Fairways

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.

Fairways is a residential care home. It is registered to provide care and accommodation for up to 24 older people some living with dementia. The home is based over three floors with a lift for access to all floors. There were 15 people living at the home at the time of this inspection.

We found the following examples of good practice.

The home facilitated face to face visits, in line with government guidance. The manager told us this was essential to help support people's psychological and emotional well-being. Alternatives to in-person visitation, such as virtual visits, were also supported.

A ‘booking in’ procedure was in place for all types of visitors to the home including, a health questionnaire. Improvements were needed to ensure evidence of a negative lateral flow test was recorded and people’s physical health such as temperature was also recorded. In addition, the system for checking professional visitors needed to be improved to ensure vaccination status and symptoms were screened before entering the home. This would help prevent visitors spreading infection on entering the premises. We referred the home to Infection Prevention and Control professionals at the local authority for support and guidance.

People and staff were tested regularly for COVID-19. Staff employed at the home had been vaccinated, to help keep people safe from the risk of infection.

Infection control policies and audits were in place to ensure the home reflected best practice and current guidance.

Cleaning schedules and audits were in place to help maintain cleanliness and minimise the spread of infection. However, some parts of the home needed to be redecorated to ensure they could be effectively cleaned or disinfected.

Staff were trained and competent in infection prevention and control best practices and how to put on and take off PPE. However, during the visit we observed staff were not consistently following the correct use of PPE such as face masks. This included not wearing masks or pulling them down when talking. We signposted the service to the local Infection Prevention and Control at the local authority for additional support and guidance.

The home had adequate supplies of appropriate PPE and more PPE stations had been established.

The manager maintained links with external health professionals to enable people to receive the care and intervention they needed. Virtual consultations took place as and when necessary.

Fairways is a residential care home. It is registered to provide care and accommodation for up to 24 older people some living with dementia. The home is based over three floors with a lift for access to all floors. There were 22 people residing at the home at the time of this inspection.

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

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 coronavirus and other infection outbreaks effectively.

We were not assured the infection prevention and control practises in the home were satisfactory. Infection control practices and the management of infected clinical waste in relation to the pandemic and Covid-19 were not being followed in line with government guidance or the homes infection control policy. This exposed people to potential risks of avoidable harm.

Some accidents and incidents within the home which had resulted in harm had not been always been adequately managed or escalated in line with the local authority safeguarding procedures and the registration requirements to notify us. Failing to recognise or report serious incidents put people at risk of receiving unsafe care and treatment.

Risks in relation to the management and oversight of fire safety within the premises was not consistent.

Where specific equipment was in use the risks associated with their use was not always managed in line with current national health and safety guidance. This put people at risk of potential or avoidable harm.

Systems in place were not effective enough to support the safe management and administration of medicines. There were unsafe practises for the management and administration of as required (PRN) medicines This placed people at risk of harm from unsafe practices in relation to the management of medicines.

Processes and systems in place to oversee, assess and monitor the safety and quality of service provided were not effective. This meant that appropriate actions could not be taken to ensure the service consistently provided safe care and treatment.

Recruitment practices adopted by the home were not robust. New staff had not been thoroughly checked prior to employment commencing. This meant staff were not checked as being suitable before commencing work with vulnerable people.

People were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

We observed people were treated with kindness and compassion. Interactions by staff with people were seen to be in a respectful and caring manner. One person living at Fairways told us they were very happy and said of the management and staff, “I love all of them so much.”

Relatives spoke very positively about the care provided. One family member told us, “I feel mum is safe here and also "It’s homely and more like a family, there’s a warmth to the place.” Another relative said, “The home has been very good at communicating with us throughout Covid. The manager is always available to talk to.”

Staff we spoke with all told us they loved working at Fairways. On staff member said, “The bosses are brilliant, everyone is so supportive. They [the management] are so approachable, there’s nothing you feel you would not be able to say.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 08 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received about a specific incident resulting in an injury. A decision was made for us to inspect and examine those risks associated with the management of falls.

You can see what action we have asked the provider to take at the end of this full report.

