This unannounced inspection took place on 18 and 19 September 2018.

Fairways is a 'care home'. 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.

Fairways is registered to provide care and accommodation for up to 24 older people living with dementia. The home is based over three floors with a lift for access to all floors. There were 20 people residing at the home at the time of inspection.

A registered manager was not in post at the time of the inspection. The previous registered manager had left their position in January 2018. At the time of the inspection visit the registered provider had applied to the Care Quality Commission (CQC) to register a new 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 2008 and associated Regulations about how the service is run.

We last carried out a comprehensive inspection at Fairways in July 2017. At the inspection in we identified no concerns within the care provided but the home was rated as Requires Improvement. We rated the home Requires Improvement as the registered provider had previously been rated inadequate and had implemented a lot of changes to meet the fundamental standards. We needed to be sure the changes were embedded.

At this inspection visit carried out in September 2018, we checked to see that all improvements had been maintained. We found the registered provider had embedded all the changes and had continued to make improvements and was now consistently meeting all the fundamental standards.

The registered provider had invested in technology and implemented an electronic system for managing and administering medicines. Medicines were stored and administered in line with good practice.

The registered provider had reviewed staffing levels and had introduced additional staff roles to enable staff to have the time to care for people who lived at the home. Staff told us this created increased opportunities for people and increased job satisfaction.

Since the last inspection visit, the registered provider had recruited an activities coordinator. We saw activities routinely took place within the home and the wider community. Staff understood the importance of providing person centred activities. There was an array of items placed around the home to encourage and motivate people to participate in activities.

There was ongoing refurbishment works within the home. For example, the registered provider had reviewed some colour schemes within the home to make the home more pleasing.

Audits had been formalised and embedded within every day practice and the registered provider understood the importance of effective auditing systems. Audits were routinely carried out and action was taken when concerns were identified.

Care plans for people were person centred, in depth and detailed. These care plans provided staff with the correct information to enable them to care for people in a person-centred way. The principles of the Human Rights Act were embedded throughout service delivery.

Risk was appropriately addressed and managed. Risks assessments were in place to ensure staff were aware of risk to keep people safe from harm.

People who lived at the home told us they felt safe. Staff could identify types of abuse and the associated responsibilities they had in reporting abuse.

People who lived at the home told us there were enough staff. Staff told us they were not rushed. Staff responded in a timely manner when call bells were activated.

We reviewed infection prevention and control processes at the home. The registered provider had taken on board advic

This unannounced inspection took place on 13 July 2017.

Fairways is registered to provide care and accommodation for up to 24 older people living with dementia. The home cares for people who require personal care and is made up of single and double rooms. Care is provided on a 24 hour basis. There is a lift to access all three floors of the building. The home is situated in the village of Heysham. At the time of the inspection visit 21 people were receiving care and support at the home.

A registered manager was in post at the time of 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.

The service was last inspected on the 09 and 13 January 2017. The registered provider did not meet the requirements of the regulations during that inspection as breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. These related to safe care and treatment, safeguarding people from abuse and good governance, person centred care, premises and equipment and a breach to Regulation 18 of the Care Quality Commission Registration Regulations. At the inspection, the service was placed in special measures by the Care Quality Commission, (CQC.)

During this inspection in July 2017, we found improvements to meet the fundamental standards had been made. As a result the service has been taken out of special measures. The service will be expected to sustain the improvements and this will be considered in the future inspections.

At this inspection visit we found improvements had been made to ensure people who lived at the home were safe. The registered provider had reviewed the premises and had put processes in place to ensure people were kept safe in the event of fire. We noted the home was undertaking a period of refurbishment, Whilst this was not completed we saw evidence of an ongoing refurbishment plan in place.

The registered manager had reviewed infection control processes at the home. They had worked in partnership with the infection prevention and control nurse to develop and manage infection control processes at the home. This had included refurbishing the laundry area and implementing new processes.

Care plans and risk assessments for people who lived at the home had been reviewed and updated to ensure they reflected people’s needs. The registered provider had reviewed ways in which falls were being managed. They had sought advice and assistance from health professionals to ensure people’s needs were met. We saw there had been a decrease in the number of reported falls since the previous inspection. Systems had been implemented to monitor and manage falls and these were consistently followed by staff.

Suitable arrangements had been implemented to ensure people were lawfully deprived of their liberty. Restrictions upon people had been reviewed and wherever possible restrictions had been reduced We saw appropriate DoLS applications had been made as required. Staff understood their responsibilities for reporting safeguarding concerns were aware how to report safeguarding alerts.

