This inspection took place on 19 January 2018 and was unannounced. The inspection continued on 22 January 2018 and was announced.

Fairfield 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 care home accommodates up to 36 people across two floors. The service is located in Lyme Regis and is a large detached building with rooms arranged over two floors and a central ground floor lounge and dining area. There is both lift and stairlift access to the first floor. People are able to access secure outside space at the home. There were 28 people living at the home at the time of our inspection.

At our last comprehensive inspection on 27 September and 4 October 2016 we found that people’s care and treatment was not always appropriate or met their needs. Care and treatment was not always designed with a view to meeting people’s individual needs. The registered persons were not acting in accordance with the Mental Capacity Act (2005) to ensure care and treatment of people was provided with consent. People’s nutritional and hydration needs were not always met to ensure food and hydration was adequate, dietary supplements were not consistently given and people were not always provided with the support required to keep them hydrated. Systems were not always in place to ensure concerns were picked up and met through the quality assurance process.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take steps to improve and ensure that they were compliant. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Effective and Well led to at least good. At this inspection we found that improvements had been made.

The service did not have a registered manager in post at the time of inspection. However the manager had applied to CQC and since our inspection they confirmed that they had successfully registered. 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.

People were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of the risks that people faced and understood their role in managing these to ensure people received safe care. Risks around behaviours that could challenge were planned to be recorded in people’s care plans where appropriate.

People were supported by enough staff to provide effective, person centred support. Staff were recruited safely with appropriate pre-employment checks and received training and support to ensure that they had the necessary skills and knowledge to meet people’s needs.

People received their medicines as prescribed and staff worked with healthcare professionals to ensure that people received joined up, consistent care. Where written guidance around medicines prescribed ‘as required’ was needed, the manager confirmed that this would be put into place.

People were supported from the spread of infection by staff who understood their role in infection control and used appropriate Personal Protective Equipment (PPE).

People were supported to make choices about all areas of their support and staff understood the principles of mental capacity. Where decisions were needed in people’s best interests, these were in place.

People were supported to have enough to eat and drink and there were systems in place to ensure that any concerns around wei

The inspection took place on the 27 September and 4 October 2016 and was unannounced. We last inspected the service on the 21 July 2014 and found regulations were met.

Fairfield House Residential Care Home (known locally as “Fairfield House”) provides residential care for up to 36 older people who may have a physical disability or be living with dementia. There are 33 rooms and 33 people were living at the service when we visited. Nursing services are provided from the community nursing service.

A registered manager was employed to manage the service. 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 found the staffing of the service did not always meet the needs of people living at the service. Staffing of the service was raised as a concern from people and the district nurse on the first day of the inspection. In particular, staff needed to understand and meet people’s increased or increasing needs. We found staff were working long hours across the week to meet people’s needs. This included the registered manager and other members of the senior management team. This meant the contingency to meet unexpected staff short falls was in operation every day and had become the norm. Staff did not have time to spend with people to ensure their emotional and social needs were met. We have recommended the provider and registered manager review staffing to ensure there are enough staff to meet needs as they change.

Staff were task focused. When staff were involved in a task, staff treated people with politeness, kindness and were considerate of people’s needs. People’s emotional and social needs were not always being met.

Staff were recruited safely to ensure they were suitable to work with vulnerable people. People were looked after by staff who understood how to identify abuse and what action to take if they had any concerns. Staff stated they would pass on any concerns to the registered manager. All staff felt action would be taken in respect of their concerns. Staff said they would raise their concerns with external agencies, such as CQC, if they felt concerns were not being addressed. Records showed safeguarding concerns had been fully investigated and action taken as required.

We found staff received training, supervision and appraisals to support them to care for people. However, this had been impacted on by the staffing issues. This meant training of some staff had been delayed, although it was still taking place. The tracker showed gaps in staff training in both mandatory subjects, as identified by the provider, and in areas that would have addressed the wider needs people had. Also, training for staff in respect of dementia care needed updating and was not offered to all staff despite having a high number of people living with dementia. Plans were in place to ensure all staff were trained in these areas.

