Inspection on 11/01/07 for Fair Glen, Gate House & Maurice House

This inspection was carried out on 11th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 Glen, Gate House & Maurice... 18/12/07

Fair Glen, Gate House & Maurice... 27/02/06

Fair Glen, Gate House & Maurice... 06/10/05

Fair Glen, Gate House & Maurice... 31/10/04

Fair Glen, Gate House & Maurice... 06/07/04

Fair Glen, Gate House & Maurice... 02/03/04

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 08/07/2008.

CARE HOME ADULTS 18-65 Fair Glen & Gate House Lancaster Gardens Whitleigh Plymouth Devon PL5 4AB Lead Inspector Kim Fowler Key Unannounced Inspection 11th January 2007 10:00 Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fair Glen & Gate House Address Lancaster Gardens Whitleigh Plymouth Devon PL5 4AB 01752 770358 01752 770358 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Gyaneshwar Purgaus Santee Sawock Purgaus Gyaneshwar Purgaus Care Home 22 Category(ies) of Learning disability (22) registration, with number of places Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Age 18 - 65 The home may accommodate two service users named elsewhere who have mental health needs 27th February 2006 Date of last inspection Brief Description of the Service: Fair Glen/The Gate House is a care home providing personal care and accommodation for seventeen people aged 18 - 65, with learning disabilities. Mr and Mrs Purgaus privately own the home. This home is located in the residential area of Whitleigh, close to shops, pubs, the post office and other amenities. The home is at the end of an un-adopted road, close to a housing estate, and overlooking the local playing fields. The home was opened in 1987 and is comprised of two detached two-storey houses. Fair Glen has twelve bedrooms and The Gate House has five bedrooms. All the homes bedrooms are single and none of them have en suite facilities. Both of the houses have separate lounge and dining rooms and Fair Glen has a conservatory off the dining room. The home has large grounds; a patio and all areas are accessible to the Residents. The owners have now extended the property and included another house next to the existing properties and have called this Maurice House. The home is staffed 24 hours a day with sleep in staff in each house at night. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over 2 days. And the Registered Owner/Manager was available on the 2nd day of the inspection to assist the inspector with changes made within the home. A full tour of the building was undertaken and the inspector spoke to 17 of the service users. The staff that were on duty at the time were spoken with. Documentation relating to the care planning process and the management of the home were examined. Two service users and three staff comment cards were received as well as one Professional and one relative feedback card. Any comments are discussed in the relevant section of the report. What the service does well: What has improved since the last inspection? What they could do better: Additional staff after 10pm would allow more choice for service users. Guidelines and risk assessments in place for service users who can challenge the service would protect both staff and service users. To promote service users independence all service users should be offered a front door key. Staffing levels should be increased when staff on rotas are on leave. All staff recruitment practices must be carefully followed. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2/4/5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information provided to prospective service users is sufficient for them to make an informed choice about living at this care home. EVIDENCE: Service users files were examined during this inspection. Of these files 4 were new admissions to the home since the last inspection. All 4 files held a copy of the Service Users Guide. And one new service user said they had received copies of the homes statement of purpose and a service users guide. Senior staff described how all new service users are admitted after a Plymouth City Council care plan is sent to the home. The owner and staff then review this care plan and a meeting is held to discuss the suitability of the service user moving into the home. After the service user is admitted a Goal Progression sheet and a Service User Plan is written. The Goal Progression sheet includes everyday tasks required to meet the service users individual needs. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 9 All files examined held a completed Goal Progression sheet. The care plans were comprehensive in detail showing full details of the needs of the service users. Records did not show that these service users had been able to make visits to the care home before moving in. However 2 of the service user said they had visited the home several times and had stayed for meals before they moved in. One said they had come with their care manager and another said they had come with a family member. All files examined held a contract with the home and with the placing authority. The fees are recorded onto the placing authority contract and were signed by the service user. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6/7/9/10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are denied opportunities to control their own lives and the right to take risks and learn from poor choices by the restrictions of the homes rules. EVIDENCE: Service users files contained a completed Care Plan. The home also completes a service user plan and a Goal Progression sheet for each service user. The care plans describe how the home will meet the assessed needs of individual service users. And the Goal Progression sheet records the tasks required for staff to meet the everyday needs of the service users. Of the 6 files examined all had good detailed records regarding medication and personal care needs. The level of information recoded enabled care staff to meet the assessed daily needs of each individual service user. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 11 The records show these service user plans and Goal Progression sheets are reviewed regularly and record any changes in needs of the service users. One service user said they remember being involved in reviewing their care plan and had agreed the goals set out. Many of the service users were spoken with during this inspection and some said they were able to make decisions about their own lives including managing their own money. Some service users are able to assist with the day-to-day running of the home. The Commission received two service users comment cards and when asked, “do they make decisions about what they do each day” both ticked always. However a number of service users felt that any decision-making about their own lives were restricted by the home rules on bedtime, going out in the evening and other issues. Several service users stated that they had to go to bed or be in their bedrooms by 10pm, as this was the time that staff members went off duty. These service users also said that they were not allowed out and had to return home by 10pm again as this was the time the staff went off duty. Service users also told the inspector about other restrictions including not being able to smoke a cigarette after 10pm and before 7.30am, not able to make sandwiches after 8pm, only able to do their laundry on one day of the week, not being able to