This inspection took place on 18 and 20 July 2018 and our first visit was unannounced.

Fairfield Care Home 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.

Fairfield Care Home provides care and accommodation for up to 21 older people. There were 19 people living at the home at the time of our inspection.

At our last inspection in February 2017 improvements were needed in three of the key questions we inspected these were Effective, Responsive and Well led and we identified one continued breach of the regulations. We rated the service Requires Improvement' overall.

We asked the provider to make improvements. They sent us an action plan which informed us the necessary improvements would be completed by July 2017.

During this inspection we found not all improvements had been made and sufficient action had not been taken in response to the breach in regulation. Lessons had not been learnt by the provider because quality assurance procedures were not effective to always keep people safe. The provider was heavily reliant on the registered manager to ensure the home was running effectively. The provider's lack of managerial oversight meant opportunities to drive forward improvement had been missed.

Also, additional areas where the home had previously performed well now required improvement. Therefore, the service continues to be rated as ‘requires improvement’ and continues to be in breach of the regulations.

The service is required to have 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 and associated Regulations about how the service is run. Since our last inspection the management at the home had changed. The previous registered manager had left their employment in April 2017. A new manager had been in post since June 2017 and registered with us in May 2018.

Enough staff were available to meet people's needs. However, the provider had not consistently followed their recruitment policy to ensure staff who worked at the home were of suitable character which placed people at potential risk. Action was being taken to address this shortfall.

Most people felt safe living at the home and procedures were in place to protect people from harm. Staff had received training to support them to understand their responsibilities to report any witnessed or allegations of abuse. However, the provider was not keeping us informed of events, such as allegations of abuse that they are required to inform us about.

Risk assessments identified potential risks to people's health and wellbeing. Risks were regularly reviewed and staff demonstrated a good knowledge of how risks were to be managed.

People received their medicines when they needed them from trained staff. However, checks of people’s medicines had not identified a series of issues. We found medicine administration records were not completed as required. People's creams did not have the date they were opened or the date when they should be discarded recorded. Also, we could not be sure staff checked people's medicine was correct before administering them.

Staff understood the provider’s emergency procedures and the actions they needed to take in the event of an emergency. Incidents and accidents that happened at the home were recorded and analysis of incidents was completed to reduce the risk of reoccurrence.

Maintenance and safety checks carried out at the home were not always effective to keep people safe. Staff understood their responsibilities in relation to infection control but improvement was required to ensure infection con

This inspection took place on 15 February 2017. The inspection visit was unannounced.

Fairfield Care Home is a residential care home which provides care for up to 21 people and supports some people who live with dementia. There were 19 people who lived at the home at the time of our inspection visit.

When we inspected Fairfield Care Home on 6 February 2015 we identified a breach of regulation in relation to how the provider monitored and assessed the quality and safety of the service provided. At that time the home did not have a registered manager. The management of the service had been inconsistent and we found some actions identified for improvements at our previous inspection on 18 September 2014 had not been taken. We asked the provider to send us an action plan of how they would address the issues we had identified.

We returned to Fairfield Care Home on 17 September 2015 and we identified a continued breach of regulation in how the provider monitored and assessed the quality and safety of the service provided. At this inspection we found that improvements had not been made and the provider continued to be in breach of this regulation. We met with the provider and issued a warning notice to become compliant with the regulation.

On 5 January 2016 we completed a focussed inspection of Fairfield Care Home to see if improvements had been made to address the issues identified within the warning notice. We found that some action had been taken to improve how the service was led, however further improvements were required and the home continued to be in breach of this regulation.

The provider had undergone changes in the management team at the home. At the time of this inspection on 15 February 2017 the service had 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. The registered manager had been registered with us since October 2016.

In addition to there being a new manager in post, there have also been changes to the deputy manager and senior care staff. Staff felt the new registered manager was open and supportive to them. However, not all felt the provider was as supportive, and felt they had not listened to their concerns about the service when they had been raised. At times, the provider’s oversight into improvements required to the service people received was ineffective.

Staff knew the importance of seeking consent when providing care to people, but did not have in-depth knowledge of the principles of the Mental Capacity Act. Where people had been diagnosed as having a condition which impacted on their capacity to understand, there were assessments to determine what decisions the person could make, and what needed to be made in their best interest. Deprivation of Liberty safeguards were in place for people whose reduced capacity had meant their liberty had been restricted, however these were out of date and had not been re-applied for.

