Inspection on 12/06/09 for Fair Bungalows Nursing Home

This inspection was carried out on 12th June 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fair Bungalows Nursing Home 14/10/09

Fair Bungalows Nursing Home 11/06/09

Fair Bungalows Nursing Home 15/05/08

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Fair Bungalows Nursing Home Franklyn Drive Cowick Lane St Thomas Exeter Devon EX2 9HS The quality rating for this care home is: zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Graham Thomas Date: 1 2 0 6 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 38 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 38 Information about the care home Name of care home: Address: Fair Bungalows Nursing Home Franklyn Drive Cowick Lane St Thomas Exeter Devon EX2 9HS 01392438430 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Fair.bungalows@guinness.org.uk Guinness Care and Support Ltd care home 7 Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is 7. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 38 A bit about the care home Fair Bungalows gives nursing support for up to seven people with a learning disability. People may also have a physical disability or difficulties with seeing or hearing. There are two bungalows. Three people live in Fair Winds and four in Fair Crest. The bungalows are Both bungalows have an adapted bathroom. There are gardens at the front and back. There is also a safe area in the back garden. When we visited we could not get information about how much it costs to live at Care Homes for Adults (18-65 years) Page 5 of 38 Fair Bungalows. Care Homes for Adults (18-65 years) Page 6 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 38 How we did our inspection: This is what the inspector did when they were at the care home Before we visited Fair Bungalows, the manager filled in a form to tell us about the h home. We went to meetings about keeping people safe. What we heard made us think we needed to visit sooner than we had planned We visited Fair Bungalows and looked around. We spoke with the manager and with staff. While were there we saw staff helping people. Page 8 of 38 Care Homes for Adults (18-65 years) We looked at peoples plans and records about staff. After our visit, people who visit the home told us what they thought about it. What the care home does well There is a minibus to take people on trips. Staff treat people with respect. Care Homes for Adults (18-65 years) Page 9 of 38 What has got better from the last inspection What the care home could do better People who might move in need better information about the home. The home needs staff who know about peoples needs. Care Homes for Adults (18-65 years) Page 10 of 38 ???? Peoples plans need to be clear and up to date so that staff know what they need and how to support them. The plans need to be made easier to understand for people living in the home. Activities need to be organised to suit each person. There should be information about activities that people can understand. Peoples complaints should be written down. This is so anyone can see what has been done about them. Staff need to know who they can talk to if they think someone is being harmed. Risk assessments need to be kept up to date. This is so that people can have the chance to do things in a safe way. Care Homes for Adults (18-65 years) Page 11 of 38 Staff need better training so they know what people need. The manager should meet with staff regularly to talk about how they can help people. Fair Bungalows needs a permanent manager Manager If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the Care Homes for Adults (18-65 years) Page 12 of 38 inspector please contact Graham Thomas CQC South West Citygate Gallowgate Newcastle upon Tyne NE1 4PA Inspector 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 13 of 38 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 14 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 1 and 2 People who might move into the home or their representatives do not have sufficiently up to date information. People cannot feel confident that their needs will be accurately assessed. Evidence: The manager of Fair Bungalows gave us a copy of the homes Statement of Purpose. This was last updated in April 2008 and contained out of date information. For example, people named in the organisational structure no longer occupied the positions described. There was also a reference to the previous provider of the service and not Guinness Care and Support. It is important to provide accurate and up to date information for people who might move into the service. All the current residents of fair bungalows are long-standing and there have been no recent admissions. The Statement of Purpose described staff skilled in assessment. Our inspection revealed that there was a lack of qualified staff with substantial experience in caring for people with a learning disability. The planning and delivery of care has not been sufficiently robust to meet the needs of people living in the home. It is therefore Care Homes for Adults (18-65 years) Page 15 of 38 Evidence: unlikely that initial and ongoing assessments would, at present, provide a sufficiently clear picture of peoples needs and whether they could be met in the home. There was, however, some work going on at the time of our visit to improve the individual care plans. This is described in the Individual Needs and Choices section of this report. Care Homes for Adults (18-65 years) Page 16 of 38 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 6, 7 and 9 People using the service and their representatives cannot be fully