Fairfield View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Fairfield View is registered to provide accommodation and personal care for 54 people. It is not registered to provide nursing care. Fairfield View has two units: The Elms is a specialist dementia unit and Fairfield View is a residential unit.

The service was last inspected in August 2017 and at the time the service was rated as Requires Improvement in the safe, effective and well led sections of the report and Good in the caring and responsive section. The service was rated as requires improvement overall. At the last inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service had no risk assessments in place to mitigate the risk to people using the service in an emergency situation and there was insufficient oversight of staff training.

At this inspection we looked to see if the required improvements had been made. We found that appropriate action had been taken to address the lack of risk assessments and that there were current risk assessments and Personal Emergency Evacuation Plans (PEEPs) in place for all the people living at the home. However, we found that the training matrix required updating and have made a recommendation in this area.

The service had 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.

The service had notified CQC of any accidents, deaths, serious incidents and safeguarding allegations as they are required to do.

Staff were knowledgeable about safeguarding and whistleblowing and had confidence that the registered manager would address any concerns identified.

Recruitment procedures were in place which ensured staff were safely recruited. There were sufficient staff to meet people's needs and staff told us they received the training, support and supervisions they needed to carry out their roles effectively.

Medicines were managed safely and people received their medicines as prescribed.

People had their nutritional needs met and had access to a range of health care professionals.

The requirements of the Mental Capacity Act 2005 were being met. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were a range of activities on offer at the home both in groups and on a one to one basis. People told us there were sufficient activities for them to join in.

The environment was clean and tidy. Any maintenance issues were reported and addressed immediately. However, the environment within the dementia unit was not in line with best practice for supporting people living with dementia. We recommend the home review the environment and make adaptations in line with best practice to best support the people living within the dementia unit.

People who used the service felt able to raise concerns and that these were responded to and addressed quickly. There was a system for recording and dealing with any complaints.

The provider had displayed the CQC rating and report from the last inspection on their website and within the home.

Fairfield View is registered with the Care Quality Commission to provide residential care for up to 54 older people. There are two units, Fairfield and The Elms. The Elms is a specialist dementia care unit.

The inspection of Fairfield View commenced on 1 August 2017 and was unannounced.

The inspection was prompted by the notification of an incident following which a person using the service died. Information shared with CQC about the incident indicated potential concerns about the management of risk of falls.

This inspection took place over three days and was unannounced.

When we previously inspected this location in March 2015, we identified one breach of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. We found that medicines were not safely managed. At this inspection we found that this regulatory requirement had been satisfactorily met. However we identified other areas where the provider was no longer meeting the legal requirements. We identified breaches of two of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which were in relation to good governance and safe care and treatment. We also identified two breaches of the Care Quality Commission (Registration) Regulations 2009 in relation to the provider not submitting statutory notifications as required. You can see what action we have told the provider to take at the back of this report. We are currently considering our options in relation to enforcement action for some of the breaches of regulations identified. We will update the section at the back of the inspection report once any enforcement work has concluded.

We also made a recommendation in relation to the service completing an analysis of all returned and completed feedback questionnaires and provide feedback to all stakeholders.

At the time of our inspection, a registered manager was 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their relatives told us Fairfield View provided a safe environment in which to live and we found that staff had been trained in the principles of keeping people safe and free from harm. When we spoke with staff they told us they understood their responsibilities in reporting any suspected abuse or poor practice taking place in the home.

Safe staff recruitment procedures were in place and staffing levels were being maintained to an appropriate level to meet the assessed needs of the people using the service.

Medicines management were found to be safe. Staff with the responsibility for the administration of medicines had received appropriate training. All medicines and controlled drugs were safely kept with appropriate arrangements for storing in place.

No risk assessments had been completed for people using the service should an emergency situation arise within the home, for example, full evacuation of the premises.

We found the home to be clean, hygienic and well maintained. The provider visited the service on a regular basis and provided continuous investments in the premises. We looked at the service’s maintenance and safety records and saw that they were up to date.

We found the service to be working within the principles of the Mental Capacity Act 2005 (MCA). The registered manager undertook assessments on people known or suspected to lack mental capacity to consent to care and treatment. Records seen indicated that consent to care and treatment had been obtained from relevant people who knew the person best, usually their relative.

Staff received supervision on a regular basis and an annual appraisal.

Although staff we spoke with told us they received regular and appropriate training, tra

We undertook a follow up inspection to Fairfield View on 17 March 2014 to see what action the registered provider had taken to become compliant. We did speak with some staff during this inspection but we did not speak with people who used the service.

We found that since our last inspection the registered provider had ensured, along with the registered manager, that all staff had received relevant and appropriate on-going training, supervision and appraisal.

Evidence was available to demonstrate that the registered manager had reviewed staffs individual training to date and ensure that, where necessary, further training was arranged and took place. We also saw evidence that the registered manager and senior staff were carrying out regular supervision sessions with the individual members of staff and that annual appraisals were taking place. This was also confirmed by those staff we spoke with.

People living in Fairfield View to us that they felt supported and well cared for and that care workers understood their needs and how to meet them. Comments from people included:

“You will not find better care that you get here”

“They have got me walking again”

“The staff are very kind and make sure we are safe and cared for.”

“The girls (care workers) take good care of you. They know what they are doing and don’t try making you do things you know you can’t do.”

One visiting healthcare professional told us:

“I am very happy with the care delivered by the staff in this home, they (the staff) are very good at putting into practice the identified care support needed.”

Staff told us that they felt supported by the manager and the supervision arrangements that were in place and that they had access to training and development opportunities.

This inspection was carried out over two days on 25 and 26 March 2015. Our visit on 25 March was unannounced.

Fairfield View is registered to provide residential care for up to 54 older people. There is also a specialist dementia care unit, known as The Elms.

There was a registered manager at the home.

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 people living in Fairfield View who we spoke with told us they felt safe.

We saw staff using handling equipment, such as hoists, in a safe manner and staff spoken with confirmed they had been trained in moving and handling, which included the use of such equipment.

Sufficient staff were on duty to provide appropriate care and support.

We looked at the way in which medicines were managed in the home. We found that medicines were not always managed safely. We checked medication administration records on both Fairfield unit and The Elms unit. Of those records two on each unit had incorrect balances of medication prescribed to be taken ‘as and when’ required. We were unable to balance the tablets administered with the tablets still unused, which meant no accurate record of this medication was available. We also found one hand written medication administration record which had not been appropriately checked or signed.

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

People who used the service and the visitors we spoke with were positive and complimentary about the attitude, skills and competency of the staff team.

We found the home to be clean and tidy at the time of our visit.

The provision of food was good and regular activities were available for those people who wished to participate.

Staff had access to appropriate training and received regular supervision and annual appraisals.

We found staff recruitment to be thorough and all relevant pre-employment checks had been completed before a member of staff started to work in the home.

The registered manager undertook checks of the quality of service provision.