This comprehensive inspection took place on 8 January 2019 and was unannounced.

Fairland House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Fairland House is registered to accommodate up to 34 people. Care is provided over two floors. There are communal areas that people can reside in along with space for dining on the ground floor. At the time of our inspection visit 29 people were living in the home, eight of whom were living with dementia.

The last manager to be registered with CQC at this service de-registered in August 2018. A new manager took up post but then left the service. The current manager started in November 2018. They are not currently registered with CQC but they have made an application to do so. A registered manager is a person who has registered with the CQC 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. Since the last inspection the nominated individual of the provider who has overall responsibility for monitoring the quality of care provided had also changed. They also commenced this new role in November 2018.

At the last inspection of Fairland House, we rated the home overall as requires improvement. This was because people had not always received care that was safe or effective to their needs and systems in place to monitor the quality of care had not been robust. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective and well led to at least good.

At this inspection we found that the provider continued to be in breach of two regulations of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for the home therefore remains as requires improvement. This is the third consecutive inspection that the home has been rated as requires improvement. This demonstrates a lack of learning and consistent drive for improvement to ensure the quality of care reached an overall rating of good.

Not all risks to people’s safety had been assessed and therefore mitigated. Most staff used good and safe practice but some did not. These factors placed people at risk of avoidable harm.

Staff had not completed all the training they needed to although the manager was aware of this and some overdue training had been booked. Activities for people to participate in to stimulate their wellbeing had declined but this was being addressed. People’s views were being sought to improve this area.

The premises would benefit from some improvements to help people living with dementia orientate themselves. We therefore recommend the provider consults appropriate guidance in this area to make the necessary improvements.

The current manager in post demonstrated a passion to learn and people and staff told us improvements had been made since the manager had started working in the home. New systems had recently been put in place to drive this improvement but these were not currently all effective or embedded to ensure that risks to people’s safety were consistently managed well. People, relative and staff views about the care provided had been sought and the manager was using this feedback to help improve the quality of care people received.

People were very happy living in the home and they were provided with support by staff who were kind and caring. People were treated with dignity and respect and they had built caring relationships with the staff.

People received enough food and drink to meet their needs and they had been involved in making decisions about the

This inspection took place on 23 and 25 January 2018. The first day was unannounced.

During our last inspection in December 2016, we found four breaches of Regulations. These had been in respect of Regulations 9, 11, 12 and 17. This was because some people’s needs and risks to their safety had not been adequately planned or managed. There had been a lack of clear guidance in place for staff to follow to help them provide people with safe and appropriate care. Also, consent for people’s care had not always been sought in line with relevant legislation and the provider’s governance systems had not been effective at monitoring the quality of care people received.

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 questions of Safe, Effective, Responsive and Well Led to at least good. This was not received at our first request but was sent after a further letter was issued to the provider regarding the matter.

At this inspection we found that improvements in certain areas had been made. However, the provider remained in breach of Regulations 12 and 17. This was because we found that some risks to people’s safety had either not been assessed or managed well. The provider’s governance systems had again failed to adequately monitor the quality of care people received and therefore, to drive the required improvements needed. In addition, we found two breaches of the Care Quality Commission (Registration) Regulations 2009 as the provider and registered manager had failed to notify us of some incidents that had occurred which they are required to do by law.

Fairland House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 34 people over two floors. At the time of the inspection, there were 27 people living in the home.

A registered manager was working at the home. A registered manager is a person who has registered with CQC 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’s medicines were not consistently managed well and staffing levels were not always in line with the provider’s requirements. Most staff used good and safe practice but some did not consistently do this for the benefit of the people living in the home.

Staff had not completed all of the training they needed to complete although the registered manager was aware of this and was booking the relevant training. People’s risk assessments did not all contain sufficient guidance for staff on how to mitigate risks to their safety.

Activities for people to participate in had declined recently. This was because the staff member who was responsible for this area had recently left the home. Again, the registered manager was aware of these areas and was actively working to improve them.

The people we spoke with were happy living in the home. They received care that was based on their individual needs and preferences. They were treated as individuals and were empowered to make decisions and take risks in relation to their own care. Their diverse needs were adhered to and respected. This was the culture that had been embedded in the home and the staff and management in the home were passionate that people should receive this type of care.

People were provided with care and support by kind and caring staff who treated them with dignity and compassion. This included as they reached the end of their life. Staff were mindful about people’s rights to privacy and ensured this took place.

The management and staff engaged people in the run

We carried out an unannounced inspection over two days on the 16 and 20 December 2016. On the second day we had arranged to go back to meet with the owner of the care service and to look at further records. At the last inspection to the service on the 05 December 2013 the service was found to be meeting all the required standards.

