Fairlie House

Updated 19 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. 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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. This was a planned inspection based on the rating at the last inspection.

Before the inspection we reviewed the information, we held about the service to inform our planning. This included notifications we had been sent. A notification is information about important events that the provider is required to send us by law. We also used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also contacted commissioners of the service and health care professionals to seek their views and help inform our inspection planning.

This unannounced inspection took place on 25 and 28 September 2018. The inspection team consisted of two inspectors, a specialist adviser and an expert by experience on the first day. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. On the second day a single inspector returned to complete the inspection.

During the inspection we spoke with six people living at the home and six relatives to understand their views about the care and treatment offered. Some people were unable to express their views and we observed the care provided and tracked that the care given was reflected in people’s care plans. We observed the care and support at meal times, spent time around the home, observing in the communal areas and attended a multi-disciplinary meeting and a sensory session. We spoke with two visiting health and social care professionals to understand their experience of working with the service.

We also spoke with the maintenance team, the chef, the therapy team leader, the activities team, administrative staff, the dignity champion, four members of care staff, two senior carers and two clinical matrons, the registered manger, operations director, director of clinical governance, nursing director and deputy manager.

We looked at ten care plans, eleven staff training and recruitment files and records related to the management of the service such as maintenance and equipment checks, accident and incident reports, assessment documents, meeting minutes and audits.

Following the inspection, we received written feedback from one person living at the home and two relatives.

Updated 19 December 2018

This unannounced inspection took place on the 25 and 28 September 2018. At the last inspection on 12 February 2016 the home was rated Good in each key question and Good overall. At this inspection we found significant improvements and examples of very good and excellent practice. We judged it to now be Outstanding in two key questions and overall.

Fairlie House 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.

Fairlie House accommodates 45 people in one adapted building across three separate floors, each of which have adapted facilities.. There were 43 people using the service at the time of the inspection. The nursing home cares for people with complex neurological needs, sensory impairments and physical disabilities as a result of brain injury or neurological conditions.

There was a registered manager in place. They had been registered with the Commission as the registered manager for the home 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.’

We found there were very good aspects to the systems to monitor safety at the home. Robust fire safety processes were in place and there were effective premises and equipment checks. Risks to people from their individual health needs were carefully assessed, monitored and comprehensive guidance provided to staff to reduce risk. However, one care record did not clearly track the monitoring of skin integrity risk. We saw this was addressed immediately at the inspection.

People were protected from the risk of abuse or neglect. Staff were fully aware of the action they needed to take to ensure people’s safety and well-being. Accidents and incidents were recorded, monitored and acted on appropriately with actions to minimise reoccurrence. There were excellent systems for identifying and sharing learning from adverse events.

There were systems in place to ensure people were protected from the risk of infection and the home was clean and well maintained. There were enough suitably trained staff to meet people’s needs and safe staff recruitment practices were in place. Medicines were managed, administered and stored safely. Staff were trained to manage medicines and their competences assessed.

The home was distinctly effective, which improved outcomes for people. There was a dedicated comprehensive system of appropriate training, competency assessment and support for staff to provide the right knowledge and competence for them to carry out their roles effectively and safely. This was constantly evaluated for improvements.

People’s clinical physical, mental, social and therapeutic needs were holistically assessed using best practice and current guidance, before they moved to the home to ensure staff and the home environment could meet their needs safely.

People’s nutritional needs were supported in a safe and highly personalised way.

People complex health needs were supported through positive working relationships amongst the home’s staff and with external health professionals.

The home fulfilled its responsibilities under the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves.

The home environment was well maintained and adapted to meet people’s needs.

People and their relatives told us the home was very caring and some relatives were exceptionally complimentary about the care at the home. We observed staff to know the people they supported well and to be respectful, caring and considerate.

There was a strong values framework that underpinned the provider’s approach to person centred care. Staff had received training on this and support to put this into practice.

People's privacy and dignity was very much respected and maintained and staff supported people to develop and maintain their independence. People were proactively supported and encouraged to maintain relationships with people that were important to them.

People’s communication needs were considered and where possible, they were able to express their views, and be involved in decisions about their day to day care. Assistive technology was promoted to improve people’s ability to communicate.

The service was exceptionally responsive. People had individually developed person centred care and therapy plans that reflected their needs. The home was proactive in supporting equality and respecting diversity.

People were encouraged to choose manageable goals which improved their lives. The staff team worked collaboratively in partnership with a range of organisations to improve people’s life experience. People’s quality of life was enhanced by assistive technology, and the stimulation and activities provided in conjunction with the therapy team.

Most people and their relatives told us they had not needed to make a complaint and any issues were promptly dealt with. There was an effective complaints process in place.

The home had recently been recognised for its outstanding end of life care.

Aspects of the home were extremely well led. People, their relatives, staff and health professionals gave us very positive feedback about the way the home was run. The home’s values framework was familiar to staff and underpinned its governance and quality control.

The home supported training and development in the community to improve care.

People were encouraged to give their views about the service and these were listened to.

The home had developed a comprehensive quality assurance framework which it was embedding at the time of the inspection.