confident, at present, that their needs and choices will be clearly identified and catered for. Evidence: Before our visit to the home we received concerns about how care was planned and provided. We looked at the plans of all the people living in the home. They were organised in a number of files. For example, records of nutritional monitoring were held in a separate file in the kitchen. The main care plan files were held on shelves in the office which was not kept locked. This means that peoples private information was not held securely. The home has lacked consistent management for some time and, as a consequence, plans have not been kept up to date. For example, no consistent records had been kept about when people had been seen by visiting therapists. Where people had been prescribed regimes of treatment by visiting professionals, it was not clear whether these Care Homes for Adults (18-65 years) Page 17 of 38 Evidence: had been followed. One persons condition had deteriorated when they had not received the treatment that had been prescribed. However, we saw that the new manager was updating the plans and had, for example, introduced a new system for recording professional visits. We also saw that the manager was receiving support from an advisor to improve the plans and make them more person-centred. This means that the plans would focus more on peoples specific individual needs. The manager told us that meetings were being arranged with peoples circles of support to agree these new plans. Work to update and improve the plans was in its very early stages at the time of our visit. We looked at how peoples individual choices were supported and respected. We found that not all staff had been trained in total communication This is an approach used to communicate with people who may have difficulties in verbal expression and understanding. It is important because it maximises peoples chances of being able to make their needs and choices known. We also noted that the home has relied heavily on agency staff. Therefore, it would be more difficult provide a consistent approach to communication. In the absence of highly detailed planning and assessment it is also unlikely that staff would be able to respond to an individuals more subtle means of communication such as movements, gestures and facial expressions. However, while we were visiting, we saw that staff were making choices available to people living there. This included, for example, choices about where they wanted be in the home and what they would like to eat. Some staff were able to describe ways in which they might use objects of reference as prompts for people. An example of this was a towel being placed next to a person to indicate that they were to be taken for a bath. An album of photographs and signs had also been produced for one person. The manager told us that staff training in total communication had begun and that more work was being done to develop resources such as the album produced for one person. The manager also told us that the home was trying to reduce its reliance on agency staff. We looked at how individual risks were being managed. Risk assessments we saw in some in individual plans had not been kept up to date or were undated. The new manager was in the process of updating these risk assessments as part of the review of care planning. Overview risk assessments had also recently been produced. Issues concerning depivation of liberty safeguards had not been cleary identified in a timely way or referred to the appropriate agency. Care Homes for Adults (18-65 years) Page 18 of 38 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 15, 16 and 17 The lifestyle supported at Fair Bungalows provides an adequate degree of choice and activity. Further work is needed to ensure that the lifestyle choices offered top people are sufficiently individualised to meet their particular needs. Evidence: We looked at the homes records concerning activities and discussed these with the manager and staff. An activities timetable was seen in the office which included, for example, reiki, music, rebound therapy, and horse riding. Some activities such as evening walks, shopping and trips to the pub, included people in the wider community. The number of activities available had recently increased. Whilst at the home we saw that a group of people were taken out in the homes minibus to their planned activity. A driver / carer is employed specifically for this purpose. At present, activities are not linked to person-centred plans though these are being developed. Activity plans and timetables had not been produced for each person in an Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: accessible format. However, an album of photographs and signs was being used to prompt one person and staff mentioned the objects of reference they might use to let individuals know that a particular activity was about to take place. We looked at how people are supported to maintain contact with people who are important to them. The new manager told us that a meeting for families of people living in the home had recently taken place and that further meetings were planned. Records and photographs around the home showed that people living there were in regular contact with their families. Visiting arrangements appeared to be sufficiently flexible to support this contact and there was evidence that families have been actively involved in the life of the home. An example of this was a safe area at the rear of the property provided for people living in the home by parents fund-raising. Access to the garden has been restricted by a lack of