This inspection took place on 15 October 2018 and was unannounced.

At our last inspection on 20 February 2017 although the service was rated ‘good’ overall, there was a breach of the regulation in relation to safe care of service users as the service did not always have risk assessments in place to guide staff when providing care.

Fairview is a ‘care home’. People in care homes receive accommodation and nursing 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. The service was registered to provide care for up to10 people. On the day of the inspection there were nine people living at the service. They varied in age, with a variety of learning and health disabilities.

The service had 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

At this inspection we found there were risk assessments in place for people for the majority of risks. The main risk assessments for moving and handling and, for example, skin integrity were in place. More specific personalised risk assessments, for example behaviours were in place on some care records but not for all people who needed them.

Medicines were in the main safely managed but the staff had adopted some practices which were potentially unsafe but these were remedied on the day of the inspection.

Care records were comprehensive and up to date. The registered manager told us they would streamline care records as it was not always easy to find the most up to date information.

People told us staff were kind and we saw this was the case. People told us the food was good and they enjoyed the activities at the service.

People had good access to health care and health professionals as needed.

Staff told us they found the registered manager approachable and they enjoyed working at the service as part of the team. Training and supervision took place in key areas. Staff recruitment was safe.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Quality audits were undertaken by the registered manager in a number of key areas but there were no provider audits taking place at the time of the inspection. Following the inspection the provider sent us an updated quality assurance framework and told us they would begin audits at the service.

At our last inspection on 16 and 17 October 2014, we found the premises was poorly maintained and paintwork in some areas had been damaged. Suitable window restrictors were not in place in two bedrooms. Cleaning chemicals were not locked away securely. Some areas of the home had not been fully cleaned. We carried out a focused inspection on 10 December 2015 to check if improvements had been made. We found a suitable window restrictor was not in place on a kitchen window that was broken, which was near to a dual carriageway. The second floor bathroom window did not have measures in place to restrict access. This was installed after the inspection and the kitchen window was fixed. The home was clean and had been maintained.

The service had 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

Risk assessments had been completed for most people. However, for some people risk assessments did not provide information on how to mitigate identified risks to ensure people were safe at all times. After the inspection the registered manager sent us evidence to demonstrate that the information had been included to mitigate identified risks.

There were systems in place for quality assurance. We discussed our concerns with risk assessments which had not been identified in the audits we saw with the registered manager, who assured us that risks were being identified and the quality assurance process would be made more robust to include how to mitigate identified risks.

Medicines were being managed safely.

Staff had the knowledge, training and skills to care for people effectively. Staff received regular supervision and support to carry out their roles.

Staff sought people's consent to the care and support they provided. People's rights were protected under the Mental Capacity Act 2005. Deprivation of Liberty safeguarding application had been made for people that, due to their own safety, required supervision when going outside.

People had the level of support needed to eat and drink enough, and to maintain a balanced diet. People were able to access healthcare services and attend routine medical appointments and health monitoring with staff support.

Staff encouraged positive, caring relationships with the people who lived at the home. Systems and procedures were in place to encourage and facilitate people's involvement in decisions that affected them.

People were treated in a respectful and dignified manner by staff who understood the need to protect people's human rights.

Activities in the home were tailored to suit people’s individual needs and preferences.

People received care that was shaped around their individual needs, interests and preferences. Care plans promoted a person-centred approach, and staff made use of these.

People found the registered manager approachable and had confidence in their ability to act on things. Staff felt well supported by the manager.

We identified a breach of regulation relating to risk management. You can see what action we have asked the provider to take at the back of the full version of this report.

We carried out an unannounced comprehensive inspection of this service on 16 and 17 October 2014. During the inspection the home was in breach of one legal requirement and regulation associated with the Health and Social Care Act 2008. The registered provider did not ensure people who used services and others were protected against the risks associated with unsafe or unsuitable premises because of inadequate maintenance.

After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook a focused inspection on 10 December 2015 to check that they had followed their plan and to confirm if they now met the legal requirement. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Fairview on our website at www.cqc.org.uk

Fairview provides care and accommodation for a maximum of 10 people with a learning disability. During the inspection six people were living at the home.

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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

During this inspection, we found a suitable window restrictor was not in place on a kitchen window that was broken, which was near to a dual carriageway. This meant that there was a risk that people could abscond or the window may fall off causing injury to people, staff or visitors.

The second floor bathroom window did not have measures in place to restrict access. The registered manager told us after the inspection the kitchen window had been repaired and a window restrictor was placed on the kitchen and bathroom window and provided evidence to support this.

The risk assessments on safety of the premises had not identified the shortfalls that we identified during our inspection.

Window restrictors were in place in people’s bedroom on the ground floor. We checked two rooms on the first floor and second floor and window restrictors were installed. All rooms were clean and tidy. People confirmed that the home was cleaned regularly and did not have any concerns about the premises. Some refurbishment to the home had taken place and there were plans to make further improvements to the home environment.

