This unannounced comprehensive inspection took place on the 4 January 2018. The last comprehensive inspection took place on the 3 November 2015. The service was meeting the requirements of the regulations at that time. At this inspection the service remained good.

Fairholme Nursing Home is a ‘care home’ that provides nursing care for a maximum of 60 adults, with a range of health care needs and physical disabilities. At the time of the inspection there were 48 people living at the service. 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.

Fairholme is situated in the town of Camborne. It is a purpose built service on two floors. All rooms were single occupancy. There was a passenger lift serving the upper floor. Two lounges and a dining room were situated on the ground floor. There were additional quiet areas for people to use.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance. Training was provided to all staff with regular updates provided. The registered manager had a record which provided them with an overview of staff training needs.

The service had sufficient staffing levels in place to provide support people required. People told us staff were responsive and available when they needed them.

Staff had been recruited safely, received on-going training relevant to their role and supported by the registered manager and team leaders. They had the skills, knowledge and experience required to support people in their care. Staffing levels were sufficient to meet the needs of people who used the service.

Risks in relation to people’s daily lives were identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible.

Accidents and incidents were being recorded and reported and any lessons learned were shared with staff. The service learned by any mistakes and used this as an opportunity to raise standards. There was a culture of openness and honesty and staff felt able to raise concerns or suggestions.

Staff were supported by a system of induction, training, supervision and appraisals. Staff received training relevant for their role and there were good opportunities for on-going training support and development. More specialised training specific to the needs of people using the service was being provided. For example, dementia care and clinical nutrition support.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

Care plans were well organised and contained personalised information about people’s needs and wishes. Care planning was reviewed regularly and whenever needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted.

There were a range of quality assurance arrangements at the service in order to raise standards and drive improvements. For example, audits to ensure quality in all areas of the service was checked, maintained, and where necessary improved.

All levels of staff engaged with all stakeholders of the service. People’s views were taken into account through regular communication and surveys

We carried out this unannounced inspection of Fairholme on 3 November 2015. Fairholme is a care home which provides accommodation for up to 60 people who require nursing or personal care. At the time of the inspection fifty people were using the service. Most people who lived at Fairholme required general nursing care due to illness. Some people were living with dementia, physical or sensory disabilities.

The service received a comprehensive inspection in April 2014 and was found to be meeting the requirements of the regulations.

The service is required to have a registered manager and 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The range of activities available to people were limited. Activities were mainly therapeutic including hand massage. People told us they would like more activities with ‘mental stimulation’. We have made a recommendation to the provider about this.

Not all staff were wearing protective clothing in the dining room when serving and supporting people to eat their meals. This meant there was a potential cross contamination risk. Protective aprons were available around the service. The registered manager acted on this issue with immediate effect.

The atmosphere at the service was welcoming, calm and friendly. The service had a central hub of lounge and dining space, as well as two separate lounges. People were able to spend their time in various areas of the service as they chose. There were a range of mobility aids and equipment to support people. People’s bedrooms were personalised as were the furnishings in lounge areas.

Some people had complex needs and were not able to tell us about their experiences. However comments from those people we spoke with told us they felt safe because there were sufficient staff on duty to meet their needs. Comments included, “I don’t have to wait long before they [staff] come if I need them” and “There is always a member of staff around if I need to speak to them about [relatives name]. People’s care and support needs had been assessed before they moved into the service. They included risk assessments to ensure peoples safety. Care records included details of people’s choices, personal preferences and dislikes.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. However the way staff were allocated around the service at lunchtime meant some people had to wait for some time before they received their meal.

Staff had been suitably trained to recognise potential signs of abuse and subsequently to take appropriate action. Staff received other suitable training to carry out their roles. Recruitment processes were satisfactory; for example pre-employment checks had been completed to help ensure people’s safety.

The medicines system was well organised, and people received their medicines on time and there were safe systems for storage. People had access to a general practitioner (GP), and other medical professionals including a dentist, chiropodist and an optician. Where referrals for further investigation were made by a GP, staff had made sure records were regularly updated so there was a clear audit trail for any prescribed treatment. A health professional told us the service managed medicine systems well.

