Archived: Fairview House

Fairview House is a residential care home providing accommodation and personal care for up to 55 people aged 65 and over. This includes people living with dementia. At the time of the inspection there were 35 people living at the service.

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

Information relating to people’s individual risks were not always recorded or did not provide enough assurance that people were safe. Suitable arrangements were not in place to ensure the proper and safe use of medicines. Effective arrangements were not in place to protect and prevent people who used the service from abuse. The staffing levels and the deployment of staff were not suitable to meet people’s care and support needs. People were not protected by the prevention and control of infection. Lessons were not learned, and improvements made when things went wrong.

The leadership, management and governance arrangements did not provide assurance the service was well-led, that people were safe, and their care and support needs could be met. Quality assurance and governance arrangements at the service were not reliable or effective in identifying shortfalls in the service. There was a lack of understanding of the risks and issues and the potential impact on people using the service.

Rating at last inspection (and update)

The last rating for this service was inadequate (published 14 January 2020) and there were multiple breaches of regulation. This service was placed in ‘Special Measures’ following our last inspection to the service.

Why we inspected

The inspection was prompted in part due to concerns received about unwitnessed falls and the provider’s arrangements for falls management. Other concerns related to unexplained bruising, inadequate staffing levels and inappropriate moving and handling practices. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of ‘Safe’ and ‘Well-Led’ only.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed and 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 Fairview House 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.

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 continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains 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 rating, we will take action 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.

Fairview House is residential care home providing personal care to 39 people aged 65 and over at the time of the inspection. The service can support up to 55 people.

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

There were systemic failings at the service. Concerns raised during the previous inspection had not been effectively addressed. The provider did not have effective systems and processes in place that enabled them to identify, monitor and assess risks to the health, safety and welfare of the people who use the service.

The service failed to give people their medicines as prescribed

People’s risk assessments were not followed in line with their current needs and known risks

The provider did not always safely maintain the environment to ensure it was safe for people living in the service.

The service did not ensure recruitment processes were followed to ensure staff were safely recruited

Peoples care and support was not delivered in line with current standards and guidance.

The service was not well led. Management lacked knowledge and oversight of the service.

The provider failed to take action where it had been identified to keep people safe from harm.

Systems were in place to monitor the quality of the service; however, these were not effective and failed to highlight concerns raised during the inspection.

Staff were instinctively caring but did not always have the skills and knowledge to undertake their role.

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 requires improvement (published 27 November 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough, improvement had not been made sustained, and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the management of medicines, staffing and management and oversight of the service/ 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 and will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating. 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.

The overall rating for this service is ‘Inadequate’ and the service 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 rating, we will take action 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.

We carried out this unannounced inspection on the 30 and 31 October 2018.

At our inspection in March 2018, the provider’s systems for learning, improving and sustaining improvements made were not effective and failed to demonstrate what action they had taken to address the issues we raised at our previous inspections. Because of our findings, the service continued to receive an overall rating of inadequate and remained in Special Measures. And conditions, which both restricted admissions and required the provider to report to us regularly, remained in place from our July 2017 inspection.

At our recent inspection carried out on the 30 and 31 October 2018, we found that there had been significant improvements in the care being delivered and people were engaged and well cared for. People were safe but further work was needed to ensure the registered provider's governance systems identified where continued improvements were needed, implemented and how they were to be sustained. The overall rating for the service is now judged as ‘Requires Improvement’ and the service is no longer in Special Measures. We have also removed the conditions on the provider’s registration.

There is 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.

In general people were kept safe from the risk of harm because care was being effectively managed and safely delivered to mitigate identified and/or potential risks. We found an instance where one person was at risk of choking but had not been harmed, this was brought to the manager's attention, who took immediate action to address this risk and ensured that all staff were aware of the person's fluid intake needs. We recommended that the service review their risk documentation to ensure that all records are consistent and up to date.

People were supported to take their medicines from staff who had received training to do so, however some further minor improvements were required to ensure all of people’s medication administration records were fully completed. There were sufficient numbers of staff, who had been safely recruited, to meet people’s needs. There were systems in place to prevent the spread of infection. But we did make a recommendation to the provider to use a recognised tool for determining staffing levels across the service.

Staff had an understanding of the principles of the Mental Capacity Act 2005 (MCA), however improvements were required to ensure staff were acting in accordance with good practice when undertaking mental capacity assessments and making best interest decisions for people who may lack capacity. We have made a recommendation to the registered manager to review the MCA and associated guidance to ensure the service is acting in accordance with the MCA.

