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Archived: Fairhaven Inadequate

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Reports


Inspection carried out on 27 April 2017

During an inspection to make sure that the improvements required had been made

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 We also found that the fire risk assessment and fire evacuation records were out of date.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

Inspection carried out on 4 August 2016

During a routine inspection

This inspection took place on the 4 August 2016 was unannounced. We last inspected the service on the 8 October 2015 and found that they were not meeting the required standards. Following the comprehensive inspection, the provider wrote to us to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found the service was now meeting the legal requirements and regulations associated with the Health and Social Care Act 2012.

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 17 people living at the home.

The home had a registered manager. 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.

People’s wellbeing was not always supported by staff who met their individual needs and preferences by ensuring people’s social needs were met.

Safe and effective recruitment practices were followed and there were sufficient numbers of suitable staff available at all times to meet people’s individual care and support needs. Information from incidents was used to good effect in reducing identified risks and keeping people safe.

There were effective plans and guidance in place to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained.

People were helped to take their medicines safely by trained staff who had their competences assessed and checked in the workplace. Potential risks to people’s health and well-being were identified, reviewed and managed effectively.

Relatives and health care professionals were positive about the skills, experience and abilities of staff who worked at the home. Staff received training and refresher updates relevant to their roles and the needs of the people they supported.

Staff regularly worked with senior colleagues and had opportunities to discuss any concerns they had, issues about their personal development and performance and how the home operated. However, the registered manager acknowledged that formal ‘one to one’ supervisions and annual appraisals were not as up to date or complete as they could be in all cases.

People were supported to maintain good physical and mental health and well-being. They had access to health and social care professionals when necessary and were supported to eat a healthy balanced diet that met their individual needs.

We saw that staff obtained people’s consent and agreement before providing personal care and support, which they did in a kind and patient way.

Arrangements were in hand to ensure that people were supported by advocacy services where appropriate to help people them access independent advice or guidance. People and their relatives were involved in the planning and reviews of care wherever possible.

We saw that staff had developed positive and caring relationships with the people they cared for. The confidentiality of information held about people’s medical and personal histories had been securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their individual needs and took account of their preferences. Staff knew the people they looked after well and were knowledgeable about their background histories, preferences, routines and personal circumstances.

Relatives told us that staff listened to them and responded to any concerns they had in a prompt and positive way. Complaints were recorded and investigated thoroughly by the registered manager with learning outcomes used to make improvements where necess

Inspection carried out on 11& 24 August and 8 October 2015

During a routine inspection

This inspection took place on the 11, 24 August & 8 October 2015 and was unannounced. We last inspected the service on the 1 December 2014 and found that they were not meeting the required standards.

At this inspection we found the service continued to be in breach of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.

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 14 people living at the home.

The home had a registered manager. 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 provider did not have appropriate systems in place to ensure there were adequate staffing levels to meet people’s needs, and to keep people safe at all times. This meant that people who used the service may not have had their needs met in a timely or safe way.

People’s wellbeing was not always supported by staff who met their individual needs and preferences by ensuring people’s social needs were met.

Some people told us they felt safe living at Fairhaven. Staff told us they knew how to keep people safe. However risks to some people’s safety and well-being were not always managed effectively.

There was an inadequate recruitment process in place which failed to ensure that staff members employed to support people were fit to do so.

There were arrangements in place for the storage, management and disposal of people’s medicines. However a serious error was discovered as part of this inspection regarding the stock control for one person’s medication. This meant that the system in place to monitor people’s medications was ineffective in identifying errors. This error was reported to the local authority safeguarding team following this inspection.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection four applications had been made to the local authority in relation to people who lived at the service and were pending an outcome. Two staff were not fully aware of their role in relation to MCA and DoLS and could not explain how to support people so not to place them at risk of being deprived of their liberty.

There were inadequate systems in place to obtain the views of people who used the service, relatives or other stakeholders.

There was limited information in place to confirm that there were systems in place to monitor and review the quality of services provided and to reduce potential risks to people and drive forward improvement.

