Fairview 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. Fairview House accommodates up to 55 older people. There were 32 people living at the service when we visited on the 30 October 2018.

We carried out this unannounced inspection on the 30 and 31 October 2018.

At our inspection in March 2018, the provider’s systems for learning, improving and sustaining improvements made were not effective and failed to demonstrate what action they had taken to address the issues we raised at our previous inspections. Because of our findings, the service continued to receive an overall rating of inadequate and remained in Special Measures. And conditions, which both restricted admissions and required the provider to report to us regularly, remained in place from our July 2017 inspection.

At our recent inspection carried out on the 30 and 31 October 2018, we found that there had been significant improvements in the care being delivered and people were engaged and well cared for. People were safe but further work was needed to ensure the registered provider's governance systems identified where continued improvements were needed, implemented and how they were to be sustained. The overall rating for the service is now judged as ‘Requires Improvement’ and the service is no longer in Special Measures. We have also removed the conditions on the provider’s registration.

There is 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 ‘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 general people were kept safe from the risk of harm because care was being effectively managed and safely delivered to mitigate identified and/or potential risks. We found an instance where one person was at risk of choking but had not been harmed, this was brought to the manager's attention, who took immediate action to address this risk and ensured that all staff were aware of the person's fluid intake needs. We recommended that the service review their risk documentation to ensure that all records are consistent and up to date.

People were supported to take their medicines from staff who had received training to do so, however some further minor improvements were required to ensure all of people’s medication administration records were fully completed. There were sufficient numbers of staff, who had been safely recruited, to meet people’s needs. There were systems in place to prevent the spread of infection. But we did make a recommendation to the provider to use a recognised tool for determining staffing levels across the service.

Staff had an understanding of the principles of the Mental Capacity Act 2005 (MCA), however improvements were required to ensure staff were acting in accordance with good practice when undertaking mental capacity assessments and making best interest decisions for people who may lack capacity. We have made a recommendation to the registered manager to review the MCA and associated guidance to ensure the service is acting in accordance with the MCA.

Since our last inspection, staff had received the support, supervision and training they needed to equip them with the skills and knowledge to meet people’s individual care and support needs. People were supported to eat and drink enough to remain hydrated and maintain their health and well-being, however improvements were required to ensure accurate records were kept of people's food and fluid intakes. The provider had also made improvements to the internal environment of the home.

Staff were kind and caring and treated peopl

This unannounced inspection took place on the 5, 6, 8 and 9 March 2018.

At our previous inspection in July 2017, we rated the service Inadequate and the service was placed in Special Measures. Following our inspection in July 2017, we sent an urgent action letter to the provider informing them about our findings and the seriousness of our concerns. We requested an urgent action plan from the provider telling us what they were going to do immediately to address our concerns. We took enforcement action and imposed conditions on the provider’s registration, which included a restriction on preventing any new admissions to Fairview House. You can read the full report from our last inspection on 17, 18, 20 and 28 July 2017 by selecting the ‘All reports’ link for Fairview House on our website at www.cqc.org.uk.

Services in Special Measures are kept under review and inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe and the rating of Inadequate remains for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

Our inspection in March 2018 was carried out to check the actions and improvements the provider told us they would make to achieve and maintain compliance with the fundamental standards under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Our findings showed that insufficient improvements had been made since our last inspection and people remained at risk of receiving unsafe care and treatment. The Commission is currently considering its enforcement powers.

For adult social care the maximum time for being in Special Measures will usually be no longer than 12 months. If the service has demonstrated improvements when we inspect it and is no longer rated as Inadequate for any of the five key questions it will no longer be in Special Measures.

At this inspection the overall rating of this service is Inadequate and the service therefore remains in ‘Special Measures'.

Fairview House 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 accommodates up to 55 older people. There were 39 people living at Fairview House when we visited the service on the 5 March 2018.

At our inspection we identified a continued lack of governance, and people remained at risk of unnecessary harm. The systems and processes in place to effectively monitor and improve the quality of the service were not robust. The provider had not taken appropriate steps to ensure they had clear scrutiny and oversight of the service which ensured people received safe care and treatment. The lack of managerial oversight had impacted on people and the quality of care provided and had failed to identify and address concerns and breaches of regulatory requirements.

There had not been a registered manager in post at the service since June 2015. A manager had been recruited in January 2018 who was not yet registered with the Care Quality 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.

Improvements were required to ensure sufficient numbers of staff were effectively deployed, so that people’s individual care and support need

Fairview House provides accommodation and personal care for up to 55 older people, some of whom may be living with dementia. At the time of our inspection there were 49 people residing at the service, two of which were in hospital.

