Archived: Fairways

Fairways is a residential care home providing accommodation and personal care for up to 12 people. The service supports people with a learning disability and/or autism. Eight people were living at the service at the time of our inspection.

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

People were not always safeguarded from harm. Concerns raised had not always been addressed and investigated appropriately which meant people were left at risk. There were insufficient amounts of staff to meet people’s needs. The service was not always clean and well maintained.

People were not always treated with respect or had their independence encouraged. People’s privacy and dignity was not always maintained.

There was a restrictive culture in the service. This included people not being able to access some communal rooms at set times without staff supervision.

The management and leadership of the service had not been effective at promoting a positive culture. Systems in place had failed to address areas of concern we identified at this inspection.

The provider had failed to use complaints and feedback to improve the quality and safety of the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not always able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Care was not always person centred to promote independence and minimise restrictions. The behaviours of leaders and care staff did not always ensure people using services lead empowered lives. We raised concerns with the locality manager who started to take immediate action to address these areas.

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 21 December 2018).

Why we inspected

The inspection was prompted in part due to concerns received about allegations of abuse, the culture of the service and the environment. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to follow up on specific concerns which we had received. We inspected and found concerns with people’s privacy and dignity not being maintained, person centred care and management and leadership, so we widened the scope of the inspection to become a comprehensive inspection of all five key questions.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding, the environment, staffing, dignity and respect and governance and oversight of the service.

Please see the action we have told the provider to take at the end of this report.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

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.

Following receipt of the draft report the provider confirmed they had made the decision to close the service.

People living at Fairways told us they were happy with the service they received. Everyone we spoke with said they enjoyed living at Fairways and were supported to have a meaningful everyday life. Staff encouraged people to be independent and promoted them to develop and maintain relationships with family and friends.

Care and support was tailored to each person needs and preferences and people were involved in developing their support plans. People had good access to support from health care professionals and the service was pro-active in recognising when interventions were required to ensure a person’s wellbeing.

People who lacked capacity were supported to have maximum choice and control of their lives. Policies and systems supported them in the least restrictive way possible.

People were supported to take positive risks and detailed risk assessments supported them to remain safe. Staff understood how to safeguard people from harm and abuse. The staff team empowered people to make choices about what they wanted to do, when they wanted to do it.

Appropriate recruitment checks were carried out. Checks included staff's previous employment, references and Disclosure and Barring Service checks (DBS). These checks helped to ensure people were supported by staff who were suitable to work in a care service.

Medicines were managed and administered safely. Records confirmed people had received their medicines as prescribed. Training records showed medication training was completed annually and regular competency checks were completed by the registered manager

The registered manager demonstrated a commitment to providing person centred care for all people. People knew the registered manager and told us they trusted them. Staff felt the registered manger was supportive and approachable. Relatives we spoke with only had positive comments to say about the service.

Rating at last inspection: Good (Report published March 2016)

About the service: Fairways is a residential care home that was providing personal care to ten people with learning disability, aged 25 and over at the time of the inspection. The service is a care home for up to 12 adults with a learning disability and/or autism.

The service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with a learning disability were supported to live as ordinary a life as any citizen.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service improved their rating to good overall at this inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Fairways provide care and support for twelve people with a learning disability, some of whom have complex needs. It is situated on the outskirts of Bridlington and consists of a large house with accommodation provided over two floors. There are two lounge areas on the ground floor, one of which also serves as a dining room. People living in the property have access to a large garden area. Parking is available on the street outside the property. At the time of our inspection there were ten people using the service.

The registered provider is required to have a registered manager in post. On the day of the inspection there was a manager that had been registered and in post for the last ten months. 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.

At the inspection on 10 March 2016 we found that the service had improved sufficiently to ensure people received a better service of care. There was still room for more improvement and in particular with the design and layout of the premises. We saw this had not been upgraded for some years (with the exception of the kitchen units and floor covering replaced two years ago) and that there was inefficient use of space within the utility and kitchen areas. We have made a recommendation regarding this.

People were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were also managed and reduced on an individual and group basis so that people avoided injury of harm whenever possible.

The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Staffing numbers were sufficient to meet people’s need and we saw that rosters accurately cross referenced with the people that were on duty. We saw that recruitment policies, procedures and practices were carefully followed to ensure staff were ‘fit’ to care for and support vulnerable people. We found that the management of medication was safely carried out.

People were supported by qualified and competent staff that were regularly supervised and appraised regarding their personal performance. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected.

People received adequate nutrition and hydration to maintain their levels of health and wellbeing. The premises were suitable for providing support to people with a learning difficulty and were undergoing refurbishment. The utility area, accessible only to staff, was poorly organised and utilised, and while it was not unsafe it did not allow for good practice with regard to storage of foodstuff, cleaning materials, cleaning equipment and laundry.

People received helpful and considerate support from staff that knew about their needs and preferences. People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before staff undertook support tasks.

People’s wellbeing, privacy, dignity and independence were monitored and respected and staff worked to maintain these wherever possible. This ensured people were respected, that they felt satisfied and were enabled to take control of their lives.

People were supported according to their person-centred support plans, which reflected their needs well and which were regularly reviewed. People had many opportunities to engage in pastimes and activities if they wished to in order to maintain their interest in life, to maintain their health and to be part of society. Activities were both physical and to stimulate the brain and were sometimes skills based to develop people’s abilities to be independent. People had good family connections and support networks.

There was an effective complaint procedure in place and people were able to have any complaints investigated without bias. People that used the service, relatives and their friends were encouraged to maintain healthy relationships through frequent visits, telephone calls and other contact.

The service was well-led and people had the benefit of this because the culture and the management style of the service was positive. There was an effective system in place for checking the quality of the service using audits, satisfaction surveys and meetings.

People had opportunities to make their views known through direct discussion with the registered provider or the staff and through more formal complaint and quality monitoring formats. People were assured that recording systems used in the service protected their privacy and confidentiality as records were appropriately maintained and were held securely on the premises.

We used a number of different methods to help us understand the experiences of people who used the service. During the day we sat with people who used the service and observed their daily activities including lunchtime and observed their interactions with staff. We spoke with staff and reviewed documentation including three care plans.

We saw that care needs were discussed with people and/or their relatives and before people received care their consent was asked for. One person said 'I get to choose which drink I want and I can get my own drink when I want'. From what we observed and noted as part of the inspection staff cared for the people who used the service appropriately. Another person said 'I love it here'.

People were protected from abuse and the risk of abuse. Staff could tell us what they would do if they saw abuse happening or someone reported abuse to them.

The provider had systems in place to assess and monitor the quality of service that people received. There were enough qualified, skilled and experienced staff to meet people's needs.

However we found that the further action was needed to make sure that people were provided with a safe and well maintained environment.