This unannounced inspection took place on the 25 and 28 September 2018. At the last inspection on 12 February 2016 the home was rated Good in each key question and Good overall. At this inspection we found significant improvements and examples of very good and excellent practice. We judged it to now be Outstanding in two key questions and overall.

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

Fairlie House accommodates 45 people in one adapted building across three separate floors, each of which have adapted facilities.. There were 43 people using the service at the time of the inspection. The nursing home cares for people with complex neurological needs, sensory impairments and physical disabilities as a result of brain injury or neurological conditions.

There was a registered manager in place. They had been registered with the Commission as the registered manager for the home since December 2016. 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 there were very good aspects to the systems to monitor safety at the home. Robust fire safety processes were in place and there were effective premises and equipment checks. Risks to people from their individual health needs were carefully assessed, monitored and comprehensive guidance provided to staff to reduce risk. However, one care record did not clearly track the monitoring of skin integrity risk. We saw this was addressed immediately at the inspection.

People were protected from the risk of abuse or neglect. Staff were fully aware of the action they needed to take to ensure people’s safety and well-being. Accidents and incidents were recorded, monitored and acted on appropriately with actions to minimise reoccurrence. There were excellent systems for identifying and sharing learning from adverse events.

There were systems in place to ensure people were protected from the risk of infection and the home was clean and well maintained. There were enough suitably trained staff to meet people’s needs and safe staff recruitment practices were in place. Medicines were managed, administered and stored safely. Staff were trained to manage medicines and their competences assessed.

The home was distinctly effective, which improved outcomes for people. There was a dedicated comprehensive system of appropriate training, competency assessment and support for staff to provide the right knowledge and competence for them to carry out their roles effectively and safely. This was constantly evaluated for improvements.

People’s clinical physical, mental, social and therapeutic needs were holistically assessed using best practice and current guidance, before they moved to the home to ensure staff and the home environment could meet their needs safely.

People’s nutritional needs were supported in a safe and highly personalised way.

People complex health needs were supported through positive working relationships amongst the home’s staff and with external health professionals.

The home fulfilled its responsibilities under the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves.

The home environment was well maintained and adapted to meet people’s needs.

People and their relatives told us the home was very caring and some relatives were exceptionally complimentary about the care at the home. We observed staff to know the people they supported well and to be respectful, caring and considerate.

There w

This inspection took place on 12 February 2016 and was unannounced.

Fairlie House offers accommodation and care to 53 people with complex care needs. At the time of the inspection there were 43 people using the service.

There was a registered manager in place. 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 against the risk of harm and abuse. Staff demonstrated knowledge of safeguarding and had received training in order to accurately identify the different types of abuse and how to report their concerns.

People were protected against identified risks. The service had risk assessments in place that gave staff guidance on how to protect people when faced with known risks.

The service had adequate numbers of staff at all times to ensure people’s needs were met.

People received their medicines safely. The service demonstrated good practice in the administration, storage, disposal and auditing of people’s medicine. The service had clear guidelines for staff to follow to ensure people’s medicines were managed safely.

People’s consent was obtained prior to care being delivered. Staff were aware of the importance of obtaining people’s consent and how to ensure consent was given. People were not deprived of their liberty unlawfully. The service had in place systems to ensure people’s capacity was assessed in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were supported to have sufficient amounts to eat and drink. The service promoted healthy eating and had in place personalised plans to support people who required specific nutritional requirements.

People were supported and encouraged to maintain good health. The service assisted people to access both in-house and community based health care professionals to monitor and maintain people’s health. The service liaised with health care professionals seeking guidance where appropriate.

People were encouraged to express their views and participate in making decisions about their care and treatment. The service supported people and their relatives to give feedback on the service they received.

People’s privacy and dignity was respected at all times. Staff were aware of the importance of maintaining people’s privacy and dignity and the impact of not doing so.

People received care and treatment that was person centred and tailored to their individual needs from staff that had undertaken the necessary training to support them effectively.

People were encouraged to raise concerns and complaints. The service had a policy for people to access if they wished to raise a complaint. At the time of the inspection the service were implementing a new ‘pictorial’ complaints form, for people that would find written text difficult.

The registered manager carried out audits of the service to ensure the environment and people were kept safe at all times. Areas identified as a risk were documented and action taken to minimise the risk to people in a timely manner.

The registered manager promoted an inclusive and respectful environment, ensuring people were encouraged to have their views shared.

The registered manager actively encouraged feedback of the service provision to improve the quality of care provided. Quality assurance questionnaires were sent to people, relatives and health care professionals annually. Information received was then recorded and concerns were acted upon.

During our inspection we spoke with seven people, and their relatives, who use the service and reviewed their care records. We spoke with four members of staff.

One person who uses the service told us, “I am so glad to be living here".

Peoples’ diversity, values and human rights were respected and people were treated with dignity. Staff demonstrated they understood peoples' care and health needs. People who use the service had their physical and mental health and social support needs assessed and monitored through the care planning process.

People who use the service told us they felt safe and we found that staff were aware of how to identify signs of abuse/possible abuse. We found that staffing levels were appropriate to meet the needs of people and staff were well supported by the provider. A system for monitoring the quality of the care provided was in place and there were regular discussions with people and their relatives using the service and staff about how the service could be improved.

We spoke to sixteen people living at Fairlie House. All the residents we spoke with were satisfied with their care and told us that they felt happy and safe at Fairlie House.

A number of people living at the home were unable to respond to us due to their state of consciousness; we observed that they were well cared for. We spoke to some of their relatives. They told us of the confidence they had in the service, they found that the service was well organised, and that staff were highly skilled and competent.

Stakeholders and relatives told us that they found that lines of communication with the home were good, and that all relevant parties were kept fully informed of events.

A relative spoken with told us that she was involved in developing her son's plan of care, as he was unable to contribute to this himself. She attended monthly meetings with the interdisciplinary team in the home to discuss his progress.

The home places emphasis on coordinating services and supporting residents to enjoy themselves and have the best quality of life possible, despite some requiring essential life saving equipment. Residents enjoy a range of activities both in and outside of the home. These included shopping trips and outings to the dog racing track, parks and places of interest. Movie nights, parties and celebrations are some of the events enjoyed at Fairlie House.

The home provides therapeutic intervention that is tailored for each individual. A new gymnasium together with the physiotherapy team provides residents with rehabilitation programmes to help regain, and improve mobility and functional ability.

One resident said, "The staff are lovely here. All of the staff are really good. They spoil me! The care is 100%. When I cried they wiped my eyes and made me smile again. They are calm and nice and I have a good joke with them. The best thing of all is the food, it's lovely, and they have a very good chef".

Relatives told us that they thought that people were well cared for and that staff were kind and attentive. A relative said, "The staff are brilliant. My son gets on well with all of them. He seems much happier since he moved here and he is enjoying the physiotherapy. He has made friends and I think he feels safe here".

Another relative has come to the home regularly over a number of years to visit, she spoke of the excellent service he received, she said, "Staff are so nice and welcoming, the same nurse has cared for my husband for 4 years, his carer helped him attend his sons wedding last year".