Archived: The Fairways

The Fairways is a care home providing personal care and accommodation to 19 people at the time of the inspection. The service can support up to 20 people and is registered to provide care to older people and people living with dementia. The home is a converted house and accommodates people across three floors. The Fairways is part of Farrington Care Homes Limited, a private company which has other care homes across England.

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

The provider did not always identify risks to people and others and did not take adequate measures to minimise the risk of harm to people. Although environmental concerns found at the last inspection had been addressed, we identified further concerns which required urgent attention.

Some people’s care plans and risk assessments did not address all risks to them and lacked guidance for staff about mitigating the identified risks. In some case the risk assessments had not been updated in a timely manner. Therefore, they did not reflect people’s current circumstances and lacked measures to keep people safe.

We checked the provider’s infection control processes and found, whilst there were protocols and procedures, further action was needed to ensure that the risk of the spread of infection was being managed robustly.

The registered manager assessed people’s mental capacity to make a range of decisions. Whilst most of these assessments were undertaken in an appropriate manner, one person's assessment was not completed in line with the Mental Capacity Act 2005. The person’s records indicated they had not always supported this person’s choices when they had been assessed as having capacity to make that choice.

The registered manager had completed audits and checks but they had not identified all the concerns found at inspection. The provider not addressed some areas of the home that required to be made good in a timely manner which could have left some areas of the environment unsafe.

The registered manager sent us an initial action plan following our inspection to tell us that they had immediately addressed some of the concerns found at the inspection and how they planned to address others.

During the inspection we found the provider had made improvements in the safe administration and storage of medicines and were no longer in breach of this section of Regulation 12.

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 requires improvement when inspected 24 October 2019 (Published 17 December 2019)

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. In addition, we also looked at whether the provider had made improvements in relation to other breaches of regulations that we identified at the same inspection. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on a Warning Notice or other 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.

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.

Enforcement

At the previous inspection the service was in breach of Regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We served a Warning Notice on the provider for the breach of Regulation 17 and requirement notices for the breaches of Regulations 11 and 12.

At this inspection we found that the provider had not fully met the requirements of the Warning Notice and remained in breach of all three of the regulations and were now also in breach of Regulation 9 (Person centred care).

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Fairways Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. We will work alongside the provider and local authority to monitor progress. If we receive any concerning information we may inspect sooner.

The Fairways is a care home that provides accommodation and personal care for up to 20 older people some of whom are living with dementia. At the time of the inspection 19 people were using this service. The Fairways is owned by Farrington Care Homes Limited who have a number of other care services in the UK.

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

At this inspection we found the provider had made some improvements, however some aspects of the service required further improvement.

The provider had addressed many of the environmental hazards identified at the last inspection. However, we found some areas unsecured that could put people at risk of harm and the garden had been made safer but was still ‘work in progress’.

Medicines were not always managed safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. The provider did not always follow the principles of the Mental Capacity Act 2005 (MCA) regarding people consenting to their care plans and did not always undertake mental capacity assessments in line with best practice.

The provider had systems in place to monitor and manage the quality of the service provided and to improve the care and support provided to people. However, these were not always robust and accurate as they had not identified issues raised during the inspection.

People and relatives spoke positively about the service they received.

The provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. Lessons learnt had been shared with staff and measures put in place to avoid a reoccurrence.

Staff had received an induction and further training to support them to develop the necessary skills to care for people using the service.

People were supported with dietary and health needs and to maintain hydrated. People were supported to access appropriate health care.

We observed, and people and relatives told us, staff were caring. People were supported to make day to day decisions.

The activities co-ordinator included both younger and older people in well thought out activities and care workers helped to make this an enjoyable experience.

There was a complaints procedure in place and the registered manager responded to complaints appropriately. People and relatives using the service told us the registered manager was approachable and listened to any concerns.

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 requires improvement on 7 February 2019 (published on 29 March 2019). At this inspection there were four breaches of the regulations in person-centred care, consent, safe care and treatment and good governance. The provider completed an action plan after the last inspection to show what they would do by July 2019 to improve.

At this inspection enough improvement had not been made and the provider was still in breach of three of the regulations. We have identified breaches in relation to safe care and treatment, consent and good governance. The service remains rated requires improvement in safe, effective and well-led. It is now good in caring and responsive but remains requires improvement overall. This service has been rated requires improvement for the last four consecutive inspections.

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

Follow up

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

People’s experience of using this service:

The service provided was not always safe. The provider did not always ensure the safe management of risks to people. This was because they did not assess the risks associated with uneven floors and paths, use of portable heaters and windows that did not have tamperproof restrictors. Where risks were identified measures were not in place to support staff to mitigate the risk of harm.