The service provides accommodation and care for up to 34 older people. At the time of our inspection there was no registered manager in post. The owner had appointed a manager and they had been in post approximately three weeks and were supported by a deputy manager, senior staff and a full complement of staff. They told us they intended to apply for registration 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.

In summary we found that people were well cared for by staff that were familiar with their needs and responsive to their wishes. People gave us positive feedback about their experiences and the staff that cared for them. The environment was clean and well maintained and refurbishment was on-going. A lift had been installed in the last few weeks. Prior to this a stair lift was in situ.

The manager was newly in post and already identified what they needed to put in place to ensure the smooth running of the service. Staffing levels were being maintained but occasional agency staff were being used to cover long term sickness. Staff were also being deployed to cover gaps in the rotas which effectively reduced the amount of care hours being provided. For example care staff were doing laundry and activity staff doing care hours. This impacted on people’s experiences.

We have made a recommendation about the use of a dependency tool to establish people’s needs which will help determine how many staff are required.

Staff were aware of people’s needs but people’s records did not clearly reflect their needs or provide information about how risks were to be effectively managed and monitored. It was evident that because staff knew people they were quick to refer concerns to other health care professionals but in terms of accountability. There were not clear records of the care given in accordance with people’s needs.

We have made a recommendation about information required in an emergency. Do not attempt pulmonary resuscitation. DNAPR.

Staff promoted people’s well-being and offered them meaningful choice. However we were not assured that the service always assessed capacity in line with the Act or always acted in a person’s best interest as there was very little recorded in people’s records about capacity, risk taking and promoting choice. The MCA and DoLS ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements. People’s capacity to give consent had been assessed and decisions had been taken in line with their best interests. DoLS applications had been appropriately submitted to the local authority. We have identified a breach.

Servicing and auditing of equipment and premises were in place to ensure safe systems of work but these were not sufficiently robust.. We found records of accidents, incidents, falls and occurrences in place but no clear overview of these to help determine patterns and trends over time.

There were systems in place to ensure people received their medicines as prescribed and staff were trained to administer them. Minor concerns were identified, which we will comment further upon in the main body of the report and were being addressed by

During our inspection we spoke with seven people who used the service. One person we spoke with told us, “It’s a marvellous place. I get all the things I need and I get on well with the staff.” Another person we spoke with told us, “The food here is just like a hotel. It’s never too much for anyone to do anything for you.”

We found that people who used the service understood the care and treatment choices available to them. People who used the service were also given appropriate information and support regarding their care or treatment.

We reviewed six sets of care records and found that people’s needs were fully assessed. Care and treatment was planned and delivered in line with people’s individual care plans. The care records showed us that care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare.

As part of our inspection we spoke with six members of staff and found that there were enough skilled, experienced and qualified to staff to meet people’s needs. We found that there was regular assessment and monitoring of the service and effective systems in place to reduce the risk and spread of infection.

During our inspection of 28 February 2013 we spoke with people living at Fairland House. They told us that they were always asked before personal care and support was provided to them by staff members.

We saw that people received appropriate care and support according to their personal needs. Risk assessments were regularly updated and advice was provided to staff members about how to provide care and support to people living at the home.

People were protected from the risks associated with medicines. We saw that medicines were stored safely and appropriately dispensed and recorded.

We saw that people living at Fairland House were supported by suitably qualified, skilled and experienced staff members.

There was an effective complaints system in place, and people knew how to make a complaint if they felt they needed to.

On the day of our visit a family carer told us that their relative liked to be part of a community and said that the staff made them feel very welcome and comfortable. People we spoke to were all extremely complimentary about the home, the manager and the staff team.

We observed that staff were attentive towards people using the service. Several people told us that they were "Very content with the care and support they receive." One person we spoke to told us that "I am very happy here and look at it as my home." "The staff treat me with kindness and care." One person we spoke to stated that they "Always enjoyed the food and if I don't like what they have on the menu they will always make me something else that I do like."

One person we spoke to stated that they would like to have access to more reading material, suggesting that the local library could supply some new books for people who are unable to access the library independently.

People told us that they felt safe and comfortable to talk to staff about any issues they may have. One person we spoke to said "People here care about us and what I think, they are kind to me and listen." Another person told us that "There is always some one to talk to and the manager is always available ."

People we spoke with told us they were happy and liked living at Fairland House. People told us they get the help and support they need from staff when they ask for it. One person we spoke with told us “I get very good care, I have no complaints”. Another person we spoke with told us “I feel happy here; I wouldn’t want to be anywhere else”.

People who were able to communicate verbally told us that they felt safe and well cared for. One person we spoke with told us that "they look after me very well here, I feel safe and cared for". One person with whom we spoke said, "People here care about us and what I think”, they are kind to me and listen".