The Fairways

The Fairways is a residential care home providing personal care to 60 people. At the time of this inspection 51 people were being supported at the service and one person was in hospital. The service is managed by the Methodist Homes group which is a charitable organisation. En-suite rooms or self-contained apartments were available in one building over two floors. The ground floor supported people who were living with Dementia.

People’s experience of using this service and what we found

We found the impact on people from the current staffing levels was minimal although staff consistently raised with us that they felt there was not enough staff.

There was a divide in the staff culture within the home. The majority of care staff that we spoke with disclosed a poor working relationship between them and the senior care staff.

Although the registered manager had responded to our findings these had not all been identified during assessments of service delivery.

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 and relatives praised the care and told us staff were kind and caring towards them. The staff were respectful and encouraging of people’s cultures and beliefs. People’s support plans were personalised and contained detailed information on how to meet their specific needs. They referred to people in respectful and dignified ways.

We saw documentation around end of life wishes recorded and the compassion shown by the staff at this time was praised.

The service had built good links with external professionals and the surrounding community. An enhanced activity role of community co-ordinator was in place and planned events that bought the community into the home.

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 Good (published 4 January 2017).

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.

The Fairways is a residential home and provides care and accommodation for up to 60 older people. Some people are living with the experience of dementia. The home is managed by the MHA group which is a charitable organisation. At the time of the inspection, a newly appointed manager had been recruited and they were undertaking an induction. They were therefore not available to us during this inspection.

The provider had taken action to meet the concerns identified at the inspection of 17 December 2015 and had put in place measures to keep the environment clean and prevent the spread of infections. Improvements had also been made to how staff supported people with eating and drinking.

Prior to the inspection we received information of concern relating to the care and welfare of people and the approach of some staff. We discussed this with the area manager who had carried out a through investigation. During the inspection we found no issues of the nature raised.

Staff and people reported to us they did not feel there were sufficient numbers of staff available at all times. Staff identified the morning time and lunch time as needing additional staff. We observed the lunch time periods and found some people were waiting long periods of time to receive their meal and to be able to eat together as a table. People told us it sometimes took a while for staff to respond to the call bell.

People told us they felt safe living at the Fairways and relatives echoed this opinion. People who use the service and their relatives were positive about the care they received and praised the staff and management. People and relatives told us staff were kind, attentive and caring. We saw staff were respectful in their interactions with people. Staff sought permission from people before any care or support was offered and personal care was carried out in the privacy of the person’s room.

Staff supported people to eat and drink in an inclusive way and which enabled the person to have a positive experience of the meal time.

Staff received appropriate training and support to be able to effectively offer safe care and treatment. Staff understood people’s needs and preferences for the way they wished their care to be delivered.

People’s care and support plans identified how they wished their care to be given and where potential risks were identified, support and management plans were in place to enable staff to deliver a consistent approach to each person’s care needs. Families were involved in their loved ones care [where agreed by the person] and felt supported by the staff.

Medicines were managed safely and people told us they received their medicines on time. Staff had the appropriate training to be able to administer medicines competently. Systems were in place to protect people from abuse and harm and staff knew how to use them.

There was a range of activities people could take part in if they wished and the newest recruit to the staff team had been a community co-ordinator.

There was a complaints procedure in place and people and their relatives knew how to make a complaint. They felt confident that their concerns would be addressed.

People and relatives were sent questionnaires to gain their feedback on the quality of the care provided. The provider had a number of systems in place to monitor the quality of the service and put action plans in place where concerns were identified.

At the time of our inspection there were 60 people living at the Fairways. People and relatives were positive about the home. People liked the staff who supported them and positive relationships had formed. Throughout the day we observed staff treated people with respect and afforded people their privacy when carrying out personal care.

Staff were knowledgeable about people's background, cultural and faith beliefs. Staff were able to tell us about people's preferences on how they wished their care to be delivered, along with people's likes and dislikes.

Medicines were managed safely and people received their medicines on time. Some people were supported to self-administer their own medicines.

The home was clean and well maintained; however, not all staff followed safe practices in relation to hand washing when serving food. The protective equipment staff wore when delivering personal care was not disposed of in a timely and appropriate manner.

