This inspection visit took place on 16 November 2016 and was unannounced.

At the last inspection on 29 October 2015 we asked the provider to take action to make improvements because we found breaches of legal requirements. This was in relation to poor management of medicines and consent and capacity. The provider sent us an action plan saying they would meet the legal requirements by 15 January 2016. During our inspection visit on 16 November 2016 we found these actions had been completed.

Fairhaven Lodge is situated close to both the sea front and the centre of St Annes. The service can accommodate a maximum of 25 people whose primary care needs are those of persons who live with dementia. Accommodation is provided on three floors. A stair lift is installed to support people with mobility problems to gain access to the upper floors. Most bedrooms have en-suite facilities. There is space at the front of the home for parking and a small, enclosed rear garden. At the time of our inspection visit there were 18 people who lived at the home.

There was 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.

Although a number of people had limited verbal communication and were unable to converse with us, we were able to speak with seven people who lived at the home. We also spoke with one person visiting their relative. People told us they were happy and well cared for and felt safe living at the home. Comments received included, “They look after me really well the staff are very kind.” And, “I am very happy here and feel safe.”

We observed staff providing support to people throughout our inspection visit. We saw they were kind and patient and showed affection towards the people in their care.

We saw people who lived at the home were clean and well dressed. One person visiting the home said, “[Relative] is always immaculately dressed when I visit them. This pleases me greatly as they always took pride in their appearance. They look so happy when I visit.”

Staff spoken with and records seen confirmed training had been provided to enable them to support people who lived with dementia. We found staff were knowledgeable about support needs of people in their care.

We saw the service had an induction training and development programme in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

We found sufficient staffing levels were in place to provide support people required. This included staff supporting people to hospital appointments. We saw staff members could undertake tasks supporting people without feeling rushed.

We looked at the recruitment of three recently appointed staff members We found appropriate checks had been undertaken before they commenced their employment confirming they were safe to work with vulnerable people.

Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

We found people had access to healthcare professionals and their healthcare needs were met. We saw the service had responded promptly when people had experienced health problems.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to liv

This inspection took place on 29 October 2015 and was unannounced.

The last inspection of Fairhaven Lodge took place on 29 May 2013. At that time we found that the provider was fully compliant with all the regulations assessed.

Fairhaven Lodge is registered to accommodate 25 people who are living with dementia. The home is situated close to both the sea front and the centre of St Annes.

The registered manager was on duty on our arrival and received feedback throughout the inspection. 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.

Some people who lived at the service were unable to provide feedback. We spoke with people's representatives and observed care and support throughout the inspection.

People who lived at the service who we were able to speak with told us that they felt safe. We spoke with people's representatives and received positive comments about how the service keeps people safe.

We found that the service protected people from abuse.

We looked at how the service identified and managed risk for people on an individual basis. We found that the service completed risk assessments for many areas of care and support for example; nutrition, falls and moving and handling. However, identified risk was not always included in care plans to ensure that management of known risk was undertaken. We have made a recommendation regarding this.

We found that the service had systems in place for recruitment of staff. However, the service did not always fully risk assess new employees. We looked at staff employment records and found that 2 out of 18 employees at the service had criminal records. Risk assessments for 2 staff with criminal records had not been undertaken to ensure that people living at the service were suitably protected. We have made a recommendation regarding this.

We saw that the service had safe systems for ordering, storing and disposing of people's medicines. We looked at people's care plans and found that information regarding medicine regimes was limited and required development to ensure that people received their medicines in a person centred way.

We found that the environment was exceptionally clean and people's bedrooms had been personalised.

We saw that the provider had started to invest in modernising the service and plans had been proposed for an extension to the building which would facilitate more ensuite bedrooms, a conservatory area and easy access to the garden. We were informed that building work would hopefully be completed for Spring 2016 and that the extra communal space would enable work to be carried out in other living areas within the service.

Staff told us that they felt supported. We looked at staff training records and found that training was provided as outlined in the providers policies and procedures.

We looked at supervision and appraisal documents and found that staff were supported on a regular basis and encouraged to develop within their designated role.

We found that the service did not always record decisions made when people were being deprived of their liberty and care planning did not reflect how the person's mental capacity had been assessed prior to such decisions being made.

We found that people were suitably supported to maintain a healthy lifestyle and we observed people enjoy meal and snack times.

We observed staff interacted with people who lived at the service throughout the inspection. We saw wonderful interactions that displayed person centred care, kindness and genuine passion for improving people's quality of life.

