Littlefair

Littlefair is a residential care home. It is registered to provided accommodation and personal care for up to 41 people. At the time of our inspection 33 people were living at the home. Littlefair provides accommodation and personal care to older people some of whom are living with dementia. It is one purpose-built property spread over three floors and has a garden and accessible patio area.

People's experience of using this service and what we found

People were supported to take their medicines safely; however the recording of people’s medicines held in stock did not match the actual stock levels in the medicine’s cabinet.

The provider’s policies and procedures for the frequency of supervision support for staff was not being followed and needed to be more regular. The acting managers told us improvements were being made to implement this immediately. We have made a recommendation regarding supervision.

People told us they felt safe and secure and well cared for.

The provider had good systems for monitoring risk and staff had a good understanding of people's needs and how to keep them safe.

People and relatives told us there were enough staff on duty to meet their needs.

Staff told us they worked well together as a team, and we noted there was a spirit of good morale amongst them.

Whistleblowing procedures were in place and displayed on notice boards. Staff told us they were confident any concerns they reported would be dealt with appropriately.

Appropriate infection control procedures were in place and staff received training with food hygiene. The home was seen to be clean. Some parts of the home were tired looking because some carpets needed replacing. The chief operating officer showed us the improvement plan for the home for 2019/20 which included a plan to replace these carpets and included other developments such as the installation of new kitchen equipment.

Feedback from people and relatives was positive. They were complimentary about the staff and commented on their caring and supportive attitude.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff were knowledgeable of the Mental Capacity Act and how it may impact on people, however not all forms giving consent had been signed. We have made a recommendation about this.

People and their relatives told us they experienced a positive approach to care and were encouraged to give their feedback to help improve the home.

The staff worked with outside professionals to improve people's health and social wellbeing. They worked collaboratively with other agencies and organisations to meet people’s needs.

People received care that was tailored to their needs and wishes. This was provided by caring, attentive and compassionate staff. The atmosphere of the home was positive and welcoming, and people and relatives told us staff were friendly, providing care and support in a way people liked and enjoyed.

The concerns and complaints procedures meant that people were able to make complaints or raise concerns and have confidence they would be responded to in an appropriate way.

Quality assurance processes were in place that monitored practice and procedure by staff, however some improvements in developing the quality assurance systems were needed and the provider was in agreement with this.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 20 June 2017).

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements.

Please see the Safe and Well Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Littlefair is registered to provide accommodation with personal care and support for up to 41 older people. At the time of this inspection there were 28 older people, some of whom were living with dementia. The service is a large purpose built property spread over three floors with a well maintained garden and accessible patio area.

The home had 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 service was last inspected on the 10 August 2016, where we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in medicines were not always managed safely or recorded correctly, people were not always supported to eat and drink safely and their requirements were not always recorded or respected, care plans were not all up to date so staff did not always have the most up to date information on how people needed to be supported and there were no formal supervision arrangements for the acting manager and limited oversight of the management of the service by the provider. The service received an overall rating of 'Requires Improvement', and after our inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.

The majority of care plans we examined had been updated and improvement had been made since the last inspection. Staff told us they found care plans to be detailed with people’s support and care needs. However, although care staff told us they felt they were aware of people’s current care needs, care plans did not always fully demonstrate the areas that had been discussed as part of the review. We have identified this as an area of practice that needs improvement.

People told us they felt safe living at the service. Comments from people included “Oh yes, I’ve felt safe and there’s always someone around, so I think there are enough staff”, “Yes, I feel safe here and everything here is alright”. People were protected from the risk of abuse because staff understood how to identify and report it. Staff had access to guidance to help them identify abuse and respond in line with the providers policy and procedures if it occurred. One member of staff told us “If we have a concern about the safety of a resident, it is reported to one of the managers. It would always be looking into”.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine when they needed it. People were supported to maintain good health and had access to health care services.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles of the MCA in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs were met and people reported that they had a good choice of food and drink. One person told us “The food’s quite good, plenty to eat and you get choice and we get tea and coffee all day”. Staff were patient and polite, supported people to maintain their dignity and were respectful of their right to privacy. People had access to and could choose suitable leisure and social activities.

