Fairfield House

Fairfield House is a nursing home. The care home accommodates up to 16 people. There were 16 people living at the home at the time of our inspection. The home is a detached building with rooms arranged over two floors and a ground floor lounge and dining area. There is lift access to the first floor. People are able to access secure outside space at the home. The majority of people living at the service had dementia or mental health diagnoses. Most people were unable to speak with us to tell us about living at the home, so we gathered this information from relatives and through observation.

People’s experience of using this service:

People felt safe and happy living at Fairfield House. Staff understood how to keep people safe from harm or abuse and understood their responsibility to raise concerns if they were to witness poor or abusive practice.

People were supported by staff who demonstrated a good understanding of how to meet their individual needs and preferences. People’s desired outcomes were known, and staff worked alongside people, health and social care professionals and, where appropriate, their relatives to help them achieve these. People and relatives expressed confidence in the skills and competence of staff at the home.

People were supported and encouraged to maintain contact with those important to them including family, friends and other people living at the home. Staff interacted with people in a kind and caring way with respectful language used at all times. Staff had got to know people well which supported mutually beneficial interactions and responsive care.

The new registered manager of the home had settled in well and, with the owner, had helped develop a cohesive and happy staff team. People, relatives and staff spoke positively about the way the management had improved the atmosphere of the home and the service people received. People and their relatives felt consulted and involved.

Improved auditing had provided greater managerial oversight. This helped ensure that practice standards were maintained and improved. Good working relationships with health and social professionals were helping to keep people living well.

Rating at last inspection:

At our last inspection we rated the home Requires Improvement (published 17/05/2018) as we found shortfalls in quality assurance, mental capacity assessments, systems used to monitor role specific training and the language staff used when talking about and interacting with people.

At this inspection we found the shortfalls had been addressed and the rating had improved.

Why we inspected:

This inspection was a scheduled inspection based on the previous rating.

Follow up:

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

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

Fairfield House 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.

The care home accommodates up to 16 people across two floors. The service is located in Chickerell and is a detached building with rooms arranged over two floors and a ground floor lounge and dining area. There is lift access to the first floor. People are able to access secure outside space at the home. There were 16 people living at the home at the time of our inspection.

The majority of people living at the service had dementia or mental health diagnoses. Most people were unable to speak with us to tell us about living at the home so we gathered this information from relatives and through observation.

Fairfield House had 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.

Quality assurance measures did not provide oversight of all areas of the service. This meant that issues relating to respectful practice, DoLS monitoring and training had not been identified. The registered manager was working with the provider to ensure full oversight of the service provided and ensure that actions were planned to drive improvements.

People were supported to make choices about all areas of their support. There were capacity and best interest’s decision in place however these were not always in line with the Mental Capacity Act good practice guidance. We have made a recommendation about assessing capacity in line with MCA.

Staff did not always use language or interact with people in ways which were respectful. The registered manager told us that they would ensure that staff culture was respectful of people in both language and body language.

Interactions with people were generally kind and friendly and relatives told us that they had peace of mind that their loved ones were receiving safe, compassionate care.

People were supported by staff who respected their individuality and protected their privacy. Staff understood how to advocate and support people to ensure that their views were heard and told us that they would ensure that people’s religious or other beliefs were supported and protected. Staff had undertaken training in equality and diversity and understood how to use this learning in practice.

People and those important to them were involved in planning the support they would receive and also regularly asked for their views about the support and any changes to people’s needs. Reviews identified where people’s needs had changed and reflected changes to the support provided in response to this.

People were supported to have one to one time with staff in social activities. Visitors were welcomed at the home and kept up to date about how their loved ones were.

People were supported to have enough to eat and drink and there were systems in place to ensure that any concerns around weight loss were monitored. People’s preferences for meals were well known and choices were offered if people did not want the meal provided.

Staff were also aware of the risks that people faced and understood their role in managing these to ensure people received safe care. Risks around behaviours that could challenge recorded in people’s care plans where appropriate and understood by staff.

People received their medicines as prescribed and staff worked with healthcare professionals to ensure that people received joined up, consistent care. Medicines were stored and disposed of safely and accurately recorded.

People were supported to receive personalised, compassionate end of life care and their wishes and preferences were recorded.

People were supported to access healthcare professionals when required and the service worked with a number of external agencies to ensure that people received joined up, consistent care.

People were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns.

People were supported by enough staff to provide effective, person centred support. Staff were recruited safely with appropriate pre-employment checks and received training to ensure that they had the necessary skills and knowledge to meet people’s needs. The registered manager told us that they would ensure oversight of additional training to ensure staff completed topics which were relevant to people’s needs.

People were protected from the spread of infection by staff who understood their role in infection control and used appropriate Personal Protective Equipment (PPE).

Staff were confident in their roles and felt supported by the manager.

Is the service safe?

This inspection was carried out to assess what the provider had done in response to the action we had told them to take following our last inspection. This was in relation to the safe management of medicines.

This is a summary of what we found-

Is the service safe?

We found that there had been improvements made to the way medicines were managed and handled in the home. There were systems in place to manage medicines safely.

In this inspection we considered five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Effective assessment of risks showed how the service took appropriate steps to ensure people's safety.

The service had taken steps to ensure people's care and welfare needs would continue to be met in the event of foreseeable emergencies.

People were not protected fully against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We identified issues in relation to the recording, storage and safe disposal of medicines.

Is the service effective?

People's health and care needs were assessed with them, and they and their representatives were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Effective planning of care helped ensure that the service met people's care and support needs.

People who used the service and their representatives were asked for their views about their care and treatment and they were acted on. People benefited because their views were sought and the provider took steps to act on feedback to improve the service. This helped ensure that the care and support provided was also in line with people's wishes.

Is the service caring?

People were supported by kind and attentive staff. Care was observed to be respectful and responsive to individuals' needs. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were happy and liked living at the home. One person told us, 'there's no aggro here,' and that staff 'definitely' met their different needs. One person told us, 'people [staff] are nice, they help me.' Another person told us, 'I'm fully satisfied, I can't fault it.'

Is the service responsive?

People using the service and their representatives completed regular customer satisfaction surveys. Where shortfalls or concerns were raised these were addressed.

We raised a number of issues with the manager and provider during the inspection. Their response was swift and positive, and they took immediate action to address concerns raised.

We found the provider had taken full and appropriate action in response to a number of minor issues we had identified previously in relation to records.

Care plans were reviewed monthly and updated as and when required. The service responded to people's changing needs. Effective systems for the ongoing review of people's care needs enabled staff to deliver continuous care according to those changing needs.

Is the service well-led?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

The service had a quality assurance system, and records showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities and spoke positively about the support they received from the manager and their peers.

The provider, manager and senior staff had appropriate experience of care provision and were knowledgeable about the systems and processes required for a care home's effective operation. Strong leadership meant staff followed those systems and processes, which helped to ensure people's care and support needs were met.

People were protected from harm as there were appropriate safeguarding procedures.

Appropriate pre-employment checks were completed before staff began work.

The home had suitable systems to monitor the quality of service provided.

People's records did not always contain accurate and appropriate information.