People had access to healthcare professionals, including GP’s, dentists, chiropodists and opticians.

Inspection carried out on 01 December 2014

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 13 October 2014. After that inspection we received concerns in relation to staffing levels, staff recruitment processes, staff knowledge and skills, administration of medicines and the quality of the food people received, As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

The inspection took place on 01 December 2014 and was unannounced. 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 17 people living at the home.

The home is required to have a registered manager. 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 provider is also the registered manager.

There was insufficient staff at all times to provide the level of care that people needed. Not all staff were aware of their responsibility to safeguard people or could identify the types of abuse people may suffer. Not all identified incidents of abuse had been reported to the appropriate safeguarding authority or the CQC.

Recruitment processes were not robust and proper checks had not been completed before staff started work at the home.

People did not receive their medicines as they had been prescribed. Medicine administration records had not been completed correctly and stocks of medicines held did not always agree with the recorded amounts.

The requirements of the Mental Capacity Act 2005 had not always been followed in relation to obtaining consent to care for people who were not able to make decisions for themselves.

Staff training was ineffective. Staff demonstrated poor skills when assisting people to move about the home. Staff were not always supported in the roles and responsibilities.

People enjoyed the food they received and there was plenty of it. However, there was no record that appropriate healthcare professionals were consulted about people’s dietary requirements.

Records and data management systems were not robust. Records were not completed by the staff who had delivered the care.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in respect of staffing, staff recruitment, support for staff, the management of medicines, safeguarding, the provision of safe care, consent and record keeping. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 13 October 2014

During a routine inspection

This inspection took place on 13 October 2014 and was unannounced. Fairhaven is a care home that provides accommodation and personal care for up to 21older people. It does not provide nursing care. On the day of the inspection, there were 17 people living in the home.

At our last inspection on 10 July 2014, we found that procedures had not been followed in relation to staff recruitment; appropriate training had not been provided for staff; there was a lack of quality monitoring systems; inadequate medication systems and a failure to ensure staff knew how to report allegations of abuse to the appropriate authorities. Mental capacity assessments for people who were unable to make decisions about their care had not been carried out and there were limited opportunities for people to pursue personal interests or hobbies. We also found that staff were completing daily care records before care was delivered.

During this inspection we checked whether the improvements had been made. We found that our concerns in relation to the accurate completion of care records had not been fully addressed.

The service has a Registered Manager. 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 treated in a way that respected their dignity. Their human rights were protected, and risks to individuals’ had been assessed and managed so that people were protected from harm or abuse. Information about the safeguarding procedures and how to report any allegations of abuse outside the service was available.

Recruitment systems had been improved and there were sufficient staff employed to care for people safely.

Medicines were managed safely and people received their medicines regularly as prescribed by their doctors.

People and their relatives had been involved in the decisions about their care and support. Their health care needs were assessed, reviewed and delivered in a person centred way. People’s nutritional and health care needs were met. They were supported to pursue their social interests or participate in activities organised for them so that they maintained their wellbeing.

The registered manager was visible and people were able to raise any concerns they had with them. A questionnaire survey had been carried out to seek the views of people about the quality of service provided. Regular staff meetings were held to discuss issues relating to people’s general wellbeing and the day to day running of the home.

Staff had received training and understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. Where people had been identified as lacking capacity, staff were aware of involving people’s relatives, other professional or the advocacy services for best interests decisions. They were working within the law to support people who lacked capacity to make decisions.

We found one breach 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 the full version of the report.

Inspection carried out on 10 July 2014

During a routine inspection

We used the information we had gathered to answer the five questions we always ask:

Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found:

Is the service safe?

People were cared for in a clean and hygienic environment. Regular cleaning of all areas of the home had been maintained.

People we spoke with said “They did not do any activities during the day”. One person said “The standard is not bad at all. Staff work really hard. Food is what they plant in front of me. I just put up with it. Others may not. I am not one for choices.”