assist with the cooking and not allowed in each others bedrooms to watch TV or a Video. The owners were interviewed on the 2nd day of the inspection. They both confirmed that service users are encouraged not to use the lounge after 10pm but are able to watch TV or listen to music in their own bedrooms. And service users are requested to have their last cigarette outside before 10pm as the staff on duty go to bed at 10pm and the main door is locked. The service users are encouraged to assist with the cooking. The homes Statement of Purpose states that due to health and safety reasons service users are not able to use the homes ovens. The staff on duty were interviewed and confirmed that they went off duty at 10pm and that the home did not have waking night staff on duty. The home sent a duty rota with the pre-inspection questionnaire and this confirmed that staff on duty after 10pm sleep in. Several risk assessments were held on individual files. However the information recorded is minimal and does not provide sufficient information on risks that have been highlighted to protect service users or staff. For example the information recorded about one service user, who could challenge the Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 12 service, did not contain guidelines that described how staff should handle situations that may develop. Neither was there information that described the potential risk to the service user. One staff member confirmed that an incident they had reported and recorded had been discussed during a staff meeting. However no follow up guidance was recorded to assist and protect staff from further incidents. The owners confirmed that one service user has been abusive and made sexual advances to staff but no formal guidelines have been put into place. Several service users said that the homes response to them being out late, after 10pm, was to inform the police they were missing and to tell their parents. The owners said that this had been agreed at the last review for several service users with care management and family involvement. It was recorded in service users daily records of times when the police were called and when parents were informed that a service user had not returned to the home by 10pm. One staff said that they had contacted the owners when a service user had not returned to the home by 10pm to take advice. But that the homes procedure was to contact the police and one particular service users family if this service user had not returned by 10pm. One service user said that when they are on the telephone they felt that the staff listened to their conversation. They also said that information they discussed with staff in confidence was passed onto their family without their permission. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12/13/14/15/16/17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be confident that the home encourages contact with family and friends. However the daily activities programme and daily menu will not satisfy the needs of all the service users. EVIDENCE: Recorded onto individual Goal Progression sheets are tasks to promote independent living skills. This included support with laundry and other household duties. Several service users spoken with said they are able to do their own laundry and receive staff support to carry out these tasks. However some service users Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 14 felt restricted in that they were only allocated one set day a week to carry out this task. However the owner says that there is a rota for service users to follow but that it is not “written in stone” and can be changed to suit the service users. Two service users said they felt they were treated like children as staff stood over them when they did their ironing. One said “someone watches you when you iron” and another service user said “ you are watched when doing iron”. The registered owners state that they had put this policy in place for health and safety reasons. Some of the service users in the home have voluntary jobs. One service user said they work at a local chemist warehouse putting boxes together. All of the service users spoken with said they visit varies places in the community. Some were able to walk to the local shops by themselves and other needed staff assistance. Some service users said they do go to local pubs but that they had to be back by 10pm at night. Many of the service users informed the inspector about their holiday last year. Some went to Exmouth and some went to Cornwall. All said they enjoyed the holiday and were looking forward to planning this year. Some service users stated that due to recent council cut backs in day services they no longer had day placements to attend. A few of the service users were happy with the activities that the house arranged. These activities usually happen within the home. Art and craftwork is popular with service users and there is an occasional game of bingo. The designated activity book recorded the activity that staff had completed with service users daily. Recent entries show that the service users had played bingo. The owners and senior staff stated that this was the service users choice. There was also an activity suggestion list on the notice board to give service users ideas and choices of activities that are available. Other service users said they only watch TV or listen to the radio during the day and they were bored. During the inspection some service users were observed participating in a group activity, which involved colouring in pictures in children’s colouring books. All the service users spoken with said they had a bedroom key. During a tour of individual bedrooms with each service user the inspector observed that they all hold a key for their personal rooms. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 15 However many of the service users did not hold a front door key. And one service user who lives in Maurice House had to ask the staff member for the key to the house to show the inspector their bedroom. This service user said they were not allowed into their house during the day. And said this was due to the number of staff on duty during the day. The owners say that this service user can go to Maurice House whenever they wished. And they confirmed that this service user does not have a key and they stated, “If you give this service user a key they will lose it and they do not have a good memory”. The owners went onto say that this service user chooses to leave Maurice House each morning to spend the day at the Gatehouse with their friends. The daily records recorded an occasion when staff had asked this service user if they wished to stay in Maurice House and it was recorded that this service user had declined. The owners confirmed that none of the service users at Fairglen or Maurice House hold front door keys. This information is not recorded anywhere in the service user plans, neither has this been considered within the risk assessment process. The inspector observed that between the hours of 10am and 1pm there was one care staff member on duty with 11 service users. Many of the service users said they either have family members that visit them in the home or they go to them. One service user regularly stays overnight with their family. Several service users said that they visit old friends either socially or at their day placements. One staff member said that family were welcome to visit and some service users have regular visitors to the home. The Commission received one relative/visitor feedback card. Though no comments were added the card had ticks for “Yes” when asked about can they visit their relative in private. One service user who lived in Fairglen house said they visited their boyfriend regularly. Their boyfriend lived in the Gatehouse, which is next door. Two service users who are in a relationship said they were restricted on the times they are able to visit each other. One lives in the Gatehouse and one lives in Maurice House. Both informed the inspector that there is a rota on the days and times they are able to see each other. Both service users felt that they were not able to develop and maintain their personal relationship due to restriction imposed by the home. