The inspection took place on 1 and 2 November 2018 and was unannounced.

At the last inspection in August 2017, we found one breach of Regulation. The provider had not done all that was reasonably practical to mitigate the risks of people choking. We made requirements for this to be addressed and the provider sent us an action plan. We required the provider to complete an action plan to show what they would do to improve people safety. At this inspection, we confirmed the provider had taken sufficient action to address the previous breach of Regulation.

At the last inspection we recommended that references were obtained from previous employers to ensure that checks were made that newly appointed staff were safe to work with people. At this inspection we found that improvements had been made and that complete checks were carried out to ensure that recruitment practices were safe.

At the last inspection we made a recommendation about staff deployment during lunchtime. At this inspection improvements had been made to staff deployment at lunchtime. There were sufficient numbers of staff to meet people's needs but we received mixed views from people about staffing numbers at other times during the day.

Fairlight Nursing Home 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.

Fairlight Nursing Home is registered to provide accommodation with personal and nursing care for up to 62 people with a variety of needs including those living with dementia. At the time of our inspection, there were 58 people living at the home who had varying needs such as those associated with old age, frailty and dementia.

Fairlight Nursing Home has a range of facilities including five lounge-dining rooms with en-suite facilities. There were two buildings joined by a corridor. There were 28 bedrooms in the new building and 34 in the old building. The home accommodates people in units, each of which have separate adapted facilities, but people and staff moved freely around all units. One of the units specialised in providing care to people living with dementia and memory loss. The premises had well maintained gardens which people were seen using, the premises were clean and brightly decorated.

Records were not always fully completed and checks were not always effective. Care records showed any risks to people and people’s needs were assessed. People's health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed. Not all staff knew how to access all documents in the online care planning systems used at the home, this led to shortfalls and gaps identified in record-keeping.

Medicines were given safely but there were shortfalls in checks and audits identifying gaps in recording and checking that we identified during the inspection. The frequency of medicine audits was monthly and there was not a procedure to guide staff on what to when medicines have been stored above average storage temperatures.

Staff said they felt supported in their work. Staff received a range of relevant training and the provider invested in additional training to support staff progression and to increase knowledge to meet people’s needs. We recommended that all staff, including agency, that are deployed to the dementia unit receive training in behaviours that challenge in dementia.

A number of audits and checks were used to check on the safety and quality of the care provided but these had not identified some shortfalls that we found at this inspection.

The home has 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 legal responsibility for meeting the requirements in th

The inspection took place on 8 and 14 August 2017 and was unannounced.

Fairlight Nursing Home is registered to provide accommodation with personal and nursing care for up to 62 people with a variety of needs including those living with dementia. At the time of our inspection, there were 61 people living at the home all of whom were over 65 years of age and had varying needs such as those associated with old age, frailty and dementia. Fairlight Nursing Home has a range of facilities including five lounge- dining rooms. Fairlight Nursing Home has 62 bedrooms all with en-suite facilities. 28 are in the new building and 34 in the old building. The service had well maintained gardens which people could use in warmer weather. The premises were well maintained, clean and brightly decorated.

At the time of the inspection the service did not have a registered manager, but there was manager in post who was in the process of registering with the Commission. Following the inspection the new manager was registered with the 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.

The last inspection took place on 16 and 20 February 2017. At that inspection we made a legal requirement as the provider had not followed the procedure for reporting allegations to the local authority safeguarding team. The provider sent us an action plan to say how this legal requirement would be met. At this inspection we found action had been taken to meet this regulation. The registered manager and staff had a good awareness of when allegations of abuse should be reported.

The inspection was prompted by a notification that one of the people who lived at the service was given food of the incorrect consistency. The person choked due to swallowing problems and died. This is being investigated by the coroner and the social services safeguarding team. Since this incident the manager had introduced a number of changes to mitigate the risks of choking for those with swallowing problems. This involved the input of a Speech and Language Therapist (SALT) to advise on the assessment and safety of people who had problems swallowing. A new system of checks when delivering food to people had been introduced. However, we identified additional monitoring was needed to ensure staff took action to prevent people choking on food. We have made a requirement about this.

Checks were made that newly appointed staff were safe to work with people but references were not always obtained from previous employers. We have made a recommendation about this.

At the time of the inspection the service was undergoing a change of management. The new manager had introduced a number of changes and improvements to the service such as reducing the use of agency staff and employing more care staff and registered nursing staff. There were sufficient numbers of staff to meet people’s needs. However, deployment of staff during lunch time was an area for development. We have made a recommend about this.

Medicines were safely managed although we noted guidance regarding a ‘when required’ medicine for mental health needs was not recorded for one person.

We recognised the positive changes the new manager was making to the service. However, we judged these needed to be sustained and embedded in practice. For example, the service had recruited additional nursing and care staff who would need to be inducted.

People told us they felt safe at the home. Staff were aware of how to report any concerns regarding the safety of people.

