service.

Systems to identify and mitigate risk were not effective. Medicines were not always being safely managed and administered. The service was following suitable recruitment processes but further work was needed to ensure a robust recording system was in place. Further work was needed to ensure good infection control processes were being followed. Lessons were not always clearly learnt when incidents occurred, and sufficient and timely action was not always taken to address shortfalls when identified.

People’s assessments were not always accurate or complete and incorporated into their care plans. Staff had not always completed the necessary training, and feedback and evidence of staff support, such as staff supervisions was varied and inconsistent. The environment and equipment needed updating or replacing to ensure it met the needs of people. Further work was required to ensure people had their nutritional needs met but people generally enjoyed the food provided.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service were in place to support good practice.

People had mixed views on how they were cared for. We observed staff did not always promote choice and independence and dignity was not always considered. People were not always clear how they had been involved in decision making.

People’s care was not always personalised. Further work was required to ensure staff met people’s communication needs, reduced the risk of people’s experiencing social isolation through personalised activities and captured people’s views and end of life preferences.

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 good (published 10 December 2018). At our last inspection we recommended that the service consider best practice guidance regarding making improvements to the home to assist people who lived with dementia and review systems for maintaining accurate records of staff training. At this inspection we found limited progress had been made in these areas.

Why we inspected

This inspection was prompted by a review of the information we held about this service. A decision was made to seek further assurance through an inspection.

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.

You can see what action we have asked the provider to take at the end of this full report.

The registered manager advised they would take appropriate action to address the concerns identified at inspection and wanted to ensure that people received good quality care.

Enforcement and Recommendations

We have identified breaches in relation to the management of environmental and individual risk; safe handling of medicines; provision of personalised care; ensuring people are cared for in a dignified way; ensuring that staff have the necessary skills and training to meet people’s needs; and there is sufficient management oversight to identify shortfalls and improve the service.

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.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Fairfield View is a care home providing accommodation and personal care for 39 older adults. The service can support up to 54 people. Fairfield View has two units: The Elms is a specialist residential dementia unit and Fairfield View is a residential unit. The home has single occupancy bedrooms, some have en-suite bathrooms, and a variety of communal areas including accessible bathrooms, seating and dining areas and a secure garden.

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

People were content at Fairfield View and looked well cared for. There were systems in place to protect people from avoidable harm and staff worked with external organisations to ensure people’s needs were met.

The service was very clean and tidy, and domestic staff completed frequent cleaning schedules for high contact areas and regular deep cleans of all rooms within the home. Staff wore personal protective equipment appropriately and information and equipment to improve hand hygiene infection prevention was readily available within the home. Visiting pods had been built within each unit to allow friends and family to visit once the local and national guidance allowed.

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 11 December 2018).

Why we inspected

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 coronavirus and other infection outbreaks effectively.

We undertook this targeted inspection to check on a specific concern we received about infection control and how people were supported with personal care and safeguarded against preventable harm. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

The service was last inspected in August 2017 and at the time the service was rated as Requires Improvement in the safe, effective and well led sections of the report and Good in the caring and responsive section. The service was rated as requires improvement overall. At the last inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service had no risk assessments in place to mitigate the risk to people using the service in an emergency situation and there was insufficient oversight of staff training.

At this inspection we looked to see if the required improvements had been made. We found that appropriate action had been taken to address the lack of risk assessments and that there were current risk assessments and Personal Emergency Evacuation Plans (PEEPs) in place for all the people living at the home. However, we found that the training matrix required updating and have made a recommendation in this area.

The service had a registered manager in place. 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 service had notified CQC of any accidents, deaths, serious incidents and safeguarding allegations as they are required to do.

Staff were knowledgeable about safeguarding and whistleblowing and had confidence that the registered manager would address any concerns identified.

Recruitment procedures were in place which ensured staff were safely recruited. There were sufficient staff to meet people's needs and staff told us they received the training, support and supervisions they needed to carry out their roles effectively.

Medicines were managed safely and people received their medicines as prescribed.

People had their nutritional needs met and had access to a range of health care professionals.

The requirements of the Mental Capacity Act 2005 were being met. People were supported to have 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.

There were a range of activities on offer at the home both in groups and on a one to one basis. People told us there were sufficient activities for them to join in.

The environment was clean and tidy. Any maintenance issues were reported and addressed immediately. However, the environment within the dementia unit was not in line with best practice for supporting people living with dementia. We recommend the home review the environment and make adaptations in line with best practice to best support the people living within the dementia unit.

People who used the service felt able to raise concerns and that these were responded to and addressed quickly. There was a system for recording and dealing with any complaints.

The provider had displayed the CQC rating and report from the last inspection on their website and within the home.

