1 June 2023
During an inspection looking at part of the service
Fairways is a residential care home providing personal care for up to 24 people. The service provides support to older people and people with dementia. At the time of our inspection there were 19 people using the service. The service is in 1 large, adapted home over 3 floors with a lift, lounge areas, an outdoor seating area, and 2 dining rooms.
People’s experience of using this service and what we found
People did not have adequate, complete, and up-to-date person-centred care plans and risk assessments. This meant there was a risk people’s individuality, preferences, and risks might not be understood by all staff and people may come to harm.
Fire safety measures, security checks, and emergency planning were not adequate. Management and oversight of fire safety and emergency planning was not consistent and up to date. Security checks did not include all areas. This meant should there have been an emergency, or an area left insecure, people would have been at risk of harm.
Recruitment practices adopted by the home were not robust. The provider did not have a clear system with documented evidence of all requirements and checks. The recruitment policy and procedures did not support safe recruitment. There were no regular checks on recruitment files. This meant it was not always possible to evidence all staff were safe to deliver care to people.
Systems in place were not effective enough to support the safe management and administration of medicines. The provider was changing from paper-based systems to electronic systems, causing duplication of entries and two systems were running at the same time. Time-specific medications were not managed well. Medication audits were not effective. This placed people at risk of harm from unsafe practices in relation to the management of medicines. The systems around the management of controlled drugs were safe.
Processes and systems in place to oversee, assess, and monitor the safety and quality of service provided were not effective. The provider had started a new quality assurance system, this was not embedded. The provider’s policies were not current. This meant appropriate actions may not be taken to ensure the service consistently provided safe care and treatment.
People and their relatives felt the service was safe. Relatives told us there were enough staff around who were kind and attentive to people’s needs. There was training for staff in keeping people safe and the manager was checking to ensure staff understood the training.
The management of infection prevention and control was good. People in the home, staff and visitors were kept safe from infection following current guidance.
The manager was learning lessons when things went wrong. There were checks on falls where the manager was looking for trends and any themes to make improvements. The manager had an improvement plan of things she was acting on.
The provider had clear vision and values regarding the support they provided. There were regular meetings with the manager and provider. Staff told us they were supported by the manager. People who used the service and their relatives found the manager approachable, and they acted on any concerns quickly. The service was working well in partnership with other healthcare professionals and the local authority.
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.
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 3 March 2022) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations. The service is now rated inadequate.
Why we inspected
We carried out an unannounced focused inspection of this service on 1 and 6 June 2023. 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 inspection to check they had followed their action plan and to confirm if 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. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this 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 the service can respond to COVID-19 and other infection outbreaks effectively.
We found evidence during this inspection people were at risk of harm regarding our concerns. We have found evidence the provider needs to make improvements. Please see the relevant key questions sections of this full report for the action we have asked the provider to take.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Fairways’ on our website at www.cqc.org.uk.
Enforcement
We have identified continued breaches in relation to safe care and treatment, good governance, and fit and proper persons employed. Please see the action we have told the provider to take at the end of this report.
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.
The overall rating for this service is ‘Inadequate’ and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.