We carried out this inspection on 1 and 2 November 2017. This inspection was announced, which meant the provider was given 48 hours’ notice of our inspection visit. This was because the location provides a small domiciliary care service and we needed to be sure that someone would be available to meet with us.

We checked progress the registered provider had made following our inspection on 27 October 2016 when we found a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safeguarding service users from abuse and improper treatment. This was because the registered manager had not ensured the systems and processes in place were operated effectively to ensure people were protected from abuse and improper treatment.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key question of safe to at least good. We found improvements had been made in this area and the service was no longer in breach of this regulation.

This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

People using the service lived in flats within a purpose built building on the outskirts of Sheffield. Not everyone living at Fairthorn received support with personal care; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of this inspection seven people were provided with ‘personal care.’

There was a manager at the service who was registered with the Care Quality Commission (CQC). 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.

People told us they felt safe living at Fairthorn, “I feel very safe indeed, because of the care I get. I really feel cosseted with kindness and their expertise they seem to have deep understanding of our needs.”

All staff we spoke with understood what it meant to protect people from abuse and what actions to take if they suspected someone was being abused.

There were enough staff available to ensure people’s needs were met. The service had robust recruitment procedures to make sure staff had the required skills and were of suitable character and background.

Procedures were in place to make sure people received their medicines as prescribed.

People were supported by staff who had the knowledge and skills necessary to carry out their roles in meeting people’s needs. Staff were suitably trained and received regular supervisions and annual appraisals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were supported to access health and social care professionals to help maintain their health and wellbeing.

Positive and supportive relationships had been developed between staff and people living at Fairthorn. We saw people were treated with dignity and respect.

There was a range of activities available to people living at Fairthorn.

People received personalised care. Care records reflected people’s current needs and preferences. Care records contained up to date risk assessments and these were reviewed regularly.

The

Fairthorn is a domiciliary care agency registered to provide personal care for older people living at the Fairthorn extra care scheme. Fairthorn comprises of 29 two bedroomed apartments. The service has a lift and wheelchair access. There is a garden and car park.

At the time of the inspection the service was supporting eight people living at Fairthorn. One person had just started using the service. We spoke with four people by telephone and visited one person in their apartment to obtain their views of the support provided.

The manager was given short notice of our inspection. We did this because the manager is sometimes out of the office and we needed to be sure that they would be available.

There was a manager at the service who was not registered with CQC. They had started working at the service at the beginning of September 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 and associated Regulations about how the service is run. The manager informed us they would be applying to become registered.

The service was last inspected on 4 September 2014 and was meeting the requirements of the regulations we checked at that time. This was the first rated inspection of the service.

Although people told us they felt ‘safe’, we found that people were not safeguarded from the risk of harm. During the inspection we found that two safeguarding concerns had not been reported to the local authority.

People spoken with did not express any concerns about the staffing levels at the service and told us any calls for support were answered promptly during the day or night. However, people were concerned about the number of staff changes that had occurred across the service.

Some people were very satisfied with the quality of care they had received whilst other people told us the care they had received from some agency staff and less experienced staff was not of the same standard.

People had risk assessments in place. We found that they could be more personalised and less generic.

People were supported with their health and dietary needs where this was part of their plan of care.

Systems were in place to manage people’s medicines. However, we noted there had been some medication errors. We saw evidence that the new manager had reviewed the processes in place and taken action to reduce the risk of medication errors continuing to occur.

Staff made very positive comments about the new manager and told us they were very supportive.

Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people.

Staff received ongoing training and supervision.

Staff told us they enjoyed caring for people using the service. Staff were able to describe people’s individual needs, likes and dislikes.

The registered provider had a complaints process in place to enable them to respond to people and/or their representative’s concerns, investigate them and take action to address their concerns.

There were regular resident meetings held at the service. This told us the service actively sought out the views of people to continuously improve the service.

People told us they were getting to know the new manager.

We found the handover of information to the new manager was not sufficient. This was reflected in the views of some people using the service.

Accidents and untoward occurrences were monitored by the registered provider to ensure any trends were identified.

We found one breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safeguarding service users from abuse and improper tr

An adult social care inspector carried out this unannounced inspection. The focus of the inspection was to answer five key questions: is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led? At the time of the inspection twelve people living at Fairthorn were receiving personal care support. As part of the inspection we spoke with a senior care worker, a domestic and one care worker. We spoke with the registered manager by telephone after the inspection.

This was a follow up inspection to check that improvements had been made to records.

At our previous inspection on the 15th May 2014 we identified concerns in relation to records. The registered manager of the service submitted an action plan following our inspection which detailed the actions they intended to take in order to achieve compliance. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service effective?

We visited the service on 4th September 2014 to check that improvements had been made to the records. We found that people were protected from the risks of unsafe or inappropriate care and treatment because appropriate records were maintained.