We carried out an unannounced comprehensive inspection of the service on the 17, 18, 20 and 28 July 2017. Previously the service had been inspected in October 2016 and received an overall rating of requires improvement with the domain ‘well led’ being rated as inadequate. The service was inspected again in March 2017 and was rated requires improvement. At this inspection there had not been sufficient improvements and we continued to have concerns about the safety, health and well-being of people; there had been inadequate management and oversight by the provider to ensure risks and/or potential risks to people were addressed and quality and safety made better.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of this registration.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. The Care Quality Commission is now considering the appropriate regulatory response to resolve the problems we found during our inspection.

There had not been a registered manager in post at the service since June 2015. It is a requirement of the service’s registration with the Care Quality Commission that there is 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.

During our inspection we found a lack of governance. There were no robust systems in place to effectively monitor and improve the quality of the service people. Furthermore, the provider had not taken appropriate steps to ensure they had scrutiny and oversight of the service. The lack of managerial oversight had impacted on people, staff and the quality of care provided.

Improvements were required to ensure sufficient staffing levels and deployment of staff to ensure people’s individual care and support needs were met. Staff did not always have time to spend with the people they supported to meet their needs; the majority of interactions by staff were routine and task orientated. This was a concern already raised at previous inspections.

Not all risks to people were identified and suitable cont

Fairview House provides accommodation and personal care for up to 55 older people and older people living with dementia. At the time of inspection there were 50 people residing at Fairview House.

We carried out an unannounced comprehensive inspection of this service on the 26, 27, 31 October 2016 and 2 November 2016. Breaches of legal requirements were found across all areas of the service. We told the provider that they must meet specific legal requirements by 23 December 2016. We asked the provider to send us an action plan which outlined the actions they would take to make the necessary improvements. In response, the provider sent us their action plan detailing their actions needed to meet regulatory requirements and to achieve compliance with the fundamental standards.

We carried out an unannounced comprehensive inspection of this service on 14, 16, 27 and 30 March 2017 to confirm that they now met those legal requirements.

As part of our inspection we met with the provider and the Local Authority to facilitate discussions regarding concerns raised during the first days of the inspection. The concerns were surrounding the environment, how staff were deployed effectively around the environment, staffing levels and their consistency, lack of staff to provide meaningful activities, as well as the importance of staff and management retention. The provider was open to listening to our concerns and gave strong assurances that with the support of the new manager in post that service delivery will be improved to good in all areas.

Although the action plan provided to us by the provider was robust in response to the last inspection, it had not been effectively actioned in all areas since the last inspection. Immediate concerns had been rectified to ensure people were safe however other areas of improvement had not been actioned as the provider had prioritised the recruitment of an effective home manager and care supervisor to implement the improvements required at Fairview House. During this inspection the provider had assured us that action would be taken accordingly to respond to concerns that had been raised prior to the appointment of the home manager and care supervisor. We were assured that the provider and new management would work collaboratively to drive improvements.

Relatives and staff spoke of the improvements made since the last inspection in October 2016. Reports made specific reference to the improved supportive management at Fairview House. The staff morale and positive, open and inclusive culture had increased within the service. People, relatives and staff consistently reported that the management team were doing their utmost to make the required improvements to the service. People and staff also told us and we saw that the management team were visible and approachable.

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 requirements in the Health and Social Care Act 2008 and associated regulations about the service is run. At the time of the inspection the home had not had a registered manager in post since June 2015. A care supervisor had been recruited in December 2016 and appointed to oversee Fairview House. There was a new home manager in post since the last inspection who had been appointed in January 2017.

Areas of improvement had been identified from the quality assurance report produced by the provider in December 2016. The newly appointed home manager confidently spoke of the improvements required and demonstrated new systems they had put in place to audit and monitor the service moving forward.

Staffing levels at the service had not been maintained above equated minimum levels since the last inspection. The environment appeared to have an obvious negative impact on the effectiveness of the deployment of staff across the service. The provider, at our me

Fairview House provides accommodation and personal care for up to 55 older people and older people living with dementia.

The inspection was completed on 26, 27, 31 October 2016 and 2 November 2016 and was unannounced. There were 48 people living at the service when we inspected.

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.

Immediate concerns and risks to people’s health were identified by us during inspection. A lack of leadership and managerial oversight meant that the service had failed to identify risks to people and staff and had the Commission not intervened the risks would likely have remained. The provider responded immediately to the Commission’s requests for urgent action and further provided an action plan to drive improvements throughout the service.

