Archived: Fairways Care Home

The service did not have a registered manager at the time of the inspection. 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 acting manager confirmed they had completed their interview with CQC two weeks previously, to support their application for registration and the certificate was issued on 13 March 2017, five days after the inspection.

We undertook this unannounced inspection on the 6 and 8 March 2017. The last inspection took place on 26 and 28 January 2016. At that inspection we found the service was in breach of one regulation around person centred care and was rated ‘Requires Improvement’ in all domains and overall. At this inspection we found improvements in relation to the previous breach and the rating in three domains had improved to ‘Good’. We found two new breaches of regulations in relation to medicines and notifications. The service rating overall remains ‘Requires Improvement.’

We found there were shortfalls in the administration and recording of some people’s medicines. This was a breach in regulations and you can see what action we have asked the registered provider to take at the back of the full version of the report.

The Care Quality Commission had not received all notifications for incidents which affected the safety and wellbeing of people who used the service, as required by registration regulations. This had been an error by the registered provider and acting manager and they told us they would forward all required notifications in future. We have written to the registered provider to remind them of their responsibilities in this area.

Improvements had been made with the standard of recording in the care files. A new recording format supported staff to provide more detailed and person centred information. Care plans had been reviewed and updated to reflect the person’s current care needs. We found risk assessments were completed, reviewed and updated when people’s needs changed. Supplementary records to monitor areas such as food and fluid intake, repositioning support and personal care were well completed and up to date.

We found some improvements had been made with the management of the service. Although aspects of the quality monitoring programme had been reviewed and strengthened, the registered provider considered the existing system remained limited and had provided a new monitoring programme, which was to be implemented by May 2017.

We found people who used the service were protected from the risk of harm and abuse. People told us they felt safe living in the service. We saw staff interacting with people and they did so in a kind, caring and sensitive manner. Staff had received safeguarding training and knew what to do if they witnessed abuse or if it was disclosed to them. Two staff were not clear about the reporting procedures to external agencies and the acting manager confirmed they would address this through training and supervision. Staff knew what to do in cases of emergencies and each person who used the service had a personal evacuation plan.

We saw there were enough skilled and experienced staff on duty to meet people’s needs. A new dependency tool assisted the acting manager to calculate the numbers of staff required. We found staff had been recruited using a robust system that made sure they were suitable to work with vulnerable people.

Staff told us they felt supported by the registered manager and confirmed they had received a range of training, formal supervisions and appraisals of their work. Gaps in the supervision programme were being addressed.

People enjoyed the meals provided to them. The menus enabled people to have choice and special diets when required. We saw people’s weight, their nutritional intake and their ability to eat and drink safely was monitored and referrals to dieticians and speech and language therapists took place when required for treatment and advice. During the day, we observed people were served drinks and snacks between meals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff demonstrated good communication skills and distraction techniques when managing people who needed additional support to manage their behaviours.

People were cared for by a stable staff team who knew them well. We saw staff encouraged people to be as independent as they were able to be and spoke with them in a friendly and respectful way. Relatives told us the atmosphere at the service was calm, friendly and open and that staff were kind. The feedback provided by relatives and staff about the acting manager was also positive.

We saw arrangements were in place that made sure people's health needs were met. The service worked closely with community healthcare teams who gave us positive feedback.

A varied programme of entertainment and activities was available; we saw people enjoyed taking part in a music session with entertainers and playing games with staff and volunteers.

There were systems in place to manage complaints and people who used the service and their relatives told us they felt able to raise concerns and complaints.

The service has 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.

Some people’s needs had not been fully assessed and some care plans did not provide clear guidance to staff in how to support people’s specific needs. We also found some risk assessments and care plans were not updated when significant events occurred such as loss of weight and falls. This meant the registered provider was not meeting the requirements of the law regarding assessing and planning care for people. You can see what action we told the registered provider to take at the back of the full version of the report.

Whilst we saw people being treated with compassion and respect we also saw occasions where people did not have their comfort and dignity respected and promoted.

The registered manager and senior management team completed quality checks on areas such as the environment, health and safety, infection prevention and control, medicines, catering, and records. We found some of the audit tools were limited in their scope and required review and update to provide a more effective system. The registered provider gave assurances they would give this due consideration.

Staff supported people to make their own decisions and choices where possible about the care they received. When people were unable to make their own decisions staff mostly followed the correct procedures and involved relatives and other professionals when important decisions about care had to be made.

Staffing levels were reviewed and increased during the inspection to meet the recent changes in occupancy and dependency levels. New staff were recruited safely and employment checks were carried out before they started work in the service.

The staff had received an induction and essential training at the beginning of their employment and we saw this had been followed by periodic refresher training to update their knowledge and skills. Although we found some gaps in refresher training for fire safety, following the inspection the registered manager confirmed this training had all been scheduled for completion in February 2016.

We saw arrangements were in place that made sure people's health needs were met. The service worked closely with community healthcare teams. Systems were in place to ensure people’s medicines were administered safely.

A varied programme of entertainment and activities was available; we saw people enjoyed taking part in a music session with entertainers, a Burn’s Night whiskey and haggis tasting session, visit from the pets as therapy (PAT) dog, crafts, painting, reading, dominoes and one to one sessions chatting about their families, previous employment and interests.

People were provided with a choice of nutritious meals. When necessary, people were given extra help to make sure that they had enough to eat and drink.

People were treated with kindness and consideration. There were no restrictions on when friends and families could visit the service and visitors were made welcome by the staff in the home.

Staff knew how to keep people safe and how to raise any concerns if they suspected someone was at risk of harm or abuse.

People felt their concerns were acted upon and taken seriously, and we saw where complaints had been made these had been addressed and acted upon.

People who used the service, relatives and staff were able to express their views on how the service was run and felt their comments and suggestions were taken seriously.

People's nutritional needs were met and people had a good choice of food. People told us they enjoyed the food.

There were systems in place to ensure the staff employed were fit to work with vulnerable adults. Staff had received training to meet people's needs safely. People told us they liked the staff.

The provider ensured people's views were sought and there were systems in place to monitor the quality of the service. Action had been taken in most areas where shortfalls had been identified to improve the service. People were satisfied with the quality of care provided.

There was a complaints procedure in place and people's complaints were investigated and action had been taken where shortfalls had been identified.

One person said, 'It's a place you can come to and not feel awkward. A relative told us, 'I think they respect people. I have sat and watched. They are always friendly and offer drinks. I come unannounced and it is a nice atmosphere.' Another relative said, 'The activities are brilliant.'

One person told us, 'The care is very good. They are always on time, clean, pleasant and they don't have favourites.' Another person told us, 'If I press the bell they are here very quickly.' A relative commented, 'Everything to keep her healthy and happy has been provided.' A visiting healthcare professional told us, 'It's a very nice place, a lovely home, and the residents seem happy.'

One person told us, 'I can't fault the staff in any way.' Another person said, 'The staff are very kind.' A relative told us, 'I haven't met any staff that have been anything but caring,' and another relative said, 'Staff are very involved and very hands-on.' A visiting healthcare professional said, 'The staff have been helpful to me.'

People and their visitors told us they would attend the planned residents' and relatives' meeting.