This comprehensive inspection took place on 28 and 29 July 2018 and was unannounced. We last inspected this service in February 2017 where it was rated ‘Requires Improvement’ overall and ‘Requires Improvement’ in the Safe, Effective and Well-led key questions. Following the previous inspection in February 2017 we identified two breaches of regulation, corresponding to regulation 11, need for consent, and regulation 9, person centred care. During this inspection in July 2018 we found that sufficient action had been taken to improve on these areas and the service was no longer in breach.

Fairways Residential Care Home (referred to in this report as Fairways) 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. Fairways accommodates up to 70 people in one adapted building. At the time of our inspection there were 45 people living in the home.

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. A new manager was going to be starting at the home the week following our inspection and the operations manager was in charge of day to day management on the days of our inspection.

Following our previous inspection in February 2017 Fairways had employed a new operations director and had made a number of improvements. Therefore, the rating at Fairways improved to ‘Good’ in all areas and ‘Good’ overall.

People and relatives praised the staff and management of Fairways. People were held in high regard, had a good quality of life, had freedom to make choices and were supported to be independent. Staff treated people with respect and kindness and we received comments during our inspection which included; “The carers are really nice people, it must be a tough job, but they are very caring, very helpful”, “This is the third home my wife has been in, and the best of them all” and “(Name of relative) and I are very impressed with the patience and professionalism of all the staff. Dad is made to feel special and receives personal attention.”

People who lived in Fairways were protected from risks relating to their health, mobility, medicines, nutrition and possible abuse. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Staff knew how to recognise possible signs of abuse. Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and staffs’ knowledge relating to the administration of medicines were regularly checked. Staff told us they felt comfortable raising concerns.

Action had been taken to ensure staff understood the Mental Capacity Act 2005, the principles of the Act and how to apply these. We found people were involved in all aspects of their care and their consent had been sought prior to any care being delivered. Where people had been unable to make a particular decision at a particular time, their capacity had been assessed and best interests decisions had taken place and been recorded. Where people were being deprived of their liberty for their own safety the registered manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority.

Recruitment procedures were in place to help ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work. Staff knew how to recognise possible signs of abuse in order to pro

Fairways Residential Care Home is registered to provide accommodation and personal care for up to 70 people. At the time of this inspection 52 people lived at the home.

The service had a change of registered manager and management team during October 2016, the new manager for the service obtained their registered manager status during February 2017. 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.

This unannounced comprehensive inspection took place on 21 and 22 February 2017, with two CQC inspectors visiting the home on both days. At the last inspection that was conducted in March 2015 the provider was compliant with the requirements of the regulations.

At this inspection we identified two breaches of the regulations and a number of recommendations for the provider to implement. You can see the action we have asked the provider to take at the end of this report.

We identified the provider did not always follow the principles of The Mental Capacity Act 2005 when making best interests decisions for people. There were also shortfalls in relation to conditions being met for people in their Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when there is no other way of supporting a person safely.

We also identified some shortfalls in the care and welfare of people in regard to maintaining healthy nutrition.

Generally risk assessments were completed for people, however, some of these had not been updated or reviewed when people’s needs had changed.

People received their medicines as prescribed. Medicines were managed safely, stored securely and recorded accurately. However, we identified some shortfalls in the system used to administer creams to people.

People told us they felt safe living at the home. They told us they knew how to call for support if they needed it. Staff were able to describe the different types of abuse that people may be at risk from and told us they would report any potential abuse to their line manager. There was evidence that learning took place from the review and analysis of accident and incidents

Staff told us they felt well supported, there was a revised system for staff supervisions and electronic learning in the process of being implemented. Staff told us the recent additional dementia training they had received had been ‘Excellent’.

People told us staff were kind, friendly and caring and took time to chat to them and make sure they had everything they needed. People said staff treated them with patience and compassion. Support was offered in accordance with people’s wishes and their privacy was protected. People received personal care and support in a personalised way. Staff knew people well and understood their physical and personal care needs and treated them with dignity and respect.

People were cared for, or supported by, sufficient numbers of suitably qualified and experienced staff. Recruitment and selection procedures ensured staff were recruited safely. Staff spoke knowledgably about their role and spoke positively regarding the training and support they received. Staff told us they felt valued and were happy working at Fairways Residential Care Home.

There was a varied programme of activities on offer throughout the day. People told us they really enjoyed the activities and entertainment the home offered. The provider had recently recruited additional activities staff which enabled every one living at the home to take part in meaningful activities if they wished.