Arrangements for the management of medicines had been reviewed. Protocols for administering as and when required, (PRN) medicines had been developed. Systems had been put in place to ensure topical creams, pain relief patches and ointments were suitably recorded after administration. All medicines were stored securely when not in use. Audits of medicines were carried out by the registered manager.

Staffing needs had been addressed. The registered provider had reviewed the needs of all people who lived at the home and had increased the numbers of staff on duty. Staff told us this had enabled them to deliver improved car

This unannounced inspection took place on 09 January and 13 January 2017.

Fairways is registered to provide care and accommodation for up to 24 older people living with dementia. The home cares for people who require personal care and is made up of single and double rooms. Care is provided on a 24 hour basis. There is a lift to access all three floors of the building. The home is situated in the village of Heysham. At the time of the inspection visit 24 people 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.

The service was last inspected in January 2016. At this inspection we found the service was not meeting the required fundamental standards. We identified breaches to Regulations 12, 13, 17 and 19 of the Health and Social Care Act, (2008) Regulated Activities 2014, as care and treatment was not always safe, recruitment checks were not consistently applied to new employees and paperwork was not always accurate and up to date.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Fairways on our website at www.cqc.org.uk

We used this inspection carried out in January 2017 to ensure action had been taken to ensure all fundamental standards were now being met. We also carried out the comprehensive inspection to review the rating of the service.

At this inspection visit, we found some but not all improvements had been made. Improvements had been made that ensured systems were in place to notify the Care Quality Commission of incidents of abuse. The registered manager had implemented a new reporting system to ensure all concerns were reported to the appropriate bodies in a timely manner. However, the registered manager had failed to consistently notify the Commission of all other incidents in a timely manner. This was a continued breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We looked at how risks were addressed and managed by the service. We found some improvements had been made to ensure people at risk of malnourishment were appropriately supported. Documentation had been introduced to manage and mitigate any risk. We found that management of risk was not consistently applied throughout the service. When people were at high risk of falls we found risks were not safely managed. This placed people at risk of harm. This was a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

We noted care records and risk assessments identified some risks to people’s health and wellbeing. These provided staff with guidance as to how to keep a person safe. Due to the ineffective deployment of staffing these risk assessments were not consistently followed by staff. This placed people at risk of harm from naturally occurring risk. This was a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

We looked at care records. We found paperwork was inaccurate, incomplete and missing. This meant falls were not appropriately managed and people were at risk of harm. This was a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Applications had been made to the supervisory body to deprive people of their liberty; however not all restrictions had been considered and documented upon the applications. This meant that two people were being unlawfully deprived of their liberty. Staff had some understanding of the Mental Capacity Act 2005 (MCA) and the relevance to their work. However, mental capacity was not routinely assessed and good practice guidelines were not refe

This unannounced inspection took place on 22 and 26 January 2016.

Fairways residential home is situated in Heysham, near Morecambe. It provides accommodation for up to 24 residents in a mixture of double and single rooms, in an old building adapted for the purpose.

There were 19 people living at the home on the day of inspection.

A registered manager was not in post at the time of the inspection. A registered manager is registered with the Care Quality Commission to manage the service. 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 registered provider had designated a member of staff to be the registered manager but they had not yet registered with the Care Quality Commission.

The service was last inspected on 05 February 2014. We identified no concerns at this inspection and found the provider was meeting all standards we assessed.

At this inspection carried out in January 2016, we found people were not always safe. The registered provider had failed to implement suitable systems to ensure risks to people’s health and safety were appropriately monitored and managed. Care plans were in place for people who lived at the home. Care plans covered support needs and personal wishes. Plans had been reviewed at regular intervals however they did not always reflect people’s individual needs. This was a breach of Regulation 17 of the Health and Social Care Act (2008) Regulated activities 2014.

Risks were not consistently addressed and managed in a proactive way. Audits of accidents and incidents and audits of people’s weights had not been carried out to identify and manage any risks to people who lived at the home. This was a breach of Regulation 12 of the Health and Social Care Act (2008) (Regulated Activities) 2014.

Robust recruitment processes were not in place to ensure people employed were of suitable nature. This was a breach of Regulation 19 of the Health and Social Care Act (2008) (Regulated Activities) 2014.

