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Inspection on 14/10/09 for Fair Bungalows Nursing Home

Also see our care home review for Fair Bungalows Nursing Home for more information

This inspection was carried out on 14th October 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home had worked well with other agencies such as the Citizenship Team and Learning Disabilities Team to bring about improvements. We saw that substantial progress had been made in improving the service and meeting the needs of people living in the home. This has included record keeping, assessment, care planning, medication, training, supervision and management and the safety of the home`s environment.

What the care home could do better:

Some further work is required in developing and implementing person-centred care plans. Staff training records have been brought up to date and these now need to be developed into a training plan for the home.

Random 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 zero star poor service 12/06/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Graham Thomas Date: 1 4 1 0 2 0 0 9 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: Fair.bungalows@guinness.org.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Guinness Care and Support Ltd care home 7 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 7 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 Brief description of 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. 1 2 0 6 2 0 0 9 Care Homes for Adults (18-65 years) Page 2 of 9 Brief description of the care home Care Homes for Adults (18-65 years) Page 3 of 9 What we found: This random inspection was to check compliance with the requirements and recommendations made at out key inspection on 12th June 2009. Following our key inspection on 12th June 2009 we recommended that there should be accurate and up to date information available to people who might use the service. During this visit we found that the homes Statement of Purpose and Service Users Guide had recently been updated. We also recommended that initial and ongoing assessments should provide an accurate appraisal of peoples needs. Since our last visit, nobody had moved into the home. However we looked at three peoples files. In the files we saw that the assessments and plans were being updated. For example, the files we examined all contained health assessments and person-centred health action plans. We made a requirement that individual plans and personal records must be held securely. During this visit we saw that the records were stored in the homes office which was kept locked when not in use. We also required that individual risk assessments must be produced and kept up to date. In the files we examined, we saw that risk assessments had been updated. These now included, for example, risk management protocols regarding best interests assessments and decision making in compliance with Mental Capacity Act. We recommended that person-centred plans should be produced for each person living in the home. The Manager told us about ongoing work with the local Citizenship Team to develop person-centred plans. We saw an example of one such plan. Though this work is not yet complete, there was evidence that the home is working towards compliance with this recommendation. Recommendations were made concerning the lifestyles of people living in the home. One recommendation was to link activities to person-centred plans so that they would be more closely linked to peoples individual needs and aspirations. We found that the development of person-centred planning was still in progress. This recommendation had therefore yet to be followed. However, activities continue to be available to people living in the home. During this visit we saw that several people were taken to an activity in the homes minibus. Another recommendation concerned producing information about activities in userfriendly formats. This recommendation had yet to be followed. However we did note during our visit, that some efforts had been made to provide other information in an accessible form. This included, for example, signage seen in the home. At our last visit we noted that the garden was not sufficiently well maintained to ensure it was accessible to people living in the home. During this visit we saw that the gardens had been maintained and that there were arrangements in place for this to continue. The manager also told us about plans for the future development of areas outside the building. Care Homes for Adults (18-65 years) Page 4 of 9 At our last visit we found that treatment regimes recommended by visiting professionals were not being consistently followed. We looked at the file of one person whose treatment included daily exercises recommended by a physiotherapist. In the file we saw specific written and pictorial guidance for staff about this treatment. We also saw daily records confirming that the treatment had been applied. The recording and follow up of these treatments was being monitored by key workers who had been allocated to each individual. A number of requirements were made at the last inspection concerning medication. This included a requirement about storage repeated from a previous visit. During this visit we found significant improvements. New secure storage arrangements had been put in place for medication. Facilities for the secure storage of controlled drugs had been fitted in the homes office. A dedicated secure drugs trolley had been obtained and this could be securely fixed to the office wall when not in use. We examined the medicines administration record. This record was up to date and in good order. All medicines had been signed for, including prescribed skin creams. Information was available for staff with the record about specific medications and their purpose. Protocols had been produced for the use of rescue medication used for prolonged epileptic seizures. Staff had received training in the use of this medication. There were clear instructions for staff concerning the use of medicines whose use had been prescribed as directed. A system of audits had been put in place to monitor the use of medicines in the home and to ensure that regular medication reviews take place. We had required the home to record all complaints together with any action taken and the outcome. We also recommended that all staff should be aware of their responsibilities concerning complaints and safeguarding people from abuse. The manager showed us a complaints record maintained since our last visit. This showed details of some complaints and contained the information specified in our requirement. Staff files and training records showed that there was an ongoing programme of staff training in safeguarding vulnerable adults from abuse. Two requirements were made about the homes environment after our last visit. During our tour of the premises on this occasion we saw that locks had been fitted to cupboards containing exposed hot water pipes as we had required. We saw that a workplace assessment had been carried out since our last visit. However the specific requirement to produce a risk assessment regarding access to the homes kitchens had yet to be met. We noted during our tour of the premises that some areas such as the bathrooms had been freshly decorated and that the home was clean and free from offensive odours. After our last visit, we made a requirement regarding recruitment checks and a recommendation concerning staff training and supervision. Since our last visit, a new driver had been recruited. The manager told us that the persons file was at the organisations head office and she was awaiting its return. However, we saw documentation confirming that a criminal record check had been Care Homes for Adults (18-65 years) Page 5 of 9 completed before the person commenced their duties. Although we have seen partial evidence of compliance, this requirement will remain in place until compliance can be fully evidenced at our next inspection visit. We saw that in her review and updating of the homes records, the new manager had updated information about the training that individual staff had received. However, this had yet to be developed into a training plan for the home as recommended. We discussed supervision arrangements with the manager. She told us that individual supervision had been reinstated and showed us records to confirm this. We also saw minutes of staff meetings at which supervisory issues had been raised. During this visit we checked a requirement made about the storage of hazardous substances. On this occasion we saw that these had been locked away when not in use. We had previously recommended that a system should be put into place to monitor the quality of the service provided. The manager told us that work had commenced on this and that questionnaires had been sent to the families of people living in the home. We saw documents confirming this. Compliance with a recommendation concerning the control of infection in the home was examined. We saw evidence of improvements such as the provision of colour coded mops and buckets for cleaning different areas. We also noted in our tour that the home was generally cleaner than it had been during our previous visit. What the care home does well: What they could do better: 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 2. Care Homes for Adults (18-65 years) Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes R 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 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 2 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 Care Homes for Adults (18-65 years) Page 7 of 9 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 Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 Care Homes for Adults (18-65 years) Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 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). 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. 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