The Fairways

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs were assessed prior to them moving into the service. However, the quality of these assessments was not consistent and there were gaps in information on people’s needs. Assessment information had not always been used to produce people’s care plans, and some assessments had not been updated to reflect people’s changing needs. This meant staff did not always have current and accurate information about people’s needs.

Following our site visit the provider told us they were reviewing care plans and assessments for all recent admissions.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People told us they did not have access to drinks in their rooms. This was because staff took jugs away to be washed in the morning and they were not returned till the afternoon. People said this was a concern for them as there had been a period of extreme heat. Whilst people knew they could ring their call bells or go and look for drinks, they wanted the convenience of their own jug in their room. We shared this feedback with the acting home manager who took immediate action to order more jugs.

Feedback about the food was mixed. Some people enjoyed their meals, however, some people said they would like to see an improvement. Comments about the food included, “The food is a bone of contention, it has no taste, it is not good but there is sufficient food, they do big portions” and “The food is good, I always enjoy my food.”

Feedback from 1 relative was that their family member was not getting the support they needed to eat. They needed more support and specific equipment. The relative told us they had repeatedly told staff about the person’s needs, however, they often found the equipment was not available. We shared this feedback with leaders.

The service used nationally recognised tools to assess risks for certain areas. For example, risks of people developing pressure ulcers or becoming malnourished. People’s weights were being monitored and if needed action taken such as a referral to the GP.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had a handover at the start of every shift. This enabled information to be shared about people’s needs. We observed staff communicating with each other whilst working and found there was effective teamwork. Senior staff also told us they had a daily meeting with leaders which they found beneficial. They were able to discuss any new admissions, discharges or information of concern.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

It was not always evident what actions the provider was taking in response to information about people’s health and wellbeing. Some monitoring was taking place for areas such as weight monitoring, falls monitoring and skin care. For example, there were monthly falls analysis which reviewed times of day and where people were when they were falling. In June there had been 25 falls, 15 between 2 and 8pm, 10 falls overnight. Actions in response were to make sure falls risk plans were reviewed and falls monitoring forms completed. However, while actions focused on reviewing people’s risk assessments and monitoring records, there was limited evidence of wider analysis. For example, whether staffing levels at peak times may have contributed to the risk of falls.

Incidents of wounds had increased. In May there had been 13 wounds but in June this had increased to 40. Visiting professionals had raised concerns about this. Whilst there was action taken, such as raising the concern in staff meetings and buying people nail kits to help keep their nails trimmed, we could see no analysis had taken place. Due to the lack of information and follow up action in incident forms it was not clear what had caused the wounds and what action could be taken to address causative factors.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Staff used a behaviour monitoring tool for when some people experienced distress. However, it was not evident what staff were doing with the information to improve outcomes for people. For 1 person staff were recording the same behaviour on different occasions, however, this information had not been used to produce a risk management plan. There was no evidence the behaviour monitoring tool had been analysed to try and prevent further incidents to improve outcomes.

There was nobody identified as needing increased fluid and food monitoring. However, records seen demonstrated some people were consistently drinking below national recommended levels. Adults should aim to drink 1.5 to 2 litres of fluid per day. We found for 1 person they were consistently having only 450 – 550 mls of fluid per day. We were not able to see any action taken as a result other than adding people to the GP weekly list. During our site visits we did not see increased fluid rounds and people in their rooms did not have jugs of drinks. One relative told us, “There is no encouragement for any of the residents to drink. Nobody should be dehydrating or over heating when in care.” We shared these findings with leaders who said they would take action. After our site visit, the provider shared evidence they had bought new jugs for people’s rooms.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People’s care records demonstrated staff had assessed their capacity where appropriate. Where the outcome was the person lacked capacity to make specific decisions, best interest processes had been followed.

Staff had been provided with training on the Mental Capacity Act (2005) and understood how the principles of the Act applied to their work.