People were not being assessed in line with the principles of the Mental Capacity Act 2005 (MCA). Requests for authorisations to deprive 15 people of their liberty had been requested without first completing an assessment of the person’s capacity to consent to their own care and treatment. This meant the legality of how people were being assessed and deprived of their liberty could not be assured. Also, decisions in relation to people’s care were being made without assessing whether the person had the capacity to consent, or whether they required a best interest decision to be made. When offering care people confirmed staff always asked their consent and staff understood the importance of seeking consent on each occasion. The registered manager had started to address this by the second day of the inspection for one person.

People

A single inspector carried out this inspection. 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? 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.

Is the service safe?

People were offered choices in their daily routine and we observed that many staff knew about people's care needs. The care plans contained sufficient information to guide staff in how to meet people's needs safely and effectively. The home worked with other agencies and took initiatives in seeking specialist advice where required. Training was given to all staff to ensure there was an awareness of adult safeguarding and so staff knew how to be alert to any signs or symptoms of abuse. Staffing was adequate to meet the need of people.

Is the service effective?

People's needs were reviewed and risk assessments were sufficiently detailed to protect people from harm. Where people did not have capacity to give consent to their care, the manager had taken appropriate steps to obtain valid consent. This meant people’s rights were respected.

Is the service caring?

We saw people being treated with respect and consideration and staff took time to engage positively with people. People told us they were happy with their care. Two people told us they had received emotional and practical support to help them with depression and low mood. Several people told us they enjoyed opportunities for which they had asked to go out to places of interest.

Is the service well led?

The home had experienced changes in staffing and management which had contributed to some uncertainty amongst staff and people. However we saw the home owners were working with external consultancy to help manage this transition and develop the service. The service was checked and audited in relation to individual care planning, incidents and accidents. Reviews of staffing had recently taken place. People and staff were asked about their views and this was used to develop on going improvements.

Our inspection of 25 November 2013 found that daily care records had not always been completed accurately and did not demonstrate that people’s care needs had been met. These records were not always consistent with other records used by staff and contained conflicting information.

During this inspection, we found that a new recording system that ensured people’s individual care needs were accurately recorded had been implemented by the registered manager.

We saw that people or their representatives were involved in the planning and delivery of care. One person we spoke with said “I’m happy here, it’s enjoyable and everything is how I like it.”

People’s care needs and risks were assessed and care was delivered to meet their needs. One person commented, “The staff are wonderful. I only have to ask and they will do whatever they can.”

People were protected from harm as there were appropriate safeguarding procedures.

Staff were supported by the provider through appropriate training, supervision and appraisal.

The home had suitable systems to monitor the quality of service provided.

People’s records did not always contain accurate and appropriate information.

People told us that they were consulted about the way the home was run. They told us that they could raise issues with the staff or manager and were confident that they would be listened too and action would be taken.

We found that improvements’ had been made in relation to ensuring that a system was in place to monitor the quality of the service provision.

We found that medicines were safely administered. We observed people being given their medicines at lunchtime and saw that they were given in a safe and friendly way. People were being asked if they needed any medicines that had been prescribed to be given when required, for example pain killers.

We found that some people were looking after some of their own medicines, and we saw records that showed it has been assessed as safe for them to do this.

People told us that they felt the staff treat them well. They told us that they felt confident that staff will help them in a way that they wish. They also told us that they felt safe living at the home.

A visiting relative told us about the satisfaction they had with the home meeting their relative’s needs. They told us they were included in the decisions made about the care of their relative and were often consulted about how the home was run.

The staff told us about people’s needs and how they met them. They were knowledgeable about the people they worked with and how they wished to be treated.

We looked at a number of records relating to the running of the home. We found that some records had improved and others had not. We looked at the auditing of the quality of care records and found them to be inconsistent. We looked at the medication audit and found that issues identified had not been acted upon. These records evidenced issues important to the health and well being of the people who lived at the home. However these issues were not always acted upon in a timely way.