Since our last inspection, staff had received the support, supervision and training they needed to equip them with the skills and knowledge to meet people’s individual care and support needs. People were supported to eat and drink enough to remain hydrated and maintain their health and well-being, however improvements were required to ensure accurate records were kept of people's food and fluid intakes. The provider had also made improvements to the internal environment of the home.

Staff were kind and caring and treated people with dignity and respect. Where appropriate, people were supported to maintain their independence. People’s diversity needs were recorded in their care plans. People were supported to access advocacy services.

People’s care plans were person centred and regularly reviewed. But we did make a recommendation around end of life care planning processes to ensure these are in line with best practice guidance when reviewing people's care.

Since our last inspection, an activities coordinator had been recruited and people were being supported to engage in meaningful activities both within the service and the local community. There was an effective system in place to manage concerns and complaints.

Whilst the registered manager had been proactive in making improvements to the service, the provider’s quality assurance systems were not yet as robust as they should be, as they had not identified the shortfalls we identified at our inspection. We have recommended the provider reviews their current systems and processes for quality assurance to ensure more robust oversight and governance of the service.

People, relatives and health and social care professionals were complimentary of the registered manager and the improvements they had made since starting work at the service. Staff enjoyed working at the service and felt supported and valued by the registered manager.

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

At our previous inspection in July 2017, we rated the service Inadequate and the service was placed in Special Measures. Following our inspection in July 2017, we sent an urgent action letter to the provider informing them about our findings and the seriousness of our concerns. We requested an urgent action plan from the provider telling us what they were going to do immediately to address our concerns. We took enforcement action and imposed conditions on the provider’s registration, which included a restriction on preventing any new admissions to Fairview House. You can read the full report from our last inspection on 17, 18, 20 and 28 July 2017 by selecting the ‘All reports’ link for Fairview House on our website at www.cqc.org.uk.

Services in Special Measures are kept under review and inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe and the rating of Inadequate remains for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

Our inspection in March 2018 was carried out to check the actions and improvements the provider told us they would make to achieve and maintain compliance with the fundamental standards under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Our findings showed that insufficient improvements had been made since our last inspection and people remained at risk of receiving unsafe care and treatment. The Commission is currently considering its enforcement powers.

For adult social care the maximum time for being in Special Measures will usually be no longer than 12 months. If the service has demonstrated improvements when we inspect it and is no longer rated as Inadequate for any of the five key questions it will no longer be in Special Measures.

At this inspection the overall rating of this service is Inadequate and the service therefore remains in ‘Special Measures'.

Fairview House is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 55 older people. There were 39 people living at Fairview House when we visited the service on the 5 March 2018.

At our inspection we identified a continued lack of governance, and people remained at risk of unnecessary harm. The systems and processes in place to effectively monitor and improve the quality of the service were not robust. The provider had not taken appropriate steps to ensure they had clear scrutiny and oversight of the service which ensured people received safe care and treatment. The lack of managerial oversight had impacted on people and the quality of care provided and had failed to identify and address concerns and breaches of regulatory requirements.

There had not been a registered manager in post at the service since June 2015. A manager had been recruited in January 2018 who was not yet registered with the Care Quality Commission. 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.

Improvements were required to ensure sufficient numbers of staff were effectively deployed, so that people’s individual care and support needs were met.

The service had not always taken appropriate action with regard to safeguarding concerns. Although staff had received safeguarding training and knew how to report abuse, not all staff were aware of external whistle blowing procedures.

The standard of record keeping was of a poor standard. Care records were not accurately maintained to ensure staff were provided with clear up to date information which reflected people’s care and support needs. Risks to people had not always been identified. Where risks had been identified people’s care records had not always been reviewed and, where appropriate, updated.

Staff completed the provider’s mandatory training but had not received specialist training to equip them with the skills, support and knowledge they needed to provide effective good quality care to people with specific health needs. Although staff felt supported, staff supervision was infrequent and not in line with the provider’s policy.

Improvements were required to ensure people received their medicines as prescribed, and appropriately trained staff were available at all times to administer people’s medicines.

Staff had received training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), however improvements were required to ensure MCA assessments were undertaken correctly, and reviewed appropriately, in line with the MCA Code of Practice.

Generally, people were positive about the meals provided. There was a choice of food and drinks each day. However, documentation used to monitor people’s daily fluid intake were not always being completed, placing them at risk of dehydration and/or poor nutritional intake.

Improvements were required to provide people with meaningful activities and support to pursue their hobbies and interests.

Whilst most staff were kind and caring towards the people they supported, they were often task orientated due to the deployment of staff. People were supported to maintain relationships with people who were important to them and visitors were welcome at the service at any time.