Where possible people and their relatives had been involved in planning the care an

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection. Our previous inspection of the home on 31 March 2013 found that people’s needs were not always assessed and care was not always planned and delivered to meet their assessed needs. We told the provider that they must make improvements to protect people from the risks of unsafe care. We required that the provider send us a report by 29 May 2014 detailing the improvements they would make to keep people safe. We did not receive this report and the provider was unable to offer an explanation as to why this report had not been sent. During this inspection we found that improvements had not been made.

The home provides accommodation and personal care for up to 70 older people some of whom have dementia care needs. At the time of inspection 41 people were living at the home. As a condition of registration the service must have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The service had not had a registered manager since 30 December 2013. A manager had been appointed and the provider told us that they would apply to become the registered manager.

People were not protected against the risks of receiving unsafe care as the provider had not assessed, planned or delivered care to ensure people’s welfare and safety. People’s bed rails were not fitted correctly to reduce the risk of injury or them becoming trapped. Not all people had a risk assessment to ensure that this type of equipment was suitable and did not pose additional risks to the person. We brought this to the attention of the provider during the inspection. We were told that the issue had been resolved. However, we checked a person’s bed rails and found that they were in the same unsafe condition as they were when we first identified the issue.

People’s nutritional needs were not always effectively met. Assessments of people’s risk of malnutrition were not completed properly and plans to monitor people’s weight loss were not followed. One person was placed at risk of choking as there were conflicting directions as to the consistency of their food and drink.

Care was not always assessed, planned or delivered to be responsive to people’s needs. For example, a person’s epilepsy care plan did not contain sufficient information to guide staff in the action to take in the event the person experienced an epileptic seizure. A person assessed as requiring a pressure-relieving mattress to reduce the risk of them developing a pressure ulcer did not have this type of equipment on their bed which placed them at risk. One person had asked staff to assist them to use the toilet. Over 40 minutes later the person remained in the lounge and had not been assisted to the toilet. We informed the manager that this person had not been assisted to ensure their needs were met.

People’s medicines were not always managed safely. Staff administered two people’s medicines at the same time which increased the risk of error. Medicine trollies were not always secured to the wall when not in use and medicine was left unattended. Controlled Drugs (CD) were not managed appropriately as the medicines recorded in the CD register did not correspond with the medicines held in the CD cupboard. The manager told us that this was a recording error as the CDs had been returned to the pharmacy but the register had not been updated.

The provider had not made suitable arrangements to respond to actual or alleged abuse. The manager was not aware of the local safeguarding and a complaint alleging neglect was not reported to the local authority as is required. Staff were aware of what constitutes abuse, the signs and how to report abuse. Staff were aware of the concept of whistle-blowing and outside organisations they could contact if they had concerns, such as the local authority.

People were not protected from the risks of unlawful deprivation of liberty as the provider had not made appropriate arrangements. People’s care records indicated that they were under continuous supervision and control and were not free to leave the home. The manager told us they were aware of a change in the law in relation to the Deprivation of Liberty Safeguards (DoLS). However, they had not taken action to assess whether or not the change in the law would require them to seek DoLS authorisations for people living at the home.

Not all staff had received the training necessary to carry out their roles. in subjects such as the Mental Capacity Act and moving and handling. Staff had not received formal supervision as identified in the provider’s policy and had not had appraisals. Staff told us they felt they had enough training and received feedback as to their performance.

People’s privacy and dignity was not always respected. Staff assisted one person to change position using a hoist in an undignified manner. Staff carried walkie-talkies and it was audible discussion around peoples personal care. However, doors to people’s bedrooms were kept closed during personal care and people’s relatives told us that staff were polite and helpful.

During our observations people had brief or no contact with staff . The television and radio were both on and call bells were audible within the lounge area. The mixture of noises may have had an adverse effect on people’s well-being.

People’s care records did not always contain accurate or up-to-date information and there was a risk that staff would not be responsive to their needs. For example, one person’s care records indicated two different pieces of equipment that the person should use to change position. It was not clear which piece of equipment the person should use. The manager told us records were not up-to-date.

The provider had not made statutory notifications to the commission. A statutory notification is information about important events which the service is required to send us by law. The manager told us that they were not aware that notifications were required for this type of event.

The provider did not have an effective system to monitor the quality of the service or identify, assess and manage risks. The manager told us that audits of practice had not been undertaken properly or consistently. Audit reports stated that practice was safe in the management of medicines which was contrary to our findings.

The provider had a complaints procedure which staff were aware of. People told us they felt able to raise concerns and were confident that the provider would respond to them. However, the complaints procedure was not displayed to ensure people had access to this.

