Fairview is a residential care home providing care and accommodation for up to eight people with a learning disability. It is comprised of a two storey building which accommodated four people in the main house and two in an attached annexe. A further two people lived in two separate annexes in the grounds.

The service is required to have a registered manager. There was a registered manager in post who had been registered to manage the service since December 2016. 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.

At the last inspection the service was rated good. At this inspection we found the service remained good overall. However, we found the service had strengthened their practice in caring and is now rated outstanding in this area.

People continued to receive safe care. Risk assessments relating to people’s individual care and to the safety of the service were completed and reviewed regularly. Where risks had been identified the least restrictive options were used to manage them and keep people safe. Robust recruitment procedures helped to ensure only suitable staff were employed to support people. There were sufficient numbers of staff to support people safely. Medicines were stored, administered and disposed of (when necessary) appropriately. Staff were trained in the safe administration of medicines including those medicines required in an emergency. Their skills were observed and assessed regularly. Routine health and safety checks were completed in accordance with guidance and legislation. Staff were aware of and had practiced fire evacuation procedures.

People continued to receive effective care. Staff were trained and supported to develop and maintain the skills and knowledge required to perform their role. The service worked in accordance with the Mental Capacity Act 2005. Applications to deprive people of their liberty had been made appropriately to the local authority. People were supported to have maximum 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. Staff supported people to monitor and maintain their health and wellbeing. They sought advice from healthcare professionals when necessary. People were involved in planning, choosing and preparing their meals. They were encouraged and supported to have a healthy diet. People’s nutrition was monitored to ensure they had sufficient to eat and to maintain their health and well-being.

The service was extremely caring. People and staff had developed positive and trusting relationships with each other and valued the time they spent together. Interactions between them were relaxed, supportive and appropriate. Staff were determined to protect people’s privacy and dignity. They found innovative ways of doing this when supporting people who were unable to protect their own privacy and dignity. Staff demonstrated an in-depth knowledge of people and their needs. They used this knowledge to support people to make decisions and choices about their lives as much as they were able. Different avenues of communication were explored and employed to give people the best chance of expressing their own views. People were helped to be as independent as possible. Staff strove to find ways to overcome obstacles to enable people to develop skills and were motivated to do so in the most compassionate way possible.

The service was very responsive. Support plans were extremely detailed and personalised providing staff with knowledge on how people wished to be supported and how to meet their needs. People had been fully involved in creating and reviewing their support plans. They spent time

This inspection of Fairview took place on 20 November 2014 and was announced. The provider was given 48 hours’ notice because the location was a small care home supporting five people who are often out during the day and we needed to be sure that someone would be in.

The home offers accommodation and support to six people who have learning and associated physical disabilities or a mental health diagnosis. Five people were living in the home at the time of our inspection. The primary aim at Fairview is to support people to lead a full and active lifestyle within their local communities and continue with life-long learning and personal development. The home is a detached house, with a bungalow annex, within a residential area and has been furnished to meet individual needs.

There was a registered manager running 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.

People in the service were actively involved in making decisions about their care and were asked for their consent before being supported. Relationships between staff and people were relaxed and positive. Support workers engaged with people to identify their individual needs and what they wanted to achieve in the future. Staff showed flexibility and creativity in supporting people to become more independent.

Comprehensive risk assessments had been completed with people and where appropriate their relatives. Where risks to people had been identified there were plans in place to manage them effectively. Staff understood the risks to people and followed guidance to safely manage these risks.

The home responded flexibly to people’s individual wishes and changing needs and sought support from health and wellbeing specialists when necessary. People’s dignity and privacy were respected and supported by staff. Support workers were skilled in using individual’s specific communication methods and were aware of changes in people’s needs, which were reported to relevant healthcare services promptly where required. People were encouraged to be as independent as they were able to be, as safely as possible. The house was well kept, homely, very clean and comfortable. People’s rooms were specifically adapted to meet their needs and reflected their individual preferences and tastes.

People at Fairview told us they trusted the staff who made them feel safe. Staff had completed safeguarding training and had access to guidance. They were able to recognise if people were at risk and knew what action they should take. People also had access to guidance about safeguarding in a format that met their needs, to help them identify abuse and respond appropriately if it occurred.

The registered manager completed a daily staffing needs analysis to ensure there were always sufficient staff with the necessary experience and skills to support people safely. Whenever possible the registered manager and staff worked together with people to identify in advance when their needs and dependency were likely to increase.

Robust recruitment procedures ensured people were supported safely by support workers with the appropriate experience, skills and character. Staff were encouraged to undertake additional relevant qualifications to enable them to provide people’s care effectively and were supported with their career development.

Medicines were administered safely in a way people preferred, by trained staff who had their competency assessed every six months by the registered manager.

Staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf. The provider utilised advocacy services for people where required.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide a lawful way to deprive someone of their liberty, where it is in their best interests or is necessary to protect them from harm. The registered manager had taken the necessary action to ensure the home was working in a way which recognised and maintained people’s rights. The registered manager had completed required training and was aware of relevant case law.

People’s needs in relation to nutrition and hydration were documented in their support plans. We observed people supported appropriately to ensure they received sufficient to eat and drink.

There was a friendly and relaxed atmosphere within the home, where people were encouraged to express their feelings, whilst respecting others. People told us that when they had a problem or were worried they felt happy to talk with any of the staff. Whenever people had raised concerns or issues prompt action had been taken by the registered manager to address them.

Staff had received training in the values of the provider as part of their induction, which were discussed at the start of all team meetings. People, their relatives and staff told us the home was well managed, with an open and positive culture. People and staff told us the registered manager was very approachable, willing to listen and make any necessary changes to improve things for people. Feedback was also sought in other ways ranging from provider surveys, house meetings, resident’s meetings and staff meetings.

We found that people understood the decisions they had made about their care and that they had been supported appropriately by relatives or advocates whilst making them.

People who used the service praised the quality of care and support they received from staff. One person said about the staff, “They are helping me to do things that people didn’t think I could do.” Another person told us, “I didn’t want to come here at first but I’m glad I did. I wouldn’t like to be anywhere else now.”

The provider had ensured that staff understood the signs of abuse and knew how to raise concerns with the right person. This meant people had been protected from abuse and that their human rights had been protected.

Staff we spoke with knew what medicines people were taking, why they were taking them and any possible side effects. We observed that medicines were given and recorded appropriately, in a safe and person centred manner. There had been no medication errors recorded since the last inspection.

People were safe and cared for by suitably qualified, skilled and experienced staff because the provider had an effective recruitment and selection process. We found that people who used the service were involved in the selection process.

The provider had an effective complaints system that was understood by people who used the service. We saw that people’s complaints were fully investigated and resolved, where possible, to their satisfaction.

People who lived in the home told us it was a safe place to live and that they were well supported by the staff and manager. People told us how they were involved in planning their care and identifying things they might like to achieve in the future. We were told that the staff were friendly and caring and treated people with respect.

Staff we spoke with said they worked well as a team and were well supported by the manager and the provider. People undertook regular training which was appropriate to the work they did.

We found that the home had systems in place to audit and monitor the quality of service provided and take appropriate action if shortfalls were identified. The provider sought the views of the people living in the home on all aspects of the service delivered.