Archived: Fairhaven

Updated 21 June 2017

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 was carried out in response to concerns we received and was carried out over two days. The first day was conducted by one inspector but due to serious concerns discovered on the first day of the inspection, two additional inspectors attended the second day. We visited the service on the 27 April and 3 May 2017.

We also reviewed information we held about the service including statutory notifications relating to the service. Statutory notifications include information about important events which the provider is required to send us.

During the inspection we spoke with seven people who used the service, one relative, seven care staff, the manager and the provider. We contacted family members and relatives to obtain feedback and also sought feedback from health and social care professional’s familiar with the service. We looked at five care plans, eight staff files, complaints, records relating to food and fluid monitoring and other information which related to the overall monitoring of the service.

Updated 21 June 2017

We carried out this inspection on 27 April and 3 May 2017. The inspection was conducted in response to concerning information received by the Care Quality Commission. We last carried out an inspection at the service on 4 August 2016. At this inspection we identified serious concerns and several breaches of regulations which put people at risk of harm. As a result we have taken enforcement action against the provider to ensure that improvements are made.

Fairhaven provides accommodation and personal care for up to 21 older people. It does not provide nursing care. At the time of our inspection there were 16 people living at the home.

There was no registered manager in post. The provider had appointed a manager and who had commenced work at Fairhaven on 26 April 2017. However this person at the time of this inspection had not applied to be registered with the Commission. 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 receiving care and support that was unsafe and did not meet their needs. There were not enough staff deployed by the service to meet people’s needs. Risk assessments were not detailed enough to adequately capture risks to people or control measures to minimise these. We also found that the fire risk assessment and fire evacuation records were out of date.

We found people were still not being given opportunities to take part or be offered activities that suited the personal preferences or choices. There were not enough competent and suitably trained staff deployed by the service to meet people’s needs. People’s medicines were not managed or accounted for correctly and changes to medicines were not identified and included in people’s care plans. We also found discrepancies in the recording of people’s medicines.

People were also placed at risk from staff who were carrying out unsafe moving and handling procedures.

Some staff did not have valid employment references on their files. Existing staff did not receive regular supervision or appraisal of their performance, training or development needs. New staff had not received an induction or training and there were no systems in place to monitor or plan a schedule to train staff in the future. Not all staff understood the correct way to safeguard people from the risk of abuse or what constituted a safeguarding incident. There was no training provided to help staff to understand the Mental Capacity Act (2005) and people’s care plans did not include any information in relation to their capacity to make and understand decisions about their care and support. Staff did not always support people to make decisions and follow the legal requirements outlined in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberties Safeguards (DoLs).

People’s consent had not been obtained prior to care and support being delivered. We found that staff did not understand the principles of the Mental Capacity Act. We found that people’s human rights had been unlawfully restricted.

The service did not adequately identify people’s needs in relation to nutrition and hydration. There was no assessment or information available in people’s care plans to help staff understand the foods and drinks that were appropriate for them. There was only limited evidence that support was being sought from external healthcare professionals as necessary. People were not offered a range of choices at mealtimes and people had no access to snacks or refreshments.

People told us that some staff were kind and caring, and staff had developed positive relationships with people. However we observed staff failed to treat people with dignity or respect. In addition, there was not always enough information in people’s care plans to provide staff with adequate knowledge of the person.

People’s care plans did not fully reflect the extent of people’s needs, and were not always reviewed if the person’s needs changed. There was limited evidence of involvement from people or relatives and care plans had not been reviewed since our last inspection in 2016.

The provider’s complaints policy was out of date and the service did not fully record or monitor all complaints and the response to complaints was inadequate.

There was inadequate governance and overall oversight which meant that systems were ineffective. There had been no quality monitoring or audits carried out in the home since the last inspection in August 2016. There was no evidence that people and their relatives had been consulted or feedback sought on the service provided.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.