At this inspection we found breaches of Regulations 9 [Person centred care], 12 [Safe care and treatment], 11 [Consent], 13 [Safeguarding service users from abuse and improper treatment], 14 [Meeting nutritional and hydration needs], 15 [Premises and equipment], 17 [Good Governance] and 18 [Staffing] of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We carried out an unannounced comprehensive inspection of the service on the 17, 18, 20 and 28 July 2017. Previously the service had been inspected in October 2016 and received an overall rating of requires improvement with the domain ‘well led’ being rated as inadequate. The service was inspected again in March 2017 and was rated requires improvement. At this inspection there had not been sufficient improvements and we continued to have concerns about the safety, health and well-being of people; there had been inadequate management and oversight by the provider to ensure risks and/or potential risks to people were addressed and quality and safety made better.

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 timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of this registration.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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. The Care Quality Commission is now considering the appropriate regulatory response to resolve the problems we found during our inspection.

There had not been a registered manager in post at the service since June 2015. It is a requirement of the service’s registration with the Care Quality Commission that there is 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.

During our inspection we found a lack of governance. There were no robust systems in place to effectively monitor and improve the quality of the service people. Furthermore, the provider had not taken appropriate steps to ensure they had scrutiny and oversight of the service. The lack of managerial oversight had impacted on people, staff and the quality of care provided.

Improvements were required to ensure sufficient staffing levels and deployment of staff to ensure people’s individual care and support needs were met. Staff did not always have time to spend with the people they supported to meet their needs; the majority of interactions by staff were routine and task orientated. This was a concern already raised at previous inspections.

Not all risks to people were identified and suitable control measures in place to mitigate associated risks or potential risks. Furthermore, where risks had been identified people’s care records had not been reviewed and, where appropriate, updated to mitigate these. Risks to people’s health and safety within the general environment were not always safely managed.

Improvements were required to ensure the safe management of medicines. Medicines were administered by senior care workers who had received medication training however no observations of staff’s practice had been undertaken to ensure they remained competent to administer medication.

Staff were not provided with the skills, support and knowledge they needed to provide effective good quality care to people. The majority of staff training was out of date. Although staff felt supported by the manager, they had not received formal supervision or appraisal. Staff were not being routinely assessed or checked to ensure they had the right skills and experience to support people using the service.

People’s care records were not accurately maintained to ensure staff were provided with clear up to date information regarding people’s care and support needs. The process of reviewing people’s care plans had fallen behind due to lack of leadership and management and the impact of low staffing levels.

There was a lack of meaningful activities for people to engage in. The environment lacked items of interaction and stimulus to engage people especially those living with dementia. There was a task led and routine led culture at the service and staff did not always have time to spend with people to provide them with person centred care.

Improvements were required to ensure people’s capacity to make decisions were being appropriately assessed, recorded and monitored. Although the manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS), some staff were unable to demonstrate an understanding of the MCA and DoLS and how they would support people so not to place them at risk of being deprived of their liberty.

There was a complaints procedure in place. Although relatives told us that they would speak with the manager if they had any concerns or complaints, some relatives were unsure if they would be listened to. There were no comprehensive systems in place to demonstrate that management learnt from concerns and complaints and that formal analysis of concerns and complaints had been undertaken.

Care records containing people’s personal information was not securely stored, maintained and kept up to date.

There were thorough recruitment procedures in place to ensure staff were suitable to work with vulnerable adults.

At our previous inspection, we met with the manager and provider of Fairview House who, at the time, gave clear assurances that improvements would be made to the service and better care and support would be delivered with appropriate staff and governance oversight. This however, has not happened; consequently the Commission is using enforcement pathways to address the shortfalls in quality and the continued breaches of regulations. Some of these actions might not be available as public information at the time of publication of this report as the provider will have a period in which to review our proposals and make representations. The Commission will however, issue a further report as appropriate once this period has passed to tell the public what action has been taken.

We carried out an unannounced comprehensive inspection of this service on the 26, 27, 31 October 2016 and 2 November 2016. Breaches of legal requirements were found across all areas of the service. We told the provider that they must meet specific legal requirements by 23 December 2016. We asked the provider to send us an action plan which outlined the actions they would take to make the necessary improvements. In response, the provider sent us their action plan detailing their actions needed to meet regulatory requirements and to achieve compliance with the fundamental standards.

We carried out an unannounced comprehensive inspection of this service on 14, 16, 27 and 30 March 2017 to confirm that they now met those legal requirements.

As part of our inspection we met with the provider and the Local Authority to facilitate discussions regarding concerns raised during the first days of the inspection. The concerns were surrounding the environment, how staff were deployed effectively around the environment, staffing levels and their consistency, lack of staff to provide meaningful activities, as well as the importance of staff and management retention. The provider was open to listening to our concerns and gave strong assurances that with the support of the new manager in post that service delivery will be improved to good in all areas.

