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Inspection carried out on 6 February 2019

During a routine inspection

About the service: This service supported people with learning disabilities and/or autism.

The home was bigger than most domestic style properties. It was registered for the support of up to seven people. Seven people were using the service at the time of the inspection. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by how the building was used. There were no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff did not wear anything which suggested they were care staff when coming and going with people.

What life is like for people using this service:

• A new manager had been appointed. The new manager advised us they were in the process of applying to become the registered manager for Fairfield House.

• People were at ease with staff, and enjoyed spending time with them.

• There had been changes in the staff caring for people. However, staff rotas had been arranged so people were always supported by staff who knew them well, as people started to develop caring relationships with new staff. There were sufficient staff to care for people at times to suite people.

• People were confident to ask for assistance and reassurance from staff when they wanted this.

• Staff promoted people’s rights to privacy and dignity and encouraged people’s independence.

• People made their own day to day choices and decisions. These included how people chose to spend their time, and what interesting things they wanted to do.

• Where people needed support to make some decisions staff and other health and social care professionals assisted them, focusing on what was best for people living at the home.

• Staff understood people’s preferred ways of communicating and supported them to develop their communication skills, further. This had led to people experiencing enhanced confidence when communicating.

• People were supported to stay as safe as possible by staff who understood risks to people’s safety.

• The risk of infections and accidental harm was reduced, as staff used their knowledge and the equipment provided to do this.

• People were supported to have their medicines safely and checks were undertaken to ensure these were administered as prescribed. People’s medicines were regularly reviewed.

• Staff had been supported to develop the skills they needed to care for people, so people’s care needs would be met.

• People had enough to eat and drink to remain well. People were encouraged to decide what they wanted to eat and were supported to choose from a healthy range of snacks.

• Staff supported people to see other health and social care professionals. This helped to ensure people experienced good health outcomes and a sense of well-being.

• 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.

• People were supported to keep in touch with relatives and others who were important to them and had opportunities to do things which they enjoyed in the community. Staff encouraged people to try new experiences which they may enjoy.

• The views of people, relatives and other health and social care professionals were considered when people’s care was assessed, planned and reviewed. This helped to ensure people’s needs and preferences continued to be met.

• Systems were in place to take any learning from complaints, concerns or suggestions, to further improve people’s care.

• Staff worked with other health and social care professionals when considering the care people wanted at the end of their lives. The manager planned to further develop the processes to support people at the end of their lives, so their wishes would be responded to.

• Other health and social care professionals told us the manager had developed good links with other organisations who regularly

Inspection carried out on 1 August 2016

During a routine inspection

This inspection took place on 1 August 2016 and was unannounced.

Fairfield House provides accommodation and personal care for up to seven adults with learning disabilities or autism. At this inspection seven people were living there.

A registered manager was in post but was not present during our inspection owing to pre-arranged annual leave. 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 registered manager had made provision for managerial assistance during their absence

People were safe as staff had been trained and understood how to support people in a way that protected them from danger, harm and abuse. Assessments of risks of harm were personal to individuals and staff followed safe practice when assisting people. Any incidents or accidents were monitored by the registered manager and provider to minimise reoccurrence.

There were enough staff to support people and to meet their needs. The provider had systems in place to adapt to the changing needs of people and to make provision for additional staffing when required. Staff members could not start work until the provider undertook checks to ensure they were safe to work with people. The provider had procedures in place to address any unsafe staff practices.

People received support with their medicines from staff who were assessed as competent and followed safe practice with medicines. The provider undertook checks to ensure staff followed safe procedures when administering medicines. If errors occurred the registered manager and provider had systems in place to learn from incidents and to take action to prevent reoccurrence.

People were supported by staff members who had the skills and knowledge to meet their needs. Staff members attended training that was relevant to the people they supported. Staff received support from the registered manager and provider who promoted an open and transparent culture.

People were involved in decisions about their day to day care. When people were not able to make decisions for themselves they were supported by staff and advocates who understood and took steps to ensure their rights were upheld.

People received care and support which was personalised to them and reflected their personal preferences. People’s care and support was adapted with people’s changing preferences. People took part in activities they liked and found interesting, stimulating and fun.

People were supported by staff who knew them well and had good relationships with them. People were involved in their own care and information was given to them in a way they could understand. People had their privacy and dignity respected by staff who also encouraged them to do as much as they could to maintain independence.

