Fairhaven 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

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 good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Safety events such as accidents and incidents were recorded and investigated and responded to appropriately to prevent reoccurrence and mitigate future risk. Following incidents consideration was given to why these may have occurred and what may be done to reduce repeat events. For example, for people who were at a high risk of falls, alternative equipment such as alert mats and movement sensors had been considered and implemented where appropriate and bedroom layouts, footwear and increased staff oversight was put in place.

Staff members were able to describe actions they would take should an incident or accident occur. This included, logging the incident, completing detailed accident forms and escalating to the management team.

Relatives and staff confirmed they were updated following accidents or incidents, and duty of candour was followed where necessary.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People and relatives confirmed they had access to GP services, specialist nurses, dentists and opticians where required. On review of people’s care records we found evidence that people received this additional support as needed.

The staff and management team told us they worked well with health and social care professionals and had developed good working relationships. External health and social care professionals confirmed the service was proactive in raising any concerns to them and following guidance. A healthcare professional said, “Managers, seniors, and weekend care staff are all very helpful and responsive in terms of communication with me, they are proactive in their approaches to co-produced care planning. No concerns about recommendations /plans are not followed.” A social care professional told us, “I feel like any advice or instructions are followed by the care team and these seem to be communicated throughout the team.”

People had personalised care plans containing clear information about their physical and mental health, communication needs and day to day support requirements. These plans were accessible to relevant healthcare professionals, supporting effective information sharing and improving consistency of care.

Care files included a hospital pack containing relevant information if a person needed to be admitted to hospital or transferred to another service, this helped to ensure continuity of care. The service used a nationally recognised tool to assess and respond should people’s conditions deteriorate. This is a key element of safety and improving outcomes.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff 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 provider shared concerns quickly and appropriately.

Relatives told us they felt their loved ones were safe living at Fairhaven Care Home. Comments included, “Very safe, they [staff] have [persons] interests at heart, they look after them”, “We are absolutely delighted with the home, we are happy with everything. They really look after [person] they are safe there; we have absolutely no concerns at all” and “Very safe, they were just so open and caring.”

There were processes and systems in place to help ensure where safeguarding concerns were identified, these would be investigated and acted on in a timely way. Staff had received training in safeguarding and were able to describe types of abuse and what action to take if they had any concerns. There was a safeguarding and whistleblowing policy in place which gave staff clear guidance to follow in the event they needed to refer any concerns to the local authority. Referrals had been made to the local safeguarding team appropriately.

Mental Capacity Act (MCA) assessments, best interest decisions and Deprivation of Liberties Safeguard (DoLS) applications had been completed where required which meant we were assured staff protected people's human rights in line with the MCA. The management team kept a record of DoLS applications and authorisations, and this was regularly reviewed to make sure authorisations were current.

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

People were assessed for risks such as skin damage, malnutrition, falls and choking. When risks were identified, care plans provided guidance for staff on how to reduce the risks. For example, some people were at risk of skin breakdown, and the care plans we reviewed included information such as any pressure relieving equipment in use, how often staff needed to support people to change position, and how to monitor for skin damage. Pressure relieving equipment we looked at was set correctly and records showed people were supported to change position in accordance with care plan guidance.

Staff were knowledgeable about specific risks to people and were able to describe steps taken to prevent and mitigate harm.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

We found shortfalls in the safe management of risks relating to fire safety. For example, we found holes in some fire doors, excessive gaps around doors and doors that were not fire rated. Fire doors are designed to resist the spread of fire for a period of time, normally a minimum of 30 minutes. The integrity of some fire doors where breached which placed people at risk of harm in the event of a fire. In addition, there were several void areas within the home that were being used for storage that did not have smoke detection. The lack of detection meant staff would not be provided with an early warning if a fire were to start in one of these areas.

Fire drills records did not demonstrate simulated scenario procedures or fire evacuation equipment being used to ensure staff were adequately prepared in the event of a fire evacuation.

The provider did not ensure there was a robust risk assessment in place to ensure staff knew what their legal requirements were and how to manage the risk of legionella.

The above concerns were raised with the provider during the assessment who agreed to take immediate action to address these issues.

There were systems in place to ensure the equipment, electrical items and gas supplies were safe in line with legislation.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People and relatives were mostly positive about the staffing levels at the home. A person told us, “They [staff] are always here when I need them.” Relatives’ comments included, “There is always three or four staff when I visit, they are always visible in the lounge” and “There are plenty of them [staff], they are very attentive.”

Staffing levels were discussed with the management team who confirmed these were determined by the number of people using the service and the level of care they required. Staffing levels were regularly reviewed to determine the numbers of staff provided remained sufficient to meet people's needs. Call bell audits were frequently completed to verify that people’s needs were met in a timely way.

Throughout our assessment visits we observed staff were always available to people as required and there was lots of positive engagement between people and staff. Staff were positive about the staffing levels in the home. Staff members comments included, “There is definitely enough staff, we have time to spend with people” and “I think this is the best care home, I feel I have time to spend with people and they are happy.”

Staff were safely recruited, and checks were carried out before they started work to reduce the risk of unsuitable staff being employed. Training was up to date and covered topics relevant to the service. A formal process was in place to support staff with staff meetings, regular 1 to 1 and group supervisions, competency checks and annual appraisals.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Some areas of the home were not maintained to a standard that supported good infection control and environmental issues had the potential to impact cleanliness and hygiene. For example, within a communal bathroom the bath seat showed signs of wear and tear, and a large gap was identified between the radiator and flooring, which meant these areas could not be effectively cleaned. These concerns were not identified in the recent infection, prevention and control audit. This was discussed with the provider at the time of the assessment who agreed to take immediate action to address these issues.

Staff had infection prevention and control training and could describe how they used this knowledge in practice to minimise infection risks. We saw personal protective equipment was readily available and used appropriately and consistently by staff.

People and relatives told us they found the home to be clean. One person said, “It’s all lovely.” A relative said, “It’s clean, it’s old it was never designed as a care home, they do well with what they have got.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

We identified shortfalls in the management of medicines. This demonstrated that the provider did not ensure the safe and proper management of medicines, exposing people to risks of harm.

Some people were prescribed 'as needed' (PRN) medicines, which require clear protocols for their use. These included medicines prescribed for people’s pain and anxiety. Detailed guidance for the use of these medicines was not always in place to guide staff on when these medicines should be given or at what dose. For example, one person’s PRN protocol for an anxiety medicine recorded 3 different dosage instructions, none of these instructions accurately reflected the prescribers’ instructions. There was no information on de-escalation techniques to use prior to administration of this medicine. This meant the provider could not be assured PRN medicines were always administered consistently.

Medicine records evidenced that a person had a transdermal pain relief patch prescribed every 7 days. The body map in place demonstrated that the patch was only being rotated between 2 sites on the person’s body. The manufacturers guidance is to avoid using the same application site for 3 -4 weeks. The lack of rotation could lead to an increase in adverse reactions or potential overdose of a medicine.

On day 1 of our assessment visit we identified shortfalls in the safe storage of medicines We found the access to the medicines room was not safely managed. This meant untrained staff had unauthorised access to medicines.

All the above concerns were raised with the management team during our assessment visits and immediate action was taken to address all the issues described above, including implementing new security systems to ensure safe storage, contacting health professionals in relation to medicine dose instructions and implementing detailed PRN plans.