There were sufficient numbers of staff to keep people safe but not always meet their needs in a timely manner. People and staff had mixed views as to whether or not there were enough staff. One person told us that there was sometimes a long wait for staff to answer their call bell. Staff reported they could be rushed and did not have enough time to spend with people. People waited an excessive amount of time to be supported to transfer from their wheelchairs to lounge chairs following their lunch.

People accessed healthcare professionals when they required. People’s care records showed that they had received treatment from a variety of healthcare professionals. People told us they saw the doctor when they needed to. Two visiting community nurses told us that the staff at the home made appropriate referrals and followed their advice.

People felt involved in making decisions about their care. One person told us they could get up and go to bed at times convenient to them. Relatives told us they felt staff were informative and helpful and involved them in developing their relative’s care plan.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Focussed inspection of 26 November 2014

After our inspection on 11 and 12 August 2014 the provider was served a warning notice because they had not taken proper steps to ensure that people were protected against the risks of inappropriate or unsafe care because care had not been assessed, planned or delivered to meet people's needs or ensure their welfare.  This required the service to be compliant by 29 September 2014.  We carried out this unannounced focussed inspection to check that the breach of the regulations had been addressed.  We found that the provider had taken appropriate action and had complied with the warning notice.

People received support from staff who were kind and attentive.  People were kept safe and protected from risks wherever possible.

People's needs were assessed and plans were in place to ensure that their care needs were met.  We saw that people's privacy and dignity were promoted.

We carried out an unannounced inspection visit to Fairways Residential Care Home on Monday 31 March 2014 because concerns had been raised with us regarding the care provided to people. During the time of the inspection there were 44 people accommodated at the home.

As part of this inspection we spoke with the acting manager, five members of staff, eight people who lived in the home and two relatives of people who lived in the home.

Most of the people and relatives we spoke with expressed satisfaction with the service provided. People told us that staff were nice and their care needs were met. One person said "I think it’s all very good really". A visitor told us that they had "pleased" with the care provided for their relative.

At this inspection we found that people who used the service received care and treatment that was not always planned in a way that was intended to ensure people's safety and welfare. Delivery of care did not always reflect people's assessed needs and people's health, safety and well-being was not fully protected.

We carried out this inspection on the 30 September 2013, to follow up on compliance actions made at the last inspection of the home in 19 June 2013. We spoke to four people living at the home, four members of staff and the manager.

People we spoke with told us that they were satisfied with the care they received. They told us that the staff knew how to care for them, that their assessed needs were met and that the staff were kind and respectful of their privacy and dignity.

We examined the care records of two people living at the home. The plans detailed what a person was able to do for themselves and where they required support. People's plans were routinely reviewed and updated when required.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

At this inspection we spoke with the manager, three members of staff on duty, three visitors and five people that lived at Fairways Residential Care Home.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We found that care plans accurately reflected people's needs and had been drawn up with their involvement. People expressed satisfaction with the care they received and told us the staff were "nice and kind". Another person told us that they felt "safe" living in the home.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

People were not protected from the risk of infection because appropriate guidance was not always followed.

The provider did not have suitable systems in place to assess and monitor the quality of service provision.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.

We carried out this inspection of Fairways Residential Home on the 18 December 2012. We spoke with the manager, seven people living at the home, one relative and four members of the staff team.

People living at Fairways were positive about their experience of living at the home and no one had any complaints or concerns about how the home was run and managed.

People told us that they had good relationships with the staff, who were described as kind and helpful. They told us that the home was kept clean and warm. They said that the standard of food was very good and there were activities arranged to keep people occupied.

We spoke with five members of staff on duty at the time of our visit and they told us they felt supported by their manager and colleagues.

We visited Fairways on the 23 August 2012, as part of our inspection process. During our visit we spoke with the manager, six people living at the home, two relatives and five members of the staff team.

People living at Fairways were positive about their experience of living at the home.

No one had any complaints or concerns about how the home was run and managed. They told us that they had good relationships with the staff, who were described as ‘very friendly’.

We found people were not always treated with consideration and respect or enabled to participate in making decisions relating to their care or treatment.

We case tracked people who lived at Fairways and noted that they benefited from their care needs being assessed and a care plan being put in place to meet these needs. We spoke to staff and were told they were not involved in this. Fairways had systems and procedures in place that ensured that the home was hygienic and clean.

People who lived at Fairways benefited from thorough processes and procedures being followed when new staff are recruited, which meant they were protected from harm.