In October 2016 the home was visited by a community pharmacist team who identified a number of issues in the way medicines were stored, audited and administered. The registered manager had worked with the pharmacist team at addressing the issues raised.

The provider did not have an effective infection control system in place that protected staff and people who used the service from the risk or spread of infection.

There were enough staff to meet people’s needs. Risks to people’s health and well-being were known by staff, and written risk assessments and care plans had up to date information to support staff in their knowledge of people. Pre-employment checks were completed to ensure, as far as possible, that people employed to support people living in the home

We carried out an unannounced comprehensive inspection of this service on 17 September 2015. At which a breach of legal requirements was found. This was because the provider did not have systems in place to monitor and assess the quality and safety of service provided. The provider did not have a registered manager at this service. We served a warning notice in relation to this.

After the comprehensive inspection, we met with the provider and they wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused unannounced inspection on 5 January 2016 to check that they had followed their plan and improvements had been made. At this inspection we found some improvements had been made, however further improvements were required in order for the provider to be fully complaint with this regulation.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Fairfield Care Home’ on our website at www.cqc.org.uk.'

Fairfield Care Home is registered for a maximum of 21 people offering accommodation for people who require nursing or personal care. At the time of our inspection there were 16 people living at the service.

A requirement of the service’s registration is that they have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There was no registered manager in post and there had not been since April 2013. The previous manager had left in August 2015 after six months in the role. A new manager had been in post since September 2015. At this inspection they told us that they had submitted an application in October 2015, however, this had been returned as it was incorrectly completed. No further application had been submitted as the provider and manager were awaiting for some further background checks to be completed for the application and told us this was near completion. The manager told us they were fully intending to resubmit their application to us.

At this inspection we found that some improvements had been made, however the provider continued to be in breach of this regulation. At times the quality and safety of care people received remained unsatisfactory.

The provider had displayed their last inspection ratings as is the legal requirement to do this, however on the day of our visit, these were not legible. The manager was aware of the notifications they were required to send us, however we had not received all of these.

Learning and development opportunities remained limited for staff. The manager had made some changes to improve this and further plans were in place.

Protocols for medicines given ‘as required,’ were now in place, however these required some further updating.

Care records and risk assessments had been reviewed, however did not always contain relevant information to support people. There was not always enough staff available to support people at times they required.

The manager and staff had some understanding of the principles of the Mental Capacity Act 2005 (MCA). Mental capacity assessments had been completed however were not personalised. Some people at the service were being deprived of their liberty and the appropriate applications had not been made.

Some quality monitoring audits had been undertaken. There were no audits in the area of infection control and we saw some areas of concern in relation to this during our visit.

People and staff told us they could raise concerns with the management team who were approachable. Staff felt more supported in their roles and there were now some opportunities to discuss any i

We carried out this inspection on 17 September 2015. The inspection was unannounced.

Fairfield Care Home is registered for a maximum of 21 people offering accommodation for people who require nursing or personal care. At the time of our inspection there were 18 people living at the service, two people were in hospital.

A requirement of the service’s registration is that they have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There was no registered manager in post and there had not been since April 2013. The previous manager had left in August 2015 after six months in the role. A new manager was in post, and had been there for five weeks at the time of this inspection. They told us that they intended to apply for registration as registered manager of the service.

At our last inspection on 8 February 2015, we identified a breach of regulation in relation to how the provider monitored and assessed the quality and safety of service provided. At this inspection we found that improvements had not been made and the provider continued to be in breach of this regulation. Inconsistency of management and leadership at the service meant, at times, the quality and safety of care people received was not satisfactory. For example safety checks of equipment were not consistently completed, audits of complaints, accidents and incidents had not been carried out, records were not kept securely and people were not asked for their views about the service.

People and staff told us they could raise concerns with the management team who were approachable. However, continued changes in management, meant staff did not always feel supported in their roles and opportunities for staff to discuss their work performance, learning and development were limited.

