Archived: Faygate House

Updated 26 February 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 12 and 16 December and was unannounced. It was carried out by an inspector and an inspection manager.

Before the inspection, we looked at the information we held about the service. We spoke with local authority commissioning and adult safeguarding teams. We reviewed previous inspection reports for this service.

During the inspection, we spoke with four people who used the service and eight relatives. We spoke with three support workers, the deputy manager and one of the two partners who operate the service. We looked at six people’s care plans, four staff files and other documents relevant to the management of the service, such as audits and staff duty rotas. We observed care being carried out and we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 26 February 2015

Faygate House provides accommodation and care for up to 23 people, some of whom are living with dementia. At the time of our visit there were 14 people using the service. The service does not provide nursing care.

This inspection took place on 12 and 16 December 2014 and was unannounced. At the time of our visit, the service had 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.

At our last inspection in June 2014, we found that some legal requirements were not being met. The provider was not taking appropriate steps to assess whether people had the mental capacity to make their own decisions and had not consulted a medical professional when making decisions about whether people should be resuscitated if they stop breathing. Some records were not available when required and others were not kept securely. The provider had failed to notify us of the deaths of two people using the service, which is required by law.

At this inspection, we checked to see if the provider had taken action to meet these requirements. We found that the required standards were still not met. Staff were not aware of the procedures they needed to follow under the Mental Capacity Act 2005 to ensure decisions about people’s care were only made with the person’s valid consent or within legal requirements. The provider was still not consulting medical professionals to assess whether resuscitation would be appropriate for each person. The provider had taken some steps to keep people’s personal records more securely by locking the filing cabinet they were kept in and installing a lockable office door. However, the door was not kept closed when the room was unattended and other personal records were not kept securely.

Although people and their relatives felt the service was safe, we found a number of shortfalls. Risks were not always fully assessed and reviewed to make sure the safety of people and that of others had been fully considered. Some risks had been assessed and management plans put in place, but this was not consistent. We saw staff using unsafe lifting techniques when assisting people to move, which could put them at risk of injury. The risk of people developing pressure ulcers was appropriately managed.

The provider carried out checks and risk assessments around the safety of the premises. However, we found several risks that had not been identified or addressed. For example, the provider had not identified that a bath tap ran hot enough to cause serious injury to people through scalding. There was a fire risk assessment in place, but people did not have individual evacuation plans in case of fire.

Accidents and injuries were not consistently recorded and there was no system for reviewing trends arising from these to help prevent them in future. Although people were offered medical attention after accidents, it was not always provided it if they needed it.

People did not always receive their medicines safely, because medicines were not always stored and given as prescribed and there were no clear instructions about how some medicines should be given. In some cases, poor recording meant that we were unable to confirm whether or not people had received their medicines.

The home was visibly clean. However, we identified a number of risks related to infection control and prevention such as a lack of hand washing materials and infection control audits that were not thorough enough to ensure these were effective.

The provider had placed some restrictions on people’s liberty to help ensure their safety, but had not followed the procedures outlined by the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) to ensure people’s rights were properly considered. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

Staff received training and supervision and attended staff meetings to support them in their roles. However, there was no training plan or annual appraisal system so the provider could monitor the individual training and development needs of staff. The provider did not consider specific training staff might require to meet the individual needs of people who used the service.

People were happy with the quality of food provided by the service. A variety of nutritious food was available to meet people’s needs. Staff made referrals to the relevant healthcare professionals when people needed extra support to meet their nutritional needs. However, advice and guidelines from specialists were not recorded in individual care plans to guide staff.

People had access to healthcare professionals when required and for regular check-ups.

People and relatives were satisfied that staff were caring and treated them with respect. At times, however, people’s privacy and dignity were not respected. Staff did not always explain to people what they were doing or pay them full attention when carrying out care tasks. Staff did not consider people’s privacy when administering medicines.

Staff knew people well enough to build positive caring relationships with them, although this was not always reflected in care plans. They had access to information telling them how best to communicate with people. People were able to receive visits when they wanted and to personalise their living space in ways that were meaningful to them.

Staff were aware of the importance of keeping people comfortable and promoting their dignity as they approached the end of their life. However, they did not support people to plan ahead for this. We recommend that the provider consider relevant guidance about supporting people and their families to plan for the end of their lives to ensure their wishes and preference are known.

Although relatives were involved in planning and discussing people’s care, there was little evidence that people using the service were consulted about their preferences. For example, people had baths according to a rota that did not take their preferences into account.

People’s needs were assessed when they were admitted to the home, but assessments were not always regularly updated and fed into care plans. This meant that in some cases people’s changing needs were not taken into account.

People had access to a choice of activities that were meaningful to them. They received support to meet their cultural and religious needs, where required.

There was a complaints policy in place. People and their relatives knew how to complain and were confident they would be taken seriously. The provider recorded any concerns raised and the remedial action taken but did not record any steps they took to prevent reoccurrence so it was not clear whether they had responded fully.

Although relatives and staff told us managers listened to what they had to say, people using the service did not always feel they could speak to managers. Some were unsure of who was in charge or told us they never saw the registered manager. He was not present during our inspection and did not attend meetings held for people, staff or relatives. Relatives said there was no clear hierarchy of leadership and it was unclear who was in charge. We did not find evidence that the registered manager was fulfilling their duties in terms of leading, supporting and monitoring the staff team.

The provider used meetings and surveys to gather the views of people and their relatives. They used the feedback to form an action plan, but this was not effective as it was not specific or measurable.

Quality audits were carried out at the service but these were not comprehensive, effective or carried out in a timely manner in accordance with the provider’s policies. The audits failed to identify the concerns that we found and the provider had failed to address failings that we had previously told them to take action to address.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of this report.