Archived: Fairfield Manor

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.

Is the service safe?

The service was not safe. People who used the service were not safe and were not protected from avoidable harm or abuse. People experienced harm and neglect because the provider had not ensured staff at the home knew how to care for people appropriately or knew what to do when people experienced harm or abuse.

Risks to people were not managed appropriately. Risks to individual's health, welfare and safety were not recorded. This meant that people were not cared for or supported safely.

Staff did not report accidents and incidents appropriately. Systems in place did not ensure that managers and staff learnt from accidents and incidents and therefore did not reduce risks to people or protect them from potential risk of harm.

People were not safe because the provider had not ensured there were sufficient numbers of suitable staff at the home. The needs of people who used the service were not taken into account when staffing levels were assessed. This was because a dependency tool used by the service was not fit for purpose and did not adequately assess people's needs. There was a high use of agency staff, in particular trained nurses. Because of a lack of proper handovers and care planning and unfamiliarity with the service, people were cared for by staff that did not know or understand their needs.

People were at risk of harm because their medicines were not managed in a safe or appropriate manner. People did not always receive their medicines on time or in line with the prescriber's instructions.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, staff did not demonstrate that they understood how to protect people's rights.

Is the service effective?

People did not experience effective care because staff did not have the knowledge or skills they needed to carry out their role and responsibilities.

People did not receive the care they needed because care needs were not adequately recorded in people's care plans. People's care plans and risk assessments were not updated to reflect any changing needs. As a result staff did not always know how to support people appropriately.

Where some people displayed changes in their behaviours, such as self-harming or displaying behaviours that staff and others found challenging, there had been no appropriate referrals to a health care or psychiatric professional.

People were not supported to maintain good health. People who were at risk of skin breakdown did not receive effective care and support as directions received from health care professionals were not acted upon. Specialist mattresses were in place to help reduce the likelihood of pressure sores, but were not maintained in accordance with people's individual needs.

We found that the home provided a suitable variety of food to meet people's nutritional needs. However, risks to people with regard to their nutritional and fluid intake were not reviewed which meant people were at risk of not receiving adequate food and hydration.

Staff had not received supervision and training records showed that not all staff had received the training they needed in order to meet the needs of the people who used the service.

People were not cared for by agency staff who had received an effective induction or knew and understood their needs.

Is the service caring?

The service was not consistently caring. Some people told us they thought staff were kind. However everyone we spoke with, who lived in the home, told us that they felt staff did not have time to look after their needs. People told us that sometimes when they asked for help, staff told them they could not help them as they were too busy.

Care records were not always written sensitively or in a manner that respected people. Care plans were not personalised and did not demonstrate that people's individual preferences, likes, dislikes and life histories had been taken into account.

Is the service responsive?

Some people who used the service and relatives who were visiting told us that they did not feel their complaints or concerns were listened to. Complaints had not been recorded properly and there was no evidence to show what actions had been taken if people had made a complaint.

Records were poorly maintained and no one took responsibility to monitor the care provided in order to ensure that people's needs were met.

People did not always receive the care they needed or wanted.

There were no activities. The activities coordinator had recently left the service and people told us that there wasn't anything to do.

Is the service well-led?

The service was not well led. We found a culture of poor management and poor leadership. This meant that people experienced poor care. There was a registered manager in place. A registered manager is a person who is registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. However, when we visited the service they were not there.

The arrangements in place to manage the service on a day to day basis were not consistent. There was a lack of senior management support and a lack of available resources in order to ensure that the service was managed effectively and safely.

Quality monitoring checks carried out by the provider showed us that they had identified concerns with the running of the service. However no action had been taken despite the provider rating the service as a 'red risk' since February 2014.

Internal auditing processes, for example the auditing of weights, pressure area care and accidents and incidents had not been completed or did not always identify areas of concern, so that these may not be picked up and dealt with in a timely manner.

The provider had not accepted responsibility or accountability for shortfalls and poor practice in the service and there had been no changes implemented to address the identified shortfalls and concerns.

Staff told us they did not feel supported by the management team and felt undermined and undervalued.

We found that the service had undergone an extensive refurbishment programme and people told us that they liked the improvements that had been made. One person told us "We were asked for our views on how the home should be re-decorated and we chose the colour schemes ".

We found that audits were completed regularly and we saw action plans to address any shortfalls that were identified. We saw evidence of regular audits in relation to documentation on accidents, infections, care planning and risk levels. We found that issues and discrepancies were addressed swiftly and effectively.

We saw minutes of regular staff meetings where changes or issues within peoples care were discussed. In addition, we saw evidence of meetings with people who used the service to ensure they were consulted and encouraged to contribute their ideas about the running of the home.

We found that the home had undergone a programme of improvements and that people who use the service had more choice on how they spent their day. For example there was a new hair dressing salon on the second floor and we observed that most of the ladies who use the service had enjoyed having their hair done. One person told us 'I loved getting my hair done today, it's been lovely we sat and chatted for ages it reminded me of how things used to be when i used to go and get my hair done regularly when I was younger'.

We saw that staff had a new office where they could complete all the necessary paperwork uninterrupted and the nurse's station had been removed to facilitate a new activities area. In addition people had more choice in where they would like to sit and which rooms they would like to use.

We saw that some improvements had been made and the manager was able to demonstrate that they had devised an ongoing programme of improvements. We saw that staff had received updates on relevant training and meetings to make decisions for those people who were no longer able to make important decisions for themselves had been arranged.

The manager had also introduced regular auditing and monitoring systems to ensure the quality of service could be improved and maintained. However, we found errors with the administration of medicines.