A small number of quality monitoring audits had been undertaken but these did not identify the concerns we found around assessing the quality of the service. These included shortfalls in staff knowledge around MCA and DoLS, and that other staff training had lapsed. Care records and risk assessments had not been updated. There had been no staff meetings since May 2015. The provider did not respond formally to complaints, and people had limited opportunities to be involved in the running of the service. Accidents and incidents were recorded but not analysed. Fire drills had not been carried out since December 2014. The provider had not displayed their last inspection rating as per the legal requirement to do this.

People told us they felt safe living at the service. Staff were trained in safeguarding adults and understood how to protect people from abuse. There were some processes to minimise the risks to people’s safety, however these were not always reviewed as people’s needs changed.

Medicines were administered as prescribed, and stored and disposed of safely. However, there were no protocols for medicines given ‘as required,’ so we could not be sure these were given consistently or correctly. There were enough staff to provide the support people required in order to meet their needs and preferences. Checks were carried out prior to staff starting work to minimise the risk of recruiting unsuitable staff to work with people who used the service.

People told us staff were respectful and had the right skills to provide the care and support they required. However, we did not see people being supported with dignity and respect at all times, for example people were not always afforded privacy by being able to lock toilet doors.

People told us they enjoyed the meals provided, were offered choice and different dietary needs were met.

The manager and staff had some understanding of the principles of the Mental Capacity Act 2005 (MCA). However mental capacity assessments were not always completed correctly, so we could not be sure the rights of people unable to make decisions for themselves were being protected.

We inspected Fairfield Care Home on 6 February 2015 as an unannounced inspection.

The home is registered to offer personal care and accommodation for up to 21 older people. Fairfield is an older style property providing care and support over two floors. At the time of our inspection 20 people lived at the home.

The service is required to have a registered manager. The 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 a 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 had not had a registered manager since April 2013. A new manager had recently been appointed and had been in post for around one week at the time of our visit. Prior to the appointment of the new manager, there had been a number of acting managers providing managerial cover. On the day of our inspection the new manager and acting manager (who had in post since October 2014) were present.

At our last inspection in September 2014, we identified some areas of concern in relation to infection control. Following this, the acting manager sent us an action plan which told us about the improvements they would put in place. At this inspection we found improvements had been made around infection control.

All the people we spoke with told us staff were caring and we saw examples of this during our visit. People were encouraged to be independent by staff and care was provided with dignity and respect. People told us they were happy living at Fairfield.

People told us they felt safe but we saw medicines were not always stored securely or given safely. The checks required to ensure the home was safe had not always been completed and improvements were required around areas such as fire safety and ensuring equipment was safe to use. Management of the service had been inconsistent and the new manager had identified some areas that required improvement and had put some plans in place to address these areas.

Staff had some knowledge around safeguarding people but were not confident in understanding the different types of abuse and how to report this. Staff told us training had lapsed recently, however more training was planned in the next few months. Due to changes in management, staff did not always have ways to share any concerns they had.

Detailed risk assessments were evident and reviewed when required to meet people’s needs. However, care staff did not always follow the recommendations of health professionals when providing care. People received the support of health professionals such as the GP, chiropodist and district nurse to ensure their health needs were met. A visiting health professional was positive in their views of staff and the support provided to people.

People told us they enjoyed the food at the home and staff were aware of people’s dietary needs. Staff had a good knowledge of the needs of the people they were caring for and supported people’s hobbies and interests.

Staff understanding of the Mental Capacity Act was minimal and there were differing views about whether people had capacity. There were no capacity assessments completed to determine whether people could make some decisions for themselves or not.

The provider was not meeting their requirements set out the in Deprivation of Liberty Safeguards (DoLS). At the time of our inspection, no applications had been submitted under DoLS for people’s liberties and freedoms to be restricted. The manager was unclear when a DoLs application should be made, however they told us they would seek further guidance.

People told us they knew how to make a complaint, however complaints had not been recorded and kept, so it was difficult for us to establish whether complaints were dealt with to people’s satisfaction.

We carried out this inspection to assess whether or not improvements had been made following our last inspection visit to this service in July 2014 . At that inspection we found improvements were required to cleanliness and infection control in the service.

We set a compliance action in relation to these areas and received a report from the manager that told us what they intended to do to achieve compliance.

We followed up on this area of non compliance by undertaking an inspection on 18 September 2014. During this inspection we spoke with some people who lived in the home and members staff on duty including care and cleaning staff. We also looked at cleaning records available and observed cleaning in five bedrooms. We found that some improvement had been made since our last visit, but the service remained non-compliant in this area.

