The inspection took place on 8 and 9 August 2016 and was unannounced.

Fawnhope Rest Home is registered to provide accommodation and personal care for up to 19 older people including people who may be living with dementia or other mental health conditions. Fawnhope Rest Home 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.

At the time of our inspection there were 16 people living at the home, 14 of whom were accommodated in a converted and extended residential building with a shared lounge and dining area. Two people were accommodated in a separate annexe. At the time of our inspection they chose to have their meals and daytime activities in the main house. There was an enclosed garden.

There was 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.

We previously inspected Fawnhope Rest Home on 24 and 25 May 2016 and rated the home as Good. We found a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) 2014, Premises and Equipment. This was because the provider had failed to adequately assess risks associated with fire safety as not all actions required by Hampshire Fire Service had been completed. At this inspection we saw that the fire risk assessment was complete and any issues identified had been actioned. The provider was no longer in breach of this regulation. However, we found that the provider did not have robust arrangements in place to ensure all staff could act appropriately in the event of an emergency. We have made a recommendation about best practice fire safety guidelines.

We also found other breaches of regulations at this inspection.

The administration and storage of medicines was not managed safely. This had not been identified by the service because effective checks had not been undertaken.

There was not a robust quality assurance process in place. Audits to assess the quality of service provision were ineffective in identifying some of the improvements needed. Action plans were not developed to ensure improvements were made.

Not all complaints received had been recorded to show how the complaint had been managed and that the complaints procedure had been followed. We have made a recommendation about the management of complaints.

Care plans did not contain information that was always reflective of people’s current needs. There was conflicting information in some people’s care plans.

Staff sought verbal consent from people, before providing support, but did not always follow legislation designed to protect people’s rights when making decisions on their behalf. Care plans did not have mental capacity assessments in place.

Some activities were provided for people; however, the provision of activities did not always meet people’s emotional, social and psychological needs. Feedback about staffing levels was mixed and we observed that people spent long periods of time without engagement from staff. We have made a recommendation about the determination of staffing levels.

Feedback about the food on offer was positive and people were given a choice. Where people needed support to eat, this was given in a dignified way. However, people did not have their fluid intake adequately monitored.

Some risk assessments were not reflective of people’s current needs and this documentation needed improvement to ensure clear guidelines were in place for staff to follow. However, we saw that measures had been put in place to address and reduce risks for people.

Most care plans i

The inspection took place on 24 and 25 May 2016 and was unannounced.

Fawnhope Rest Home is registered to provide accommodation and personal care services for up to 19 older people, and people who may be living with dementia, a learning disability or other mental health condition. At the time of our inspection there were 16 people living at the home. They were accommodated in a converted and extended residential building with a shared lounge and dining area. One person was accommodated in a separate annexe intended for people with greater independence. At the time of our inspection they chose to have their meals and daytime activities in the main house. There was an enclosed garden.

There was 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.

Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided. However the provider did not always make sure that required maintenance to the building and equipment was arranged in a timely manner. They had not completed maintenance actions identified in a fire safety audit. The provider relied on informal systems of management in some areas.

The provider had arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely. Recruitment processes were in place to make sure only workers who were suitable to work in a care setting were employed. Arrangements were in place to store medicines safely.

Staff received appropriate training and supervision to maintain their skills and knowledge. Staff were aware of the need to gain people’s consent to their care and support. Staff were aware of the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They did not apply to anyone living at the home at the time of our inspection.

People were supported to eat and drink enough to maintain their health and welfare. They were able to make choices about their food and drink, and meals were prepared appropriately where people had particular dietary needs. People were supported to access healthcare services, such as GPs and community nursing teams.

People told us they had caring relationships with their care workers. They were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people’s individuality, privacy, and dignity.

The provider involved people in the care assessment and care planning processes. Care and support were based on plans which took into account people’s needs and conditions, but also their abilities and preferences. Care plans were updated as people’s needs changed, and were reviewed regularly. People were able to take part in leisure activities which reflected their interests. Group activities and entertainments were available if people wished to take part.

The home had an open, friendly atmosphere in which people felt able to make their views and opinions known.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to take at the end of the full version of this report.

We carried out a routine inspection to answer our five questions. Is the service safe, is it effective, is it caring, is it responsive and is it well led? We also checked effective action had been taken where we found at a previous inspection that minimum standards were not being met. On the day of our inspection there were 15 people using the service. We spoke with five of them and two visiting relatives to understand the service from their point of view. We observed the care and support people received in the shared areas of the home and looked at records and files. We spoke with the registered manager, and four members of staff.