The provider took immediate actions to mitigate some of the risks we found in the practises of infection prevention and control and in making the environment safer. This minimised the potential of harm being caused.

We reviewed the information we held about the service. No areas of concern were identified 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.

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 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 identified breaches in relation to infection control, recruitment, safe use of equipment, reporting of incidents, management of medicines, and in risk assessing and monitoring the service at this inspection. We have also identified a potential failure to inform CQC of notifiable incidents and this will be dealt with outside of this process.

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 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.

Fairways 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.

Fairways is registered to provide care and accommodation for up to 24 older people living with dementia. The home is based over three floors with a lift for access to all floors. There were 20 people residing at the home at the time of inspection.

A registered manager was not in post at the time of the inspection. The previous registered manager had left their position in January 2018. At the time of the inspection visit the registered provider had applied to the Care Quality Commission (CQC) to register a new 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.

We last carried out a comprehensive inspection at Fairways in July 2017. At the inspection in we identified no concerns within the care provided but the home was rated as Requires Improvement. We rated the home Requires Improvement as the registered provider had previously been rated inadequate and had implemented a lot of changes to meet the fundamental standards. We needed to be sure the changes were embedded.

At this inspection visit carried out in September 2018, we checked to see that all improvements had been maintained. We found the registered provider had embedded all the changes and had continued to make improvements and was now consistently meeting all the fundamental standards.

The registered provider had invested in technology and implemented an electronic system for managing and administering medicines. Medicines were stored and administered in line with good practice.

The registered provider had reviewed staffing levels and had introduced additional staff roles to enable staff to have the time to care for people who lived at the home. Staff told us this created increased opportunities for people and increased job satisfaction.

Since the last inspection visit, the registered provider had recruited an activities coordinator. We saw activities routinely took place within the home and the wider community. Staff understood the importance of providing person centred activities. There was an array of items placed around the home to encourage and motivate people to participate in activities.

There was ongoing refurbishment works within the home. For example, the registered provider had reviewed some colour schemes within the home to make the home more pleasing.

Audits had been formalised and embedded within every day practice and the registered provider understood the importance of effective auditing systems. Audits were routinely carried out and action was taken when concerns were identified.

Care plans for people were person centred, in depth and detailed. These care plans provided staff with the correct information to enable them to care for people in a person-centred way. The principles of the Human Rights Act were embedded throughout service delivery.

Risk was appropriately addressed and managed. Risks assessments were in place to ensure staff were aware of risk to keep people safe from harm.

People who lived at the home told us they felt safe. Staff could identify types of abuse and the associated responsibilities they had in reporting abuse.

People who lived at the home told us there were enough staff. Staff told us they were not rushed. Staff responded in a timely manner when call bells were activated.

We reviewed infection prevention and control processes at the home. The registered provider had taken on board advice and guidance provided by specialist advisors and ensured that good infection prevention and control procedures were carried out.

Staff praised the training provided and the supportive nature of the management team. We saw evidence of staff being provided with training to enable people who were living with dementia experience better lives.

People praised the quality of the food provided. People had been consulted with about the menu choices. We observed two meal times and saw people were not rushed. The registered provider had recruited a hostess who spent time with each person before mealtimes to find out what they would like to eat.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Consent to care and treatment was routinely sought. When people lacked capacity to make their own decisions good practice guidance was followed to ensure best interest decisions were made on behalf of people.

We saw evidence of multi-agency working to promote effective care. A health professional said they were happy with the standard of care provided. Relatives told us the home was good at meeting the needs of people.

People and relatives told us staff were caring. We observed staff providing care and found they were patient, kind and caring.

Staff who worked at the home described the home as a good place to work. They told us the new manager was good at their role and had helped the registered provider improve the way in which the home was managed. They said they considered the home to be well-led. Relatives we spoke with also told us they also considered the service to be well-managed.

The registered provider liaised with health professionals when people required end of life care at the home to ensure people received care in line with good practice.

At the time of the inspection no one had any complaints about how the service was delivered. People and relatives said they were happy with the standard of care provided. Relatives were aware of their right to complain and the process to follow.

