Fairfield House Residential Care Home

Fairfield House Residential Care Home is a residential care home providing accommodation for persons who require nursing or personal care for up to 36 people. The service provides support to older people, older people with physical disabilities and older people living with dementia. At the time of our inspection there were 24 people using the service. Fairfield House Residential Care Home has a main house split across two floors accessible by a lift or stairs. People also lived in 3 separate cottages in the grounds.

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

People told us they felt safe and well looked after at the home. Comments included, “This is a lovely home, the staff are great…” and “I am happy here, I can’t fault it…the staff ask whatever you want, they will sort it out.”

Some improvements had been made by the provider since our last inspection in May 2023 to implement changes. The provider’s area manager had stepped into the role as manager and was working with the provider and staff team to implement the changes. This included a new electronic care system and call bell system. On the first day of our visit we found staff were using 2 systems to record monitoring and care tasks they had undertaken, the electronic care system and paper monitoring charts. There was no oversight monitoring to ensure people received enough fluids and safe care which placed people at risk.

Action was taken by the management and staff were supported to use the new electronic system and improved management oversight was put in pace to ensure people received enough fluids and were regularly repositioned in line with their care plans.

Peoples’ paper care plans and risk assessments had been reviewed monthly and some information had been added to the new electronic care system. However, these had not been updated promptly when peoples’ needs changed. This meant staff might not always have up to date information to support people safely.

Over the past few years there had been several managers at the home which had caused inconsistency and upheaval for people and staff. Staff were unclear about their roles and responsibilities. This meant tasks were not always consistently completed. The manager showed us new job descriptions they were working on with staff to implement and ensure staff were clear about their job roles and expectations.

A new audit system was being used to identify areas which required improvement. Audits we looked at had identified areas for improvement and some had actions required. We discussed with the manager the need for a more robust process to ensure actions were completed.

Concerns had been raised with CQC regarding the high amount of agency staff being used at the home and that some shifts were covered only with agency staff. We found consistent agency worked at the home and they were always supported by staff who worked at Fairfield House.

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 requires improvement (published 27 May 2023).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we had previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We had also received concerns about staffing levels and skill mix at the home which we reviewed. We did not find people were at risk of harm in relation to these concerns.

The overall rating for the service has not changed following this targeted inspection and remains requires improvement. We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Fairfield House Residential Care Home is a residential care home providing accommodation for persons who require nursing or personal care to up to 36 people. The service provides support to older people, older people with physical disabilities and older people living with dementia. At the time of our inspection there were 28 people using the service. Fairfield House Residential Care Home has a main house split across two floors accessible by a lift or stairs. The grounds also contained separate cottages where people lived.

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

At the time of our inspection Fairfield House Residential home was going through a period of transition. With a recent change of managers, the home had been inconsistently led and this had impacted on some of the systems and processes needed to ensure people were consistently safe and had their care needs identified and met.

Staff knew people well, we received feedback such as, “The staff are very pleasant I don’t think you would get much better attention anywhere else.” However, systems were not robust to ensure risks to people had been identified, managed, and reduced to protect people from the risk of harm.

Staff did not always feel proud to work at the home, did not always feel listened to and appreciated. Inconsistencies in leadership had led to staff not always being clear on managers’ and other staff roles and responsibilities.

Recruitment files were not always fully completed to show people had been recruited safely into the service and governance systems failed to identify this.

Whilst some areas had improved since our last inspection, we found not all risks to people’s health, safety and wellbeing had been considered to keep them safe from harm. Provider oversight of the home had improved since our last inspection; however, the home’s governance had been inconsistent and had failed to identify areas requiring improvement we found at this inspection.

Healthcare professionals told us managers had not always listened to their advice however, had a good relationship with the home and the staff who provided care to people.

Staff knew how to safeguard people from abuse. The home used a dependency tool to ensure there were enough staff to meet people’s needs.

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 told us they felt safe, had good relationships with the staff and enjoyed living at Fairfield House Residential Home. One person said, “It is very nice here.”