On the day of the inspection we spoke with four people in their apartments who were receiving support with their personal care at Fairthorn. We also spoke with the registered manager, the manager of the service, administrative assistant, domestic assistant and two care workers.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; 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 is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

Is the service safe?

During the inspection we observed staff giving care and assistance to people in the communal areas. They were respectful and treated people in a caring and supportive way. Staff spoken with were able to describe how they maintained people’s privacy and dignity whilst providing personal care support. During the inspection we observed staff knocking on peoples doors prior to gaining entry and ensuring that confidential information could not be heard by other people.

We saw the service had a process in place to respond to and to record safeguarding concerns. We found the service had a copy of the local protocols and followed them to safeguard people from harm.

We found that the arrangements in place to record people's financial transactions to safeguard people using the service from financial abuse could be more robust.

Is the service effective?

We looked at four people’s care plans. We saw people’s care plans contained a range of information including the following: personal hygiene, nutrition, medication, moving and handling, people's personal preferences, religious and spiritual needs and details of people's life history. However, we identified a number of concerns relating to the records in place at Fairthorn. Whilst there was no evidence to suggest that these issues had negatively impacted upon people, there was a risk that the lack of completed care plans could result in people not receiving appropriate care and treatment. We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to records .

Is the service caring?

People spoken with told us they were very happy living at Fairthorn and were satisfied with the quality of care they had received. They also made positive comments about the staff. Their comments included: “I am getting all the help I need”, "[staff member] is lovely, she is the most willing person, always cheerful”, “the staff are friends”, “the manager is very helpful”, “the staff are most friendly and helpful”, “they [the staff] are very good at keeping an eye on us to see if we need any help” and “I am very happy here it is very nice”.

We found the service promoted people’s wellbeing by taking account of their needs including daytime activities. On the day of the inspection a small group of people were participating in an exercise class in the morning. People’s comments included: “I am really looking forward to the cream tea this afternoon”; “I liked to join in all the activities and having a chat” and “I really enjoy the knit and natter group”.

Is the service responsive?

We found people in their apartments had access to a pull cord in different areas of their apartment to call for assistance. Some of the people we spoke with also used a pendant to call for assistance. Most people spoken with told us staff responded promptly to their calls during the day and at night. One person told us that on the odd occasion staff did not respond straight away to their calls. People commented: “I accidently used my pendant and they [the staff] were up here immediately” and “I rang the staff and they came straight away”.

A copy of the service’s complaints procedure was included in people’s care plans and a feedback form was available for people to complete in the communal lounge. People told us if they had any concerns they would raise these with a family member and/or with the manager.

Is the service well-led?

We saw there was a range of quality monitoring checks in place to make sure managers and staff learned from audit checks.

We looked at the minutes of residents meetings held in October 2013 and February 2014. There was a range of topics discussed at the meeting including the following: the income and expenditure statement, service charge, activities, garden area and new staff. This helped to ensure people’s views were sought and people received a good quality service at all times.

We spoke with six people who received support with their personal care and they told us that they were treated with respect. They also told us that their opinions were sought so that they were involved in decisions and that they had choice. Their comments included the following: “I am definitely treated with dignity and respect by the staff” and “they (the staff) always ask me what I want to eat”.

The majority of people we spoke with made positive comments about the staff. Their comments included: “the staff that are here are very good” and “x (name) is an excellent care worker”. People told us that staff were very busy which affected how quickly they responded to their calls for assistance. Their comments included: “you have to wait longer for somebody to support you at night” and “they (the staff) are always in a hurry and they never have enough time”. The manager told us that the service was recruiting additional staff to work at the service.

People told us that they felt "safe" and that they had no worries or concerns. They all said that if they had any concerns or worries they would speak to a relative or staff.

We found that the service had recruitment policies and procedures in place that the manager followed when employing new members of staff.

People who used the service and those acting on their behalf could be confident that their comments and complaints were listened to and dealt with effectively.

People we visited in their apartments told us that they were happy with the care and support they received. People’s comments included, "The staff are very good, pleasant and helpful", “I’m very happy the staff are lovely”,” all the staff are wonderful”, “absolutely wonderful care”,” staff are very friendly but don’t overstep the mark, they maintain their professional boundaries” and “you cannot fault staff they are fantastic.”

People receiving care said they were also involved in making decisions about their support needs. One person said, "I have a care plan and staff speak to me about it. It tells them exactly what my wishes and needs are."

People told us that they felt safe, and if they had concerns they would speak with staff or the manager of the service.

We spoke with healthcare professionals who were visiting people at Fairthorn at the time of our inspection. They said they visited the service on a frequent basis. They said they thought the standard of care delivered by staff was “as good as it gets.”