Fairmile Grange Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to good. This meant people were safe and were protected from avoidable harm.

The service was no longer in breach of legal regulations in relation to safe care and treatment and safeguarding.
 

This service scored 66 (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 was developing a culture of safety, based on openness and honesty and improvements had been noted since our previous inspection. Feedback from people and their relatives was divided as to whether the service listened to concerns about safety.

Following our previous inspection, the provider had implemented new processes to review accidents and incidents. This meant adverse events were reviewed by different levels of leadership and analysed for trends or patterns. Lessons learnt from events were shared with all staff using the service’s electronic care planning system. A staff member told us, “Managers have given us more information about people. We are learning every day. That has improved how we care for people.”

A relative told us, “I have also noticed that the care staff are checking on people more often, which is reassuring.”

The provider told us they plan to continue to make progress with their action plan to embed and sustain these improvements and work with the local authority to ensure they respond to previous safeguarding concerns.
 

The service did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services. This remains an area for improvement.

People and their relatives told us they could not always see the visiting doctor or nurse practitioner when they wanted to because the appointment system requires you to be on a waiting list in advance. Relatives also spoke of challenges had when supporting their loved one to access private healthcare services such as physiotherapy and chiropody. One relative told us, “The staff do not follow the exercise programme my relative was discharged from hospital with, they have it but say they don’t have time.”

A visiting health and social care professional described the service as, “Busy. It often takes a while to find the right member of staff to discuss a patient with.”
 

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

People told us they feel safe living at Fairmile Grange Care Home. Comments included, “I am happy and safe here” and “I haven’t had to raise any concerns.”
Relatives told us, “Staff call whenever they need to update about my loved one. We have no concerns of any maltreatment by staff.”

Safeguarding procedures were in place to ensure people were protected from avoidable harm. We observed staff working in safe ways throughout the inspection. Records showed safeguarding referrals had been made as necessary and this included notifying CQC of certain events as required by law. All legal applications had been made in accordance with the Deprivation of Liberty Safeguards (DoLS), this meant people’s rights were fully respected. The registered manager had oversight of DoLS applications, authorisations, and conditions and used records to ensure all documentation was in date. A member of staff said, “We've worked hard to improve the quality of care and what we do to keep people safe. We truly have and it hasn't been easy, but we've made changes by listening to people and taking action.”
 

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People and their relatives told us they felt involved in planning for their needs in relation to risks and keeping safe. For example, one relative said, “I feel the staff do know who my loved one is, and they are treated as a person.” Another relative told us, “Alternative strategies for engaging more positively in activities and personal hygiene are being explored. This is a big switch from a few months earlier, when my relative’s resistance towards showering or washing was just accepted.”

People’s risk assessments had been created and updated to provide clear direction for staff, guiding them how to support people and encourage their independence. A staff member said, “I am able to support residents, contribute towards and be responsible for residents’ safety and I endeavour to assist where possible.”
 

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People and their relatives told us of improvements made to the environment. A relative stated, “The home is now far more welcoming, and the general ambience has improved enormously.”

An ongoing plan of building developments were underway, including the refurbishment of outdoor balcony spaces. Work was undertaken to remove railings and install clear safety glass to allow people to have an unobstructed view.

Staff understood and followed the service’s health and safety procedures. Health and safety audits aimed at supporting people to live in a safe, well-maintained environment took place regularly and any areas for action were addressed. There were new and improved systems in place to report repairs. Staff listed improvements driven by the registered manager, for example the purchasing of easy clean furniture and crockery.
 

The service did not always make sure there were enough qualified, skilled and experienced staff. They did not always work together well to provide safe care that met people’s individual needs. This remains an area for improvement.

Feedback from people, relatives and staff raised continued concerns about whether there were always enough staff on duty. Comments included, “Sometimes I am left waiting because they are with the other people”, “More staff are needed for an effective response time at busy times of the day like mealtimes”, “A set number of staff per floor is not proportionate. We have told the registered manager reduced staff levels can be dangerous to the residents, and many things need to be taken into account” and “We continue to rely on the wellbeing team going above and beyond when care staff are low in numbers to keep our loved one safe.”

The provider assured us they were reviewing staffing levels to ensure staff were there when people needed them in response to this feedback. We observed the service to have a calm atmosphere and there appeared to be sufficient staff on duty to support people without rushing and we noted call bells were responded to. Leaders within the service told us of progress made to support new staff, “We know some are new to their role but we are able to support them to develop, we have a plan in place and time to teach them things.” Other members of staff spoke highly of their induction informing us of changes made since our previous inspection, “You are mentored by the strongest staff, welcomed by everyone and not left on duty with other new staff or agency now” and “There is an expectation to do more shadow shifts and have your care certificate completed before you work alone.” The Care Certificate standards define the knowledge, skills and behaviours expected of specific job roles in health and social care.

The provider had effective processes in place to ensure staff had the necessary skills and competence to carry out their roles. Recruitment records showed staff were recruited safely. This included an enhanced Disclosure and Barring Service (DBS) checks for adults. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.
 

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People told us, “The home is clean and well maintained.”

During our inspection we observed all areas of the service were clean. Staff used appropriate cleaning materials. Soap and paper towels were available to ensure good hand hygiene. Staff told us they had access to personal protective equipment, such as gloves and aprons. Staff had received training as well as spot checks from the management team to ensure they used this correctly.

We identified improvements made by the provider in records to consider how infection may have contributed to adverse events and noted action taken to reduce the risk of cross contamination.
 

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Medicines errors had significantly reduced since the last inspection. People received their medicines safely as prescribed for them. A person told us, “I know what I’m taking, and I get my tablets on time.” Another said, “Staff tell me if anything has changed with my medicines, I don’t always remember but I can always ask.”

Staff told us that they felt well supported with medicines, and they knew how to report any issues. They told us they had training, and competency checks to make sure they gave medicines safely. They told us that they found the new system in place for managing people’s medicines worked well.

Records showed that people received their medicines safely as prescribed. There were suitable arrangements for the storage, administration and disposal of medicines. When medicines were prescribed to be taken ‘when required’ there were detailed and person-centred protocols in place to guide staff when these might be needed.