The provider's systems for improving the quality of the service and mitigating risks were not always operated effectively. This meant that people were not protected from the risk of experiencing safe or effective care.

The provider did not always make sure people's consent to care and treatment was evidenced. Some relatives had signed people’s care plans and people’s mental capacity to consent to their care and treatment was not assessed prior to this. We saw that best interest decision had not always been made in line with the Mental Capacity Act 2005.

People had care plans in place that gave guidance to staff about how they wanted their care to be provided. However, these had not been reviewed monthly. Therefore, it was not possible to confirm if these care plans were up to date and if care was being provided as people wanted or needed it to be done.

There were activities in place for people but some younger people's care records did not contain plans about addressing their social interests and hobbies. One younger person told us they were bored at times.

People’s care records were not always kept in a secure manner. We found archived records in an unsecured cabinet in a communal area.

Most people using the service, their representatives were happy with the service provided. They said that it met their needs and they felt safe with the staff.

Most people said that the staff were “lovely” kind, caring and they had good relationships with them. We observed staff to be caring and respectful in their interactions with people. The staff felt they could approach the manager should they need to and found the manager responsive when they needed support. support they needed.

Health care professionals spoken with confirmed staff were quick to ask for advice and followed their guidance. They found staff kind and caring. The staff worked with other healthcare professionals to make sure people had the right support and equipment to gain skills and remain as independent as possible.

Rating at last inspection:

The last inspection took place on 27 March 2018 and the service was rated as Requires Improvement. This was because some shortfalls we found at inspection had not been identified through the providers checks and audits and was a breach of the regulations in good governance. The report published on the 8 May 2018. Since using our new inspection approach the provider has been rated as Requires Improvement in three inspections.

Why we inspected:

This was a comprehensive inspection based on the previous rating. We also took into consideration shared information from commissioning bodies and other feedback we had received in planning when we would return to inspect the service.

Action we have asked the provider to take:

We found four breaches of the regulations with regard to Safe care and treatment, need for consent, Person centred care and Good governance. You can see what action we have asked the provider to take within our table of actions.

Follow up:

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

There was 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.

Following the last inspection on the 9 and 11 May 2017, we rated the key questions, 'Is the service safe?,' ‘Is the service Effective?, ‘Is the service Responsive?’ and 'Is the service well-led?' as 'Requires Improvement' and the service overall was rated 'Requires Improvement'. We asked the provider to complete an action plan to tell us what improvements they would make at the service. They told us they would make the necessary improvements by 15 October 2017.

During this inspection we found that the provider had taken steps to address the shortfalls previously found. There was ongoing work on the redecoration and refurbishment of the building. Some improvements had been made to make the environment more suitable for people living with dementia. There was an ongoing programme of work to improve both the building and garden.

Health and safety checks were in place, however, some of the fire safety checks needed to be reviewed to ensure people were wherever possible safe in the event of a fire.

For the most part, care plans and risk assessments were reviewed and updated whenever people's needs changed. Improvements still needed to be made to ensure information was accurate and complete.

The audits and monitoring systems had improved, with the registered manager clearly recording the different ways they reviewed how the service was running. However, these checks had not identified some of the issues we had found during this inspection.

We found a breach of regulation in relation to good governance. You can see what action we have asked the provider to take at the end of this report

People received the medicines they needed safely and as prescribed. Audits needed to ensure staff were following the ‘as required’ PRN medicines protocols.

People's healthcare needs had been assessed and the service had good links with health care

professionals. People's nutritional needs had been assessed, recorded and monitored. Improvements in the recording of fluid intake needed to be made to monitor how much people drank and to minimise the risk of people becoming dehydrated.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA) because they had ensured that people were given choices about their daily lives and where possible had consented to decisions or that these were being made in their best interests where they could not give consent.

Staff were polite and caring. They knew people's needs and respected choices that people expressed.

Staff received ongoing one to one and group support through supervision and staff meetings. The registered manager confirmed they were feeling more supported in their role. Staff continued to receive training on a range of subjects relevant to their roles and responsibilities so that they could meet people’s needs.

Activities had improved and although the staff member in charge of this area only worked part-time, they had made a positive impact on people’s lives by identifying new interests, engaging with people and encouraging them to take part in events.

People were protected by the provider's arrangements in relation to the prevention and control of infection. The provider had a procedure regarding infection control and the staff had specific training in this area.

People using the service and their relatives knew how to raise concerns and that they would be listened to.

At the last focused short inspection in October 2015 we saw improvements had been made to the service but we wanted to see that these improvements and checks continued to ensure the service was managed well. The registered manager continues to work hard to make improvements. However, we found areas requiring attention. They were aware of areas that needed to be improved in the service and were receptive to the findings of the inspection.

