Fairlea

The care service has been developed and designed in line with the values that underpin the Registering the Right Support CQC policy and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.

We previously inspected Fairlea on 7 November 2017. We found three breaches of the Health and Social Care Act 2008 (Regulated Activities). We rated the service requires improvement. At this inspection we found improvements had been made and the provider had met the requirement notices. At this inspection we rated the service as good.

People were safeguarded from avoidable harm. Staff adhered to safeguarding adults procedures and reported any concerns to their manager and the local authority.

Staff assessed, managed and reduced risks to people’s safety at the service and in the community. There were sufficient staff on duty to meet people’s needs.

Safe medicines management was followed and people received their medicines as prescribed. Staff protected people from the risk of infection and followed procedures to prevent and control the spread of infections.

Staff completed regular refresher training to ensure their knowledge and skills stayed in line with good practice guidance. Staff shared knowledge with their colleagues to ensure any learning was shared throughout the team.

Staff supported people to eat and drink sufficient amounts to meet their needs. Staff liaised with other health and social care professionals and ensured people received effective, coordinated care in regards to any health needs.

Staff applied the principles of the Mental Capacity Act 2005. 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. An appropriate, well maintained environment was provided that met people’s needs.

Staff treated people with kindness, respect and compassion. They were aware of people’s communication methods and how they expressed themselves. Staff empowered people to make choices about their care. Staff respected people’s individual differences and supported them with any religious or cultural needs. Staff supported people to maintain relationships with families. People’s privacy and dignity was respected and promoted.

People received personalised care that met their needs. Assessments were undertaken to identify people’s support needs and these were regularly reviewed. Detailed care records were developed informing staff of the level of support people required and how they wanted it to be delivered. People participated in a range of activities.

A complaints process ensured any concerns raised were listened to and investigated.

The registered manager adhered to the requirements of their Care Quality Commission registration, including submitting notifications about key events that occurred. An inclusive and open culture had been established and the provider welcomed feedback from staff, relatives and health and social care professionals in order to improve service delivery. A programme of audits and checks were in place to monitor the quality of the service and improvements were made where required.

At the last inspection we found a breach of Regulation 17 HSCA 2008 (Regulated Activities) Regulations 2014 Good Governance. The lack of management and auditing of the service meant that records were not always complete to reflect the service delivery and people's needs.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key line of enquiry (KLOE) “Are people’s records accurate, complete, legible, up to date, securely stored and available to relevant staff so that they support people to stay safe”, to at least good.”

We found they had met this requirement although records were not all easily found.

Fairlea is a residential care home accommodating up to two adults with learning disabilities. 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. The care home accommodates two people in one adapted building. There were two people living at the home at the time of inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. “People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy.

There was no 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.

There was a manager who also manages another service for the provider in the immediate area. They were they intending to register but have yet to submit an application to be registered.

The provider had not always acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find. The provider had not carried out mental capacity assessments for people using the service. The provider had not acted within the Mental Capacity Act as they had not applied for a DoLS for people who were as a result being restricted outside of the requirements of the Act.

Quality assurance systems were not always effective and had not identified issues found in relation to the mental capacity assessments, Deprivation of Liberty safeguards, medicines and accessibility of care plans.

There was a complaints procedure but complaints were not always logged.

Medicines were not always managed safely as accurate records were not always kept regarding stock. Emergency systems had been put in place to keep people safe.

Care plans were not always readily available for staff to read, to ensure they were offering the relevant support.

People’s healthcare needs were met and staff worked with health and social care professionals to access relevant services.

People received a service that was caring. They were cared for and supported by staff who knew them well. Staff treated people with dignity and respect.

People were supported to maintain relationships with family and friends.

People received person centred care and support. People were encouraged to participate in employment and leisure activities. Transitions for people moving from the service were well planned.

Quality assurance systems were not always effective and had not identified issues found in relation to the mental capacity assessments, Deprivation of Liberty safeguards, medicines and accessibility of care plans.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report.

46 Fairlea Road is a care home that does not provide nursing. It provides support for two people, with a learning disability and behaviour which challenges. Fairlea Road is a quiet residential road in Emsworth with access to the local community.

The home had not had regular management input for about a year. There was a longstanding staff group who knew people well. One of the staff was the deputy manager.

A registered manager was in place however they had a new role which meant they had not visited the care home regularly. A new manager had been appointed and they told us they would be applying to the Commission. We refer to this person as manager throughout the report. 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.

Risks associated with people’s care and support had been assessed and plans had been developed to ensure that staff met people’s needs consistently and reduced such risks.

During the inspection people told us, or indicated that they enjoyed living at the home, and staff we spoke with and observed understood people's needs and preferences well. Staff were able to describe to us how people needed to be supported to ensure they were cared for safely, and the rationale behind this.

Whilst staff knew people well, it was not possible to see how staff had involved people in looking at their support needs and risks associated with those needs.

