Faircross Care Home London Limited

We found the following examples of good practice.

Visitors to the home were checked before entering the building. Their temperature, COVID-19 vaccination status and recent negative COVID-19 Lateral Flow Test (LFT) result were required before being permitted to enter the home. This was done to limit the risk of catching or spreading infections. Visitors were provided with Personal Protective Equipment (PPE) to wear, such as a face mask, to also limit potential infection transmission.

Staff were tested regularly. Staff members took Polymerase Chain Reaction (PCR) tests weekly and LFT tests three times a week. Only staff providing a negative test result were permitted to work.

The service had enough staff. Staff absences were covered by existing staff, but the registered manager had a contingency plan in place with an employment agency should they be required to meet people’s need in the event of an emergency. During a recent outbreak of COVID-19 in the home, the provider had stopped visitors attending the service and had put other measures in place to limit the spread of infection, such as isolating those infected. Where people had been unable to have visitors, people were assisted with video calls to maintain contact with relatives.

Infection control policies, procedures and risk assessments were up to date. These supported staff to keep people safe. The provider kept up to date with government guidance with regard to COVID-19 to ensure they were following it correctly.

All staff had been trained in infection control and the use of PPE. We saw staff using PPE correctly. Handwashing guidance and infection control signage was displayed in prominent places. The premises were kept clean at all times to maintain hygiene and help prevent the spread of infections.

Faircross Care Home London Limited is a residential care home that provides personal care for up to five people with learning disabilities. At the time of the inspection there were five people living at the service receiving care.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a domestic style terraced house set over two floors. Each person had their own bedroom. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service

The service applied the principles and values Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People told us they felt safe living at the service. Staff understood safeguarding and what to do if they suspected abuse. Risks relating to people were assessed and these risks were monitored and mitigated. The service completed numerous, regular health and safety checks to ensure people’s safety. There were sufficient staff, all of whom had been recruited safely. Medicines were managed safely. Staff understood the importance of infection control. Incident and accidents were recorded, and actions put in place to limit their reoccurrence.

People’s needs were assessed before admission to ensure the service could meet their needs. Staff received inductions to ready them in their new roles. Staff received training to do their jobs and were supervised by the registered manager. People were supported to eat and drink and maintain healthy diets. Staff communicated with each other and other agencies. People were supported with their health care needs. People were able to decorate their rooms how they pleased. 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.

People were treated well by staff. Staff were trained in equality and diversity and documentation at the service supported people’s human rights. People and their relatives were involved in decisions about their care. People’s independence was promoted and their dignity and privacy respected.

The service provided personalised care. People’s needs and preferences were detailed in care plans and these were reviewed regularly. People’s communication needs were met by the service. People were supported to take part in activities. People and their relatives were able to make complaints and when this happened the service responded appropriately. People’s end of life wishes were recorded.

People and relatives spoke positively about the management. The registered manager and other staff knew their roles and responsibilities. The service was person centred and the registered manager acted on the duty of candour appropriately. Quality assurance processes measured the quality of care and safety of people in the home. People, relatives and staff were engaged and involved in the service through meetings and surveys. The service worked in partnership with other agencies.

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

Rating at last inspection

The last rating for this service was requires improvement (published 15 February 2019.) The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People and relatives told us they were happy with the care provided by Faircross Care Home London Limited. One person told us, “I like living here and I am going to stay a little while longer.” One relative told us, “Overall I’m happy – I’ve seen the best the worst and the in-betweens and They provide really good care for [person].” Another relative said, “They are very good, practically family.”

There were safeguarding processes in place and staff knew what to do if they suspected abuse. Risks to people were recorded and reviewed, however, there was no input from people and their relatives within the review process. Lessons were learned when things went wrong and we found incidents had been recorded and referred to the local authority appropriately. Recruitment practices were robust. There were sufficient staff working at the service. Medicines were recorded and managed properly. There were robust infection control measures in place.

Some staff had not completed their mandatory training though the person applying to be the registered manager was aware of this and had plans to correct it in early 2019. Staff received inductions, supervisions and appraisals. We checked whether the service was working within the principles of the Mental Capacity Act (MCA), legislation that protects people with mental capacity and memory issues, and found them to be compliant. However, some staff had not received training on the MCA. People’s needs were assessed before they received a service. People were supported to eat and drink healthily. Staff communicated effectively with each other about people’s needs using a variety of methods. People were supported to lead healthier lives.

People and their relatives told us staff were caring. People and their relatives were supported to express their views and were involved in decision making about people’s care and treatment. People’s privacy was respected and their independence promoted.

People’s needs and preferences were recorded in care plans and they received care from staff who knew them. People and their relatives knew how make complaints and the service responded to these appropriately. People’s end of life wishes were recorded and some staff were trained to work with people if they were at end of life, though no one was at the time of our inspection.

The person applying to be registered manager was highly thought of and had a positive impact on the service. They were aware of their responsibilities and knew there were still areas of the service that required improvement. There were adequate quality assurance measures at the service. People, relatives and staff were engaged and involved with the service through meetings and surveys. The service had good links with others.

Rating at last inspection: The home was last inspected on 26 April and 02 May 2018 when it was found to be in breach of seven health and social care regulations. These breaches related to safe care and treatment, safeguarding adults, complaints, good governance, staffing and fit and proper persons employed. The home was rated Inadequate overall and therefore this service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection, the provider demonstrated to us that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. However, we found some areas that required further improvement and therefore the home has been rated 'Requires Improvement'.

Why we inspected: This was a planned inspection based on our scheduling of regulated services.

Follow up: We will continue to monitor intelligence we receive about this service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner

This was the service’s first inspection since it registered with us in January 2017.

Faircross Care Home London Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Faircross Care Home London is a terraced house in east London. It can accommodate up to five people. At the time of our inspection four people were living in the home. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was 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.

People were not protected from avoidable harm and abuse. The registered manager had not appropriately identified or escalated incidents to the local safeguarding team. Incident records had been compled using inappropriate language and there was no recorded follow up action to ensure incidents were not repeated.

Care plans and risk assessments lacked detail. Significant risks faced by people had not been appropriately identified and measures in place to mitigate risk were insufficient. Assessments of people’s needs were not robust and this was reflected in the lack of detail in the care plans. People lived with complex health conditions, but staff had insufficient information about how to respond to ensure people received appropriate care and support.

Staff had not been recruited in a way that ensured they were suitable to work in a care setting. Staff had not received the training and support they needed to perform their roles.

The provider’s complaints policy did not inform people of the expected timescale for response to their complaint, and contained inaccurate information about the role of CQC in complaints. Survey’s showed relatives had raised concerns but these had not been captured as complaints.

There was no clear vision or strategy for the service. The registered manager and provider did not complete audits or checks on the quality and safety of the service. There was no plan in place for the improvement of the service.

Information about people’s capacity to consent to their care was not always clear. When people had been assessed as lacking capacity to consent to their placements appropriate applications had been made under the Mental Capacity Act (2005) to deprive them of their liberty. People who were not subject to deprivation of liberty safeguards were able to access the community when they wished.

People and staff had developed strong relationships with each other. We observed positive, compassionate interactions between staff and people who lived in the home.

People were supported to eat and drink in line with their preferences.

People were supported to maintain relationships that were important to them.

We identified breaches of seven regulations relating to person centred care, safe care and treatment, safeguarding adults, complaints, good governance, staffing and fit and proper persons employed. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.