About the service:

Fairview Farm is a large home, bigger than most domestic style properties. It was registered to support up to 22 people. 19 people were using the service. There was also a respite facility where people could stay for a period of time. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service received planned and co-ordinated person-centered support appropriate for them.

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways:

People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives.

People were supported in the least restrictive way possible.

People were able to take part in a range of activities and outings and their independence was promoted.

People and their family were involved in care planning as much as was possible.

People received safe care. Staff understood safeguarding procedures. Risk assessments were in place to reduce and manage risks within people’s lives.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

Medicines were stored and administered safely.

Staffing support matched the level of assessed needs within the service during our inspection.

Staff were trained to support people effectively. Staff were supervised well and felt confident in their roles.

People were supported to have a varied diet. Healthcare needs were met, and people could see health professionals as needed.

Staff treated people with kindness, dignity and respect, and spent time getting to know them.

Care plans reflected people likes, dislikes and preferences. A complaints system was in place and was used effectively.

The manager was open and honest, and worked in partnership with outside agencies to improve people’s support when needed. Audits of the service were detailed. Any issues found were addressed promptly.

The service had a registered manager in place, and staff felt well supported by them.

The service met the characteristics for a rating of Good in all of five key questions we inspected. Therefore, our overall rating for the service after this inspection was Good. More information is in the full report.

Rating at last inspection: Requires Improvement (report published September 2017)

Why we inspected: This was a planned inspection.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We carried out this announced inspection on 25 July 2017.

Fairview Farm can provide accommodation and personal care for 22 people who have a learning disability. There were 19 people living in the service at the time of our inspection.

The service was run by a charitable body who was the registered provider. Although there was a registered manager they were not working in the service at the time of our inspection visit. In their absence the service was being managed by the chairperson of the charitable body and the senior care team leader. 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 this report when we speak about the charitable body (as represented by the chairperson) we refer to them as being, ‘the registered person’.

At our inspection on 30 August 2016 we found that improvements needed to be made to ensure that people who lived in the service fully benefited from it being safe, effective, responsive and well led.

In more detail, at our inspection on 30 August 2016 we found that in order to keep people safe the registered person needed to address shortfalls in the way people were supported to manage their personal spending money. Another of our concerns involved shortfalls in the provision that had been made to keep people safe in the event of an emergency. At the present inspection we found that these concerns had been addressed. We also found that a particular background check had not been updated to confirm that some care staff continued to be suitable people to be employed in the service. Although at the present inspection we found that this check had been completed we also noted that additional improvements needed to be made in the way new care staff were recruited. A further concern we highlighted involved the need to strengthen the way in which medicines were managed to ensure that people were reliably assisted to use them in the right way. At the present inspection we found although improvements had been made further developments were needed to ensure that the progress made could be sustained.

At our inspection on 30 August 2016 we also found that the registered person needed to ensure that care staff received all of the training, support and guidance they needed in order to make the service more effective. At the present inspection we found that care staff had been provided with training, guidance and support. We also noted that care staff had the knowledge and skills they needed to care for people in the right way.

At our inspection on 30 August 2016 we concluded that more needed to be done to provide people with a responsive service by more actively involving them in deciding what care they wanted to receive. We also highlighted the need for people to be offered more opportunities to enjoy participating in occupational and social activities. At the present inspection we found that both of these concerns had been addressed.

As a result of the shortfalls we noted on 30 August 2016 we identified that more robust arrangements needed to be put in place to manage the day to day running of the service. At the present inspection we found that although a number of quality checks had been completed further progress was needed to ensure that people consistently received all of the care they needed.

Our other findings at the present inspection were as follows. We found one breach of the Care Quality Commission (Registration) Regulations 2009. This was because the registered person had not told us about a number of significant events that had occurred in the service. You can see what action we have told the registered person to take at the end of the full version of this report.

Care staff knew how to respond to any co

This was an announced inspection carried out on 30 August 2016.

Fairview Farm can provide accommodation and support for 22 people who have a learning disability. There were 19 people living in the service at the time of our inspection. Some of the people had special communication needs and used personal versions of sign assisted language to express themselves. The main accommodation was an adapted older building. In addition, there were two self-contained bungalows that were on the same site but which were separate to the main building. Although people could choose to stay in the building where their bedroom was located, in practice they used all of the accommodation as they visited friends and joined in social activities.

There was 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. In our report when we were refer both to the charitable organisation that ran the service and to the registered manager, we refer to them as being, ‘the registered persons’.

People were not fully protected from the risk of financial mistreatment and medicines were not consistently being managed safely. The arrangements used to establish how many staff needed to be on duty were not robust. People had been helped to avoid the risk of accidents and background checks had been completed before new staff were appointed.

Staff had not received all of the training and guidance the registered persons said they needed. People were being reliably assisted to have enough to eat and drink and they had been supported to receive all of the healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had liaised with the relevant local authorities to ensure that people only received lawful care that respected their rights.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had not been fully involved in planning and reviewing the support they received. This included the opportunities they were offered to pursue hobbies and interests. Staff had developed sensitive ways of providing additional reassurance to people who could become distressed and there was a reliable system for resolving complaints.

