Fairburn Mews

Fairburn Mews is a nursing home providing accommodation for persons who require nursing or personal care for up to 20 people. The service provides support to people who have physical and mental health needs. At the time of our inspection, there were 19 people using the service.

The home is set out across two separate floors, each of which has adapted facilities.

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

Out of the four people and nine relatives we spoke with, 11 shared positive feedback. However, our findings indicated people did not always receive safe care and the service was not always well-led.

People’s risk management was not always appropriately assessed and mitigated by staff and behaviours that may challenge was not always appropriately managed.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests.

The requirements of the Mental Capacity Act were not always being followed. We found some people who lacked capacity in relation to some areas of their care, did not appropriately have their liberty restricted as part of their care arrangements and this was not always properly assessed and documented in a timely manner.

Care plans were not always person-centred or reflective of the person’s voice. The provider was receptive of feedback and told us they will be completing a review of all people’s care records.

The provider was not always using their quality processes effectively to monitor the service and our inspection-initiated action from the provider to improve safety and quality monitoring for people.

Staff knew people well and understood their care and support needs. One relative said, “They know [person] so well they know [person] better than me”. We saw staff supporting people in a caring and dignified way, but records did not always reflect this practice.

The service had a new management team and staff feedback was positive and indicated the management team were open and supportive. People knew who the registered manager was, and one relative said, “The atmosphere is very positive, there is a family dynamic.” The registered manager and provider were receptive of feedback and acted promptly for some areas of concern raised during the inspection process.

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 10 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services. To understand the experience of social care providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

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

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 monitor the service and will take further action if needed.

We have identified breaches in relation to risk management and lack of good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Processes were in place to prevent visitors from catching and spreading infections. In line with government guidance, the home had recently commenced in-home visits. There was a clear pre-booking system and deep cleaning was undertaken between each visit. The home had a dedicated area to be used for these visits. Stocks of personal protective equipment (PPE), such as masks, gloves, aprons, face visors, hand washing facilities and hand sanitising gel were readily available. Temperature tests were done in a secure entrance area, and a COVID-19 questionnaire was completed. Lateral flow testing for COVID-19 was done.

A documented, ongoing testing regime was in place for visitors, staff and people living in the home. There was access and take up of vaccination for staff and people using services. The service had in place a robust admission and discharge process for people.

The layout of the premises promoted safety and reduced the potential for the transmission of infections. We observed the home to be clean, maintained and with a programme of improvements. There was clear signage throughout the home on social distancing rules and robust cleaning arrangements, including frequent deep cleaning, were in place.

We observed staff wore a full range of PPE appropriately and consistently.

Staff training, practices and deployment showed the service could prevent transmission of infection and manage any outbreaks.

Staff supported people's social and emotional wellbeing. Alternative forms of maintaining social contact were in place including, video calls.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

There was a registered manager in post although they were on annual leave on the day of the inspection. They were interviewed on their return from leave the following week. 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 supported by knowledgeable and well trained staff who showed competence in all aspects of care delivery. All staff knew what may constitute a safeguarding concern and what action to take if required. Any adverse events, whether safeguarding or accidents, were reviewed in depth and lessons learnt shared with all staff.

The home had a positive risk-taking culture which was supported by robust risk assessments. People’s needs and preferences were considered in all aspects of care delivery and any identified risks were minimised in conjunction with people’s wishes to reduce the risk of harm.

Staffing levels were appropriate to meet the needs of people in the service although it was identified there were pockets of pressure at times due to the complexity of needs and number of staff some people needed for support. This was constantly re-assessed and all shifts were covered.

Medication was administered, stored and recorded safely and in line with best practice.

Supervision and training was available for all staff and we saw progress had been made to incorporate additional specialist topics such as autism and dementia to assist staff further in providing good care.

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

Nutritional and hydration needs of people were well managed with guidance from speech and language therapists and dieticians closely followed. This was mirrored for any other health or social care needs where regular reviews and advice was sought as needed.

Staff showed compassion and empathy to all people they were supporting, and we observed very positive interactions between people. It was evident staff knew people well and we saw much humour and joviality in the home. The atmosphere was calm and relaxed and very much recognised as people’s home.

Care records provided detailed information for staff to follow and ensured people’s needs were met in the way they wished. They were regularly reviewed and included all aspects of a person’s life. Daily notes were an accurate reflection of care interventions and completed in full.

Activities were well managed with a full range of group and individual opportunities for people to engage with as they wished.

Complaints were managed in a timely manner and resolutions sought to the satisfaction of all parties.

The home had a robust quality assurance process which unpicked every aspect of care delivery, and ensured any shortcomings were addressed promptly and effectively. The actions which had been completed were also reviewed to ensure they were still relevant. This showed a culture of continuous improvement was embedded in the home.

The registered manager provided directional leadership and had a knowledgeable leadership and staff team who echoed the values of the home which were to provide a high quality of life for people promoting their independence.

Further information is in the detailed findings below

During the inspection we spoke with one person who used the service, one relative, six staff, a visiting healthcare professional and the home manager. We reviewed three people's care records and spent time on both units in the home.

We found people's privacy, dignity and choices were respected and upheld. We saw people were actively supported by staff to lead as fulfilling and active lives as possible.

We found people's care and welfare needs were met. Care records were personalised, detailed and up to date. One relative told us: 'The staff here are very good and caring. My relative is happy here and her family are more than happy'.

We found people were provided with a choice of meals and drinks and people's nutritional needs were met.

We found there were effective recruitment and selection processes in place.

We found there were effective systems in place to monitor the quality of service people received.

We spoke with two members of staff who were able to demonstrate a good understanding of the needs of the people who lived at Fairburn Mews. They told us that they were well supported by the management team and there were good opportunities for training.