Fairview

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 on a regular basis with the key worker making sure their support plan was working for them. People's preferences and lifestyle choices were clearly recorded along with excellent guidance for staff in supporting people with these. People had an individualised timetable of activities which encouraged the development of independent skills and also provided social interaction and entertainment. People and their relatives knew how to raise a complaint if they needed to. They were confident in approaching staff about any concerns they had. When concerns had been raised they were responded to and action had been taken.

The service continued to be well-led. There was a relaxed, friendly and open culture at the service. Staff were valued and supported by the registered manager and provider. The registered manager and provider were clear on the values and ethos they expected from staff. Staff worked to these values and told us they were led by example. There was a system to monitor and improve the quality of the service and there was a clear commitment to driving up quality. People's views were sought as were those of their relatives and other professional stakeholders. People were involved in all levels of the organisation, they provided opinions on the service which were used to make improvements and address concerns. Links with the local community were developed and maintained.

The five questions we ask about services and what we found