We found there was no robust system in place to ensure that staff learning and development needs were met. Supervision of staff had not been organised to ensure people were assisted by staff who were supported to carry out their role.

This was the first inspection of the home since MD Care UK Ltd was registered and took over the management of the service in September 2011. We were assisted by the Registered Provider and the home’s manager. We spoke with three people who were able to tell us what it was like to live at the home and with one relative. We also spoke with three members of staff.

People told us that they were treated respectfully by the staff who were kind and helpful. People said that their care and support needs were met by the staff and medical appointments were arranged on their behalf when required. People said that the staff administered their medication and they had no concerns about how this was managed.

This unannounced comprehensive inspection took place on 18 and 20 March 2015, with one CQC inspector visiting the home on both days.

Our previous inspection of the home on 11 and 12 August 2014 identified breaches of the regulations relating to; care and welfare of people, assessing and monitoring the quality of service provision, safeguarding people who use services from abuse, management of medicines, respecting and involving people who use services, consent to care and treatment, people’s personal records and supporting workers.

We took enforcement action and issued a warning notice regarding Regulation 9 Health and Social Care Act 2008 because the provider had not taken proper steps to ensure that people were protected against the risks of inappropriate or unsafe care as care had not been assessed, planned or delivered to meet people’s needs or ensure their welfare.

We told the provider that they must make improvements to protect people from the risks of unsafe care. We required that the provider to meet Regulation 9 by 29 September 2014. We carried out an unannounced focussed inspection on 26 November 2014 to check that the breach of Regulation 9 had been addressed. We found that the provider had taken appropriate action and had complied with the warning notice.

This inspection visit took place to ensure the provider had made improvements in regard to the remaining breaches in the regulations we had found during our visit in August 2014. At this inspection we found the provider had made major staff changes and made the required improvements to meet the regulations.

Fairways Residential Care Home provides accommodation, care and support for up to 70 people. At the time of the inspection there were 59 people living at Fairways Residential Care Home. The provider was in the process of making an application for 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 home had been undergoing extensive refurbishment and renovation and the majority of the works had been completed, giving a light, bright and airy atmosphere to the home. The acting manager showed us around the home and we saw attention had been given to ensure people living with dementia would be able to navigate their way around the home safely. For example, hand rails were available in all corridors and memory boxes were located outside people’s bedrooms with their names and photo’s that would prompt their memory. Bathrooms and toilets were clearly signed.

There was a varied programme of activities on offer, with scheduled activities taking place both morning and afternoon. People told us they really enjoyed the activities and entertainment the home offered and actively sought out the company of the activity staff to check what they would be doing that day.

People told us they felt safe at the home. Staff took time with people and were friendly, kind and patient, caring for them with consideration and compassion. People were relaxed with members of staff and actively sought their company for support and to talk to. Support was offered in accordance with people’s wishes and their privacy was protected. People received personal care and support in a personalised way. Staff knew people well and understood their physical and personal care needs and treated them with dignity and respect.

Medicines were handled appropriately, stored securely and managed and disposed of safely. A new medicine administration system had been recently introduced which staff spoke positively about.

People’s needs were assessed and care was planned and delivered to meet their needs. Risk assessments were in place for areas of risk such as nutrition, falls, pressure area care and moving and handling. Records showed an assessment of need had been carried out to ensure risks to people’s health were managed. People and their relatives were involved in assessing and planning the care and support they received. People were referred to health care professionals as required. Equipment such as hoists and pressure relieving mattresses and cushions were readily available, well maintained and used safely by staff in accordance with people’s risk assessments.

There was a system in place to ensure staff received their required training courses and refresher training as required. Staff were knowledgeable about their role and spoke positively regarding the induction and training they received. Staff demonstrated a good understanding of The Mental Capacity Act 2005 and were able to give examples concerning ‘best interest ‘decisions that had been made for people.

There were enough qualified, skilled and experienced staff employed to meet people’s needs. Staff felt well supported by the management team and received regular supervision sessions and appraisals. The acting manager told us they were in the process of recruiting additional staff on an on-going basis. The process used to recruit staff was safe and ensured staff were suitable for their role.

The acting manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when there is no other way of supporting a person safely.

People knew how to make a complaint and felt confident they would be listened to if they needed to raise concerns or queries. The provider regularly sought feedback from people and changes were made if required.

The service was well led, with a clear management structure in place. There were systems in place to drive the improvement of the safety and quality of the service and there was evidence that learning took place from the review and analysis of accident and incidents.

The acting manager kept up to date with current guidance and regulations.