People’s nutrition and hydration needs were being met. The cook had information about people’s dietary needs and special diets. Staff supported people to eat meals where they needed help. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Staff were positive about their work and confirmed they were supported by the management team. Staff received regular training to make sure they had the skills and knowledge to meet people’s needs. The service had signed up and achieved the Gold Standard Framework. This aims to provide optimal care for people approaching the end of life.

People told us they knew how to complain and would be happy to speak with a manager if they had any concerns. Families and staff felt they could raise any concerns or issues they may have with the manager, who they said was approachable. People felt their views and experiences were listened to.

The management team used a variety of methods to assess and monitor the quality of the service. These included regular audits and meetings with all stakeholders of the service. Response from this monitoring showed that overall satisfaction with the service was very positive.

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe? People told us they felt safe. Systems were in place to help the manager and staff members learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

Fairholme alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Fairholme had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). This helped to ensure that people’s needs were met.

Is the service effective? People’s health and care needs were assessed with them, although people were not involved in writing or reviewing their plans of care. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs.

Specialist dietary needs had been identified where required. Care plans were up-to-date.

We saw that there was good liaison and communication with other professionals and agencies to ensure people’s care needs were met.

Is the service caring? We spoke with people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, “He’s a nice boy, they all are” and “I enjoy being here, the staff are wonderful”. When speaking with staff it was clear that they genuinely cared for the people they supported.

People’s preferences and interests had usually been recorded although the quality of life histories was variable.

Fairholme had regular support from the GPs from the local GP practices and other visiting health professionals. This ensured people received appropriate care in a timely way.

Is the service responsive? Many people who lived at Fairholme had complex health needs and were either not able, or chose not to join in group activities. The care records did not always evidence the lifestyle of these people, or show that they were routinely offered one-to-one or group activities, although the manager told us action was being taken to remedy this.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led? Fairholme had a new manager, who had only been in place for approximately three weeks, but people told us they had confidence in the manager, the providers and the staff.

We saw minutes of meetings held with the staff and the people that lived at Fairholme. This showed the management consulted with people and staff to gain their views and experiences and improve support for people who lived at the service.

The service had a quality assurance system, and staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

We spoke to six people who lived at Fairholme Nursing Home, as well as three nurses and two care staff, and the providers. The comments we received were all positive. The people praised the way they were treated by the staff and said they “it is better than okay, it is five star”. People agreed that they were treated with respect, and confirmed there were activities provided and they could choose whether to participate or not.

People experienced care, treatment and support that met their needs and protected their rights and people were protected against abuse because the provider had appropriate arrangements in place.

There was sufficient, appropriately skilled and experienced, staff on duty to meet people’s care needs. People were protected by the home’s robust recruitment procedures.

Records were legible, up to date and stored securely, although not all required records were available for inspection.

We spoke to people who lived at Fairholme Nursing Home, as well as the staff, the manager, clinical lead and the providers. The comments we received were all positive. The people praised the way they were treated by the staff and said they “felt at home”. They all agreed that they were treated with respect.

People told us they felt they had enough to do to keep occupied, they confirmed there were activities provided and they could choose whether to participate or not. People told us they were happy with the care provided.

During our inspection, we found people’s privacy, dignity and independence were respected and people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People experienced care, treatment and support that met their needs and protected their rights, people were protected against abuse because the provider had appropriate arrangements in place and staff were well supported and trained.

The providers had systems in place to monitor the quality of the service provided at Fairholme.

During our inspection we observed staff, spoke to five people that lived at Fairholme and one person who was visiting. People told us that they felt that there were sufficient staff to assist them. People using the service were complimentary of the staff and told us that they worked “tremendously hard” and they felt the staff were “marvellous”.

We looked at the care planning and found that this had not improved since our last inspection on the 8 October 2012. The care plans did not direct, inform or guide staff, this meant that staff were not aware of how to provide care to individuals in a consistent manner. A consultant had been employed to implement new systems to improve the service.

The recruitment process had improved and we saw that all pre-employment checks had been gained prior to the person commencing employment.

Since our last inspection in October most of the staff had received training in areas such as safeguarding and pressure area care.

The system for monitoring the quality of service had not improved since our previous visit. The providers had sought advice from “consultants” in order to implement a new system to ensure that there will be an effective system in place.