maintenance over which we have received relatives and professional concerns. At one stage grass had been allowed to grow very tall, reducing physical access and proving a potential barrier for one person known to have hay fever. On the day of our visit a new lawn mower arrived and the manager was in discussion with maintenance staff about plans for the garden areas. During our visit we saw that people were taking meals according to their individual needs and routines. We saw menus for four weeks which represented a varied and nutritious diet. No menus were available in an accessible format for people using the service. The new manager told us that the MUST (Malnutrition Universal Screening Tool) was being introduced. We saw evidence of this in individual plans and in separate nutritional monitoring files. The manager also told us that following discussions with an external professional a persons diet had been modified. This had reduced behaviour which challenges the service. Care Homes for Adults (18-65 years) Page 20 of 38 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 18, 19 and 20 Standards of personal and health care support are improving. However, there needs to be a sustained and permanent improvement so that people can feel confident that they will receive the support they need. Evidence: Before our inspection visit we received concerns about health care support in the home. These concerns included whether people were receiving the treatments they needed and whether staff were trained to provide this care. We looked at peoples plans and spoke with the staff and manager about individual health care support. We saw that each person had been allocated a key worker and named Nurse. We saw examples of how staff were supporting people and recognising their changing needs. For example, a staff member accompanying people to an activity had noticed that a person was looking tired and returned with them so that they could rest. The people we met who lived in the home appeared clean and well groomed and were dressed in individual styles. As described in the Individual Needs and Choices section of this report, care planning Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: was in the early stages of reorganisation when we visited. The plans showed that there had been a lack of consistent recording and monitoring of peoples health needs. It was not possible, for example, to establish when and whether health professionals had visited individuals. Records of weight monitoring for one person were inconsistent. In another instance, a prescribed physiotherapy regime had not been followed. Immediately prior to our visit, no staff in the home were trained to administer rescue medication for people with epilepsy. This type of medication is used where a prolonged seizure may place the person at risk. Until very recently there had been no clear protocol as to what staff should do in these circumstances. Some improvements had been made when we visited. All the permanent staff had been trained in epilepsy awareness and the administration of rescue medication. Further training was planned for agency staff. A protocol was in place and this was understood by the staff with whom we spoke. During our visit, one person had a prolonged seizure. We saw that the protocol was being followed although it ultimately proved to be unnecessary. Nutritional monitoring was being improved by the introduction of the MUST tool (Malnutrition Universal Screening Tool) and we saw examples of how peoples nutritional needs were being monitored. We examined the homes systems concerning medication. We saw that the cupboard currently used for storing medicines was not secure because an inner bolt had not been dropped. Storage for controlled drugs was currently in a lockable tin within the cupboard. The manager told us that a secure medication trolley was on order and showed us a lockable cabinet which the supplier had also provided for the home to assess. The home uses a monitored dosage system for medication in which medicines are dispensed in pre-prepared doses in blister packs by the pharmacy. Some medications that could not be stored in blister packs were supplied in bottles or packages. At the front of each persons medicines administration record we found a laminated sheet This sheet had a photograph of the person and instructions to the staff about how their medicines must be administered. This is good practice as it provides an additional safety measure to ensure people receive their medicines correctly. In the medicines administration records we saw that most medicines had been recorded accurately. However, prescribed creams had not been signed for. We also noted that some people had been prescribed as required medicines. There was no protocol for the use of some of these medicines. Such protocols are important as they describe the circumstances in which the medicine should be given, how much and what the maximum dose should be. Where there is a reliance on agency staff, this is of particular importance to reduce the possibility of error. Some medicines had been supplied with the instruction as directed. It was not made Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: clear what these directions were. Under these circumstances, the best practice would be for staff to consult with the Doctor and/or Pharmacist to clarify the directions for administering the medicine. This should be checked by two staff and signed by each. Care Homes for Adults (18-65 years) Page 23 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 22 and 23 Systems in the home for receiving and acting on complaints and