People and relatives found staff to be kind and caring and the care they received was good. Comments included “The staff are very nice, kind, helpful and obliging” and “The staff are quite pleasant and caring and the carers do come round and ask if I’m alright”. A relative told us “When we first came, I overheard lovely kind words being given by a carer to a resident in bed. The carer did not know I was there”.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. For example staff were offered the opportunity to undertake additional training and development courses to increase their understanding of the needs of people. One member of staff told us “Yes we have supervision with the manager, we talk about how things are and what we want to train in. I had an action plan set up of what I wanted to achieve.

There was a calm and relaxed atmosphere at the service. People, staff and relatives found the management team approachable. One person told us “I find the manager is understanding and find it reasonably well run”. A member of staff told us “The manager and team leaders are good and supportive, everyone is very approachable”. The registered manager and provider carried out regular audits in order to monitor the quality of the service and plan improvements.

Littlefair is registered to provide accommodation with personal care and support for up to 41 older people. At the time of this inspection there were 35 older people, some of whom were living with dementia. The home is a large purpose built property spread over three floors with a well maintained garden and accessible patio area.

The service did not 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 previous registered manager had recently left. The provider had an acting manager in place while recruiting a new registered manager.

The home was currently in a transitional period due to new management and staff that had recently left. People had variable experiences because of this and we found areas for improvement.

Medicines were not always managed safely and recorded correctly The provider had not ensured care and treatment had been delivered in a safe way, medicines and risks to people had not been managed safely.

The provider had not ensured peoples nutrition and hydration needs were documented correctly and guidance for staff was insufficient to support people to eat and drink safely. People were not always supported to eat and drink safely and their needs and preferences were not always recorded or respected.

People had their needs assessed and care plans devised to inform staff of their care and support needs. People told us that they were involved in their care and could make their thoughts and suggestions known. However Our findings in relation to the quality and detail of the guidance in the care plans were mixed.

Although people and staff told us they had meetings, people and staff felt that they had not been kept up to date fully on the changes that had been taking place at the home. People were concerned why some staff had left with little or no explanations. One person told us “They should have a meeting with us and tell us what’s going on”.

There were no formal supervision arrangements for the acting manager and limited oversight of the management of the home by the provider.

The experiences of people were positive. People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good. One person told us “I’m amazed how caring they all are, even the younger ones that you might think wouldn’t be that interested”. Another person said “They’re always happy to see me in the mornings and have a smiley happy face for me”. We observed people at lunchtime and through the day and found people to be in a positive mood with warm and supportive staff interactions.

We found staffing levels were consistent over time with the provider using permanent and bank staff. The majority of people felt there was enough staff to meet their needs. One person told us “Most of the time yes there is enough staff, sometimes I wait a little longer for them to come when I call my bell but they are busy and always come to me”. The provider was also currently recruiting more staff.

People’s safety was maintained as they were cared for by staff that had undertaken training in safeguarding adults at risk and who knew what to do if they had any concerns over people’s safety. Risk assessments ensured that risks were managed and people were able to maintain their independence. One member of staff told us "Any concerns I had like if I noticed someone’s mood had changed or any marks on their body, I would report straight away no hesitation”.

People’s consent was gained and staff respected people’s right to make decisions and be involved in their care. Staff were aware of the legislative requirements in relation to gaining consent for people who lacked capacity and people confirmed that they were asked for their consent before being supported.

Staff felt fully supported by the acting manager to undertake their roles. Staff were given training updates, supervision and development opportunities. For example staff were offered the opportunity to undertake a diploma in health and social care. One staff member told us “We do quite a bit of training and do updates each year”.

The acting manager was fully involved in the day to day running of the Home. People and staff felt they were approachable and supportive. There were systems of quality assurance in place that provided evidence of the monitoring of the service and actions for improvement.

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