Prior to staff being employed at the home, recruitment checks took place, to ensure staff were of good character and had the correct skills for working with people who could sometimes be vulnerable.

The registered provider was committed to ensuring the service was well-led. Since the last inspection visit the home had received external accreditation to demonstrate leadership at the home was good and staff were invested in. Additionally, the registered provider continued to demonstrate they understood the importance of networking with other similar groups and professionals to ensure good practice was shared and followed.

Fairways is registered to provide care and accommodation for up to 24 older people living with dementia. The home cares for people who require personal care and is made up of single and double rooms. Care is provided on a 24 hour basis. There is a lift to access all three floors of the building. The home is situated in the village of Heysham. At the time of the inspection visit 21 people were receiving care and support at the home.

A registered manager was in post at the time of the inspection. 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 service was last inspected on the 09 and 13 January 2017. The registered provider did not meet the requirements of the regulations during that inspection as breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. These related to safe care and treatment, safeguarding people from abuse and good governance, person centred care, premises and equipment and a breach to Regulation 18 of the Care Quality Commission Registration Regulations. At the inspection, the service was placed in special measures by the Care Quality Commission, (CQC.)

During this inspection in July 2017, we found improvements to meet the fundamental standards had been made. As a result the service has been taken out of special measures. The service will be expected to sustain the improvements and this will be considered in the future inspections.

At this inspection visit we found improvements had been made to ensure people who lived at the home were safe. The registered provider had reviewed the premises and had put processes in place to ensure people were kept safe in the event of fire. We noted the home was undertaking a period of refurbishment, Whilst this was not completed we saw evidence of an ongoing refurbishment plan in place.

The registered manager had reviewed infection control processes at the home. They had worked in partnership with the infection prevention and control nurse to develop and manage infection control processes at the home. This had included refurbishing the laundry area and implementing new processes.

Care plans and risk assessments for people who lived at the home had been reviewed and updated to ensure they reflected people’s needs. The registered provider had reviewed ways in which falls were being managed. They had sought advice and assistance from health professionals to ensure people’s needs were met. We saw there had been a decrease in the number of reported falls since the previous inspection. Systems had been implemented to monitor and manage falls and these were consistently followed by staff.

Suitable arrangements had been implemented to ensure people were lawfully deprived of their liberty. Restrictions upon people had been reviewed and wherever possible restrictions had been reduced We saw appropriate DoLS applications had been made as required. Staff understood their responsibilities for reporting safeguarding concerns were aware how to report safeguarding alerts.

Arrangements for the management of medicines had been reviewed. Protocols for administering as and when required, (PRN) medicines had been developed. Systems had been put in place to ensure topical creams, pain relief patches and ointments were suitably recorded after administration. All medicines were stored securely when not in use. Audits of medicines were carried out by the registered manager.

Staffing needs had been addressed. The registered provider had reviewed the needs of all people who lived at the home and had increased the numbers of staff on duty. Staff told us this had enabled them to deliver improved care and person centred support to people.

The mental capacity and consent of all people who lived at the home had been reviewed. We saw evidence best practice guidelines were followed when people were assessed as not have capacity. Advocates had been sought for people without families to assist people with decision making.

We observed staff responding to requests and noted people’s needs were promptly addressed. People who lived at the home spoke highly of the staff and their attitude. We noted staff were patient and respectful with people.

Training had been arranged to ensure staff were equipped with the necessary skills required to carry out their role. Staff had received training so they could suitably support people with behaviours which may challenge the service. We saw staff working appropriately and putting their skills in practice. For example, we saw staff trying to de-escalate situations and use distraction techniques when people started to display signs of being anxious.

Person centred care was provided at all times by staff who knew the people well. Staff knew of people’s likes and dislikes and respected these whilst supporting people. People who lived at the home were encouraged to be involved in how the home was run and were encouraged to make suggestions as to how the service could be improved.

The registered provider had reviewed the provision of meals and had introduced an additional cook with responsibility for breakfasts. This relieved care staff from the cooking duties and allowed them time to spend with people requiring help and support. People’s nutritional needs were met by the registered provider. People were offered a choice of meals and meals were prepared according to health needs. Support was given in a respectful manner if people required support at meal times.