Although the action plan provided to us by the provider was robust in response to the last inspection, it had not been effectively actioned in all areas since the last inspection. Immediate concerns had been rectified to ensure people were safe however other areas of improvement had not been actioned as the provider had prioritised the recruitment of an effective home manager and care supervisor to implement the improvements required at Fairview House. During this inspection the provider had assured us that action would be taken accordingly to respond to concerns that had been raised prior to the appointment of the home manager and care supervisor. We were assured that the provider and new management would work collaboratively to drive improvements.

Relatives and staff spoke of the improvements made since the last inspection in October 2016. Reports made specific reference to the improved supportive management at Fairview House. The staff morale and positive, open and inclusive culture had increased within the service. People, relatives and staff consistently reported that the management team were doing their utmost to make the required improvements to the service. People and staff also told us and we saw that the management team were visible and approachable.

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 requirements in the Health and Social Care Act 2008 and associated regulations about the service is run. At the time of the inspection the home had not had a registered manager in post since June 2015. A care supervisor had been recruited in December 2016 and appointed to oversee Fairview House. There was a new home manager in post since the last inspection who had been appointed in January 2017.

Areas of improvement had been identified from the quality assurance report produced by the provider in December 2016. The newly appointed home manager confidently spoke of the improvements required and demonstrated new systems they had put in place to audit and monitor the service moving forward.

Staffing levels at the service had not been maintained above equated minimum levels since the last inspection. The environment appeared to have an obvious negative impact on the effectiveness of the deployment of staff across the service. The provider, at our meeting with them, advised that staffing levels and tools to determine staffing levels would be reviewed and the impact of the environment would be considered. Shortly after our last day of inspection the home manager confirmed that all dependency levels for people had been reviewed and that staffing levels were correct and that they continued to review the deployment of staff to ensure good care delivery at all times.

The home manager confirmed that they were working on ensuring suitable arrangements were implemented for all staff to receive regular formal supervision and an annual appraisal of their overall performance. However the atmosphere and morale of staff had much improved since our last inspection. Staff felt supported and optimistic about the new manager and their vision for the service. Staff told us and records confirmed that a range of training opportunities were available and provided to them.

The manager was already making changes to people’s lives and activities and they were aware that further improvements were needed in the way the service and staff supported people to lead meaningful lives and to participate in social activities of their choice and ability, particularly for people living with dementia or who had complex care needs. Care and support provided by staff for people using the service was, at times, task and routine led and not as person centred as it should be.

People were supported to have enough to eat and drink, however increased supervision was required for some people at mealtimes. People were supported to maintain good health and have access to healthcare services as and when required.

Relatives and people confirmed they were not involved in the review and development of care plans. Improvements were required to ensure that people’s care plan and risk assessment documentation was accurate and up-to-date. The provider had intentions to implement electronic care plan systems, however the date of implementation is not yet known.

Whilst medication practices and procedures were generally safe, some improvements were still required. Immediate action had been taken to work with Southend Clinical Commissioning Group to achieve best practice management of medicines. We saw action plans were in place and being completed by the home manager and care supervisor. An electronic medicines management system was also being implemented in May 2017 to increase the robustness of medicines management.

The home manager had a good knowledge of the Deprivation of Liberty Safeguards [DoLS] and the key requirements of the Mental Capacity Act [2005]. They had made improvements to ensure particular decisions which had been made in people’s best interests were recorded and evidence of Lasting Power of Attorney [LPA] arrangements were sought.

People were protected from abuse and avoidable harm and people living at the service confirmed they were kept safe. Safe recruitment practices were in place and being followed. The complaints procedures had been managed and improved since the last inspection.

Staff knew the care needs of the people they supported and people told us that staff were kind and caring. People and those acting on their behalf told us that they were generally happy with the care and support provided by staff.

The inspection was completed on 26, 27, 31 October 2016 and 2 November 2016 and was unannounced. There were 48 people living at the service when we inspected.

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.

Immediate concerns and risks to people’s health were identified by us during inspection. A lack of leadership and managerial oversight meant that the service had failed to identify risks to people and staff and had the Commission not intervened the risks would likely have remained. The provider responded immediately to the Commission’s requests for urgent action and further provided an action plan to drive improvements throughout the service.

Quality assurance checks and audits carried out by the provider were not robust, did not identify the issues we identified during our inspection and had not identified where people were put at risk of harm or where their health and wellbeing was compromised. Although some systems and processes were in place they were not being used effectively or at all to ensure robust quality monitoring of the service.