Observation demonstrated people’s consent was sought before staff provided support. Staff and the manager demonstrated a good understanding of the Mental Capacity Act 2005.

We found that staff received a good level of training; the provider's own records evidenced this, as did the staff we spoke with.

Staff demonstrated a good understanding of safeguarding people at risk. They were confident any concerns raised would be acted upon by management and knew what action to take if they were not. Medicines were managed safely, although temperature checks were not always recorded.

Although no new staff had been employed at the service for over 18 months we saw that thorough recruitment checks had been carried out and the provider ensured there were enough staff on duty to meet people’s needs. Staff received a thorough induction when they first started work which helped them to understand their roles and responsibilities.

Due to a lack of consistent management we saw that staff had only received supervision twice in the last 18 months. However the staff told us they felt they supported each other well.

People and their relatives knew how to make a complaint and these were managed in line with the provider’s policy. Systems were in place to gather people’s views and assess and monitor the quality of the service.

There has been a lack of regular manager input in the last 12 months which had impacted areas such as audits, staff supervision and recording. The provider had systems in place to ensure people's safety by monitoring the service provided and this should improve now there is a manager in place.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

People we spoke with told us they felt safe while being supported. They told us the care staff were good. One person told us "They help me to do things and are always around'. None of the people we spoke with had any concerns about the support they received. Staff told us the care and support plans gave them the information they needed to provide the level of support people required.

We saw care and treatment was planned and delivered in a way that ensured people's safety and welfare. Both of the care plans we looked at had risk assessments in place to help minimise any risk that had been identified.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager told us that currently no applications for DoLS had been made.

There were effective recruitment and selection processes in place. The provider, Dolphin Homes Limited operated a robust recruitment process.

The fire log book showed regular checks of the fire alarm and emergency lighting systems were recorded. We also saw that regular fire evacuation exercises were conducted

We saw safety certificates were in date for gas safety, electrical wiring and for portable appliances.

Is the service effective?

Each person had a plan of care and support. We saw that support plans explained what the person could do for themselves and what support they needed from staff.

During our visit we saw staff consulted people as much as possible when they supported them. Staff spoke to people clearly and explained to people what they were doing. Staff told us that the care and support plans gave them the information they needed to provide the level of support people required.

We looked at how staff recorded what support had been provided each day. We saw that recording took place throughout the day and provided good information about the care and support given and provided evidence of care delivery.

Is the service caring?

We observed staff speaking to people appropriately and they used people's preferred form of address; We saw people and staff got on well together. There was a good rapport between staff and people who used the service and we observed staff and people enjoying each others company.

We observed that people were happy with the support they received and a relative of one person we spoke with was very happy with the care and support their relative received. They told us that the staff were caring and provided the help, care and support their relative needed.

Is the service responsive?

We saw people had regular reviews of the care and support they received. We saw review notes which showed alterations had been made to people's plans of care as people's needs had changed.

We saw that people were able to participate in a range of activities both in the home and in the local community. Staff told us that they encouraged and supported people to participate in activities to promote and maintain their well-being.

People who used the service, their relatives and staff were asked for their views about how the home was meeting people's needs and any concerns or ways to improve the service were acted on.

Is the service well led?

Fairlea had a policy and procedure for quality assurance and the provider organisation also employed a quality manager who ensured that six monthly checks on the quality of the service provided were carried out. Following this audit the person conducting the audit compiled a report for the home manager on how the service was performing. This report identified any shortfalls and an action plan was issued to the manager of the service detailing what action needed to be taken to rectify any shortfalls.

The provider organisation also employed an area manager who carried out regular visits to the service. This was used to check on progress from the quality audit. The area manager also used this visit to consult with staff and to obtain people's views on how the service was meeting their needs.

A relative we spoke with told us that they had regular contact with the home and said that they could speak to the manager or staff at any time. They told us they were kept informed about any issues which affected their relatives.

Staff meetings took place every three months and minutes of these meetings were kept. Staff we spoke with confirmed this and said the staff meetings enabled them to discuss issues openly with the manager and the rest of the staff team.

Meetings with people who used the service also took place weekly and these were used to discuss any issues in the home and also to plan activities and menu's for the following week.

The manager told us that all staff received supervision every six to eight weeks where staff performance issues were discussed and additional staff training was identified as necessary. The manager also told us that staff received annual appraisals. Staff we spoke with confirmed this.

We also spoke with two relatives of people and they told us that they were happy with the care and support their relatives received. They said that they were consulted about the care and support their relative received. However one relative told us that their relative was anxious when they were returning to Fairlea if they had been out on an activity. They were unsure why this was happening.

Both of the relatives told us that they knew how to make a complaint if they needed to. They were confident that any complaints would be dealt with appropriately.

We spoke with the registered manager and two members of staff. They all said that they enjoyed working at the home and that everyone got on well together. Staff said they were well supported and that they were provided with the training and information they needed to support people effectively. All staff said the management were supportive and approachable.