People had not been fully consulted about the development of the service and quality checks had not always quickly resolved problems. Staff were supported to speak out if they had any concerns because the service was run in an open and inclusive way. People had benefited from staff acting upon good practice guidance.

We carried out an announced comprehensive inspection of this service on 25 February 2015 and found that there was a breach of legal requirements. The service was not consistently safe. This was because the registered persons had not ensured that medicines were always managed safely.

We completed an announced focused inspection on 7 August 2015. This inspection was undertaken to make sure that improvements had been made and that the breach of legal requirements had been addressed.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Fairview Farm on our website at www.cqc.org.uk.

Fairview Farm provides accommodation for up to 22 people who have a learning disability. There were 21 people living in the service at the time of our inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are a ‘registered person’. The registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found that the registered persons had followed their action plan that they had told us would be completed by 27 April 2015. This action plan had enabled the registered persons to meet legal requirements.

We found that the registered persons had strengthened the way in which medicines were managed. The improvements had better enabled the registered persons to ensure that people reliably received all of the medicines they needed. However, further improvements were still needed to eliminate a small number of remaining errors in the way that people were supported to use medicines .

Fairview Farm provides accommodation for up to 22 people who need personal care. The service provides care for people who have a learning disability and who need extra support to be involved in making decisions about the care they receive. The main accommodation is an adapted older building. In addition, there are two self contained bungalows that are on the same site but which are separate to the main building. Although people can choose to stay in the building where their bedroom is located, in practice they use all of the accommodation as they visit friends and attend social activities.

There were 21 people living in the service at the time of our inspection.

This was an announced inspection carried out on 25 February 2015. We told the registered persons about our inspection before we called to the service. We did this so that people who lived there would not be upset by having unexpected visitors in their home. There was 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.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people’s medicines were not safely managed. You can see what action we told the registered persons to take at the back of the full version of this report.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. At the time of our inspection the registered persons had sought advice from the local authority to ensure that they were providing care in a lawful way and that no one was being deprived of their liberty.

Staff knew how to recognise and report any concerns so that people were kept safe from harm. Staff helped people to promote their wellbeing and to avoid having accidents. There were enough staff on duty and background checks had been completed before new staff were appointed.

Although people had received the right care staff had not been given all of the training and guidance the registered persons said they needed. People had been helped to eat and drink enough to stay well. Staff had ensured that people had received all of the healthcare assistance they needed.

People were treated with kindness, compassion and respect. Staff recognised people’s right to privacy, respected confidential information and promoted people’s dignity.

Although care plans were not user-friendly people had been involved in planning and reviewing their care. People received all of the care they needed including those who had special communication needs or who could become distressed. People were supported to celebrate their diversity and were offered the opportunity to pursue their interests and hobbies. There was a good system for handling and resolving complaints.

People had not been fully consulted about the development of the service. Some of the regular quality checks completed by the registered persons were not robust. The service was run in an open and inclusive way that encouraged staff to speak out if they had any concerns. People had benefitted from staff being informed about good-practice guidance

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with eight people who used the service and asked them for their views. We also spoke with five care workers, one team leader and the registered manager. We also looked at some of the records held in the service including the care files for three people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people gave consent to their care and support and received care and support that met their needs. A person told us, “Staff help us to do what we want to do.”

We found the equipment used was safe, properly maintained and suitable for its purpose. A person told us, “I think all the equipment works properly at the moment.”

We found the staff team were supported through training. A person told us, “They do training on driving the mini bus, it makes us feel safe.” We saw records were accurate and contained appropriate information in relation to the care and welfare of people who used the service. One person said, “They write down when I have my tablets at dinner.”

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with seven people who used the service and asked them for their views. We also spoke with four care workers and the deputy manager. We also looked at some of the records held in the service including the care files for seven people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found where people were able to they gave consent to their care and treatment. A person told us, “They (staff) listen to us.” When people could not give consent the provider did not follow the correct legal requirements.

We found people received care and support that met their needs, but this was not always recorded in the person’s plan of care and kept under review. A person told us, “I enjoy snooker, we also go bowling and swimming.”

We found the provider took appropriate action when they suspected abuse may have taken place. A group of six people who used the service told us they felt safe at the home.

We found the staff team did not receive all the support they needed through training and supervision. We found people felt they could say if they had any comments and complaints. One person said, “I would tell my keyworker if I wasn’t happy about something.”

People told us they were happy with the support they received, there was a nice atmosphere in the home and everyone was like a big family.

People described various activities they took part in both in and out of the home including baking and playing snooker. One person said they liked to go out for a meal and another said, “I go out to the pub and have a pint of lager.”

One person showed us a jigsaw they were making and they told us when it was finished the manager would put it in a frame and put it on their bedroom wall. We saw the person’s room and there were other framed jigsaws’ there.

People spoke of helping with daily chores such as laying the table and putting dishes in the dishwasher. One person said they would like to be able to walk to the shops alone but knew they could not as there were busy roads to cross.