Fairmile Grange Care Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.
 

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs were not always assessed prior to their admission to the service.

The provider had identified their admissions policy was not being followed, and some staff had made an attempt to start collecting required information about people using the service. However, during this time the provider continued to allow admissions whereby people did not have completed pre-assessment forms, this meant the service could not be sure they could meet the needs of the person safely. People did not have care plans, risk assessments, mental capacity assessments or where necessary, appropriate applications had not been made to lawfully deprive them of their liberty. This meant staff were not aware of people’s needs, wishes or goals and were unable to provide care that met people’s needs.

A relative told us, “Since CQC have been in, they have emailed me a new care plan for my loved one but there are still things wrong in it, they have not talked to me as my loved one’s representative.”
 

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Care plans were not updated to reflect when a person’s needs changed or their health deteriorated.

Health and social care professionals commented, “The nurse on duty does not always understand their role is to assess symptoms and respond appropriately” and, “There is no clinical thinking alongside performing a nursing task.” We discussed this feedback with the provider who responded, “We have introduced ‘resident of the day' review that will cover; a care plan review for each person, medication review, deep clean of the room, chef’s visit to confirm food preferences; and wellbeing/activities discussion.”

The service did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

People living at the service were not always supported to share their personal histories, preferences, and routines. Information about people was not always shared as appropriate with external partners. A health and social care professional told us, “When we have requested blood pressure recordings following a person experiencing falls or a period of ill health, there have been times when these have not been done, and not because the person had declined them.”

Staff told us the information they had for people was not accessible to them using the providers electronic recording system, a staff member said “The paperwork is not always up to date, but the nurses in charge are always very helpful. You can ask them about the person, and they will tell you what they need.”
 

The service did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. The service did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People and their relatives told us they were not involved in regularly monitoring their health, including health assessments and checks with health and care professionals. Comments included, “I am waiting for a call bell, for round my neck. It’s been months since staff said they would order new ones as there aren’t enough.” And, “I ask the nurses to come and check on my relative, but they often say they are busy.”

Records reflected routine health screening tools were often not completed as planned.
 

The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Staff told us not all records to support people were clear, and sometimes records were inconsistent. Comments included, “Some staff often forget to document checks on people’s health” and, “It can be disappointing and even a bit embarrassing, especially in front of residents’ relatives, when it’s clear we’re all rushing around trying to complete care tasks in a hurry.”

Leaders had recognised tools provided to monitor people’s health, such as those to identify pain and support skin integrity, were not being used consistently and had introduced a regular clinical meeting to improve information sharing about people’s current health conditions.
 

The service did not tell people about their rights around consent or respect these when delivering care and treatment.

Principles of the Mental Capacity Act 2005 (MCA) were not followed in practice; people were not empowered to make decisions. Managers told us, “We know we are behind with mental capacity assessments. It is something that is on the radar to do.”

Care was not planned in consultation with those who had the correct legal authority to be involved in their care. A relative told us, “I tell them again and again what my loved one needs and what has worked to get them motivated in the past, but they don’t listen to me even though I hold the Lasting Power of Attorney.”

We found 3 people had not had the required MCA assessments completed and for people who did assessments and care plans did not detail all the options explored or include how the person was supported to make decisions. MCA assessments and care plans did not evidence how the least restrictive care was planned as the outcome as required by law.