safeguarding people from abuse are not yet sufficiently robust. Evidence: Since our last key inspection of Fair Bungalows, we have received two complaints and notifications of a number of incidents which resulted in a referral to the Devon Safeguarding Team. We looked at how complaints and concerns were recorded so that we could see what complaints had been received in the home and how they had been dealt with. At the time of our visit the new manager had not been able to locate the complaints record so it was not possible to assess whether complaints were being accurately recorded and what action had been taken. People living at Fair Bungalows have limited communication skills and would be unlikely to be able to tell people if they wanted to complain about something. Recent reliance upon agency staff who may not be familiar with the subtleties of an individuals communication may create an additional barrier. The staff training records held in the home were poor so it was not possible to confirm which staff had received training in safeguarding vulnerable people from abuse. There was no evidence of staff training in the Mental Capacity Act and Deprivation of Liberty Safeguards. This is new legislation which safeguards people who cannot speak for themselves. Individual records concerning the use of wheelchair lap straps indicated that Care Homes for Adults (18-65 years) Page 24 of 38 Evidence: best interests assessments might be needed. The manager told us that training in the new legislation had been arranged and was awaited. Further advice was being sought about best interest assessments. Staff with whom we spoke were clear about their responsibility to report any suspicion of abuse but were less clear about external agencies they might contact under these circumstances. Care Homes for Adults (18-65 years) Page 25 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 24 and 30 The homes environment is reasonably clean, comfortable and well maintained. Some shortfalls identified at this inspection place people at risk. Evidence: The home comprises two bungalows which are connected by a corridor in which there is a nurses station and laundry. Each bungalow has individual bedrooms as well as its own kitchen and bathroom. Since our last key inspection visit, the homes office has been moved into a former bedroom. When we looked around the home we saw that there was a fair standard of decoration. Peoples own rooms contained their own possessions. Communal lounges were comfortably furnished. Half glazed entrance doors to both bungalows presented a potential hazard. This was discussed with the manager who stated that the doors were always left open and never closed. The possibility of removing these doors was therefore being considered. We saw that hot water to hand basins and baths had been regulated to prevent scalding. Hot surfaces on radiators had been covered. However, cupboards containing hot water tanks and exposed hot pipes were not fitted with locks. This poses a risk to people who might not understand the danger. In our presence the manager requested the Care Homes for Adults (18-65 years) Page 26 of 38 Evidence: maintenance man to fit locks to these cupboards at the earliest opportunity. Similarly, we noted that kitchen doors were left open. In the kitchens there were various hazards including hot surfaces and unregulated water. Bathrooms contained baths adapted to the needs of people using the service. Cupboards in the bathrooms were left unlocked. Potentially hazardous substances had been left inside and on top of these cupboards. These were removed and the cupboards locked. Outside, the bungalows are surrounded by level gardens. At the time of this visit the lawns at the rear were becoming overgrown. A new mower arrived during our visit and the manager discussed plans for external maintenance with the homes hnadyman. A fenced off area at the rear of the bungalows provides a safe area for people to sit. We looked at hygiene and the control of infection. At our last key inspection, an odour was noted in some areas of the home. This had been eliminated. We saw that liquid soap and paper towels were available at wash hand basins. While we were touring the premises we saw cleaning staff at work. At wash handbasins we saw that there was liquid soap and paper towels.The laundry facilities are sited in the corridor connecting the two bungalows. This has an impermeable floor. Care Homes for Adults (18-65 years) Page 27 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 32, 34, 35 and 36 Recent improvements in staffing arrangements were noted. However, people living in the home cannot presently feel confident that their needs will be met by skilled and knowledgeable staff. Evidence: Before the inspection, we received information that there had been a number of changes to the staff team and that the home had become reliant on agency staff. This was confirmed in the records we saw during our visit. Stable relationships with staff are important for people with high levels of need and communication difficulties. This is because regular contact enables staff to observe and learn the subtleties of an individuals communication. In the absence of clear and detailed care planning and guidance for staff, important signs might be missed. On the morning of our visit, the home was staffed by the manager, two agency nurses, and three care assistants. There were also a driver, handyman and domestic. In the afternoon there were four care assistants and one registered nurse. At night, the home is staffed by two waking staff members on of whom is a qualified nurse. We observed staff supporting