Care records showed any risks to people were assessed and there was guidance of how those risks should be managed to prevent any risk of harm.

Since the last inspection the manager

The inspection took place on 16 and 20 February 2017 and was unannounced.

Fairlight Nursing Home is registered to provide accommodation and nursing care for up to 62 people with a variety of needs including those living with dementia and when people leave hospital for rehabilitation, which is called ‘step down’ care. At the time of our inspection, there were 60 people living at the home all of whom were over 65 years of age and had varying needs such as those associated with old age, frailty and dementia. Fairlight Nursing Home has a range of facilities including five lounge- dining rooms. All bedrooms are single and each had an en suite toilet. Thirty three of the 60 bedrooms had an suite shower and toilet. Communal bathrooms are also provided. The service has well maintained gardens which people could use in warmer weather. The premises were well maintained, clean and brightly decorated.

The service had 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The last inspection took place on 23 and 24 September 2015. At that inspection we made legal requirements for four breaches of our regulations; these were regarding the unsafe management of medicines, not maintaining a safe environment, a lack of adequate training for staff, care records not accurately reflecting people’s needs and preferences and the lack of an adequate system to assess, monitor and improve the quality and safety of the services provided. The provider sent us an action plan to say how these legal requirements would be met. At this inspection we found action had been taken to meet these regulations, but we still found aspects of the service that were requiring improvement.

At this inspection we found the service had policies and procedures regarding the safeguarding of people and staff were aware of their responsibility to report any concerns of this nature. However, the provider had not notified the local authority safeguarding team of an allegation of abuse.

The provider had not always ensured accurate records were maintained. We identified omissions in the recording of care provided to people. This was in regard to care plans and the use of charts to monitor care. Where charts were used to record people’s food and fluid intake these were not always recorded accurately. Where people were repositioned to prevent pressure areas developing on people’s skin the person’s care plan did not always detail how often this should take place. Staff had a good knowledge of when to use ‘as required’ medicines but this was not recorded to ensure staff had the correct guidance of when to administer it. The arrangements for the supervision of staff were not recorded and there was a lack of records to show staff supervision had taken place.

Care records showed any risks to people were assessed and there was guidance of how those risks should be managed to prevent any risk of harm.

There were sufficient numbers of staff to meet people’s needs. Staff recruitment procedures showed only suitable staff were employed.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People’s capacity to consent to their care and treatment was assessed and applications made to the local authority where people’s liberty needed to be restricted for their own safety.

There was a choice of food and people were complimentary about the meals. The food was wholesome and nutritious and people were supported to eat and drink. People were consulted about the food and meal choices.

People’s h

As part of this inspection we spoke to five members of staff and seven people who live at the home. We also spoke to five friends and relatives and one visiting professional.

There was no registered manager at the home, however, a newly appointed manager has applied to be registered with us. They were present for the inspection.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found

Is the service safe?

People told us they felt safe because “There’s always someone around” and “You ring your call bell and they come like a shot.” Staff told us the service was safe for people because of “The surroundings, the equipment and the staff.”

We found that the home had suitable procedures in place to protect people from abuse. They worked well with other professionals and responded when concerns were raised to them.

Is the service caring?

People who lived in the home said the staff were caring and they felt well looked after. One said “Very kind, very caring and very quick off the mark. Efficient and caring, top marks.” Everyone we spoke to said they would recommend the home to a loved one. One member of staff told us that a relative of theirs had lived there prior to them working in the home. The said "So I knew it was a good home before I applied for the job."

Staff spoke about people in a caring and respectful manner. They knew people well and treated them as individuals.

Is the service effective?

The service was effective because people were involved in their care planning and their individual needs were recorded in their care plans. We saw examples of how people’s needs were met and this was confirmed to us by the people we spoke to. One relative said “What I like is they don’t leave them in bed all day.” This person described how their loved one had been admitted to the home, “A shrivelled up [person] in bed.” They went on to describe their surprise and delight to find them up and playing bowls within a few days.” They added, “It’s like a hotel.”

Is the service responsive?

We saw the home responded to people’s individual needs and preferences. There was evidence that the home responded to concerns and was committed to learning from mistakes and improving the service.

Is the service well led?

The manager was very open and transparent about the improvements they intended to make. People we spoke to said they thought the service was well led. Staff spoke highly of the new manager, they spoke of an “Open door policy” and one said they got “Great support from [manager] and the directors.”

We spoke with four of the 37 people who lived at Fairlight Nursing Home. People told us they were very satisfied with the care they had received. One person said, "I think it is very good! The food is good and the care staff are kind and nice. I would definitely recommend it to others.” Another person told us, "Fairlight Nursing Home is very good indeed. I can’t think there is anywhere better!"

We did not meet and speak with any relatives during our visit. However, we noted that comments made on recently completed satisfaction questionnaires were very positive. For example one relative had written, “I am delighted to say that X has settled in very well.”

