Archived: Fairhaven

Fairhaven provides accommodation and personal care for up to 21 older people. It does not provide nursing care. At the time of our inspection there were 16 people living at the home.

There was no registered manager in post. The provider had appointed a manager and who had commenced work at Fairhaven on 26 April 2017. However this person at the time of this inspection had not applied to be registered with the Commission. 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 at risk of receiving care and support that was unsafe and did not meet their needs. There were not enough staff deployed by the service to meet people’s needs. Risk assessments were not detailed enough to adequately capture risks to people or control measures to minimise these. We also found that the fire risk assessment and fire evacuation records were out of date.

We found people were still not being given opportunities to take part or be offered activities that suited the personal preferences or choices. There were not enough competent and suitably trained staff deployed by the service to meet people’s needs. People’s medicines were not managed or accounted for correctly and changes to medicines were not identified and included in people’s care plans. We also found discrepancies in the recording of people’s medicines.

People were also placed at risk from staff who were carrying out unsafe moving and handling procedures.

Some staff did not have valid employment references on their files. Existing staff did not receive regular supervision or appraisal of their performance, training or development needs. New staff had not received an induction or training and there were no systems in place to monitor or plan a schedule to train staff in the future. Not all staff understood the correct way to safeguard people from the risk of abuse or what constituted a safeguarding incident. There was no training provided to help staff to understand the Mental Capacity Act (2005) and people’s care plans did not include any information in relation to their capacity to make and understand decisions about their care and support. Staff did not always support people to make decisions and follow the legal requirements outlined in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberties Safeguards (DoLs).

People’s consent had not been obtained prior to care and support being delivered. We found that staff did not understand the principles of the Mental Capacity Act. We found that people’s human rights had been unlawfully restricted.

The service did not adequately identify people’s needs in relation to nutrition and hydration. There was no assessment or information available in people’s care plans to help staff understand the foods and drinks that were appropriate for them. There was only limited evidence that support was being sought from external healthcare professionals as necessary. People were not offered a range of choices at mealtimes and people had no access to snacks or refreshments.

People told us that some staff were kind and caring, and staff had developed positive relationships with people. However we observed staff failed to treat people with dignity or respect. In addition, there was not always enough information in people’s care plans to provide staff with adequate knowledge of the person.

People’s care plans did not fully reflect the extent of people’s needs, and were not always reviewed if the person’s needs changed. There was limited evidence of involvement from people or relatives and care plans had not been reviewed since our last inspection in 2016.

The provider’s complaints policy was out of date and the service did not fully record or monitor all complaints and the response to complaints was inadequate.

There was inadequate governance and overall oversight which meant that systems were ineffective. There had been no quality monitoring or audits carried out in the home since the last inspection in August 2016. There was no evidence that people and their relatives had been consulted or feedback sought on the service provided.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Fairhaven provides accommodation and personal care for up to 21 older people. It does not provide nursing care. At the time of our inspection there were 17 people living at the home.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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’s wellbeing was not always supported by staff who met their individual needs and preferences by ensuring people’s social needs were met.

Safe and effective recruitment practices were followed and there were sufficient numbers of suitable staff available at all times to meet people’s individual care and support needs. Information from incidents was used to good effect in reducing identified risks and keeping people safe.

There were effective plans and guidance in place to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained.

People were helped to take their medicines safely by trained staff who had their competences assessed and checked in the workplace. Potential risks to people’s health and well-being were identified, reviewed and managed effectively.

Relatives and health care professionals were positive about the skills, experience and abilities of staff who worked at the home. Staff received training and refresher updates relevant to their roles and the needs of the people they supported.

Staff regularly worked with senior colleagues and had opportunities to discuss any concerns they had, issues about their personal development and performance and how the home operated. However, the registered manager acknowledged that formal ‘one to one’ supervisions and annual appraisals were not as up to date or complete as they could be in all cases.

People were supported to maintain good physical and mental health and well-being. They had access to health and social care professionals when necessary and were supported to eat a healthy balanced diet that met their individual needs.

