Archived: Fairhaven Residential Care Home

Fairhaven Residential Care Home provides residential care for older people over the age of 65. The home is registered for up to 13 people and at the time of this inspection there were 10 people living at the home.

At our previous inspection in February 2016 we found breaches of three regulations and rated the service Requires improvement. The breaches were in the areas of obtaining consent to care and support, management systems, and checks to make sure staff employed were suitable to work in a care setting.

At this inspection we found improvements had been made and sustained in all areas. There were no longer breaches of regulation, but further improvement was needed in respect to obtaining consent where people lacked capacity.

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.

There were arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely. The provider had recruitment processes in place to make sure they only employed workers who were suitable to work in a care setting. Suitable arrangements were in place to store medicines safely and administer them safely and as prescribed.

Staff received appropriate training and supervision to maintain and develop their skills and knowledge to support people according to their needs. Staff were aware of the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. However the application of the principles in practice was not consistent. People were supported to eat and drink enough and they had access to healthcare services, such as GPs and specialist nurses.

Care workers had developed caring relationships with people they supported. People were encouraged to take part in decisions about their care and support, and their views were listened to. Staff respected people’s independence, privacy, and dignity.

Care and support were based on assessments and plans which took into account people’s abilities, needs and preferences. People were able to take part in leisure activities which reflected their preferences. The provider had a complaints procedure in place, but no formal complaints had been received.

The home had a warm, homely atmosphere. The provider had put in place systems to make sure the service was managed efficiently and to monitor and assess the quality of service provided.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 service is required by a condition of its registration to have a registered manager.

At the time of our visit effective governance systems to monitor the quality of the service and identify the risks to the health and safety of people were not in place. The registered manager told us that they checked the quality of the service regularly as they were in day to day control of the service. However, we could not see that these systems were effective in ensuring compliance with the regulatory requirements. Systems currently in place had not identified the areas of concern we found during the inspection so that action could be taken to improve the quality of care and ensure the safety of people.

The required pre-employment information relating to staff employed at the service had not always been obtained when staff were recruited. The provider did not ensure that safe recruitment practices had been followed to ensure staff were suitable for their roles.

Staff were able to demonstrate their understanding of the risks to people’s health and welfare and people told us they received care that met their needs. Risks associated with people’s care and support needs had been identified and guidance provided to help staff protect them from harm. However, people’s care records were not always sufficiently comprehensive to ensure staff who were new to the service would have all the information they required to enable them to meet people's needs, wishes and preferences.

Staff had received training to support them to effectively meet the individual needs of people. Even though staff felt supported they did not always receive supervision (one to one meetings with their line manager) to ensure they maintained the skills and knowledge needed to meet people’s needs effectively. We have made a recommendation to support the provider to improve staff support and supervision.

We were concerned that opportunities and appropriate support had not been provided for people to be involved in decisions about their care and that their rights under the Mental Capacity Act 2005 had not been upheld. Where the provider placed restrictions on people to keep them safe, they were waiting for legal authorisation instructing them to do so. The registered manager could not show restrictions were only placed on people as a last resort after less restrictive approaches had been

exhausted. There was a risk that people’s rights might not be upheld and restrictions might be placed on people unlawfully, whilst the registered manager awaited the outcome of Deprivation of Liberty Safeguarding (DoLS) applications.

People told us they felt involved in their care. They enjoyed time spent with staff and told us they had sufficient opportunities to stay active and pursue their interests. However, we could not see from people’s care plans what opportunities had been created for people living with dementia to maintain their skills, remain involved and have a stimulating day. We have a recommendation to support the provider to develop opportunities for people living with dementia to engage in meaningful activities.

People and staff views about the management of the service were positive. People and staff spoke positively about the registered manager. They felt she was approachable, listened to them and asked for their views. The registered manager and staff had promoted a culture that put people at the centre of the work they did. Opportunities were available for people, their relatives and professionals to provide feedback about the service. However, the registered manager had not always used this information to improve the service.

People were treated with kindness, compassion and respect. Staff promoted people’s independence and right to privacy. We observed staff putting the provider’s values of respect, caring and dignity in practice, and people told us the care they received reflected these values.

People knew how to make a complaint. People told us the manager and staff would do their best to put things right if they ever needed to complain.

People received their prescribed medicines when required and had access to healthcare services when they needed them. People liked the food and told us their preferences were catered for. People received the support they needed to eat and drink enough.

There were enough staff to meet people's needs. People were positive about the staffing levels and said they received support quickly when they needed it. Staff had a good knowledge of their responsibilities for keeping people safe from abuse.

We found three breaches of the Health and Social Care Act 2008 (Regulations) 2014. You can see what action we told the provider to take at the back of the full version of this report.

The SOFI tool enabled us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences. We spent most of our visit observing care and found that generally people had positive experiences. Staff interacted well with people and they responded in a positive manner. We noted staff and people walking around the home together in conversation and whilst sometimes the people presented challenges to staff these were addressed in a kind and considerate manner.

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. People were protected by the medicine procedures in place at the home.

Staff recruitment procedures had improved since or previous inspection and staff had been properly vetted prior to starting work. The provider's statement of purpose was current and provided people with clear information regarding the services provided at the home.

The provider had an effective system in place to identify, assess and manage the risks to the health, safety and welfare of people using the service and others.

We spoke with two people who could express a view and they told us they were happy at the home. One person said 'I have lived her for a considerable amount of time. It really feels like my home.' Another person told us 'It's really good here. I can do as I please. The staff are very friendly and always know just what I need.'

Risks to people's health and welfare were assessed and care was planned and delivered according to people's needs. The provider worked in cooperation with other health and social care professionals to ensure people's needs had been met.

People were protected from the risks of acquiring an infection because infection control practices at the home had improved since the previous inspection. Areas of the environment had not been properly maintained and consequently people who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises.

People's health and welfare needs were met by staff that had not been properly vetted. The provider's statement of purpose was not current and did not provide the Care Quality Commission or people with the information required.

The quality of the service at the home was not monitored frequently or effectively. The provider had notified us appropriately when people at the home had died.

People's personal records were accurate and fit for purpose. Staff records and other records relevant to the management of the service were accurate and fit for purpose. Records were kept securely and could be located promptly.

Those people who could communicate with us in a meaningful way told us staff always asked looked after them well. One person said "I think staff are lovely. They are very kind and caring". People told us they were treated with respect, one person said " When I am in my bedroom staff always knock on my door" another person said " The staff here are very polite. They have good manners and always ask my permission to do things".

We found people were supported to be able to eat and drink sufficient amounts to meet their needs. People told us they felt safe living at the home.

We found that people were not protected by the infection control measures in place at the home. We also found some records were not available for us to review when we inspected.