people who live in the home. They treated people with respect and were patient and supportive. Care Homes for Adults (18-65 years) Page 28 of 38 Evidence: We saw that there had been no clear, consistent or coherent approach to staff training. None of the qualified nurses has been trained in learning disability.Whilst this is not a requirement, it is important that people are supported by staff who are skilled and knowledgeable in meeting their needs. Records concerning other training received by staff were in disarray. It was not possible to establish what training staff had received as there were no clear records and no training plan. The new manager was in the process of collating information and had asked staff to bring their certificates to work so that she could establish a clearer picture of staff training. Recent incidents in the home have highlighted the lack of staff training in important areas relating to the needs of people living in the home. For example, it had come to light that none of the staff were trained in the administration of rescue medication for people with epilepsy. In the absence of a clear protocol as to what to do in the event of a prolonged seizure, people living in the home could be placed at significant risk. In the week prior to our visit, the manager and Guinness Care and Support had worked with the local learning disability team to put this training in place. Similarly, staff had received no recent training in total communication or none at all. This is key to understanding and meeting the needs of people living at Fair Bungalows. Some good practice in this area was noted in our visit and some recent initiatives were seen such as the development of an album of pictures and signs for one person. The manager stated that this training had just started and some staff had already attended. We looked at staff files. The manager was in the process of re-organising the files and an example was seen of one file which had been clearly organised. Other files were disorganised and incomplete. For example, some files did not contain clear evidence of recruitment checks with the Criminal Records Bureau. One file showed that a POVA First check had been completed before the person had commenced duties and prior to the completion of a Criminal records check two months later. Under these circumstances, the person must be supervised by a named, experienced colleague until the criminal records check is complete. There was no records of such supervision and the staff member confirmed that she had worked alone with people during this time. This is poor practice and places people using the service at risk from potentially unsuitable staff. This appointment pre-dated the arrival of the new manager who was aware of this recruitment requirement. There was no evidence of recent staff supervision. The manager stated that she was planning to re-introduce this. In the meantime she had introduced regular handover and general staff meetings. Care Homes for Adults (18-65 years) Page 29 of 38 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 37, 39, 41 and 42 There have been very recent improvements in the management of the home. However, a sustained and consistent improvement must be demonstrated so that people can feel confident that the home is being well-managed in the best interests of people living there. Evidence: Fair Bungalows does not have a manager registered with the Care Quality Commission and has not had a registered manager for a considerable time. Since the home was last inspected, the management of the home has been inconsistent, involving a number of temporary arrangements. At the time of our recent visit, a new manager had recently been appointed. The new manager is a Registered General Nurse who does not have substantial experience in working with people with learning disability. However, she has many years nursing experience and has completed the Registered Managers Award. Since her recent appointment she has attended some courses relevant to the needs of people living in the home such as epilepsy awareness and the administration of rescue medication. She is presently being supported by a service manager employed by Guinness Care and Support. Care Homes for Adults (18-65 years) Page 30 of 38 Evidence: Evidence throughout this report indicates that there has been little effective monitoring of the quality of the service provided. This is indicated by shortfalls in care planning, risk assessment, medication practice, staff recruitment, training and supervision and neglect of the homes environment. Important records such as risk assessments, care plans and staffing records had not been kept up to date and in good order. Some records required by regulation were not available for inspection. An action plan had been produced to address the immediate concerns following recent safeguarding concerns and bring about improvements. Though recently appointed, we saw evidence that the new manager is working cooperatively with local services to bring about these improvements. This is referred to throughout this report in areas such as staff training. However, this work is in its very early stages and consistent, sustained improvement will need to be demonstrated to show that the home is being well-managed in the best interests of people living there. We looked at safe working practices within the home. We saw several records that demonstrate regular servicing and maintenance. These included, for example, a gas safety check in March 2009, the repair of a hoist in May 2009, and maintenance of the homes seated scales. Due to the disorganisation of training