This inspection took place on 13 and 14 October 2016 and was announced. The provider was given 48 hours’ notice because it was a small service and people were often out in the local community during the day. We wanted to make sure someone would be in.

We last visited the service on 4 August 2014 where the provider was found to have met all the regulations we inspected.

Fairleigh House provides support and personal care for up to seven people with learning disabilities. There were seven people living at the home at the time of our visit. There were five single rooms, a semi-independent flat on the top floor and an independent flat on the lower ground floor.

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 person we spoke with and relatives told us that the service was exceptionally caring. Staff were highly motivated and demonstrated a clear commitment to providing dignified and compassionate care and support. Staff used creative and inclusive ways to make sure that people had accessible and tailored methods of communication.

The person with whom we spoke and relatives described the responsiveness of staff as "outstanding." Staff found inclusive ways to meet people's needs and enable them to live as full a life as possible. An extremely creative activities programme was in place to help meet people's social needs.

People were actively encouraged to give their views and raise concerns or complaints. Various inclusive and effective feedback systems were in place to obtain people's views.

People told us that they felt safe living at the service. There were no ongoing safeguarding concerns. Medicines were managed safely. We checked medicines administration records and noted that these were completed accurately.

Checks were carried out to ensure that applicants were suitable to work with vulnerable people. This included obtaining written references and a Disclosure and Barring Service check [DBS]. People told us and our own observations confirmed that there were sufficient staff deployed to meet people’s needs.

Staff followed the principles of the Mental Capacity Act 2005. The manager was strengthening the service's records with regards to the documentation of any decisions relating to mental capacity to ensure that it was clear how the MCA was followed.

People’s nutritional needs were met and they had access to a range of healthcare services.

There was an effective system in place to monitor the quality and safety of the service. Various audits and checks were carried out. Actions were taken when any deficits in standards were identified. We looked at the maintenance of records. We saw that care files were stored securely. The manager was able to locate all records we requested promptly.

There was evidence that people and staff were involved in the running of the service. Feedback systems were in place to obtain people's views. Meetings and surveys were carried out. Staff told us that morale was good and they enjoyed working at the service.

The manager had submitted notifications to CQC in keeping with their obligations under the Care Quality Commission (Registration) Regulations 2009.

During our visit, we spoke with two of the seven people who used the service. They shared some of their experiences at the home although due to medical conditions they were not able to describe their experiences in detail. We spoke with two care staff, the team leader, the registered manager and the regional manager.

One inspector carried out the inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

Is the service safe?

We saw people were being cared for in an environment which was safe and clean. There were enough staff on duty to meet the needs of the people living at the home. A member of the management team was on duty on each shift and available on call in case of emergencies. Processes for the prevention and control of infection were in place. For health, safety and security reasons, visitors were asked to sign in and out.

The people we spoke with who used the service told us they felt safe. One person said “I like it here.”

We saw training records and certificates which showed staff had received training to enable them to meet the needs of the people who used the service. This helped ensure the people who used the service were supported by staff who had the necessary skills and experience. We saw staff rotas which showed appropriate numbers of staff were on duty each shift.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). The aim is to make sure people in care homes and hospitals are looked after in a way which does not restrict their freedom inappropriately. We saw that one person had been the subject of a DoLS authorisation. The authorisation had been reviewed appropriately and restrictions were no longer necessary. Several members of staff had received training about the Mental Capacity Act and Deprivation of Liberty Safeguards so they understood when an application should be made and how to submit one.

Is the service effective?

People’s health, social and care needs were assessed with them and they were involved in writing and reviewing their care plans. Specialist needs had been identified in care plans, for example, ways to communicate. Care plans were reviewed every year and when necessary due to changing needs.

From the training records we viewed we found staff had received training to enable them to meet the needs of the people who used the service. Discussion with staff and examination of records confirmed a programme of training was in place so all members of staff were kept up to date with current practice.

The people we spoke with told us they were happy with the care they received and said their needs were met. They spoke positively about the staff who supported them. From what we saw and from speaking with staff it was clear they had a good understanding of the care and support needs of the people who used the service.

Is the service caring?

People we spoke with told us they liked living at the home. Comments included “I like it here.”

We saw the staff showed patience and gave encouragement when they were supporting people so people were able to do things at their own pace and were not rushed.

Is the service responsive?

The records we saw confirmed people’s preferences and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People had access to activities which were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We saw documentary evidence which showed the service worked well with other agencies and services to make sure people received their care in a joined up way.

From speaking with staff we found they had a good understanding of the home’s values. They told us about their roles and responsibilities and they were clear about these. We saw quality assurance processes were in place to make sure the provider monitored the care provided and made improvements where necessary. For example, meetings were held with people who used the service so that they had the opportunity to express their opinions.

People who used the service had limited communication skills due to their learning disability but we spoke to one person who stated that they enjoyed living at Fairleigh House and appeared happy. We spoke with peoples relatives and reviewed family satisfaction questionnaire comments, to find out what they thought of the service and how their relatives were being cared for. We also spoke to staff, observed care practices and observed people who used the service.

Comments were mainly positive and people stated “My family member is well looked after” and “My family member is happy in his routine”. However some people stated that in their opinion, changes in staff could disrupt the continuity of care for people living at Fairleigh House.

People who used the service had limited communication skills due to their learning disability and because of this we could not directly obtain their views of the service and how they were treated. In light of this we spoke with peoples relatives to find out what they thought of the service and how their relatives were being cared for. We also spoke to care staff, observed care practices and observed people who used the service.

One relative we spoke with said of Fairleigh House, “They do a marvellous job and it’s the best place that x has lived in.” And, “They do a fantastic job and the staff are fantastic.”

One relative said, “I can’t praise them enough. I have no worries.”

Relatives told us that staff were patient and considerate. They told us, “Care staff are nice, really good and helpful.”

Another relative told us they had complete peace of mind that their relative was safe and well cared for by care staff at Fairleigh House.

Two relatives we spoke with said that had never made a complaint and they never had reason to complain.

Relatives told us that care staff always kept them informed of any health care issues or other changes.

One relative said that the structured routines and activities that were arranged for people living at Fairleigh were really good and this benefitted their relative.