The registered manager had improved the provision of activities at the home. An activities coordinator had been recruited and was due to commence employment. On the day of our visit, we observed a singer visiting the home. They sang with people and gave people instruments to join in. We also saw care staff carrying out short activities with people who lived at the home.

We looked at how complaints were managed and addressed by the service. At the time of the inspection no one had any complaints about how the service was delivered. We saw evidence that when complaints were raised they were dealt with professionally and in a timely manner.

Feedback from staff who worked at the home was positive. Staff said teamwork had improved and care provided was now more organised and efficient.

We saw that audits had been reviewed and new audits had been developed and audited. Audits for the premises and maintenance had been implemented and we saw evidence of changes being implemented as a result of the audits.

We saw evidence of partnership working. The registered manager had identified staff within the home to take on role of champions. Champions are staff who have a specific interest and are committed to undertaking additional training. Champions had attended external training and had cascaded advice and guidance to other staff at the home.

Although this service had improved since the last inspection we still need to ensure the improvements will be sustained. This is because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

Fairways is registered to provide care and accommodation for up to 24 older people living with dementia. The home cares for people who require personal care and is made up of single and double rooms. Care is provided on a 24 hour basis. There is a lift to access all three floors of the building. The home is situated in the village of Heysham. At the time of the inspection visit 24 people lived at the home.

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.

The service was last inspected in January 2016. At this inspection we found the service was not meeting the required fundamental standards. We identified breaches to Regulations 12, 13, 17 and 19 of the Health and Social Care Act, (2008) Regulated Activities 2014, as care and treatment was not always safe, recruitment checks were not consistently applied to new employees and paperwork was not always accurate and up to date.

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

We used this inspection carried out in January 2017 to ensure action had been taken to ensure all fundamental standards were now being met. We also carried out the comprehensive inspection to review the rating of the service.

At this inspection visit, we found some but not all improvements had been made. Improvements had been made that ensured systems were in place to notify the Care Quality Commission of incidents of abuse. The registered manager had implemented a new reporting system to ensure all concerns were reported to the appropriate bodies in a timely manner. However, the registered manager had failed to consistently notify the Commission of all other incidents in a timely manner. This was a continued breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We looked at how risks were addressed and managed by the service. We found some improvements had been made to ensure people at risk of malnourishment were appropriately supported. Documentation had been introduced to manage and mitigate any risk. We found that management of risk was not consistently applied throughout the service. When people were at high risk of falls we found risks were not safely managed. This placed people at risk of harm. This was a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

We noted care records and risk assessments identified some risks to people’s health and wellbeing. These provided staff with guidance as to how to keep a person safe. Due to the ineffective deployment of staffing these risk assessments were not consistently followed by staff. This placed people at risk of harm from naturally occurring risk. This was a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

We looked at care records. We found paperwork was inaccurate, incomplete and missing. This meant falls were not appropriately managed and people were at risk of harm. This was a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Applications had been made to the supervisory body to deprive people of their liberty; however not all restrictions had been considered and documented upon the applications. This meant that two people were being unlawfully deprived of their liberty. Staff had some understanding of the Mental Capacity Act 2005 (MCA) and the relevance to their work. However, mental capacity was not routinely assessed and good practice guidelines were not referred to when a person lacked capacity. This was a continued breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as the registered manager was restricting people’s liberty without lawful authority.

We looked at how medicines were managed by the service. We found good practice guidelines were not consistently followed. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The registered manager had partly implemented an auditing system to monitor the administration of medicines and to monitor accidents and incidents. However, these audits were ineffective and had not identified some of the concerns we identified during the inspection process. This was a breach of Regulation 17 of the Health and Social Care Act (2008) Regulated Activities 2014 as the registered manager had failed to assess, monitor and improve the quality and safety of the services provided.

