18-02-2015
During a routine inspection
The inspection took place on 18 February 2015 and it was unannounced, which meant that the provider did not know that we were coming.
Fairby Grange is a residential home providing personal care with accommodation for up to 30 older people, some of whom were living with dementia. At the time of our inspection there were 24 people lived at the home.
There was a registered manager at Fairby Grange. 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.
People were at risk of abuse because all staff had not undertaken suitable training in order to recognise and respond to suspected abuse. Relevant safeguarding guidance for staff was not available to enable staff to make sure people were safe. We have made a recommendation about the use of appropriate safeguarding guidance for staff.
Although people told us that they felt safe when the staff were providing their care, the practices within the home were not always consistent with people’s positive views about their safety.
Medicine records were not recorded correctly or handled safely and members of staff were not adequately trained in medicine administration.
Not all staff had the training they needed to effectively care for people. Staff had not received effective training, support and supervision. Annual appraisals had not taken place. Staff had not received regular checks of their competency to carry out their roles.
Staff did not respond in a timely way to people when they requested their care or support, which showed that the provider did not have sufficient staff to meet the needs of people.
The leadership of the service was not effective and quality assurance systems were not in place, which would enable recognising and addressing shortfalls in the service to ensure people were safe and their health, care and welfare needs were met.
People’s consent to their care and treatment had not been sought or acted upon. Staff showed a lack of understanding with regard to the principles of MCA. Staff had not received the appropriate training and support to ensure people were supported to make decisions in their best interests and how they should recognise if someone was being restricted unlawfully.
Mental capacity assessments did not always follow the principles of the MCA (2005) and DoLS applications had been made without following any assessment of the person’s capacity to make certain decisions. People or their relatives had not been consulted or involved in these assessments.
There were no records of involvement of people in the preparation of menus in the home. Some people stated the food was good, others told us the food was not to their liking. People had limited choices in the menu. We have made a recommendation about the use of appropriate guidance for the provider to seek involvement from people in menu chooses.
Person centred care plans were in place and had been reviewed. However, the records could not demonstrate each person or their relatives were involved in regular review of their care, treatment and support. We have made a recommend that the provider involves people in the decisions about their care, treatment and support.
People and relatives knew how to make a complaint if they were unhappy. The provider had a complaints procedure. However, the procedure did not refer to other agencies which meant people did not have easy access to all the information about their rights should they wish to make a complaint about the service. We have made a recommendation about the use of appropriate guidance on complaints.
Staff did not consistently demonstrate respect for people’s dignity.
People spoke positively about the way the home was run. They stated the registered manager was very approachable and understanding. However, there were no systems in place to review the quality of service that was provided for people. Regular audits were not carried out to make sure all aspects of the service promoted people’s safety and welfare.
Accidents and incidents were recorded but there was no evidence to show that the registered manager or the staff had regularly reviewed, monitored or learned lessons from incidents that had occurred.
Risk assessments were in place to identify risks when meeting people’s needs. There were assessments on various areas of care such as falls, mobility, bed rails and diabetes. These risk assessments were reviewed in 2014.
Staff supported people with their health care appointments and visits from health care professionals such as the local GP. Care plans were amended immediately to show any changes, and reviewed by staff as and when necessary to ensure that they were up to date.
People received the care and support they needed. They said they liked living in the home. One person said, “I like living here. I have my pet cat with me in the home and I feel this is an example of how caring they are. They love him. Can you believe it?”
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
You can see what action we told the provider to take at the back of the full version of this report.