Suitable control measures were not always put in place to mitigate risks or potential risk of harm for people using the service. Care records and risk assessments had not been updated for all areas of identified risk and pressure mattresses were not correctly set in relation to people’s weight. The management of medicines was not always safe and improvements were required to staff’s practices and procedures to ensure these were in line with current legislation and guidance.

Assessments regarding people’s individual decision making were generalised and not decision specific. Not all care workers were able to demonstrate a good knowledge and understanding of MCA and DoLS despite having received training. Arrangements for the use of covert medication were poor and ‘best interest’ meetings to evidence decisions had not been considered.

Relatives’ reports regarding staffing levels were varied and we judged that there were not sufficient numbers of staff available to meet people’s needs at all times. Our observations showed that staffing levels and the deployment of staff were not suitable during the entire inspection. In addition, the majority of interactions by staff were routine and task orientated and improvements were required. The provider responded to our concerns and reviewed staffing levels and implemented contingency plans should staffing levels fall below the assessed minimum level of staff.

Whilst some staff’s interactions with people were positive, this was in contrast to other observations where we saw some staff’s practice when supporting people required further improvement and development as they displayed a lack of regard for people’s privacy at times and did not always have due respect for people.

People’s care and support needs had not always been documented as required and reflected in their care plans. Improvements were required to ensure that the care plans for people were detailed accurately to ensure staff had adequate information to support people. Although people knew how to make a complaint or raise a concern, records showed that complaints had not been responded to in line with guidance.

Improvements were needed in the way the service and staff supported people to lead meaningful lives and to participate in social activities of their choice and ability. The provider advised us this had been addressed and an activity co-ordinator had been recruited.

Systems were in place for newly employed staff to receive an induction. Although arrangements required improving to ensure that formal supervision and appraisal measures were in place. Although care staff had largely completed mandatory training their knowledge was not adequately embedded in order to apply it to people’s needs effectively. Competency of staff in charge was not formally recorded however plans were in place to address these concerns. The provider’s recruitment procedures were adequate so as to safeguard people using the service.

The dining experience for people was positive for people with independence. Although reports from relative’s regarding meal times were not always positive on behalf of those requiring more support. This was also the case regarding accessing appropriate healthcare services.

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

We looked at four people's care records. Other records viewed included staff training records and rotas, health and safety checks and staff and resident meeting minutes. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service our identification was checked and we were asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse. Some staff had also received training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS.) This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

We saw records which showed that the health and safety in the service was regularly checked. This included regular fire safety checks which meant that people were protected in the event of a fire.

The service was kept clean and staff practice ensured that people were protected as far as possible from the risk of infection.

We saw the staff rota and dependency levels assessment which showed that the service assessed people's needs to ensure that there were sufficient numbers of staff to meet their needs. Most people told us that the staff were available when they needed them.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. People made comments such as, "I am happy here and have everything I need," "I have no complaints and can't fault it," "The carers are wonderful, nice people and kind," and, "It might not suit everyone but it suits me."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Staff working in the service were supported through induction, ongoing training and supervision to offer people care and support to meet their needs.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect. One person said, "The staff are kind and caring." Another person said, "They work very hard but are always patient."

Is the service responsive?

We saw that staff consulted with people and offered them choices in their daily lives. People's choices were taken in to account and listened to.

We saw that staff were responsive to people's changing wishes and needs and supported them well.

People told us that they felt able to raise any issues they might have and felt that the service would act upon their concerns.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service had not benefited from having a registered manager in post to provide good and stable leadership for some time. However, we are currently assessing an application for registered manager. People told us that they liked the current manager and felt that they were improving the service. One person told us, "[Manager] is on the ball and has sorted out a few things."

People's care was well organised. Staff had lead areas to monitor practice in aspects such as dementia care, health and safety and infection control.

People had the opportunity to express their views about the service.

People were mostly satisfied with the care and support offered. We found that people's needs were assessed and planned for to ensure that their individual needs would be met. Improvements were needed to ensure that people were more involved with this process and a fuller picture of their needs and wishes gained.

We found that people had limited opportunities through activities for stimulation and occupation.

We saw that peoples' medicines were managed safely and effectively.

Fairview house was clean but the service was not working to the required guidelines for maintaining good standards of infection control.

People told us that the staff who worked at the service were good. One person said; "I can't praise them enough." We found that staff were supported through induction and supervision to have the skills and knowledge needed to carry out their role effectively. There were however shortfalls in staff training that needed to be addressed.

We found that the provider needed to improve and maintain more consistently the systems in place to monitor the quality and safety of the service.