We looked at staffing levels and deployment of staff on shift. Staff told us staffing levels met the needs of the people. Our observations demonstrated that deployment of staffing was sometimes poor. We observed people having to wait to have their needs met. Oversight in communal areas to supervise people at risk of falls was not consistent and placed people at risk of harm. People who displayed behaviours which challenged were not supported as documented within their care plan. This was a breach of Regulation 18 of the Health and Social Care Act 2008) Regulated Activities (2014) as staff were not effectively deployed to meet people’s needs.

People who lived at the home told us the living space was busy. We reviewed the communal areas where people spent their time during the day. We found these areas cramped. This hindered people’s mobility and increased the risk of people falling. We looked at accidents and incidents and noted three accidents had occurred where people had fallen into equipment or other people. On the day of the inspection, we observed another accident taking place. This was a breach of Regulation 15 of the Health and Social Care Act (2008) Regulated Activities 2014 as the registered provider had not ensured premises were maintained and fit for purpose.

Although we observed some caring and positive interactions, we noted person centred care was not always carried out. People received care which did not suit their preferences or needs. This was a breach of Regulation 9 of the Health and Social Care Act (2008) Regulated Activities 2014 as the registered manager had not ensured person centred care was consistently provided.

Staff responsible for providing care and support had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns.

During the inspection visit we walked around the home to assess the standards of cleanliness. On the first day of the inspection we found equipment at the home was not always available to ensure suitable hand hygiene processes could be consistently followed by staff. We found dirty mops being stored in a communal bathroom area. In another bathroom we found a seal had come away from a bath leaving a dirty residue around the bathing area. We have made a recommendation about this.

We spoke with the registered manager to see how people’s voices were heard. Good practice guidelines were not in place to ensure people who could not speak for themselves and had no relatives to speak for them had an independent voice. We have made a recommendation about this.

We looked at recruitment checks undertaken by the registered manager and found improvements had been made. We found the provider had followed safe practices in relation to the recruitment of new staff.

Systems were in place for managing people’s dietary needs. We noted input from health specialists when people were at risk of malnutrition. Documentation was up-to-date to ensure people’s dietary needs were managed effectively. We received mixed feedback from people who lived at the home about the quality of the food.

People who lived at the home and relatives spoke highly about the staff. Staff were described as caring and kind. We observed positive interactions between staff and people who lived at the home during the inspection visit. Caring relationships were sometimes hampered by ineffective deployment of staffing.

Staff told us Fairways was a good place to work. They told us training was good and said they felt supported within their role. From viewing training records and speaking to staff however, we noted that staff had not received all appropriate training to enable them to carry out the duties they were employed to perform. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Relatives told us they were happy with the service provided. They said the management team was approachable and they were confident if they had any concerns action would be taken.

Following the inspection visit we raised several safeguarding concerns relating to some of the people who lived at the home. We also consulted with the infection prevention and control team, the fire and rescue service and the clinical commissioning group safeguarding lead. We requested that immediate action was taken by the registered provider to address and mitigate the risks we had identified during the inspection process. We received written confirmation from the nominated individual and the registered manager that immediate action would be taken.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this

Fairways residential home is situated in Heysham, near Morecambe. It provides accommodation for up to 24 residents in a mixture of double and single rooms, in an old building adapted for the purpose.

There were 19 people living at the home on the day of inspection.

A registered manager was not in post at the time of the inspection. A registered manager is registered with the Care Quality Commission to manage the service. 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 registered provider had designated a member of staff to be the registered manager but they had not yet registered with the Care Quality Commission.

The service was last inspected on 05 February 2014. We identified no concerns at this inspection and found the provider was meeting all standards we assessed.

At this inspection carried out in January 2016, we found people were not always safe. The registered provider had failed to implement suitable systems to ensure risks to people’s health and safety were appropriately monitored and managed. Care plans were in place for people who lived at the home. Care plans covered support needs and personal wishes. Plans had been reviewed at regular intervals however they did not always reflect people’s individual needs. This was a breach of Regulation 17 of the Health and Social Care Act (2008) Regulated activities 2014.

Risks were not consistently addressed and managed in a proactive way. Audits of accidents and incidents and audits of people’s weights had not been carried out to identify and manage any risks to people who lived at the home. This was a breach of Regulation 12 of the Health and Social Care Act (2008) (Regulated Activities) 2014.