Care plans did not give clear directions on how to recognise or how to meet the needs of people. We found that the daily written records for people did not reflect what we had seen. Daily diaries had been completed in advance. We found gaps in the recording of daily entries which meant that the continuity in the delivery of care had not been maintained. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The practice for the management and administration of medicines was not safe. There were gaps in the MAR charts which meant that people did not received their medicines regularly and on time. Medicines which had been prescribed previously had been given to people who used the service. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Appropriate checks had not been carried out before staff began work. We reviewed the recruitment records of all the current staff in the home and there was not enough information for us to be able to verify the Disclosure and Barring Service (DBS) checks as none of the staff had a starting date.

Staff had not received training in safeguarding people from abuse and they said they did not have time to read people’s care plans so that they would be able to meet the identified needs of people appropriately. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. One application had been submitted under this system.

Is the service effective?

People had not been consulted in all aspects of their care. People did not have a mental capacity assessment done so that any decisions made would be in their ‘best interests’. Staff had not been provided with regular formal supervision and relevant training so that they were skilled and competent in their roles. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People told us that the staff were caring, helpful and that they worked very hard. They felt that their needs were reasonably met. One person said "I moved here two weeks ago. I used to help doing the washing up but do not do anything here. Sometimes, I go out in the morning for a walk. The staff are kind and I have no concerns." One relative said “My mother receives good care. We take her out often. She is happy and the staff are caring.” However, we observed that there was a lack of interaction between staff members and people who used the service. People were not engaged in meaningful activities during the day. Some people had fallen asleep at the dining tables after their breakfast and staff were not to be seen. This meant that people’s needs had not been met as identified. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service responsive?

The care plans we looked at showed that people's needs had been assessed and but not met appropriately. There had been no complaints received since December 2012.

Is the service well-led?

People’s care and support had not been planned and delivered in accordance with their identified needs. The manager said that they were not good at documenting and keeping records as required by legislations. There was not effective system in place to assess and monitor the quality of service.

Inspection carried out on 8 October 2013

During an inspection to make sure that the improvements required had been made

Following our previous inspection on the 12 August 2013, the provider was found to be non-compliant with Regulations 9, 10 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. During our follow-up inspection the provider was found to have made some improvements however remains non-complaint in all areas we assessed.

Inspection carried out on 12 August 2013

During an inspection to make sure that the improvements required had been made

During our inspection on 12 and 18 February 2013, the provider was found to be non- compliant with regulation 9 and relation 23.

On a follow-up inspection on 17 and 20 May 2013, the provider was found to be compliant with regulation 23, however the provider was still not compliant with regulation 9 and was also found to be non –complaint with Regulations 10, 11,and 13.

We received an action plan from the provider telling us that they would be compliant with regulations 9, 10, 11 and 13 by 31 July 2013. During our follow –up inspection on the 28 June 2013 and 12 August 2013, we found that the provider was still not compliant with regulation 9, 10 and 13.

Inspection carried out on 17, 20 May 2013

During an inspection in response to concerns

On our previous inspection carried out on the 12 and 18 February 2013, the provider was found to be non-compliant with regulation 9 and regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations

2010. During our follow up inspection the provider was found to still be non- compliant with regulation 9, as well as regulation 10, 11 and 13.

Inspection carried out on 12, 18 February 2013

During a routine inspection

During our site visit, we found that the provider was non-compliant with two of the outcomes of the standards inspected. Accurate records pertaining to night checks had not been maintained and not all staff had received the mandatory training that they needed to carry out their role

We observed that people were given a choice of food and were offered cold or hot drinks during lunch time.

On the day of our visit, staff, who had received safeguarding training, were not able to explain what safeguarding meant and what their responsibilities were under the safeguarding of vulnerable adults provision.

Inspection carried out on 1 August 2012

During a routine inspection

People we spoke with told us that they were happy living at the home and were satisfied with the social activities available to them. They found staff to be caring and helpful and felt confident that staff were able to met their needs.

We spoke with four people who had been visiting the home. Comments from visitors included “Staff know my mum very well, they know what she wants and how to care for her” and “I am very happy with the care my dad receives”.