Quality assurance checks and audits carried out by the provider were not robust, did not identify the issues we identified during our inspection and had not identified where people were put at risk of harm or where their health and wellbeing was compromised. Although some systems and processes were in place they were not being used effectively or at all to ensure robust quality monitoring of the service.

Suitable control measures were not always put in place to mitigate risks or potential risk of harm for people using the service. Care records and risk assessments had not been updated for all areas of identified risk and pressure mattresses were not correctly set in relation to people’s weight. The management of medicines was not always safe and improvements were required to staff’s practices and procedures to ensure these were in line with current legislation and guidance.

Assessments regarding people’s individual decision making were generalised and not decision specific. Not all care workers were able to demonstrate a good knowledge and understanding of MCA and DoLS despite having received training. Arrangements for the use of covert medication were poor and ‘best interest’ meetings to evidence decisions had not been considered.

Relatives’ reports regarding staffing levels were varied and we judged that there were not sufficient numbers of staff available to meet people’s needs at all times. Our observations showed that staffing levels and the deployment of staff were not suitable during the entire inspection. In addition, the majority of interactions by staff were routine and task orientated and improvements were required. The provider responded to our concerns and reviewed staffing levels and implemented contingency plans should staffing levels fall below the assessed minimum level of staff.

Whilst some staff’s interactions with people were positive, this was in contrast to other observations where we saw some staff’s practice when supporting people required further improvement and development as they displayed a lack of regard for people’s privacy at times and did not always have due respect for people.

People’s care and support needs had not always been documented as required and reflected in their care plans. Improvements were required to ensure that the care plans for people were detailed accurately to ensure staff had adequate information to support people. Although people knew how to make a complaint or raise a concern, records showed that complaints had not been responded to in line with guidance.

Improvements were needed in the way the service and staff supported people to lead meaningful lives and to participate in social activities of their choice and ability. The provider advised us this had been addressed and an activity co-ordinator had been recruited.

Systems were in place for newly employed staff to receive an induction. Although arrangements requi

This inspection took place on 21 October 2014.

Fairview House provides care and accommodation for up to 55 older people who may also have care needs associated with living with dementia. When we inspected 51 people were living at the service.

The service did not have a registered manager in post. There had been no registered manager in post since June 2014. An application was in the process of being assessed by us at the time of our inspection and the manager was subsequently registered in December 2014. 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 who used the service told us they felt safe. The provider had taken reasonable steps to identify the possibility of abuse and prevent abuse happening through ensuring staff had a good understanding of the issues and had access to information and training.

People said that they were treated with kindness, compassion and respect by the staff and were happy with the care they received. The home had an open and friendly atmosphere and staff told us that the teamwork was good, helping them to ensure that people’s needs were met.

Staff worked well with people and demonstrated knowledge and skills in carrying out their role. There were however shortfalls in the expected level of staff training and staff were not supported through effective supervision. Improvements were being made in these areas.

Throughout the inspection we observed staff interacting with people in a caring, respectful and professional manner. Where people were not always able to express their needs verbally we saw that staff were skilled at responding to people’s non-verbal requests promptly and had a good understanding of people’s individual care and support needs. Care tasks were carried out in ways that respected people’s privacy and dignity.

CQC monitors the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and reports on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. We found that the manager had knowledge of most aspects of the MCA 2005 and DoLS legislation. They knew how to make a referral for an authorisation. However, the needs of people using the service needed to be re-assessed in the light of new guidance to ensure that their rights were being fully protected.

People’s medication was being managed well but some improvements to practice were needed to ensure that all aspects of medication administration were robust and effective in ensuring people’s safe care.

People were supported to be able to eat and drink sufficient amounts to meet their needs. People told us they liked the food and were provided with a variety of meals. We found that lunchtime arrangements needed to be reviewed to ensure that people had a proper choice about where they ate their meal and that this was not dictated by the space and furniture available.

People’s care needs were assessed and planned for. Care plans and risk assessments were in place so that staff would have information and understand how to care for people safely and in ways that they preferred. People’s healthcare needs were monitored, and assistance was sought from other professionals so that they were supported to maintain their health and wellbeing.

People had opportunities to participate in activities to suit their individual needs and interests. We found that the level of activity had improved since our pervious visit to the service and an enthusiastic member of staff was being instrumental in providing engagement and stimulation for people.

Systems were in place to assess and monitor the quality of the service, but this needed to be improved by seeking and including the views of people who used the service, their relatives, staff employed at the service and visiting health and social care professionals.

We found that the provider was not meeting the requirements of Regulations. The service was not keeping people safe through ensuring that staff were properly recruited with thorough checks being undertaken to ensure that they were safe to work with people.