People had a choice of food to eat and were prompted to maintain a healthy balanced diet. People’s routine health needs were looked after and people had access to healthcare when they needed it.

People and staff felt able to express their views and felt their opinions mattered. People were involved in the day to day running of their home and were involved in any changes. The provider and registered manager undertook regular quality checks in order to drive improvements.

Inspection carried out on 8 July 2014

During an inspection in response to concerns

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found.

Is the service safe?

We saw that people’s views were respected and listened to.

We saw that people were free to go out and about in the secure grounds or into the community with assistance. This enabled the people to maintain as much independence as possible.

We saw that staff had received specialist training in the handling of difficult behaviours. This was to protect people’s physical wellbeing as well as their human rights and dignity.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While nobody was currently subject to a DoLS, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service effective?

Personal records confirmed people’s needs and preferences had been recorded and support had been provided in accordance with their wishes.

Is the service caring?

Staff took the time to find out about people’s background. Staff knew people’s needs well and how they needed to be supported. This meant that staff cared about the person as an individual and were concerned about their well-being.

People and their relatives were encouraged to make their views known about their care. We saw that people found the staff easy to approach about any issues they had. This meant that people were listened to and they felt that their views mattered.

Is the service responsive?

People regularly completed a range of activities in and outside the service and staff supported them in arranging and attending these activities.

We saw the home had been responsive to people’s changing needs and had responded to professional advice that had been provided. For example, we saw the home had requested the assistance of a psychologist for someone who had behavioural needs. They had developed a behaviour management plan to meet the change in needs.

Is the service well led?

The registered manager and the staff demonstrated values that promoted involvement, openness, dignity, respect and independence. We talked with staff who showed they understood those values as they discussed their role and responsibilities in their work. This meant the service promoted an open culture that was centred on the individual and empowered them to take control of their life as much as they were able.

Inspection carried out on 13 August 2013

During a routine inspection

Most of the people who lived in this home were unable to communicate verbally.

As we watched and listened we saw the staff were very attentive towards them. We saw that the staff always considered their privacy and treated them with respect.. We saw that staff talked with them as they provided their support.

Staff told us that they felt able to raise any issues with the manager or senior staff should they have any concerns. Staff talked about how the needed to act to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

We saw staff were always available when people needed help.

The provider had developed a system whereby they can monitor how well the home is meeting the needs of the people who live there.

Inspection carried out on 27 December 2012

During a routine inspection

We observed staff interaction with seven people who used the service as people were unable to tell us their views. We looked at two people’s care records and a variety of records about other people. We spoke with four staff and the manager, looked at records about staff and the running of the home.

The atmosphere was friendly. People made choices about food and activities offerred by staff skilled in people's communication methods. Dignity was respected. Staff worked well as a team to respond sensitively to people’s moods and kept people safe in the home and grounds.

Care reviews were regularly held with families and the home worked with other professionals to carry out best interest treatment decisions. Most people had health checks. Everyone had regular exercise and stimulation. People had their prescribed medicines, which were suitably stored and accessible when needed.

Gender needs were well met and there was opportunity to attend religious festivals. The manager told us of steps they would take to improve the way best interest care decisions were made and recorded to fully comply with mental capacity law and to respect people’s rights to independent advocacy.

New staff had been recruited, trained and were flexibly deployed. People had care from consistent staff and had more opportunity at this inspection for activities with individual support. There were systems to respond to and learn from incidents and complaints should they arise.

Inspection carried out on 6 October 2011

During a routine inspection

We found that the preferences of the people living in the home were at the heart of the way the service was run. The daily routines seemed homely and relaxed. People were taking part in running their home and were making choices about activities and how to spend their time.

We saw people in the home engaging with staff in a calm and affectionate way. The support staff we observed seemed patient and were encouraging people to get involved and be independent where possible. The support staff we spoke with were very positive and enthusiastic about their work.

People were being supported with their medicines in a safe way and were having their health care needs met. Their support needs were included in their care plans and regular review meetings had been held.

People were being supported by a committed staff team who had been trained for their role and who felt well supported by senior staff.

On some occasions there had not been enough support staff for people to go out to all their planned activities. The owners were taking steps to speed up the recruitment of new staff.

The management of the home had remained stable and checks were being carried out by the owners to help keep standards high.