This is a summary of what people told us and what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and comfortable in the home. One said “It is like a new family.” A visitor told us, “I know [my partner] is safe and warm.” We saw people being supported in a way that took into account their safety and welfare.

The service had appropriate risk assessments in place. These were written to ensure people’s safety and welfare when receiving personal care. There was a contingency plan to cover foreseeable emergencies, and general risk assessments to do with the environment people lived in. Procedures were in place to control and reduce the risk of the spread of infection.

Is the service effective?

People told us that they were satisfied with the care and support they received. One said, “They look after you marvellously.” Another said, “I would not want to be anywhere else.”

We found people’s care and support were based on thorough assessments and detailed and personalised support plans. Staff were supported to deliver care to the required standard by appropriate training and a system of appraisal and supervision.

Is the service caring?

We observed support being delivered in a caring manner. Staff were aware of people’s family histories, hobbies and interests and engaged with them about these subjects. Staff checked regularly that people were comfortable and offered frequent hot and cold drinks between meal times. They encouraged and praised people and facilitated their independence where possible.

Staff we spoke with were motivated to provide quality care. They had a thorough knowledge of people’s needs and how they preferred to have their care delivered.

Is the service responsive?

People and their relatives told us they had been involved in the care planning process, and that people’s views and preferences were taken into account. The service responded to changes in their needs or circumstances. Care plans were reviewed and updated regularly.

The service had systems in place to ensure the care provided was appropriate to peoples’ changing needs. There were enough staff to respond to people’s needs as they arose. A visitor told us, “If you ask them for something they do it straight away.”

Is the service well-led?

Staff told us they were supported to deliver care and support to the required standard and they were able to get advice if they needed it. They said if they raised concerns with the manager or senior staff, they were dealt with and resolved.

Systems were in place to regularly assess and monitor the quality of service provided. Risks were assessed and appropriate action plans were in place. There were processes in place to review and learn from incidents, accidents and complaints.

15 people were living at the home. We spoke with relatives of three people, who gave differing views. One visitor said “It’s lovely, nothing is too much trouble”. Another said their relative had “come on tremendously – they are on her wavelength”. A third said “It’s sloppy”.

We spoke with a nurse who visited the home regularly. They told us “The manager is great, but the home needs input generally”, referring to the cleanliness of the home and the practice of some staff, which they had not raised with the manager.

We spoke with the provider, the manager, the improvement coordinator, all five care staff on duty and the chef. We found that there was conflict amongst the care staff and individuals and as a consequence we received varying views about the service. For example one of the care staff told us there was “good teamwork – it’s not cliquey”, while another said “the management needs to wake up”. A third staff member told us “People feed off (the staff) negativity”.

We reviewed care records for three people and observed practice. We found that people experienced effective care because their needs were assessed and reviewed.

People could choose from a varied menu and had the support they needed to help them eat and drink.

People were protected from the risks of unsafe management of medication because there were effective systems in place.

Staff did not receive suitable training and this presented a risk to people using the service.

During our visit, there were sixteen people living in the home. People that we spoke with told us they were happy with the care and support being provided.

Comments included. “They look after me well and they help me. The helpers are very kind and the food is nice.”

For each person living in the home there was a detailed, person centred plan of care in place that included people’s individual needs and wishes. The plans also contained clear information regarding staff supporting people’s emotional wellbeing.

In order to meet people’s individual needs, the home’s staff worked with a variety of healthcare professionals including district nurses and mental health teams. We were shown that advocates and specialist consultants were used where appropriate.

People were protected from risk of abuse or harm by there being safeguarding polices and procedures in place and by staff knowing how and when to use them.

Evidence we saw showed us that people were supported by a caring, experienced staff team. The staff team were well supported and trained.

People had their social needs assessed and had access to a range of activities and outings.

There was a regular cycle of quality audits undertaken to ensure that the home was kept under review.

Comments from four family members that spoke with us included. “They always make us very welcome; staff are very good and always let us know if our relative is poorly.”

We spoke to two people who live at Fawnhope Rest Home. They told us about the involvement they have in discussions regarding the level of care they need and whether they have given consent before care and support is provided. They also told us about the care they receive and whether it meets their needs. They told us about how they would make a complaint if it was necessary.

We spoke to the manager about the systems that were in place to assess and review the needs of each person. We also spoke to the manager about how complaints are recorded, managed and dealt with.

We were visiting at this time as a result of information we had received that indicated the care home may not be compliant with the essential standards we have looked at.