Medicines were managed and administered safely by staff who had training and were signed off as competent to do so. The home was clean, and staff wore appropriate personal protective equipment (PPE) to prevent the spread of infection.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 March 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up on the breaches of regulation from the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced focused inspection of this service on 15 December 2021. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last focused inspection, by selecting the ‘all reports’ link for Fairfield House Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the safe care and treatment and good governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Fairfield House Residential Care Home is a residential care home providing personal care to 27 people aged 65 and over at the time of the inspection. The service can support up to 36 people.

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

People lived in a home that had been through changes in leadership. There had been three different managers of the service in the year prior to our inspection. The acting manager had been in post since mid-November 2021.

The oversight of the home had not been sufficient to ensure people received safe care and treatment.

There was mixed evidence regarding how well risks were managed in the home. We identified positive examples of how risks were identified and managed, however we found examples where risks were not sufficiently monitored and mitigated. The acting manager took steps to address these shortfalls.

People were supported by staff who understood how to reduce the risk of cross infection. Staff mostly wore PPE appropriately the acting manager addressed issues identified during the inspection immediately. One person told us, "They always wear their masks."

There were enough staff deployed to meet people’s needs. The staff team was well established with the majority of the team having worked in the home for a sustained period of time.

Relatives were confident in the care provided for loved ones.

People were being supported to see visitors safely, and to go out with friends and family in line with current government Covid-19 guidance. The manager was seeking to encourage the role of essential care givers. Essential Care giver status is given to a relative or friend in order that they can provide enhanced emotional or physical support to a person to ensure their well-being. Essential care givers are subject to the same testing regime as the staff in the care home and can visit more frequently and for longer to provide the identified support.

People told us they felt safe and we saw that they were relaxed in the company of staff. People were supported by staff who understood how to identify and report safeguarding concerns.

Staff supported people to eat and drink well during the inspection. Where people were at risk of not eating and drinking safely or were at risk of not eating and drinking enough, staff liaised with appropriate professionals.

A healthcare professional spoke positively about the way the staff monitored risks associated with people’s well-being and followed guidance.

The management team was responsive to the feedback throughout our inspection.

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 March 2018).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to Covid-19 and other infection outbreaks effectively.

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the management of risks. A decision was made for us to inspect and examine those risks.

We inspected and identified concerns with the management of risk, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fairfield House Residential Care Home on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 36 people across two floors. The service is located in Lyme Regis and is a large detached building with rooms arranged over two floors and a central ground floor lounge and dining area. There is both lift and stairlift access to the first floor. People are able to access secure outside space at the home. There were 28 people living at the home at the time of our inspection.

At our last comprehensive inspection on 27 September and 4 October 2016 we found that people’s care and treatment was not always appropriate or met their needs. Care and treatment was not always designed with a view to meeting people’s individual needs. The registered persons were not acting in accordance with the Mental Capacity Act (2005) to ensure care and treatment of people was provided with consent. People’s nutritional and hydration needs were not always met to ensure food and hydration was adequate, dietary supplements were not consistently given and people were not always provided with the support required to keep them hydrated. Systems were not always in place to ensure concerns were picked up and met through the quality assurance process.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take steps to improve and ensure that they were compliant. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Effective and Well led to at least good. At this inspection we found that improvements had been made.

The service did not have a registered manager in post at the time of inspection. However the manager had applied to CQC and since our inspection they confirmed that they had successfully registered. 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.

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. 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 were planned to be recorded in people’s care plans where appropriate.

People were supported by enough staff to provide effective, person centred support. Staff were recruited safely with appropriate pre-employment checks and received training and support to ensure that they had the necessary skills and knowledge to meet people’s needs.

People received their medicines as prescribed and staff worked with healthcare professionals to ensure that people received joined up, consistent care. Where written guidance around medicines prescribed ‘as required’ was needed, the manager confirmed that this would be put into place.

