This inspection visit took place unannounced on 26 September 2018 and we returned announced on 28 September 2018.

Fairfield is a two-storey residential home which provides care to older people including people who are living with dementia. Fairfield is registered to provide care for 36 people. At the time of our inspection visit there were 32 people living at the home. Care and support was provided across both floors and each floor had two communal lounges and dining areas.

People in care homes receive accommodation and nursing and/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.

A requirement of the services’ registration with us is that they have 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 registered manager was absent from the service at the time of our inspection visit. A new manager had been appointed and had submitted their application to be registered with us (CQC).

At our last inspection we rated the service Good overall, with the leadership of the service as ‘Outstanding’ because we found the provider learnt from previous inspections to drive improvements, shared good practice and the culture promoted open and continuous learning. At this inspection we rated the leadership of the service as Good and the service remains rated Good overall.

There were sufficient staff to ensure people’s wellbeing and safety. The provider ensured staff had training and support to provide effective care that reflected good practice. Staff had a good understanding of their responsibility to manage risks to people and report any concerns they had about people’s safety.

Staff worked within the principles of the Mental Capacity Act 2005. Staff recognised and understood the importance of helping people to make their own choices regarding the care and support they received. Staff gained people’s consent before providing support to them.

Staff were kind and compassionate in the way they interacted with people and ensured people were comfortable in their surroundings. Staff were discreet when supporting people with their personal care and promoted people's privacy and dignity.

The environment of the home enabled people to live comfortably and was supportive of the needs of people living with dementia. The home was clean and hygienic.

People received a nutritious diet, had a choice of food and were encouraged to have enough to drink. People were referred to other external healthcare professionals to ensure their health and wellbeing was maintained. Overall, medicines were managed to ensure people received their medicines as prescribed.

There was a new management team in place who were motivated to ensure that, in accordance with the provider’s values, every day was a day well lived for the people who lived at Fairfield. The provider’s quality assurance systems enabled the managers to identify which areas they needed to concentrate on to drive improvement within the home. People had opportunities to put forward their suggestions about the service provided and these were acted upon to ensure the service was responsive and effectively met people’s physical, emotional and social needs.

The inspection took place on 17 and 18 February and was unannounced.

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 ‘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 service provides accommodation and personal care for up to 36 older people, who may have dementia. Thirty-six people were living at the home at the time of our inspection.

People were at the heart of the service. The provider’s philosophy, vision and values were understood and shared across the staff team. Staff received training in the provider’s values and philosophy, which included, ‘play, make their day, be there and choose your attitude’. People were supported to maintain their purpose and pleasure in life. People’s right to lead a fulfilling life was enshrined in a charter of rights, which was displayed in the entrance to the home.

The provider was innovative and creative and constantly strived to improve the quality of people’s lives, by working in partnership with experts in the field of dementia care. The provider had researched and reflected on how international exemplar services provided care and planned to refurbish the home in accordance with current best practice principles.

Planned improvements were focused on improving people’s quality of life, based on the research and experience of experts. People, their relatives and healthcare professionals were encouraged to share their opinions about the quality of the service, to ensure planned improvements focused on people’s experiences.

All the staff were involved in monitoring the quality of the service, which included regular checks of people’s care plans, medicines administration and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence. The provider shared their learning with all the homes in the group.

The home was divided into three ‘households’, each with their own lounges and dining rooms. Each household was individually supported by a care co-ordinator and three care staff. Care co-ordinators were part of the duty management system, which meant there was a named manager available to respond to issues and to support staff, seven days a week.

There were enough staff on duty to meet people’s physical and social needs. The registered manager checked staff’s suitability to deliver personal care during the recruitment process. The premises and equipment were regularly checked to ensure risks to people’s safety were minimised. People’s medicines were managed, stored in their own rooms and administered safely.

Staff understood their responsibilities to protect people from harm and were encouraged and supported to raise any concerns. Staff understood the risks to people’s individual health and wellbeing and risks were clearly recorded in their care plans.

Staff received training that matched people’s needs effectively. Staff were encouraged to reflect on their practice and to develop their skills and knowledge, which improved people’s experience of care.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). For people who were assessed as not having the capacity to make all of their own decisions, records showed that their advocates, families and healthcare professionals were involved in making decisions in their best interests.

Risks to people’s nutrition were minimised because people were offered meals that were suitable for their individual dietary needs and met their preferences. People were supported to eat and drink according to their needs and people knew staff would support them to maintain a balanced di

People's privacy, dignity and independence was respected, as people understood the care treatment choices available to them. One person said 'I always feel comfortable with the care provided to me.'

Care and treatment was planned in a way that ensured people's safety and welfare. One person said 'The staff are always trying to help me and never rush me although they are busy.'

All staff were subject to appropriate checks and references were taken up prior to commencement of employment. One person said 'The team here are really hard working and know what they are doing which makes us feel safe.'

We spoke with the service, home and care managers, staff, relatives and people who use the services on the day of our visit. Comments we received were on the whole positive and included 'The care remains good although we would like more activities.'

Staff we spoke with told us that it was a good place to work but that there had been a few challenges with recent changes which the home was working through.'

Staff spoken to had a good awareness of individuals care needs and the importance of treating people with respect and dignity. This was confirmed by training provided by the provider around respect and dignity and by talking to people who use services relatives. One person said 'The staff are so good, they take really good care of my mother and I feel confident in the care they provide.'

When we visited Fairfield we met with most of the people using the service and spoke to four people in more detail about their care. We met and spoke with two relatives, four members of staff and the manager. People using the service told us staff were kind and they felt well cared for. One person told us, “We can do what we want during the day, staff do not keep telling you what you can, or can’t do. That’s good. Another person told us, "The staff are marvellous.” We asked people about the food being served to them and they told us they enjoyed their meals and there was always a choice. They told us, “The food is lovely” and “The meals vary but we have a choice.”

We saw people's bedrooms were clean, warm and well furnished. One person told us, “My room is kept very clean and I have net curtains so I can see out but people cannot see me.”

We asked relatives about the care provided to their family and they each told us that the care delivered to people was good. They told us, “I am very happy with the care.” and “This is like home from home. Nothing is too much trouble.”

On the day we visited we found sufficient staff on duty to meet the needs of people using the service. We found that before staff were recruited to work at the home criminal record checks were made to ensure they were fit people to deliver care to vulnerable people.

We visited Fairfield on 24 February 2012 and we spoke with eight people using the service, four relatives who were visiting at the time and five staff.

People using the service told us they liked living at the care home and felt well cared for. One person told us, “I am very happy with the staff, they are good. I only have to ask if I want anything.” Another person told us, “We like it because staff speak nicely.” People told us staff were “friendly” towards them and “helped” them with their food and personal care.

Each person we spoke with told us they felt safe and would be able to talk with staff if they felt concerned about their care. Some people were not able to talk to us about their care because of their dementia, however when we asked them if they were comfortable they smiled and nodded.

We asked people about the food being served to them and they told us they enjoyed their meals and there was always a choice. One person told us, “The food is great. There is always plenty.” Another person told us, “I have plenty to drink each day.”

People we spoke with told us about the medicines they were taking and how they always had this on time. One person told us, “Staff know I have some tablets with my food and some tablets later in the day.”

We saw people’s bedrooms were clean, warm and well furnished. People had brought some personal items with them into the care home and this made their rooms “homely”.

We asked relatives about the care provided to their family and they each told us that they had no concerns about how their family member was being cared for. One relative told us, “I would stay here. Staff listen to you and deal with any problems straightaway.” Another relative told us, “Staff are brilliant, I can’t fault it. Staff always get straight on the phone to me with any concerns.”