People we spoke with told us they were satisfied with the cleanliness of the home. "It's lovely and clean", "My room gets a clean every day" and "It's not necessary to clean my room every day but it gets done all the same," were comments made.

We did not detect any offensive odours during our visit and the home appeared clean and tidy.

Care and cleaning staff had been provided with infection control training to ensure they were aware of the national guidelines for infection prevention.

Care staff were aware of the need to follow appropriate guidelines when dealing with people's laundry to prevent the risk of infection.

Practices used in the process of cleaning peoples bedrooms did not protect them from the risk of infection via cross contamination.

This inspection was a scheduled inspection completed by one inspector. We spoke with four people and one relative of people who used the service. We also spoke with the manager, three carers and one housekeeping staff.

The evidence we collected helped us to answer 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 we observed, the records we looked at and what people using the service, their relatives and staff told us.

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

Is the service safe?

People we spoke with told us they felt safe. One person we spoke with said: “Oh yes, the staff are ever so good here and look after me."

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager was able to describe when an application should be considered and who should be involved in the process. We saw records that showed a number of staff had received training in mental capacity. The registered manager was aware of the recent High Court judgement that may have an impact of future applications and had received further training in this area.

The home was clean and tidy with no apparent odours. However, we identified staff did not always follow infection control guidelines when required. We have asked the provider to send us an action plan informing us of how this issue will be addressed.

People told us if they needed anything repaired or replaced, this had been done with minimal delay. We saw maintenance records that confirmed repairs had been undertaken promptly.

We found equipment was maintained and regularly serviced. We found the provider carried out regular fire checks and ensured people and staff knew what to do in the event of an emergency.

Is the service effective?

People had an individual care plan which explained what their needs were. People and relatives told us they had been involved in the care assessment and their contributions were listened to. Risk assessments were regularly reviewed and identified current risks.

We found staff had received the necessary training that enabled them to provide suitable and appropriate care for people.

Is the service caring?

People were supported by staff who provided care at people’s preferred pace. Staff were kind and attentive and responded appropriately to people’s requests.

Staff promoted individual choice and supported people who wanted to remain as independent as possible. We found individual wishes were taken into account.

Is the service responsive?

People received help and support from other health professionals when required, such as doctors, opticians, speech and language therapists and district nurses.

People were supported to participate in activities inside and outside of the home. At the time of our inspection people participated in a game of indoor skittles and dominoes.

The service had systems in place to monitor the care provided to people. This included reviews of people’s care records.

Staff said they had a handover at the start of each shift to update them of any changes in people’s needs since they were last on duty.

Is the service well led?

The service worked alongside other health care professionals and agencies to make sure people received the care they required. We spoke with relatives who confirmed outside health professionals had provided care and support to their family members.

The service had an effective system in place that assured the quality of service they provided. The service completed regular checks and sought the views of people who used the service. The service also gained the views of staff and we found the service listened and acted upon these views.

People’s care records and other records were accurate, available and completed.

On the day of our inspection there were seventeen people living at the home, with three care staff on duty. Along with the manager, a housekeeper and handyman were also working in the home.

The manager had been in post at Fairfield for ten weeks and had already made significant changes in the way the service was provided. We could see that improvements had been made throughout the home. For example, documentation and records were very well organised. Care plans had been rewritten involving the individual and their families. Recruitment of staff was underway and staff training was now taking place.

Furniture and fittings had been reorganised to make the communal areas more welcoming and comfortable. Dining room tables had been rearranged to make more space in the room. Tables were nicely laid with tablecloths, runners and napkins. Condiments were available and flowers in pretty vases decorated each table.

The whole atmosphere in the home had changed for the better. Staff were smiling, people living there were happy and engaged in conversations and activities, and visitors to the home were made very welcome.

People told us they were very happy living at the home and were well cared for.

We inspected Fairfield Care Home in July 2012 and found the provider was not complying with regulations about the management of risks to people’s health. We told the provider they must make improvements and they sent us an action plan telling us what they were going to do.

We inspected Fairfield Care Home again in September 2012 and found the provider had not made the necessary improvements. We issued a warning notice to the provider and manager requiring them to become compliant with Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 by 19 October 2012 or we would take further action to make sure that they achieve compliance.