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

People were supported to make choices about all areas of their support and staff understood the principles of mental capacity. Where decisions were needed in people’s best interests, these were in place.

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.

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

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 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.

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

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

Staff were confident in their roles and felt supported by the manager. Feedback from people and relatives indicated that the manager was approachable, listened and took actions where necessary.

Quality assurance measures were used to highlight whether any changes to policy, processes or improvements in practice were required. We were given examples where feedback had been used to drive improvements at the home.

Fairfield House Residential Care Home (known locally as “Fairfield House”) provides residential care for up to 36 older people who may have a physical disability or be living with dementia. There are 33 rooms and 33 people were living at the service when we visited. Nursing services are provided from the community nursing service.

A registered manager was employed to manage the service. 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.

We found the staffing of the service did not always meet the needs of people living at the service. Staffing of the service was raised as a concern from people and the district nurse on the first day of the inspection. In particular, staff needed to understand and meet people’s increased or increasing needs. We found staff were working long hours across the week to meet people’s needs. This included the registered manager and other members of the senior management team. This meant the contingency to meet unexpected staff short falls was in operation every day and had become the norm. Staff did not have time to spend with people to ensure their emotional and social needs were met. We have recommended the provider and registered manager review staffing to ensure there are enough staff to meet needs as they change.

Staff were task focused. When staff were involved in a task, staff treated people with politeness, kindness and were considerate of people’s needs. People’s emotional and social needs were not always being met.

Staff were recruited safely to ensure they were suitable to work with vulnerable people. People were looked after by staff who understood how to identify abuse and what action to take if they had any concerns. Staff stated they would pass on any concerns to the registered manager. All staff felt action would be taken in respect of their concerns. Staff said they would raise their concerns with external agencies, such as CQC, if they felt concerns were not being addressed. Records showed safeguarding concerns had been fully investigated and action taken as required.

We found staff received training, supervision and appraisals to support them to care for people. However, this had been impacted on by the staffing issues. This meant training of some staff had been delayed, although it was still taking place. The tracker showed gaps in staff training in both mandatory subjects, as identified by the provider, and in areas that would have addressed the wider needs people had. Also, training for staff in respect of dementia care needed updating and was not offered to all staff despite having a high number of people living with dementia. Plans were in place to ensure all staff were trained in these areas.

People were not being assessed in line with the principles of the Mental Capacity Act 2005 (MCA). Requests for authorisations to deprive 15 people of their liberty had been requested without first completing an assessment of the person’s capacity to consent to their own care and treatment. This meant the legality of how people were being assessed and deprived of their liberty could not be assured. Also, decisions in relation to people’s care were being made without assessing whether the person had the capacity to consent, or whether they required a best interest decision to be made. When offering care people confirmed staff always asked their consent and staff understood the importance of seeking consent on each occasion. The registered manager had started to address this by the second day of the inspection for one person.

People’s nutritional and hydration needs were not always met. On the first day we found two people had lost weight. Where advice had been taken from health professionals this was not always followed, sustained or further support requested if needed. Also, tracking of people’s food and fluid intake was not always in place. People’s health needs were not always met when needed. People could see their GP or district nurse and a range of other health professionals. However, the timeliness of some referrals meant some needs were not being met promptly. For example, a Grade 2 pressure sore was noted on one person’s sacrum when the district nurse was asked by the GP to address another health issue. Referrals were made to occupational therapy, CPNs and other services without involving or informing the GP or District Nurse to ensure consistency of care and treatment. Communication issues within the service meant that the registered manager, deputy manager and care lead did not always know of the referral or why it had been made. This meant consistency of care and treatment was not always being achieved for people. New systems for meeting people’s needs were being introduced by the end of the inspection.

People spoke positively about the food with choice available. People could contribute ideas to the menu and have alternative choices, if preferred.