We spoke with three members of care and nursing staff, who were on duty. We found that they had a good understanding of their roles and responsibilities. They also demonstrated they knew what was expected of them to ensure people’s needs had been met.

We also gathered evidence of people's experiences of the service by looking at a selection of records. This included care records, medication records and staff recruitment records. They demonstrated that people had given consent to the care they had received. We found that the needs of people had been assessed prior to admission. We found that care records provided nursing and care staff with appropriate information to follow with regard to the delivery of care. We found that medication records had been well maintained. This demonstrated that medication had been managed safely. We also found that the provider’s recruitment practices were sufficiently robust to ensure nursing and care staff employed were safe to work with vulnerable people.

We spoke to four people who lived at the home. They told us that they liked living at the home and that they felt safe. They said that the staff were kind. One person said, "They look after you extremely well". One of the relatives we spoke to said, "We like it here, its friendly". Another said, about her husband who lived there, "I think he is happy here, he seems content".

We looked at the care records of three people that lived at the home and found evidence that people had been involved in decisions about their care. There was a care planning system in place that enabled people to receive care that was appropriate to their needs.

We spoke to three members of staff who worked at the home. They said they enjoyed working there and felt well supported and trained in their roles.

When we looked around the home we saw that it was calm and relaxed but that some improvements were required to the decor. We saw activities being provided for people to take part in. We observed that staff were kind and helpful to the people who lived there, however there were some areas where choice could be improved.

People told us that they liked living at the home and that they were happy there. People told us that the staff were kind and caring.

People said that their needs were met by staff at the home. People said that they had no concerns and told us that there was always someone around to provide help and support.

Comments included the following: ‘I am happy here’, ‘The staff are very nice’, I have all the help I need’ and ‘I am very comfortable living here’.

People said that they did not have any complaints about the service and that if they did they would speak to the staff.

We spoke with three visiting relative’s who told us that in their opinion the care provided was good. They also told us that the home always kept them informed about any changes to their relatives care needs.

Fairlight Nursing Home provides accommodation for up to 60 older people. It provides a service for people with nursing needs, people living with dementia and people who are discharged from hospital following a period of rehabilitation. These people are medically fit but waiting for social care or housing arrangements to be put in place.

The service has 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

Medicines were not always managed properly. Topical creams, such as prescribed barrier or moisturising creams, were not consistently administered or recorded. However policies and procedures were in place to ensure the safe ordering, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely. We observed medicines being administered and saw that the staff who administered medicines did this safely.

Premises were not always safe. There was an area of the home which was being refurbished, which could create a risk to people’s safety. The entrance to the room was not appropriately secured and presented a trip hazard for people

There were sufficient numbers of staff on duty to keep people safe and meet their needs. Staffing levels were assessed by the manager and varied with the changing needs of people living at the home.

People told us that they felt safe. One person said, “They (staff) are around so you don’t come to any harm”. Staff recognise signs of abuse and knew who to report this to. Staff felt that reported signs of suspected abuse would be taken seriously and knew who to contact externally should they feel their concerns had not been dealt with appropriately.

Risk assessments were in place to identify individual risks. Risks to people’s health and safety were assessed prior to admission and were regularly reviewed.

Staff had not always undertaken training to ensure they had the skills and competencies to meet people’s needs. We reviewed training records and saw that, from a team of 91 staff, 51 had completed the dementia awareness training. The registered manager told us that they had identified this as a gap in training and they were planning training to address this, although no date had been confirmed. We saw that there were 91 members of staff and 36 had completed their manual handling training. We spoke with the registered manager about manual handling training and were told that the training was face to face. We did not observe any concerns relating to manual handling practices, however the provider had not ensured that staff were suitably trained and competent.

People were happy with the food and told us they were offered choices at each mealtime. People told us the food was “excellent”. People’s nutritional and hydration needs were assessed and regularly reviewed.

People were supported to maintain good health and had access to healthcare services when needed. Staff had regular contact with professionals when needed. When people received end of life care, staff ensured that they had access to specialist advice from a local hospice.

People we spoke with provided positive feedback on the caring approach of staff and told us they were kind and considerate. One person told us, “nothing is too much trouble.” We saw one member of staff discreetly rearranged someone’s clothing to ensure that their privacy and dignity was maintained. However, we saw that one person had the support they required with moving and handling pinned to the front of the bedroom door. This did not promote people people’s dignity.

People’s care records contained little information about choices, preferences and life history of individuals. The registered manager told us that care plans were a “work in progress” and they were in the process of reviewing care plans to ensure they included information on how people would like their care to be delivered and their individual likes and dislikes.

There was a schedule daily and weekly activities for people to enjoy and activities were arranged outside of the home. However where people spent most of their day in the room there was limited social interaction.

The atmosphere in the home was friendly and people spoke positively about the registered manager. Resident and relative meetings took place and people were asked for feedback through an annual survey.

Although the provider had a quality monitoring system in place, this had not been effective in identifying and actioning areas for improvement.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the report.