Fairview Court Care Home

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 previous inspection we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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; incidents were not always appropriately reported. Lessons learnt were not always well documented and shared to embed good practice. People, relatives and staff told us they felt comfortable raising concerns. A person said, “If I have a problem, I would talk to people, talk to senior staff.” The provider had processes to identify and record incidents and complaints, and records showed analysis was completed to identify trends and patterns. Following a recent investigation, the provider told us they had identified governance shortfalls and found some risks to people were not being sufficiently checked and monitored, which placed people at increased risk of harm. In response, they were reviewing staff performance and, with support from their internal quality team, had carried out a review of identified risks and governance processes. However, we were not assured appropriate action was always taken in response to incidents. The provider had identified the concern; however, it had not been referred to the local authority safeguarding team. We found several other incidents were also not reported to the Care Quality Commission (CQC) as required. The management team shared examples of lessons learned from recent incidents and complaints; however, these were not consistently shared with the staff team. This meant recurrence may not be prevented. Care staff were familiar with reporting procedures; most staff told us learning from incidents was discussed during meetings. However, these discussions were not always well documented in meeting records. The provider had identified this issue in a recent audit. Feedback from professionals working with the service was mixed. Some expressed concerns about learning from incidents not always being shared effectively with staff to support improvement. The provider’s quality team was on site during our assessment and had been present for several weeks. While the provider had taken steps to make improvements and promote learning, work remained ongoing to embed recent changes and strengthen a culture of safety and effective response to risk.

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 and their relatives spoke positively of their experience and told us health professionals were involved in people’s care when needed. Records showed the service worked with health professionals to support individuals’ needs, for example the GP and speech and language therapy team. The provider had policies and procedures to support staff with new referrals and when working alongside other professionals.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. The provider did not always share concerns quickly and appropriately. We observed people appeared safe and comfortable within the service, which was confirmed by people and their relatives. People and their relatives told us they felt able to speak with staff if they had any concerns. However, most people and relatives we spoke with mentioned the impact of others wandering into their rooms. A person said, “I feel safe, but the person next door can open the stairgate and come in, I just ask them to leave and press my buzzer.” The management team told us about their responses to recent safeguarding concerns. Following a concern which was raised, the provider had identified governance shortfalls, which had placed people at increased risk of harm. Although the provider had acted promptly to make improvements, the concern had not been referred to the local authority safeguarding team, and CQC had not been notified. We reviewed other records of safeguarding concerns where actions were documented, and referrals were made to the local authority. However, we found several other safeguarding concerns had not been notified to CQC as required. The provider acknowledged this was an oversight and submitted the notifications following the assessment. They informed us their quality team had recently started overseeing incidents to help ensure all appropriate actions were taken. Staff had completed safeguarding training and those we spoke with understood safeguarding procedures. They reported no concerns about people living at the service. Where people were deprived of their liberty, appropriate referrals had been made to the local authority to ensure this was done lawfully and in the least restrictive way.

The provider did not always work effectively with people to understand and manage risks. Although the provider had processes to assess and monitor risks, they were not consistently completed. The provider had recently identified governance shortfalls, which identified some risks to people, such as those relating to skin integrity and weight loss, were not being sufficiently monitored by staff. Records confirmed the provider was taking action to improve these areas following a period of intensive support from the providers quality team. During this time, new admissions had been paused to focus on improvements. Risk assessments we reviewed, relating to falls, swallowing difficulties, and catheter care, were documented and included clear guidance for staff to follow. Where people’s behaviour posed a specific risk, these risks were assessed, and guidance was available for staff. However, staff did not always consistently complete behaviour monitoring and individual safety checks. People told us others sometimes wandered into their rooms. In response, some people had consented to the use of door gates to help manage this risk. We were not assured the provider had sufficiently assessed the mix and compatibility of people within each unit. This increased the likelihood of people’s behaviours impacting others.