We saw that staff obtained people’s consent and agreement before providing personal care and support, which they did in a kind and patient way.

Arrangements were in hand to ensure that people were supported by advocacy services where appropriate to help people them access independent advice or guidance. People and their relatives were involved in the planning and reviews of care wherever possible.

We saw that staff had developed positive and caring relationships with the people they cared for. The confidentiality of information held about people’s medical and personal histories had been securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their individual needs and took account of their preferences. Staff knew the people they looked after well and were knowledgeable about their background histories, preferences, routines and personal circumstances.

Relatives told us that staff listened to them and responded to any concerns they had in a prompt and positive way. Complaints were recorded and investigated thoroughly by the registered manager with learning outcomes used to make improvements where necessary.

Relatives, staff and health care professionals were positive and complimentary about the new management team and how the home was run. Appropriate steps were taken to monitor the quality of services provided, reduce potential risks and drive continuous improvement in consultation with staff and people who lived at the home.

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?

People were cared for in a clean and hygienic environment. Regular cleaning of all areas of the home had been maintained.

People we spoke with said 'They did not do any activities during the day'. One person said 'The standard is not bad at all. Staff work really hard. Food is what they plant in front of me. I just put up with it. Others may not. I am not one for choices.'

Care plans did not give clear directions on how to recognise or how to meet the needs of people. We found that the daily written records for people did not reflect what we had seen. Daily diaries had been completed in advance. We found gaps in the recording of daily entries which meant that the continuity in the delivery of care had not been maintained. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The practice for the management and administration of medicines was not safe. There were gaps in the MAR charts which meant that people did not received their medicines regularly and on time. Medicines which had been prescribed previously had been given to people who used the service. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Appropriate checks had not been carried out before staff began work. We reviewed the recruitment records of all the current staff in the home and there was not enough information for us to be able to verify the Disclosure and Barring Service (DBS) checks as none of the staff had a starting date.

Staff had not received training in safeguarding people from abuse and they said they did not have time to read people's care plans so that they would be able to meet the identified needs of people appropriately. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. One application had been submitted under this system.

Is the service effective?

People had not been consulted in all aspects of their care. People did not have a mental capacity assessment done so that any decisions made would be in their 'best interests'. Staff had not been provided with regular formal supervision and relevant training so that they were skilled and competent in their roles. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

People told us that the staff were caring, helpful and that they worked very hard. They felt that their needs were reasonably met. One person said "I moved here two weeks ago. I used to help doing the washing up but do not do anything here. Sometimes, I go out in the morning for a walk. The staff are kind and I have no concerns." One relative said 'My mother receives good care. We take her out often. She is happy and the staff are caring.' However, we observed that there was a lack of interaction between staff members and people who used the service. People were not engaged in meaningful activities during the day. Some people had fallen asleep at the dining tables after their breakfast and staff were not to be seen. This meant that people's needs had not been met as identified. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service responsive?

The care plans we looked at showed that people's needs had been assessed and but not met appropriately. There had been no complaints received since December 2012.

Is the service well-led?

People's care and support had not been planned and delivered in accordance with their identified needs. The manager said that they were not good at documenting and keeping records as required by legislations. There was not effective system in place to assess and monitor the quality of service.

On a follow-up inspection on 17 and 20 May 2013, the provider was found to be compliant with regulation 23, however the provider was still not compliant with regulation 9 and was also found to be non 'complaint with Regulations 10, 11,and 13.

We received an action plan from the provider telling us that they would be compliant with regulations 9, 10, 11 and 13 by 31 July 2013. During our follow 'up inspection on the 28 June 2013 and 12 August 2013, we found that the provider was still not compliant with regulation 9, 10 and 13.

2010. During our follow up inspection the provider was found to still be non- compliant with regulation 9, as well as regulation 10, 11 and 13.

We observed that people were given a choice of food and were offered cold or hot drinks during lunch time.

On the day of our visit, staff, who had received safeguarding training, were not able to explain what safeguarding meant and what their responsibilities were under the safeguarding of vulnerable adults provision.