records we could not establish a clear picture of staff training in health and safety topics such as moving and handling. We asked to see copies of environmental risk assessments but these could not be found. Therefore these were not available for inspection During our tour of the home we saw that some hazardous substances had not been locked away. We also saw that gloves were not being changed between cleaning tasks, posing a risk of cross infection. Care Homes for Adults (18-65 years) Page 31 of 38 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 20 13 (2) You must review the 01/10/2008 arrangements for storing controlled drugs (including Temazepam) and medicines requiring refrigeration, to ensure that, if such medicines are received into the home any time in the future secure storage facilities comply with current legislation. Prescribed creams and lotions administered by the home must be recorded each time they are administered. Care Homes for Adults (18-65 years) Page 32 of 38 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 6 17 Peoples individual plans and 13/07/2009 personal records must be held securely. This is so that private information about people is only accisible to people who need to see it. 2 9 13 Individual risk assessments 27/07/2009 must be produced in consultation with relevant professionals. These must be reviewed regularly and kept up to date. This is so that the risks of participating in activities can be recognised and managed. 3 19 12 The Registered Person must ensure that any prescribed treatment regimes are followed. 13/07/2009 Care Homes for Adults (18-65 years) Page 33 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action This is to ensure peoples health is maintained by getting the treatments they needs 4 20 13 All prescribed medicines must be signed for when administered, including skin creams 13/07/2009 This is to ensure there is a clear record as to whether people have received their precribed treatments 5 20 13 A protocol must be produced 13/07/2009 for all medicines prescribed as required (PRN) This is to ensure people receive medicines when they need them and reduce the possibility of error. 6 22 17 The Registered Person must ensure that all complaints are recorded together with any action taken and the outcome. 13/07/2009 This is to ensure there is a clear audit trail of any complaints or concerns and how these have been handled 7 24 13 Locks must be fitted to 13/07/2009 cupboards containing hot tanks and exposed hot water Care Homes for Adults (18-65 years) Page 34 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action pipes This is to prevent people using the service from being burned by contact with hot surfaces 8 24 13 A risk assessment must be 13/07/2009 produced concerning access to the homes kitchens and a copy supplied to the Commission. This is to ensure that people are not put at unnecessary risk 9 34 19 The registered person must 13/07/2009 ensure that there is a robust recruitment procedure in place. This includes the supervision by a named, experienced colleague of any staff member who commences duties before the completion of a criminal records check This is so that people living in the home are safeguarded from potentially unsuitable staff 10 42 13 The Registered Person must ensure that hazardous substances are kept locked away when not in use 13/07/2009 Care Homes for Adults (18-65 years) Page 35 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action This is to protect people living in the home from unnecessary risks to their helath and safety. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 1 2 Up to date and accurate information should be available fo people who might use the service. The Registered Person should ensure that arrangements for the initial and ongoing assessment of people can provide an accurate appraisal of their needs. Person-centered plans should be developed for all people living in the home. These should be kept up to date and reviewed regularly. Activities should be linked to person-centred plans so that they link more closely with peoples individual needs and aspirations. The homes gardens should be maintained so that people living there can have unrestricted access. Information should be produced in user-friendly formats to help people make choices about their daily routines. This might include, for example, activity timetables and menus. Clear directions must be obtained from the prescribing Doctor for any medicines supplied with the instruction as directed The registered person should ensure that staff are aware of their responsibilities and procedures concerning complaints and safeguarding people from abuse. The Registered Person should develop a staff training plan. This should ensure that staff receive regularly updated training relevenat to the needs of people living in the Page 36 of 38 3 6 4 12 5 6 16 16 7 20 8 23 9 35 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations home. 10 36 Staff should receive regular, recorded supervision. This should include the translation of the homes philosophy and aims into work with individuals; monitoring of work with individuals; support and professional guidanceand identification of training needs. The Registered Person should put in place an effective system to monitor the quality of the service provided as a basis for continual improvement. The Registered Person should ensure that best practice is followed in controlling infections in the home by staff training, supervision and monitoring. 11 39 12 42 Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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