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

The service had a complaints procedure in place and people told us that they would feel confident in raising any concerns that they had. However, the service did not have robust systems in place to ensure that complaints were well recorded and that any issues raised could be learnt from. This meant that issues might reoccur.

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

We spoke with and spent time with people who used the service. We also spoke with some of their relatives, a visiting professional and a number of staff members. On the day of our inspection the manager of the service was not available. We were assisted by a senior person in the organisation in their role as acting manager.

We looked at four people's care records. Other records viewed included staff training records and rotas, health and safety checks and staff and resident meeting minutes. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service our identification was checked and we were asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse. Some staff had also received training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS.) This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

We saw records which showed that the health and safety in the service was regularly checked. This included regular fire safety checks which meant that people were protected in the event of a fire.

The service was kept clean and staff practice ensured that people were protected as far as possible from the risk of infection.

We saw the staff rota and dependency levels assessment which showed that the service assessed people's needs to ensure that there were sufficient numbers of staff to meet their needs. Most people told us that the staff were available when they needed them.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. People made comments such as, "I am happy here and have everything I need," "I have no complaints and can't fault it," "The carers are wonderful, nice people and kind," and, "It might not suit everyone but it suits me."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Staff working in the service were supported through induction, ongoing training and supervision to offer people care and support to meet their needs.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect. One person said, "The staff are kind and caring." Another person said, "They work very hard but are always patient."

Is the service responsive?

We saw that staff consulted with people and offered them choices in their daily lives. People's choices were taken in to account and listened to.

We saw that staff were responsive to people's changing wishes and needs and supported them well.

People told us that they felt able to raise any issues they might have and felt that the service would act upon their concerns.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service had not benefited from having a registered manager in post to provide good and stable leadership for some time. However, we are currently assessing an application for registered manager. People told us that they liked the current manager and felt that they were improving the service. One person told us, "[Manager] is on the ball and has sorted out a few things."

People's care was well organised. Staff had lead areas to monitor practice in aspects such as dementia care, health and safety and infection control.

People had the opportunity to express their views about the service.

People told us that they felt comfortable living in Fairview House. One person said that they were; “Quite content and have everything I need.” People told us that staff treated them kindly. We saw that staff treated people respectfully and accommodated their individual needs and wishes.

People were mostly satisfied with the care and support offered. We found that people's needs were assessed and planned for to ensure that their individual needs would be met. Improvements were needed to ensure that people were more involved with this process and a fuller picture of their needs and wishes gained.

We found that people had limited opportunities through activities for stimulation and occupation.

We saw that peoples' medicines were managed safely and effectively.

Fairview house was clean but the service was not working to the required guidelines for maintaining good standards of infection control.

People told us that the staff who worked at the service were good. One person said; "I can't praise them enough." We found that staff were supported through induction and supervision to have the skills and knowledge needed to carry out their role effectively. There were however shortfalls in staff training that needed to be addressed.

We found that the provider needed to improve and maintain more consistently the systems in place to monitor the quality and safety of the service.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an “expert by experience” (people who have experience of using services and who can provide that perspective), and a professional advisor.

People we spoke withy told us that they felt respected and well treated by staff. One person commented that on occasions staff did not always wait to be invited into their bedroom before entering.

People said that they were happy with the choice of meals available to them and that they enjoyed the food at Fairview House.

People told us that they were well cared for and that they felt safe living at Fairview House.

People generally felt that there were enough staff available to assist them. However people felt that at times staff were very busy and that mealtimes in particular were disorganised and at times ''chaotic.''

People living in Fairview House told us that they generally experience good care and are happy with the service they receive. One person told us that they had got better since moving into the home, “I thought I was finished, but the staff are wonderful and encourage you to do things for yourself. They have made my life so much better now I can’t believe it.” Another person told us, “I am very happy here.” A relative told us, “It’s a very good home here. The staff are lovely and the manager is good and kind.”

Another relative told us that although there had been a couple of incidents in the past when they had not been happy with the care offered they felt that the home was now getting back on track and that things had generally improved. A visitor told us, “I can’t fault the care here. I’m always made very welcome, the staff are fantastic and I enjoy coming here.”

People said that they liked the food at the home and were offered choices about what they ate. One person said, “The food is good and you always get choices.”

People told us that they were happy with the accommodation provided. We saw that many rooms were very personalised and that people had brought in their own items to make them feel at home. People said, “I like my room and have everything I need,” and “I prefer to spend time in my room and am very comfortable.”

People told us that they felt safe and secure at Fairview House and that the staff were nice. One person told us, “Oh yes the staff are ever so helpful, we haven’t got any nasty ones.”