The inspection took place on 8 September and was unannounced. This meant the provider did not know we were coming. Fairholme is a care home with accommodation for up to 22 people who require personal care, some of whom are living with mental health problems. At the time of our inspection 20 people were receiving a service.
We previously carried out a comprehensive inspection of this service on 8 February 2016.
Breaches of legal requirements were found because the provider did not have effective systems to ensure the care and treatment of service users was appropriate, met their needs or reflected their preferences. The quality assurance system was not effective in monitoring the quality and safety of the service provided to service users.
After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of the regulations relating to person centred care and good governance.
As part of this comprehensive inspection we checked that they had followed their plan to confirm that they now met the legal requirements.
We found the assurances the registered provider had given us in the action plan had been met.
Care plans had undergone redevelopment and people had been included in their care planning. Care plans and risk assessments were reviewed monthly as a minimum or when a change in need took place.
The provider had developed a quality assurance process to obtain the views of people, other health care professionals, relatives and staff. Questionnaires were sent to people who used the service and were in being returned. The manager had a system in place to analyse responses received.
At this inspection we found there were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, specifically medicine management and premises and equipment.
We found anomalies in the stock balance recording for one person’s medicine. The medicine administration record (MAR) did not contain the amount of medicine received in the last medicine delivery cycle. There were gaps in recording for one medicine on the MAR.
We found on one person’s MAR, the dates and amount of medicines received were not always recorded. For example, diazepam was recorded as being delivered but no amount, olanzapine receipt was dated but no amount received was recorded.
Where a person was self-administering their own inhaler, the date they were issued with a new inhaler was not recorded on their current MAR. Previous MARs showed that staff had recorded when a new inhaler had been issued. This meant that the service’s recording process in relation to medicines had not been followed correctly or consistently.
The recording process for returning controlled medicines had not been followed. Controlled medicines for one person had been returned to the pharmacy but the service’s controlled medicine record book had not been signed by the collecting pharmacy. The service’s general returns medicine book had been signed by the collecting pharmacy.
The medicine audit process had failed to identify short falls in medicine management.
This was a breach of Regulation 12 (Safe care and treatment) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Some areas within the premises appeared tired and in need of updating, the furniture in people’s rooms was stained and in need of replacing. The provider had a plan of refurbishment but this did set specific dates for completion. This meant the provider had failed to ensure suitable arrangements for maintenance of the premises and equipment.
This was a breach of Regulations 15 (Premises and equipment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The provider had not ensured results from health and safety audits where actioned within specific timescales. The audits that the management team were completing had failed to identify the shortfalls in meeting the requirements of all the necessary regulations. We have made a recommendation that the service seek advice and guidance to enable them to create systems and processes to respond appropriately and without delay where quality or safety is being compromised.
The service did not have a registered manager in post. 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.
The manager has recently submitted an application to the Care Quality Commission for registration but this was rejected due to inaccuracies. The application had recently been resubmitted but had not been validated at the time of the inspection.
People told us they received their medicines at the right time. The medicine room was clean and tidy. Staff responsible for administering medicines had received competency checks.
People were complimentary about the service and made positive comments. They were happy with the care and support they received. One person said, “I am happy here, the staff are canny (Nice).” Another person said, “I’m part of a family here.”
Recruitment practices at the service were thorough and safe. Staff training was up to date and staff received regular supervision and appraisal. We looked at current and recent staffing rotas for the service. There were enough staff employed to make sure people were supported appropriately. People told us they felt the service had the correct level of staff supporting them.
Staff had an understanding of safeguarding and whistleblowing and told us they would speak to management if they had any concerns. They felt confident that management would listen and act on any concerns they raised.
Systems were in place for recording and managing safeguarding concerns, complaints, accidents and incidents. People told us they knew how to make a complaint. On person told us, “Oh I would make a complaint, no bother, [manager] is great.” Another person said,” I have nothing to complain about but I would speak with staff, they do listen.”
The registered provider had procedures in place in case of an emergency. People had personal evacuation plans (PEEPs) in place. A business continuity plan had been developed so staff knew what to do in an emergency. Health and safety checks were carried out to ensure the service was safe for people and staff. Checks included gas and electrical safety checks.
People’s health needs were regularly monitored and assessed. The service contacted other health care professionals when necessary, such as GPs and dieticians. People accessed community health care by way of attending dentist and optician appointments.
People said they were involved in their care and how they were supported. One person told us, “I don’t like doing my plans but I know it’s important so I am involved.” Another person said, “I have ambitions and speak to the staff about these to see if I can do things.”
People were supported to have a healthy varied diet. A snack station was available for people to help themselves to hot and cold drinks and snacks. One person told us, “We help plan the menu but can have something different if you want to.”
Staff understood the Mental Capacity Act 2005 (MCA) where people lacked capacity to make a decision and the Deprivation of Liberty Safeguards (DoLS) to make sure any restrictions were in people’s best interests. DoLS authorisations were in place for people who required one.
People engaged in a variety of organised activities. Group activities and one to one sessions took place and the service facilitated day trips. We saw records of recent and future planned outings.
People told us they would feel confident to approach the staff or manager if something was wrong. Resident meetings were held and a recent survey had been undertaken to gather feedback and opinions about the home and the service.
People felt the management in the home was open and honest. One person told us, “[Manager] and [deputy manager] are great, it is so much better now.”
People had individual bedrooms which allowed privacy. We saw personal effects on display such as pictures and ornaments. We found some bathroom areas had been recently decorated and new carpets laid. Supplies had been purchased to start decorating people’s bedrooms. We viewed evidence of quotes for improvement work which the manager had obtained for head office.