Archived: Fairlawns Care Home

You can read the report from our comprehensive inspection of 20 August 2015, by selecting the ‘all reports’ link for ‘Fairlawns care Home’ on our website at www.cqc.org.uk

This unannounced comprehensive inspection was carried out on the 10 and 11 March 2016. There was a serious lack of oversight from senior management who were failing to recognise and address poor standards. As a result people living in the service were at serious risk of not receiving the care and support they needed. We found no improvements had been made to the overall quality and safety of the service since our last inspection. At the end of the first day we fed back our concerns to the representative of the provider (a director) and the manager. We were given assurances that they took our concerns seriously and would take immediate action to address them.

However, the next day we received two separate serious concerns stating that people continued to be at risk and there was no managerial presence in the service. We were unable to contact the manager or provider to discuss these concerns so we returned to the service at 3.45pm. We found insufficient staff and people had not been given their morning medicines. We reported our concerns to the local authority, who arranged for an external care service to provide 24 hour support to existing staff specifically focussing on safe medicines administration. We took urgent action to restrict the service taking any new admissions. In addition an urgent condition was made for the provider to ensure there were systems in place for the safe oversight and management of medicines, provided by trained and competent staff.

Fairlawns Care Home provides accommodation and personal care for up to 19 older people, some living with dementia. There were nine people living in the service when we inspected on the 10 and 11 of March 2016.

There was not a registered manager in post. 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 manager had submitted an application to be registered with the Commission which was being processed.

The provider was failing to ensure that people were provided with a service that kept them safe and took prompt effective action to minimise risks. There were not enough suitability trained and competent staff to meet people’s needs. This included the manager who did not have the skills to oversee medicine management and did not recognise poor practice in general. The environment and equipment was not maintained to a safe level. The lift, washing machines and dryers were not working properly. People were not protected by the recruitment checks undertaken to ensure staff were of good character and had the required experience and skills to carry out their role.

The manager and director were unable to demonstrate that they and the staff had the skills and knowledge to provide people with care that was responsive to their needs.

People’s nutritional needs were not being monitored effectively to ensure they had enough to eat. Where records showed people had lost weight, no action had been taken to seek health professional’s advice and/or promote weight gain by offering nutritious snacks.

Improvements were needed in how people’s ability to make decisions were assessed and recorded. The management of the service lacked a working knowledge of the recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS). Therefore they could not demonstrate any restrictions in place were lawful.

People and their relatives told us they were treated in a kind, friendly and respectful manner, but felt staff did not always have the time to sit and talk with them. People’s personal information was not kept secure and confidential. The practice of drying people’s clothing, including underwear, in the communal areas of the service, did not support people’s dignity and respect.

People did not receive personalised care that was responsive to their needs. There was a lack of information about their health, social and emotional well-being. People were not always being provided and/or supported, to access activities and social contact which provided mental stimulation. This put them at risk of becoming socially isolated.

There was a poor culture in the service where staff felt they were not valued, listened to, or able to influence service improvement. The service’s quality assurance system was not robust. It failed to independently identify shortfalls in the care provided to people. Complaints and outcomes from safeguarding investigations had not been used to improve the service overall.

We found multiple and continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This inspection found that there was not enough improvement to take the provider out of special measures and urgent action was taken.

The local authority made arrangements for all people living at the service to move to alternative services by 24 March 2016.

You can see what action we have told the provider to take at the back of the full version of this report.

During our inspection we saw that care was not delivered consistently by all staff. We observed some staff to be respectful and sensitive in their approach to people using the service; they showed an understanding of people's needs and preferences and were polite when speaking with people. However we also noted other poor practices, which meant that people living in the home could not be assured that they would receive care appropriately.

The home did not have a permanent manager in post and we saw that processes for the management of the home were either disorganised or not in place. This included processes around record keeping, care planning, supporting staff, maintaining the environment and monitoring the quality of the service.

Some attempts had been made to improve the care planning system but there were many areas were information was missing. These areas included risk assessments and care records relating to specific health conditions. This meant that the care planning arrangements did not give staff the necessary information and guidance to enable them to deliver care safely.

During our inspection we spoke with people who said they were happy living at Fairlawns Care Home.

Staff showed an understanding of people's needs and preferences and we saw that staff were polite when speaking with people. We also noted that people living in the home appeared comfortable with staff and we saw good-humoured conversations.

There had been inconsistencies in the management of the service and some of the procedures such as record keeping were not robust and were not well organised.

People's rooms were homely and overall the home was clean. However, we saw that some areas such as the conservatory were cluttered and untidy, which had an impact on the standard of the environment.