Cleaning chemicals were locked away in a cupboard and the home was clean. There was a cleaning schedule, which covered all areas of the house.

Checks had been made by qualified professionals in gas safety and electrical installations.

People were supported to give valid consent to care and support they received from the provider. We saw evidence of a number of opportunities that were made available to people to express their views.

Peoples' needs were assessed and care and treatment delivered in line with their individual plan of care. The care records examined by us contained evidence that the care needs of people had been assessed.

The provider had taken reasonable steps to identify the possibility of abuse. They provided us with examples of what constituted abuse and were aware of action to take when responding to allegations or incidents of abuse.

Staff told us they were able to perform well in their roles because they received support from their manager. They told us that they felt able to approach their manger with their concerns, knowing they would be acted upon.

We reviewed the records of some people who used the service. We observed that all plans of care contained detailed information relating to people’s care and treatment.

One person told us "I really like it here." We found that care plans and assessments of risks to people who use the service were regularly reviewed. Staff demonstrated the knowledge and skills needed to protect people from abuse.

The registered manager had taken steps to ensure the premises were being maintained appropriately. We found that staffing levels were sufficient for the needs of people who use the service. The provider had an effective system in place to regularly assess and monitor the quality of service that people receive. This meant that people were protected and received safe care and treatment.

People spoken to confirmed that staff knocked on their bedroom doors and asked to come in. This was also recorded by people on quality assurance questionnaires.

We observed that people had gone to the gym, Christmas shopping and work experience on the day of the inspection.

People felt staff were helpful and supportive.

We asked about the food and were told, “I think that the food is nice". Another person said they made their own food at times.

People said they felt safe living in the home and safe with the people supporting them.

People said they were very happy with their newly decorated bedrooms and the refurbishment of the home.

People spoken to felt that staff could meet their needs. A person said, “Staff are helpful and kind”.

The surveys received from people that used the service included positive comments. For example, people reported that the staff were always smiling and the manager was approachable.

We asked people who use services about being treated with dignity and respect.

Everyone confirmed that staff knock on their bedroom doors and ask to come in. People said they choose when they go to bed. "One person said "staff treated them well". Another person said, "staff are good".

When we asked whether there was enough to do living at the home, people indicated that there was. They gave examples of day trips to the London eye, Waterloo, going to the gym,shopping, cinema, going to the park, going to museums and eating out.

People told us they attended day centres and had work experience.

We observed that some people spent some time sitting interacting with each other.

People had mixed views of the meals provided by the home. Comments we received were, " I think that the food is nice". Another person said they made their own food at times. We were told by people that they sometimes had a meal out or could eat their meals in the bedroom if they wanted to. Some people said they could choose their meals others said they could not.

People said they felt safe living in the home and safe with the people supporting them. Names were given of who they could speak to if they were worried about anything or if they were upset and these included the names of members of staff working in the home or the manager. People said " I feel safe here". We asked people if they felt comfortable raising concerns about their care and they said they did.

Some people said they were happy with their bedrooms. However, other people said they would like their bedrooms and the home redecorated.

People that use the service said the area manager came to the home to check that everything is alright.

This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. Fairview provides care and accommodation for a maximum of 10 people with a learning disability.

The home has 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 and associated Regulations about how the service is run.

On both days of the inspection people in the home were relaxed and well cared for. We saw staff talking with people in a pleasant and respectful manner. One person said, “I feel safe here. They take good care of us.” Another person commented, “I am satisfied with the care. The staff listen to us.” Three professionals who provided us with feedback stated that their clients were well cared for and they had no concerns.

Throughout the inspection we saw that people could prepare snacks and meals for themselves. People could go out if they wanted to. Staff respected people’s privacy and knocked on bedroom doors to ask for permission before they went in.

Staff had assessed people’s needs and prepared appropriate care plans with the involvement of people and their representatives. Staff provided good support which met people’s physical and mental health needs. There were regular reviews of people’s health and the home responded to changes in need. Staff assisted people to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs.

The provider carefully recruited staff and provided essential training to enable them to care effectively for people. Staff we spoke with had a good understanding of the needs of people. Professionals informed us that staff were able to meet the needs of people.

The home had a safeguarding policy. Staff knew how to recognise and report any concerns or allegation of abuse.

The manager and staff team worked with other professionals to ensure people received appropriate care and support. With one exception, the feedback received from the three professionals we contacted, was positive. Meetings and one to one sessions were held to ensure that people could express their views. A recent satisfaction survey indicated that people were satisfied with the quality of care provided.

We found the premises were poorly maintained. Suitable window restrictors which can only be released with a special tool were not in place and two bedroom windows on the ground floor which was near to a public footpath were left open. Cleaning chemicals were not locked away in a cupboard. These were a risk to people’s safety. Some areas of the home were not fully cleaned and had cobwebs.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.