Robust recruitment processes were not in place to ensure people employed were of suitable nature. This was a breach of Regulation 19 of the Health and Social Care Act (2008) (Regulated Activities) 2014.

Staffing levels were conducive to meet people’s needs. We observed staff being patient with people and meeting their needs in a responsive manner.

Arrangements were in place to protect people from the risk of abuse. People told us they felt safe and secure. Staff had a sound knowledge of safeguarding and were aware of their responsibilities for reporting any concerns. However processes in place were inconsistent to ensure all safeguarding alerts were communicated to the Care Quality Commission (CQC.) This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

The registered provider had suitable arrangements in place for managing medicines. Medicines were safely kept and appropriate arrangements for administering them were in place. The registered provider carried out regular audits of medicines to ensure systems in place were being followed correctly by staff.

People’s healthcare needs were monitored and referrals were made to health professionals in a timely manner when people’s health needs changed.

Staff had received training in Mental Capacity awareness and Deprivation of Liberty Safeguards. However we noted procedures were not always followed to ensure compliance with the Deprivation of Liberty Safeguards (DoLS). We identified two people being deprived of their liberty without legal authorisation. This was a breach of Regulation 13 of the Health and Social Care Act (2008) Regulated Activities 2014.

People were happy with the variety and choice of meals available to them. Feedback on the quality of food provided was positive from both people who lived at the home and relatives.

The registered provider kept a detailed log of all accidents and incidents that had occurred at the home. However during the course of the inspection we identified three serious incidents that had not been reported, as required to the Care Quality Commission. This was a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009.

The home provided social activities for people who lived at the home. However, staff told they were sometimes limited to providing social activities due to other constraints. The registered provider advised us they were currently addressing this and were in the process of recruiting an activities coordinator.

Feedback from relatives and health professionals in regards to service quality was positive. The registered provider engaged with people who lived at the home and their relatives to ensure service quality was appropriate to people’s needs.

Staff were positive about their work and confirmed they were supported by the registered provider. Staff received regular training and supervision to make sure they had the skills and knowledge to meet people’s needs.

You can see what action we told the provider to take at the back of the full version of the report.

We spoke with people living at the home, their relatives and staff throughout the inspection. We observed the quality of care and support provided by staff during the inspection.

We found care plan records were up to date and people were happy with the service they were receiving. We found people were supported by staff who had been trained and appropriate support arrangements were in place for them. Good care practices were observed and people told us they were happy with their relatives care. One person said, 'I can't fault my wife's care. The home has a really relaxed atmosphere and I enjoy visiting. The staff are very kind and patient people'. Four people living at the home said they were happy and had no complaints. One person said, 'The staff are very helpful and have a pleasing nature. I enjoy the meals and we have activities organised to keep us entertained'.

During our inspection we contacted the Lancashire contracts monitoring team. They told us they had no concerns about the service.

We found that a range of improvements had been put into place. These included some practical measures, such as rearranging the Senior Carers' office to create more space, and laying a new floor in one bedroom. We checked most of the bedrooms and the communal areas and found that they were clean. The manager had put some new checks in place to reduce the risk of dirty rooms or beds or soiled incontinence pads being overlooked. Staff had been advised to adhere to the home's policies to ensure medication was safely stored and administered. We saw that staff were being monitored by the manager to ensure that they adhered to the policies. These improvements meant that the home was a safer environment.

We found that the provider had made many improvements to the home, such as refurbishing rooms and buying new furniture in communal areas. Some changes had been introduced to make the handling of medicines safer. Auditing had been introduced so that the manager and senior care staff could systematically check standards. However we found that the new systems were not all working well enough. Some rooms we looked at had not been cleaned on the morning we inspected: we found dried faeces in one room and a used incontinence pad in another room on a chair. We found also that staff were not dispensing medication in a safe way, the person administering the drugs did not have the medication administration records (MAR charts) with them. We also found medication was not always dispensed on an individual basis, which increases the risk of mix ups.