People’s care records had recently been reviewed by the management team and included personalised details. Staff we spoke with demonstrated an understanding of people’s risks and told us risk assessments contained sufficient information to support safe care. However, some staff told us they occasionally worked across different units and supported people whose care records they had not had the opportunity to review. This meant there was a risk staff sometimes did not have all the necessary information to support people. Feedback from professionals working with the service was mixed. Most professionals spoke positively of care staff and the registered manager. However, some professionals raised concerns about difficulties engaging with the service and individual staff members, as well as how risks were managed for people with complex needs. We observed a supportive environment where people were encouraged to maintain their independence, staff responded appropriately when people showed signs of distress. The provider shared examples of how the service supported people to take positive risks, including helping with maintenance tasks, accessing the local community and support to move on and live more independently. The provider told us they had identified compatibility between people on units as an issue they planned to address. Following the assessment, the provider told us about several internal room moves which were being supported in consultation with people and their relatives to address this. Dedicated units were being established for people requiring more specialist care to help improve safety and service dynamics.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Since our last inspection, new areas of the service were built and some existing parts refurbished, increasing capacity to 81 people. Areas of the service were decorated to support people living with dementia; however, this was not consistent across all areas of the service. The provider told us there were plans to update older areas and we observed refurbishment works in progress. The service was clean, well maintained, and included a well presented, accessible outdoor space. There were dedicated staff responsible for overseeing the premises and a system for staff to report any maintenance issues. Building safety and equipment checks were carried out to ensure the safety of people living within the service, including fire, gas, and electrical checks. A staff member said, “If anything is broken, they fix it right away. They do a lot of checks every month.” People using the service, their relatives and staff told us they were satisfied with the environment.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. We observed sufficient staff were available to meet people’s needs. Where people were allocated 1 to 1 support, this was in place as required. Overall, people and their relatives spoke positively about the support provided. However, some felt staffing levels were not always sufficient. One relative commented, “It can depend. [Person] needs 2 people to support them, and it may take a while. If short staffed, it might take longer.” The service used a dependency tool to assess safe staffing levels, and any gaps in the rota were covered by existing staff. Staffing records we reviewed confirmed this. Staff told us staffing levels were sufficient. A staff member said, “We do have a good level of staff. When someone goes off sick, it might affect our levels. We don’t use agency staff. Most of our team are forthcoming in picking up extra shifts.” Staff reported feeling supported and said they received regular supervision. They confirmed completing an induction, which included shadowing a colleague and undertaking the provider’s mandatory training. Training records we reviewed confirmed this. A staff member said, “I’ve been supported, I did my training, shadowing, and completed the induction checklist.” Staff had access to sufficient training opportunities. Records showed training was being refreshed in line with the provider’s procedure. Overall, staff were competent; we observed appropriate support being provided when people showed signs of distress. However, we shared 1 observation with the provider where 1 to 1 support appeared functional and task oriented. The provider told us this training need had been identified during a recent audit. The provider described how they had responded to recent shortfalls identified and feedback from the local authority by reviewing staff performance and arranging additional training on skin integrity, diabetes, and positive behaviour support. There had been recent changes within the nursing team, with the regional support manager now overseeing the team and offering additional assurance around competency. Staff were recruited safely, with relevant checks completed before they began working at the service. These included criminal record and employment history checks to ensure suitability for the role.

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. The service was clean, well maintained and free of malodours. People and their relatives told us the service was regularly cleaned, and staff used personal protective equipment (PPE) appropriately. A relative said, “Always clean and tidy.” Staff told us they had completed relevant training, and their competency in using PPE and hand washing was assessed. A staff member said, “We do a donning and doffing check every 3 months.” Another staff member commented, “We have PPE, gloves, aprons to use for personal care.” The provider’s infection prevention and control policy reflected national guidance. Where the service had recently experienced an outbreak of covid, staff and leaders were able to explain the additional measures they took to ensure this was safely managed.

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. Medicines policies supported the safe administration of medicines. Protocols were available to guide staff in the use of ‘PRN ‘as required’ medicines. Regular audits of medicine practices were carried out by the management team, and where shortfalls were identified, action plans had been put in place to address them. During the assessment, the regional support manager was overseeing the implementation of a new electronic medication administration record (eMAR) system, alongside other improvements identified in recent audits. For example, medicines were moved from being stored in people’s rooms to dedicated storage areas. Medicines were stored securely; however, we identified some gaps in temperature monitoring. The registered manager informed us this would be addressed. Staff received medicines training and were assessed as competent before administering medicines. A staff member said, “Yes, we do medicines checks and competencies. Staff have to retrain until they are competent.” People and their relatives told us they were satisfied with the support they received with medicines. A person said, “I get my tablets when I am meant to.” Another person commented, “It’s very good, they make sure I have my medications.”