The inspection took place on 13 November 2018 and was unannounced. The inspection continued on 14 November 2018 and was announced.

The service is registered to provide accommodation and personal care for up to 60 older people. At the time of our inspection the service was providing residential care to 57 older people.

Fairlawn 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 was not safe. Systems and processes were not always operated effectively to protect people from abuse and improper treatment. Medicines were not always managed safely and people were not supported in accordance with the provider’s protocol following falls. This was a breach of the regulations

People were not protected from the risk of infection. The home was not clean and the fabric of the building was damaged in parts making cleaning difficult. Improvements were not always consistently followed or completed when things went wrong and lessons were learnt. This was a breach of the regulations.

Staff had not received supervision and appraisals. This was a breach of the regulations.

Systems to monitor and improve the quality of the service were not fully effective. A number of quality monitoring systems were in place including audits and monthly visits by the operations manager. While these activities identified some areas for improvement they did not always result in actions being taken to improve safety or quality. This was a breach of the regulations.

Two people’s DoLS authorisations had expired and applications had not been made in advance of the expiry date. This was due to a system failure. Staffing was not always arranged to ensure people’s needs were met. Professionals and staff told us there were not enough staff.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs and the people important to them. A complaints process was in place and people felt they would be listened to and actions taken if they raised concerns. People’s end of life wishes were known including their individual spiritual and cultural wishes. Feedback and observations of social and occupational stimulation within the home was mixed.

We have made a recommendation about helping people in care homes access activities that will improve their health and social wellbeing.

People had been involved in assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People had their eating and drinking needs understood and met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. People were supported to have choice and control of their lives.

People, their families and professionals described the staff as caring, kind and friendly and the atmosphere of the home as warm and inviting. People could express their views about their care and felt in control of their day to day lives. People had their dignity, privacy and independence respected.

People’s, professional’s and staff’s feedback on the management at the home was positive. They described them as, approachable, supportive and professional.

During our inspection we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

The service provides accommodation and personal care for up to 60 older people. On the second floor there is a specialist care unit for people living with dementia. This service did not provide nursing care. At the time of our inspection there were 57 people using the service.

The service had a newly appointed manager in place who had applied to the Care Quality Commission to become the 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 legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People’s nutritional needs were assessed to make sure they received a diet in line with their needs and wishes. We observed the midday meal being served in two dining areas of the home. Staff made sure that people received any specialist diets they required including soft textured food and were clear about who required support to eat and when. However the deployment of staff meant that not all people were able to be supported individually or received their meal whilst still hot. We addressed our concerns with the manager, who said they would review the deployment of staff at mealtimes with immediate effect.

Safe procedures had been followed when recruiting new staff. Checks and references had been carried out before a new staff member started working in the home. This meant that new staff were suitable for the job they had applied for and there was a robust recruitment process in place.

New staff completed an induction programme which gave them the basic skills to care for people safely. New staff were also able to shadow more experienced staff. One new member of staff said they had been given time to read policies and procedures at the providers head office, and had been able to shadow other staff for a number of weeks. They said. “The induction was good and gave me confidence to support people, I had someone with more experience to guide me for the first couple of weeks”.

The manager, deputy manager and staff knew the importance of safeguarding the people they supported. Staff told us, and records seen, confirmed that all staff received training in how to recognise and report abuse. Staff spoken with had a clear understanding of what may constitute abuse and how to report it. All were confident any concerns would be fully investigated and action would be taken to make sure people were safe.

Care plans were personalised to each individual and contained information to assist staff to provide care in a manner that respected needs and individual wishes. Risk assessments which outlined measures to minimise risks and keep people safe were held in people’s care plans.

Safe systems were in place to protect people from the risks associated with medicines. Medicines were managed in accordance with best practice. Medicines were stored, administered and recorded safely. Health professionals were routinely involved in supporting people with their health and wellbeing.

People saw healthcare professionals as required, for example the GP, district nurse, chiropodist and dentist. Staff supported people to attend appointments with specialist healthcare professionals in hospitals and clinics. Staff made sure when there were changes to people’s physical wellbeing, such as changes in weight or mobility, effective measures were put in place to address any issues.

On the day of the inspection there was a calm and happy atmosphere throughout the home. Staff were kind and interacted with people in a friendly and respectful way. People’s needs were assessed and care was planned and delivered in line with their individual care plan.

The provider had a complaints procedure the operation manager told us if a complaint was to reach the written stage it is responded to within the specific time scales as detailed wit

People were supported to maintain their independence. For example, one person told us how staff encouraged them to maintain their mobility by supporting them to get their own drinks. Another person told us, “Staff encourage me to do things for myself.” Another person told us, “Staff will do it for you (personal care) but I prefer to do what I can myself.”

People’s needs were regularly reviewed. Each care plan we looked at had been reviewed and updated when the person’s needs had changed. For example, one person was very unwell and there was a short term care plan in place, detailing the action staff needed to take to ensure the person was comfortable and pain free.

People were supported at meal time. We observed staff supporting people who could not eat without assistance. Staff were respectful, sitting beside people, engaging them in conversation and helping them with their meal at their own pace. One person told us, “ I prefer to eat on my own.” Another person told us the food was, “excellent”.

There were cleaning schedules to maintain standards in the home. We were told by domestic staff that during the week different sections of the home were thoroughly cleaned.

People told us that staff responded quickly when they used the call bell. One person told us, “staff are always thoughtful” another person said “ staff always support me the way I prefer”. One person said “ staff are marvellous”

Monthly audits were completed to monitor quality.

People we spoke to told us that care workers were polite and treated them with respect. One person told us that the care workers were “lovely and they work hard”. Although we heard positive comments from people about the help and support they received including a comment from one person: “if I wanted help they would come quickly”. We also heard concerns from both people using the service and staff that indicated that staffing levels were not always appropriate to meet people’s needs. For example: “Lovely girls, but we do have to wait because the girls are getting people dressed in the morning and sometimes at mealtimes”. Another person told us “there is never quite enough staff”.

We found people were provided with a choice of suitable and nutritious food and drink. One person told us "we have a choice of menu which is very nice". Three fluid charts we saw were completed fully by staff protecting people from dehydration. However we saw that the charts did not have an individuals' target food intake written upon them and there were no specific amounts of food consumed recorded on the chart. People therefore would not be protected against the risk of inadequate nutrition.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There was an effective complaints system available. Comments and complaints were responded to appropriately

People told us they are listened to and that staff care about their wellbeing.

People who visit the home told us they consider there is good communication with staff and that their relatives are receiving good care.

People think the home is clean and well maintained and they feel they have their own things around them.