Fairkytes

About the service

Fairkytes is a residential care home which was providing personal care to 3 people at the time of our inspection. All people living at the service were autistic or had learning disabilities. The service can support up to 5 people in one adapted building over two floors.

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

Right Support

People were supported in a way that was safe. They received medicines from staff who had been trained and competency assessed to do so. This was an improvement from our last inspection. People were supported by the right amount of staff. We had previously made a recommendation about this. Staff working with people were recruited safely. People were supported appropriately with their finances and there were systems in place to safeguard them from abuse. We had previously made a recommendation about this. Infection prevention and control measures were in place to keep people safe. The provider worked with other agencies to help provide the right support for people.

People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

Risks to people were assessed and monitored. Checks were made on health and safety to ensure the building was safe for people to live in. Care was person-centred and people’s communication needs were met. There were quality assurance measures in place to ensure people were getting the right care.

Right culture

Although improvements had been made at the service, there was still work to be done to build an open and positive culture at the service. This was because relatives had mixed views about how the service was managed and how they dealt with complaints and incidents. Relatives also had mixed views on how complaints were responded to. The evidence we saw showed the provider had recorded concerns and attempted to resolve issues. The provider had also not re-registered the service along with its sister service next door, which was something they told us they would do at the last inspection.

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 (07 November 2020) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider follow best practice guidance on maintaining safe and suitable staffing levels, we recommended the provider follow best practice guidance on developing a culture of keeping people safe from abuse and we also recommended the provider follow best practice guidance on seeking advice and guidance from CQC about re-registering the service. At this inspection we found improvements made around all three recommendations, but the service had not re-registered the service or sought guidance from CQC in this regard.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture and to follow up on action we told the provider to take at 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.

Follow up

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

Fairkytes is a residential care home providing personal care to people with learning disabilities and/or autism.

The home is an adapted two floor building with facilities, including en-suite bathrooms. The home was located in a residential area close to a town centre. The home’s building design fitted into the residential area and other large domestic homes of a similar size. There were no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.

The service was registered to provide support to up to four people and there were three people using the service at the time of our inspection.

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

The service was not always safe. Medicines were not managed safely because robust procedures were not in place to ensure staff followed prescribing instructions for some medicines, including controlled drugs.

We were not assured with the way staff were deployed in the home because some people required additional support, particularly when they went out. This could lead to shortages of staff.

People were not fully protected from the risk of abuse due to a number of serious allegations made against the home within a short space of time. The provider was complying with the police and the local authority to investigate these cases. We have made a recommendation in this area.

People’s care plans and risk assessments were not always up to date or reviewed when needed.

The provider had planned for improvements in the home but audits had not identified the other shortfalls we found. Accidents and incidents that had taken place in the home were not always reviewed to learn lessons to prevent them re-occurring. The provider had a plan in place to improve this.

The provider was not meeting regulatory requirements and had failed to notify us within a suitable timeframe of when it had received authorisation to deprive people of their liberty. Notifications of incidents were not always submitted to us on time.

The service didn’t always consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. However, the home was situated next to another home managed by the same provider. People were supported by staff who sometimes worked in the other home. Staff from the other home could easily access Fairkytes via the front door or garden. Both services operated as one larger service, for example by having a shared staff rota and food menu. This meant the provider had not mitigated against environmental factors which could make the environment feel institutional and had not ensured they could provide truly person-centred care.

We have made a recommendation about seeking advice and guidance about Registering the Right Support.

Premises and equipment safety was maintained to ensure the home environment was safe.

Staff had the skills and knowledge to support them. People and relatives were given opportunities to provide feedback about the quality of the service.

Team meetings with staff were held with the management team to discuss important topics and go through concerns.

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 good (published 20 February 2018).

Why we inspected

We received concerns in relation to people not being protected from the risk of abuse and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were received 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 improvements. Please see the safe and well-led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines management, good governance of the service and registration regulations at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Fairkytes is a care home that accommodates up to four people in one adapted building. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. On the day of our visit there were four people using the service one of which was on respite and another away with their family.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in place. 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 told us they felt safe. Staff had attended safeguarding training and were aware of the systems in place to report any allegations of abuse.

Recruitment processes remained robust and ensured all the appropriate checks were completed before staff were employed. Rotas and our observations noted sufficient numbers of skilled staff were deployed to ensure people's needs were met safely.

Medicines were managed safely and any anomalies or discrepancies were quickly rectified to ensure people received their medicines as prescribed.

Risks to people were assessed and appropriate steps were in place to mitigate any identified risk. Similarly incidents and accidents were monitored to ensure staff learnt from them.

People were protected from the risks of infection because staff had attended the necessary training and followed infection control guidelines.

People were supported by staff who had regular appraisals, supervision, training and meetings in order to ensure they were able to support people effectively. Staff were aware of the Mental Capacity Act 2005 and how they applied it in practice. They told us that any unnecessary restrictions were avoided.

The service continued to be caring and responsive to people’s needs. People told us they were treated with dignity and respect. Care plans were pictorial, individual and depicted people’s social, physical, emotional needs. Special effort and attention had been made to ensure information was accessible and in format people could understand.

People were enabled to access health care services when required. They were also supported to maintain a balanced diet that met their individual preferences.

People were able to express any concerns. The complaints process in place was comprehensive and available in a format people could understand.

People and staff told us the service was well-led. Their feedback was listened to and considered in the way in which the service was run. There were effective quality assurance systems in place to ensure the quality of care was improved.

We spoke to one person living at Fairkytes and their carer workers. They told us that they "loved their room" and were "very happy." We observed the interactions between staff and other people living at the home. We found that the interactions were positive and that staff clearly knew the individual's care needs.

We looked at the care records of three people living at the home. They reflected the views, preferences and needs of the people using the service. The staff told us that they had good information available to them to deliver good quality care.

There were appropriate arrangements in place to obtain people's consent. We saw recorded decisions in the care files for best interest and mental capacity decisions demonstrating a clear understanding of the issues and how best they could be resolved.

We looked around the home and in the garden. We found that the premises were well maintained but some further decoration was required on the first floor. The ground floor was in good condition.

We found that all support staff received planned training and were supported to care for people safely.

We were able to speak to most and observe other people who used this service. We saw that people's interaction with staff was appropriate and that staff treated people with dignity and respect. We saw evidence that people were able to have an input into all areas of their daily lives and that their independence was respected.

Care plans were personalised and staff had used aids to ensure that people with communication issues were able to put their views across. Care plans demonstrated that people's needs were being met and that they had good links to all appropriate professionals.

We spoke to people who told us that they felt safe at the home. Staff were aware of the signs of abuse and training records showed that safeguarding training was mandatory.

Staff were supported in their training and in their everyday working environment. All staff that we spoke to said that they were happy with the training they received. Rotas showed that the provider had taken measures to ensure that there was always enough staff on duty to provide an effective, safe service.

We found that all areas of risk had been appropriately assessed and that the provider carried out regular checks and reviews of the home and the care provided. Policies and procedures were comprehensive and appropriate to ensure the delivery of a safe, effective service.