A range of activities was available which people could take part in if they wished. People told us they made their own decisions about how they spent their day and what activities they wanted to take part in. Some people told us they did not wish to participate in activities and other people told us they sometimes felt lonely. The activities co-ordinator visited people in their room and offered one to one time to socialise.

People told us the food was good and there was sufficient to eat and drink. The chef catered for different types of diets such as vegetarian and fortified diets and the staff were knowledgeable about people’s likes and dislikes. During meal times in the dementia wing, there was a lack of interaction between staff in ensuring people were able to make a choice and given appropriate support. The deployment of staff during the meal times meant that there was a delay in people receiving their meal together.

People told us they felt safe living in the home and with the staff who supported them. Staff had received training in how to recognise and report abuse. There was an open and transparent culture in the home and all staff were clear about how to report any concerns they had. Staff were confident that the registered manager would respond appropriately. People we spoke with knew how to make a complaint if they were not satisfied with the service they received.

The registered manager carried out audits on the safety and quality of the service provided. People and relatives told us they were asked for their views on how the service was run.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found '

Is the service safe?

During the day we spoke with three people who used the service and one relative. We observed staff interaction with people and saw that staff and people had developed trusting relationships. People told us that staff treated them with dignity and respect and they felt safe. One person told us that all of the staff were very good, they said 'I have no complaints'. All of the comments made by people were very positive.

People's safety was promoted because the service obtained advice and support from other health and social care services that people required in order to meet their needs effectively. We spoke with two visiting professionals who stated that they felt people received care which was safe and caring and met the needs of the individual.

Staff had attended safeguarding training and knew how to recognise and report abuse. There were reporting systems in place to make an alert to the local authority regarding abuse. The provider made notifications as required to the Care Quality Commission regarding incidents which may impact on the safety of people who lived in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care settings. While no applications have been submitted, appropriate policies and procedures were in place. Relevant staff had received training in the Mental Capacity Act and the application of DoLS.

Is the service effective?

People's needs were assessed and they told us that they were involved in planning their care. People we spoke with told us 'they do things the way I want' and one relative told us that the 'manager was very pro-active in ensuring that their relative received appropriate care and support'. We saw from the care records kept in their home that people were involved in making decisions about their care and that these were respected by staff.

People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. This ensured their needs were clearly identified and the support they received was meaningful and person centred.

Is the service caring?

We observed that all staff treated people respectfully and were attentive and caring. All of the comments we received were of a positive nature and confirmed that people and relatives were happy with the support received.

Support workers had sufficient information about people's needs and how they should be cared for. This included their preferences and the things that were important to them. The care records we looked at demonstrated that people were consulted about their care needs and that the service offered had been tailored to the individual.

Is the service responsive?

People's care had been reviewed regularly. Other agencies were consulted when there were changes to people's care. All those involved in the person's care were aware of changes so they could respond appropriately and consistently. Positive comments were received from two healthcare professional about the way the home responded to people's changing needs.

Is the service well-led?

People were asked for their views about the service to help ensure their views contributed towards improvements and further development of the service.

The service had quality assurance systems in place so that the quality of service could be maintained and shortfalls could be identified.

The home had a clear staffing structure in place. Staff we spoke with were clear on their roles and responsibilities and there were defined reporting lines so all staff knew who to report to.

The home had a welcoming atmosphere and the furnishings and decor were age appropriate for the people who lived there. Most people had moved into the home no longer than eight weeks prior to our visit. One person told us 'We didn't think we were ready for a retirement home, but now we are here, we love it and are so lucky to have found such as lovely place to live, it really feels like home'.

People told us that although they had not long moved into the home, they liked the other people who were their neighbours. One person told us that the staff were 'exemplary'. People said they felt safe.

We looked at the recruitment of staff and found that the home had followed appropriate selection and recruitment procedures. Staff told us they were well supported by the management team and by the training which they had received.

We looked at the recordkeeping of care plans and incidents and found that some improvements were needed. We also found that the home had failed to notify the Care Quality Commission regarding incidents as they are required to do.

There were systems in place to monitor the quality of the service people received, however we found that some improvements were needed to ensure that quality assurance systems were robust and fit for purpose.