The Fairways provides accommodation to older people, some of whom were living with dementia. There were 19 people using the service at the time of this inspection.

There was 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 registered manager had been in post for approximately 18 months and had worked in the service as head of care since 2012.

There were systems in place to check the fire procedures and that equipment protected people in the event of a fire. However, it was identified that nine fire doors did not fully close on the first day of the inspection and the checks carried out had not picked this up as an issue. Therefore, this placed people at risk of harm. Work was carried out during and after the inspection to fix the doors, however, we contacted the London Fire and Emergency Planning Authority (LFEPA) so that they could assess the service’s fire safety.

Although there was some improvements being made to the flooring of the service the windows needed attention. Consideration had not been given to make the environment more dementia friendly.

People’s care records included people's needs and preferences. We saw information had been reviewed, although not in April 2017, but these reviews had not picked up that some of the information within the care records was inconsistent and contradictory.

We found some records were incomplete and were not available to view, such as the minutes from a meeting.

Staff received support through daily handover meetings and team meetings. However, they had not all had regular one to one supervision meetings and had not received an annual appraisal of their work. The registered manager told us they had also not received a one to one supervision meeting for a long time and had not had an annual appraisal of their work.

Some activities were provided by the care staff as there was no activities co-ordinator. On the first day of the inspection there was no activity schedule to inform people of what was occurring each day and to help staff know what to provide. Staff had not received training on providing activities for older people, some of whom were living with dementia. Therefore, we saw no evidence that activities met people’s needs and individual preferences.

Although there were checks and audits in place, these had not picked up on the issues found during this inspection. Where issues had been identified there were no timescales for when to address the problems.

Feedback from people using the service, staff we spoke with and the social care professional was positive about the registered manager. However, we were informed that the provider rarely visited the service and that the registered manager needed more support.

Staff received training on safeguarding adults from abuse and there were policies and procedures in place. We saw evidence in the policies and in staff meeting minutes that staff were reminded to report any concerns to the registered manager and to the local authority and to CQC.

Regular training on various topics relating to care and refresher training had been arranged to support staff in their roles.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service supported this practice.

Recruitment checks were carried out to make sure staff were suitable to work with people using the service.

People received the medicines they needed safely.

People had access to the health care services they needed and their nutritional needs were being met.

There was a complaints procedure available and the majority of people were able to raise a complaint if they had one. People also had friends and relatives who could represent their views and share concerns if necessary.

We met with the head of care and carried out observations in the lounge. We saw staff interacting positively with people throughout the inspection visit. Staff were checking on people to make sure they were happy and comfortable. We also observed lunch and saw that everyone received a meal and staff were encouraging people to eat and offering support where needed. Where people did not wish to eat the food, alternatives were provided to ensure people ate something during the mealtime.

We viewed three people's care records and these recorded people's needs, personal preferences and risks to their health and well-being. People's needs were assessed prior to their admission into the home and reviewed each month or whenever their needs changed.

We looked at how the staff managed and administered medicines. There were good systems in place to ensure people safely received their prescribed medicines.

During this inspection visit we found that the provider was complying with the outcome areas that we assessed. Improvements had been made to ensure people's needs were assessed and were being met. People could also be confident that recruitment checks were more through and that medication audits were now carried out on a regular basis to ensure that people were safely receiving their medicines.

We spoke with six people who use the service, two members of staff and one relative. We also met with the manager and head of care (who was in day to day charge of the home). Overall people said they were happy living in the home and that the majority of staff were friendly and easy to talk to. People said they had a choice of a male or female member of staff supporting them with their personal care.

We observed staff sitting and chatting with people and staff were available for people if they required assistance. The relative we spoke with confirmed they were happy with the home and the services provided.

The staff we met told us they were supported by the staff team and received one to one support and ongoing training. The training records confirmed staff were receiving training relevant to their roles and responsibilities.

People's needs were assessed either prior to their admission into the home or on the day of the admission. However, the development of care plans and risk assessments did not always take place in a timely way. This could place people at risk of being supported inappropriately because staff did not always have clear plans to follow to meet people's needs.

The home had some systems in place for the safe management of medicines, but staff had not received recent refresher training and medicine audits and checks had not taken place by the staff in the home since October 2012. Therefore the provider could not be certain that people were safely receiving their prescribed medicines.

The premises were maintained, however the provider might find it useful to note the conservatory was cold and the use of portable heaters to warm this area could place people at risk.

The service had recruitment and selection processes in place but appropriate checks were not always undertaken before staff began working in the home.

The home had a system in place to respond to complaints and two people who live in the home said they would talk with staff if they had a concern. The two relatives we spoke with said they had no concerns or complaints but would feel able to address any issues with staff.