The inspection of Fairfield View commenced on 1 August 2017 and was unannounced.

The inspection was prompted by the notification of an incident following which a person using the service died. Information shared with CQC about the incident indicated potential concerns about the management of risk of falls.

This inspection took place over three days and was unannounced.

When we previously inspected this location in March 2015, we identified one breach of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. We found that medicines were not safely managed. At this inspection we found that this regulatory requirement had been satisfactorily met. However we identified other areas where the provider was no longer meeting the legal requirements. We identified breaches of two of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which were in relation to good governance and safe care and treatment. We also identified two breaches of the Care Quality Commission (Registration) Regulations 2009 in relation to the provider not submitting statutory notifications as required. You can see what action we have told the provider to take at the back of this report. We are currently considering our options in relation to enforcement action for some of the breaches of regulations identified. We will update the section at the back of the inspection report once any enforcement work has concluded.

We also made a recommendation in relation to the service completing an analysis of all returned and completed feedback questionnaires and provide feedback to all stakeholders.

At the time of our inspection, a registered manager was 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their relatives told us Fairfield View provided a safe environment in which to live and we found that staff had been trained in the principles of keeping people safe and free from harm. When we spoke with staff they told us they understood their responsibilities in reporting any suspected abuse or poor practice taking place in the home.

Safe staff recruitment procedures were in place and staffing levels were being maintained to an appropriate level to meet the assessed needs of the people using the service.

Medicines management were found to be safe. Staff with the responsibility for the administration of medicines had received appropriate training. All medicines and controlled drugs were safely kept with appropriate arrangements for storing in place.

No risk assessments had been completed for people using the service should an emergency situation arise within the home, for example, full evacuation of the premises.

We found the home to be clean, hygienic and well maintained. The provider visited the service on a regular basis and provided continuous investments in the premises. We looked at the service’s maintenance and safety records and saw that they were up to date.

We found the service to be working within the principles of the Mental Capacity Act 2005 (MCA). The registered manager undertook assessments on people known or suspected to lack mental capacity to consent to care and treatment. Records seen indicated that consent to care and treatment had been obtained from relevant people who knew the person best, usually their relative.

Staff received supervision on a regular basis and an annual appraisal.

Although staff we spoke with told us they received regular and appropriate training, training records were poor and did not clearly identify the training individual members of the staff team had completed and records were also out of date.

People told us they were happy with their care and liked the staff that supported and looked after them and felt safe when their care was being delivered. The atmosphere in the home was calm and relaxed.

People had access to health and social care professionals as required.

People, healthcare professionals and other visitors to the home spoke positively about the registered manager and the staff.

A range of activities were available and people were encouraged to participate in those activities that interested them.

We observed that the registered manager and provider ensured they were visible within the service. People, visitors and staff said that both the registered manager and provider were both approachable and supportive.

Since our last inspection, the registered manager had updated and further developed a system for auditing and monitoring the health, safety and quality of the service. However, at the time of this inspection the system was not robust enough to identify the shortfalls we found at this inspection.

The Care Quality Commission had not always been notified about incidents that had occurred at the home.

We found that since our last inspection the registered provider had ensured, along with the registered manager, that all staff had received relevant and appropriate on-going training, supervision and appraisal.

Evidence was available to demonstrate that the registered manager had reviewed staffs individual training to date and ensure that, where necessary, further training was arranged and took place. We also saw evidence that the registered manager and senior staff were carrying out regular supervision sessions with the individual members of staff and that annual appraisals were taking place. This was also confirmed by those staff we spoke with.

We found that nursing care was no longer being provided at Fairfield View and nursing staff no longer employed.

We found the provider obtained consent from people who used the service before they provided care and support. When a person had limited capacity to make an informed decision, relatives and other relevant healthcare professionals were involved so that decisions were made in the person's best interests.

Care plans and risk assessments were in place for each person. We found that the content of care plans and assessments varied in terms of the amount of detail they included.

On the day of our unannounced visit we found the home to be clean and fresh with no unpleasant smells detectable. However, we did find some areas on The Elms that required immediate attention.

The staff training records indicated that not all staff were up to date with the required training.

'The staff are very nice, very friendly and plenty of them around'.

'The food is perfect, plenty to eat, plenty of choice'.

'I do feel safe and well looked after'.

'I have a comfortable bed and a comfortable room, what more can I say'.

'This place definitely meets my needs'.

'The staff respect me as a person'.

Staff told us what it was like to work in the home and told us how they felt supported by a "good manager with excellent management skills."

From speaking with the manager and staff it was demonstrated that they had a good knowledge and understanding of people's needs and how best to meet those needs.

During our visit we saw staff speaking with people respectfully and politely. We saw staff supporting and assisting people at a pace that was unhurried and met their needs.