This inspection took place over three days on 28 June and 04 and 06 July 2018. The first and second days were unannounced and the third day was announced. The last inspection of the service was carried out in July 2016 and during that inspection we found a breach of regulation 9, person centred care. Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to make the required improvements.
During this inspection we found improvements had been made, however we found breaches of regulations 12, 15 and 17. This was because; medication was not always managed safety and parts of the premises and equipment were unclean and unsafe. In addition the quality monitoring processes failed to identify and mitigate risks to people.
Fazakerley House is a ‘care home’. 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. Fazakerley House accommodates up to 45 people who require personal care. At the time of the inspection there were 43 people using the service. The service provides accommodation over two floors.
The service had a registered manager. 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 management of medication was not always safe. On the first day of inspection the medication room was unlocked with no staff present. There were items of pre-dispensed medication in pots on top of a cabinet which posed a risk to people who may have entered the room. We raised this at the time with a senior member of staff and they immediately locked the door to the medication room.
Parts of the environment and items of personal equipment were unclean and unsafe. An outside patio and a wooden summerhouse which people used were littered with weeds, cigarette ends and general waste, including used disposable gloves. Cigarette ends had been disposed of in a plastic bin which also contained used tissues and sweet wrappers, posing a fire risk. Items of personal equipment including wheelchairs and stand aids were heavily stained with food debris, dust and spillages. This increased the risk of the spread of infection. The patio and summerhouse were cleaned and made safe on the first day of inspection and by the second day of inspection personal equipment had had been cleaned.
Although people’s care was planned based on assessments carried out, some people’s care plans lacked information about how their needs were to be effectively met. Some people’s care plans did not clearly demonstrate what was the expected outcome for the person and there was a lack of monitoring of some people’s care.
The environment was equipped with aids and adaptations such as handrails and a passenger lift to help people move about safely and independently. However, there was a lack signage and stimulus for people living with dementia, such as items and focal points to support reminiscence. We were provided with information regarding plans to develop the environment.
People’s dignity and confidentiality was not always respected. Staff used dirty equipment to help people with their mobility and safety and an outside area which people accessed was unattractive. People’s confidentiality was not fully protected as files containing personal information about people were left in communal areas. Staff did however approach people in a kind and compassionate way and they used their knowledge of people to provide them with comfort and reassurance at times they were upset.
The approach to care planning for some people was person centred in that their care plans took account of the person’s views and preferences about how their care was to be provided. Work is in progress to ensure that each person’s care is planned using this approach. Staff responded to people’s needs in line with their care plans.
The registered providers quality assurance framework was not always effective. Checks carried out on the environment, equipment and care records failed to identify and mitigate risks to people which we found during our inspection. Records of daily checks carried out on the environment and equipment did not accurately reflect the findings. Although the concerns had been actioned by the second day of inspection, a consistent approach is needed to ensuring risks to people are identified and mitigated.
People told us they felt safe living at the service and that they would tell someone if they were worried about anything. Staff had access to training and procedures for safeguarding people from abuse. They knew the different types of abuse and how to report any safeguarding concerns. Allegations of abuse had been reported to the relevant agencies.
The recruitment of staff was safe. Applicants were subject to a series of checks prior to an offer of employment being made. This included checks on their criminal background, previous work history, skills and qualifications. There were sufficient numbers of suitably skilled and experienced staff deployed across the service to meet the needs of people and keep them safe.
Staff were provided with training and support for their role. New staff were provided with induction training which was linked to the Care Certificate. All staff were required to complete annual refresher training in topics linked to the Care Certificate as well as other topics relevant to their role and people’s needs. Staff received support through one to one supervisions and staff meetings.
People’s mental capacity had been assessed and plans put in place to guide staff on ensuring people’s rights were protected within the law. Records demonstrated that best interest decisions were made with the involvement of people and relevant others.
People’s nutritional and hydration needs were assessed and planned for. People were given a choice of food and drink which was prepared in accordance with their likes, dislikes and dietary requirements. Food and fluid intake was monitored for people where this was required. People commented positively about the provision of food and drink.
People received appropriate healthcare to meet their needs. People accessed healthcare services as and when they needed to, including their GP, dieticians and community nursing teams. Records were maintained for each person detailing the contact and input from external healthcare services.