Staffing levels were conducive to meet people’s needs. We observed staff being patient with people and meeting their needs in a responsive manner.

Arrangements were in place to protect people from the risk of abuse. People told us they felt safe and secure. Staff had a sound knowledge of safeguarding and were aware of their responsibilities for reporting any concerns. However processes in place were inconsistent to ensure all safeguarding alerts were communicated to the Care Quality Commission (CQC.) This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

The registered provider had suitable arrangements in place for managing medicines. Medicines were safely kept and appropriate arrangements for administering them were in place. The registered provider carried out regular audits of medicines to ensure systems in place were being followed correctly by staff.

People’s healthcare needs were monitored and referrals were made to health professionals in a timely manner when people’s health needs changed.

Staff had received training in Mental Capacity awareness and Deprivation of Liberty Safeguards. However we noted procedures were not always followed to ensure compliance with the Deprivation of Liberty Safeguards (DoLS). We identified two people being deprived of their liberty without legal authorisation. This was a breach of Regulation 13 of the Health and Social Care Act (2008) Regulated Activities 2014.

People were happy with the variety and choice of meals available to them. Feedback on the quality of food provided was positive from both people who lived at the home and relatives.

The registered provider kept a detailed log of all accidents and incidents that had occurred at the home. However during the course of the inspection we identified three serious incidents that had not been reported, as required to the Care Quality Commis

During our inspection we looked at staff training records, staff supervision arrangements, the services complaints procedure and quality monitoring procedures. We did this because we wanted to identify appropriate arrangements were in place to support staff members. We also wanted to ensure people using the service felt listened to.

We spoke with people living at the home, their relatives and staff throughout the inspection. We observed the quality of care and support provided by staff during the inspection.

We found care plan records were up to date and people were happy with the service they were receiving. We found people were supported by staff who had been trained and appropriate support arrangements were in place for them. Good care practices were observed and people told us they were happy with their relatives care. One person said, “I can’t fault my wife’s care. The home has a really relaxed atmosphere and I enjoy visiting. The staff are very kind and patient people”. Four people living at the home said they were happy and had no complaints. One person said, “The staff are very helpful and have a pleasing nature. I enjoy the meals and we have activities organised to keep us entertained”.

During our inspection we contacted the Lancashire contracts monitoring team. They told us they had no concerns about the service.

At our last inspection in April 2013, we found that the home was non-compliant with two outcomes. People were not cared for in a clean environment and medicines were not safely stored and administered. The provider submitted an action plan explaining how they would rectify these problems. At this follow up inspection in October 2013 we checked that the provider had put their plan into practice.

We found that a range of improvements had been put into place. These included some practical measures, such as rearranging the Senior Carers’ office to create more space, and laying a new floor in one bedroom. We checked most of the bedrooms and the communal areas and found that they were clean. The manager had put some new checks in place to reduce the risk of dirty rooms or beds or soiled incontinence pads being overlooked. Staff had been advised to adhere to the home’s policies to ensure medication was safely stored and administered. We saw that staff were being monitored by the manager to ensure that they adhered to the policies. These improvements meant that the home was a safer environment.

We inspected Fairways in October 2012 and found areas of non compliance in cleanliness, safe handling of medication and quality of management. The provider sent us an action plan in November 2012 and told us actions would be completed by January 2013. On our follow up visit in April 2013 we checked whether these actions had been completed.

We found that the provider had made many improvements to the home, such as refurbishing rooms and buying new furniture in communal areas. Some changes had been introduced to make the handling of medicines safer. Auditing had been introduced so that the manager and senior care staff could systematically check standards. However we found that the new systems were not all working well enough. Some rooms we looked at had not been cleaned on the morning we inspected: we found dried faeces in one room and a used incontinence pad in another room on a chair. We found also that staff were not dispensing medication in a safe way, the person administering the drugs did not have the medication administration records (MAR charts) with them. We also found medication was not always dispensed on an individual basis, which increases the risk of mix ups.

We spoke with residents while inspecting the home. Those able to express a view told us they were happy with the care and the staff. We observed staff interactions with residents, which were respectful and individual. Care plans were a useful basis for supporting people's individual needs, and daily records reflected these were being followed. We found that most medication was stored securely, but that there were some unsafe recording practices. The senior's room and manager's office were both small and cluttered, hindering efficiency. We saw that there were sufficient staff to look after residents needs. Quality monitoring had been started, but was not yet working effectively.