People and representatives told us that their dignity and privacy was always maintained.

We saw that people who lived at the service had access to information that told them about how to complain and how to access advocacy support. We discussed with the registered manager need for easy read documents that would aid people living with cognitive and visual impairments. The registered manager agreed that this would be beneficial for people living at Fairhaven Lodge and acted immediately.

We found that the service provided a good standard of person centred care. We looked at people's care plans and found that they did not reflect the amount of person centred detail that we found located in other documents that were not held on the person's allocated file.

Care plans were very basic and required improvement. We found that information was not easily accessible for staff caring for people who lived at the service.

People told us that the manager was approachable and listened to their concerns. We looked at systems in place to monitor care standards at the service and found that the manager undertook audits on a regular basis.

We found a positive, caring culture throughout the service and staff told us that they enjoyed working at Fairhaven Lodge.

We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safe care and treatment and need for consent.

We spoke with a range of people about the home. They included the manager, staff, relatives and people who lived at the home. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Fairhaven Lodge.

Although some residents had limited verbal communication due to a dementia condition, we did receive positive comments from people about the service. Three of the residents we were able to speak with said, “Great food, we are lucky to have a good cook here.” Also, “The staff are so helpful always willing to listen when you are down a bit. They are really wonderful.”

During our inspection we looked at care records and undertook a tour of the building. A relative we spoke with about the home told us the building was always clean and never had any offensive odours. They also told us the staff were helpful, polite and knew how to support people who had dementia. One aid, “They do keep the place clean. Also the staff are so helpful. The only thing is it could do with doing up a bit.”

Staff told us they felt supported, had regular meetings with their manager, and their training was kept up to date. Staff training records we looked at confirmed this.

Prior to our visit we contacted the Lancashire contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

We spoke with a range of people about the home. They included, the manager, assistant manager, staff and people who lived at the home individually and in a group setting. We also had responses from external agencies such as social services in order to gain a balanced overview of what people experienced. This home cares for people with a range of dementia conditions, therefore there were limited comments made from people who lived there.

Conversation with most residents was very limited due to their dementia condition. We therefore spent much of the time in various lounges and communal areas making observations of how people were being cared for. However people we did speak with about respect and dignity only said good things about the staff and people running the home. Comments included, "Absolutely lovely people all of them." Also, "I am called by my first name and they never enter my room without knocking first."

We spoke with Lancashire County Council Contracts monitoring department and they had no concerns or issues with the service.

Peoples’ admission to the home was managed very well. Every effort had been made to ensure their admission was a good experience for them because they had an opportunity to discuss the help they needed. They were given information about the service and were involved in planning their care.

One relative wrote to us and said, “On choosing the home, I looked for the important care elements… At that time the building was home to many residents who it seemed, were allowed a feeling of ownership and choice. The staff though obviously managing all aspects of daily living were respectful visitors in the home of these people. This is how residence should be.” The standard of care and attention was also described by relatives as “incredible” and “giving great comfort”.

People living in the home said staff knew and understood what they wanted. They listened to them and took into account their views. Staff were very helpful and spent a lot of time with them and they were supported to access other health and social care services they needed. One person told us she had managed to have a holiday with staff support.

Visitors considered staff were respectful to people in the home and were friendly and accommodating when they visited. They told us, their relatives had the support they needed for their health, personal and social needs. They said, “It is very good here. They are very patient and kind to the residents.” And “They are always doing something with them, and they go out.” “I visit regularly and I find the manager and staff on duty very helpful, professional and caring.”

People made complimentary comments about the food. They enjoyed their meals and could have as much as they liked. Alternative meals were always provided.

There were good arrangements in place for safeguarding people to make sure they were protected from abuse and their human rights upheld.

Visitors to the home said the home was kept clean and they were happy with the level of cleanliness maintained. People liked their bedrooms and were able to furnish them with them with their own belongings and possessions.

People told us they were very happy in the home. Staff were attentive to their needs and always responded to their call for assistance. They did not feel hurried and staff helped them as they wanted. They could talk to them if they had any problem or query. Relatives who wrote to the Commission about the standard of care at Fairhaven Lodge described the staff as “without exception, professional and caring”. People visiting said staff were “very caring” and thorough in their work. They were always friendly when they visited and “obviously care for the residents”.

People said they were confident the manager would deal with any issue of concern they may have.