People were not always assessed to ensure care was personalised, appropriate and met their needs. Care plans were in place however, generalised statements that were on all care plans meant staff responses to people’s needs were not personalised. Significant areas of need were not addressed within the care plans to ensure staff had the right guidance to meet people’s needs. A “This is me” and daily routine documents were on most records however, we found key information staff would need to know was not always included. People living with dementia did not have care plans in place to meet their specific needs. For example, there was no recording of how the dementia was affecting them at that time and the role staff could take to meet their needs. We found key risk indicators, in terms of dementia, were not evident. Some people were recorded as having behaviour management challenges for staff, and one person constantly wished to leave. We found that these people’s records did not evidence any risk management or mitigation. Staff described how people’s end of life needs were met in a personalised way, however people were not involved with planning them.

Activities were provided but did not reflect the needs of people living with dementia. There were 20 people identified as living with dementia at the service but there were no clear plans in place for meeting their social needs through activities. The religious and social needs of people without dementia were met. People could maintain contact within the community or their own church or club.

People had risk assessments in place to keep them safe whilst living at the service. These were being reviewed to ensure all areas of personal risk were identified and assessed. Also, work was taking place to ensure these were linked to people’s care plans. People had plans in place to help keep them safe if there was an emergency such as a fire.

People’s medicines were generally managed safely. We identified some practice issues for the registered manager to address. People’s prescribed creams were accounted for and clearly recorded.

The registered manager had a range of audits in place. The provider had employed the services of a consultant to audit the service. They also had regular contact with the registered manager. However, this had not identified and prevented the concerns being raised in respect of the inspection. The roles of the registered manager and other members of the senior management team were not defined enough to ensure the service was well-led at the local level. For example, there was duplication of roles and an assumption some tasks were being done by another team member.

Staff, people and visitors felt the registered manager was approachable. People were asked their view about the service and how it was run. Action was taken to address any suggestions.

People’s concerns and complaints were acknowledged and investigated. People said they knew how to raise a complaint and felt comfortable speaking to the registered manager. A complaints policy was in place and made available to people and relatives.

Staff followed safe infection control practices. We identified one person’s bed room smelt of urine. Action was taken to ensure this was addressed.

We found breaches of the regulations. We have advised the local authority of our concerns. A safeguarding meeting was held by the local authority to review the concerns and recommendations made on reviewing aspects of the service. You can see what action we have told the provider to take at the back of the full version of the report.

Is the service safe?

People were offered choices in their daily routine and we observed that many staff knew about people's care needs. The care plans contained sufficient information to guide staff in how to meet people's needs safely and effectively. The home worked with other agencies and took initiatives in seeking specialist advice where required. Training was given to all staff to ensure there was an awareness of adult safeguarding and so staff knew how to be alert to any signs or symptoms of abuse. Staffing was adequate to meet the need of people.

Is the service effective?

People's needs were reviewed and risk assessments were sufficiently detailed to protect people from harm. Where people did not have capacity to give consent to their care, the manager had taken appropriate steps to obtain valid consent. This meant people's rights were respected.

Is the service caring?

We saw people being treated with respect and consideration and staff took time to engage positively with people. People told us they were happy with their care. Two people told us they had received emotional and practical support to help them with depression and low mood. Several people told us they enjoyed opportunities for which they had asked to go out to places of interest.

Is the service well led?

The home had experienced changes in staffing and management which had contributed to some uncertainty amongst staff and people. However we saw the home owners were working with external consultancy to help manage this transition and develop the service. The service was checked and audited in relation to individual care planning, incidents and accidents. Reviews of staffing had recently taken place. People and staff were asked about their views and this was used to develop on going improvements.

During this inspection, we found that a new recording system that ensured people’s individual care needs were accurately recorded had been implemented by the registered manager.

People’s care needs and risks were assessed and care was delivered to meet their needs. One person commented, “The staff are wonderful. I only have to ask and they will do whatever they can.”

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

Staff were supported by the provider through appropriate training, supervision and appraisal.

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

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

We found that improvements' had been made in relation to ensuring that a system was in place to monitor the quality of the service provision.