We undertook an unannounced inspection on 22 October 2012 to check whether the provider complied with our warning notice. We met and spoke with 10 of the 11 people using the service.

We spoke with the provider, manager, care staff and two care workers. We also spoke with a care business consultant the provider had employed to advise on improving the care planning systems in the home. We looked in detail at the care records for three people. We looked at some of the other records relating to people’s welfare, such as weight monitoring records.

We found evidence of improvement. Risks to people’s health and welfare were identified and appropriate action was taken to minimise the risks. This meant the provider had complied with our warning notice.

We inspected Fairfield Care Home in July 2012. The provider was not complying with regulations about the management of risks to people’s health, safe management of medicines, promoting people’s dignity and the way complaints were handled.

We told the provider they must make improvements and they sent us an action plan. The action plan did not include enough detail about what the provider was going to do and how they were going to do it.

We met with the provider on 14 August 2012 to discuss our serious concerns. The provider subsequently sent us two further versions of their original action plan.

We undertook this inspection to check if the provider had taken action to make improvements and comply with regulations.

We made an unannounced visit to Fairfield Care Home on 19 September 2012. There were 13 people using the service at the time of our inspection.

We looked in detail at the experience of three people using the service and spoke with eight others.

Their comments included,

“Everyone is helpful and friendly.”

“The owners said to me, ‘if there is anything troubling you, feel free to come to the office and we will sort it out.”

We spoke with the manager and two care staff. We looked at some records relating to the running of the home, such as the staff files and complaints records.

We found evidence of improvement in some but not all of the outcomes we assessed. We still have serious concerns about the way the service manages risks to people’s health.

We decided to inspect this service because information was shared with us that raised concerns about whether people’s needs were met safely.

We made an unannounced visit to this care home on Wednesday 25 July 2012. There were 14 people using the service when we visited.

We met most of the 14 people using the service and spoke with eight of them about the service they received. People’s comments included,

“I am satisfied with the care I get.”

“It’s ok. It’s a roof over my head.”

We looked closely at the care and support experienced by two people. We looked at some of the care records for all of the people using the service, for example weight, nutrition and medicine records.

We spent time in the lounge and dining room closely observing people’s experience. We looked at their mood, how they spent their time and how staff interacted with them.

The manager was not at work on the day of our inspection visit. We spoke with three care staff, the cook and one of the owners of the home.

We observed staff addressing people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We were concerned that the personal appearance of people using the service varied, which meant people were not consistently supported to maintain their dignity.

We were concerned that people did not experience care, treatment and support that consistently met their needs and protected their rights. For example, some people were not supported to maintain their personal hygiene.

We found that people’s nutritional needs were met and there were systems in place to monitor people’s weight. People told us they were satisfied with the food they were given.

We were concerned that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. For example, we found recording errors which meant it could not be confirmed that medicines had been administered correctly.

We found there were enough staff on duty to meet the needs of the people using the service.

We were concerned that the systems in place to deal with comments and complaints were ineffective, so people could not be confident their concerns were taken seriously.

We observed good interaction between staff and people living at the home. People were treated with respect, and involved in making decisions about their day.

We spoke to people living at the home and their visiting relatives, they were all very positive about the care they received at Fairfield. Comments included: ‘I am very happy here’ ‘Everyone is very nice’ ‘The staff are always friendly and helpful’ ‘The home is good, run by caring and efficient staff’.

All the staff we spoke to during our visit were very friendly, helpful and professional.

People at the home told us that they enjoyed living there. They felt well cared for and they liked the staff. They said:" They are very kind to me" "They look after me well" "I have no complaints".

There was an issue around the lack of choice at mealtimes, and the lack of assistance from staff to support people during mealtimes. People told us that the food was very nice but there was always too much on the plate.

People feel safe and protected at the home. They told us: "I feel very safe living here, it’s the best decision I made" "Staff are very kind and friendly".

The home was warm, welcoming and comfortable. People who live there told us they were happy with their living environment. They said: "Its very comfortable here" "Its always very clean, and there are no smells" "I like living here, its warm and comfortable".

People living at the home told us that the manager was very competent and friendly. They said they felt safe knowing that the manager was in charge.