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 16 The owners denied that any rota was in place for these two service users and neither service user had approached the staff or owners about staying at each other’s house. They did confirm that 2 other service users did have a rota in place but this was at the request of both service users. This request was made to enable both service users some time on their own. All the service users were asked for comments about the menu and food on offer. Many of the service users said they thought the food was either “good”, “OK” or “quite nice and I can choose what I want”. One service user confirmed that they required a specialist diet and that this was arranged for them. Other service users said about the food “I don’t eat the food because I don’t like it, as it is cheap food”. Another said “I can’t have fried food” and another said “the food is rubbish, it’s cheap food and it’s the same food all the time”. Two of the service users said they are not able to do any cooking now. One service user said its only pasties, sausage rolls or soup at lunchtime. One service user said that they were unable to make a sandwich after 8pm and only allowed biscuits after this time. Another said due to having to go to their bedroom by 10pm they were unable to make any drinks after this time. Two other service users said that when they had used all the cold meat or cheese for sandwiches up in their house they either had to buy their own or go without. Several service users said that the home only supplied squash, water or tea and coffee. And no other drinks were available. One said they would like a beer sometimes but the home did not allow this. When asked the owners stated that there is always a choice of meals and all service users are able to make sandwiches and snacks whenever they wish. The owners went onto to say that there is always food available for sandwiches and if one of the houses runs out of some type of food the stock is held in Fairglen and service users are able to access this. Of the three service users living in Maurice House all three eat in either Fairglen or the Gatehouse. The owners said that they have asked each service user what they want to do, and they replied that they are happy with this arrangement. During the inspection the meal severed at lunchtime was sausage rolls. One service user had chosen to have a sandwich. The staff stated that the service users could have something else if they wished. Three service users were observed in the kitchen assisting the staff to prepare their lunch. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 17 The evening meal was being prepared during the inspection and potatoes and some fresh vegetables were being prepared. The menus were sent with the pre-inspection questionnaire and showed that many of the meals were shop prepared food. This included meat pies and battered fish portions. The menus stated that vegetables would be served with these meals. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18/19/20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be assured that they will receive healthcare support and some service users felt that their privacy and dignity will be respected. The home has a medication policy which is accessible to staff and medication records are generally up to date. The home does not facilitate independent choice or encourage service users who have capacity to be responsible for their own medication. EVIDENCE: Many of the service users at this home are able to carry out their personal care needs independently. Other service users require minimal assistance. Most of the service users said the staff only assists them when required or requested. And most agreed that their privacy and dignity is maintained. These Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 19 service users also said that the staff knock on their bedroom doors before entering. One service user said that “I bath by myself and staff help me keep my independence” and another service user said, “ Staff help me get out of the bath and the door is always shut”. One service user said, “I don’t get any privacy” and also said “staff are always checking on me when I am in the lounge having coffee”. The owners agreed that this service user is regularly checked and the reason is because they get occasional epileptic seizures. All Care Plans and Goal Progression sheets have details as to how personal support should be carried out. One staff member confirmed that the recoded details in the care plans and Goal Progression sheets are reviewed and discussed when needed or a change had been noted. Two of the service users said they only have their own clothes and they choose their clothes daily. The home has a key worker system in operation, this can assist service users in their daily lives. Some of the service users felt the home had restrictions on getting up and going to bed and other restrictions as disclosed in standard 11-17. Information was recorded onto individual files of input from professionals including Consultant Psychiatrist. Observed during the inspection was two service users discussing with staff about GP appointments. And staff was observed taking details of ailments and supporting and comforting one service user. Staff record into individual files when GP or other health visits take place. And the staff record the outcome and any further treatment required. Other service users said that they attend GP and other health appointments with staff support. During the inspection one service user had attended a Diabetic clinic with staff. Other appointments the service users said they had attended included dentist, opticians and chiropody. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 20 To assist staff to understand the medication they administer the home has sent up a file containing information on all prescribed medication that includes side effects. Staff on duty were observed carrying out a medication round. The staff talked through the procedure with the inspector and confirmed that only one staff carries out the administration of medication. The staff dispense the medication into a pot and then observed the service user taking the medication. The home uses the Dosage box system for administration of medication and the home MARS (Medication and Record Sheet) were examined. Some of the MARS sheets were hand written but not signed by staff to state who had recorded this information or if this hand written information was witnessed by a second person. One medication was discontinued but this information was not signed or dated. Several of the service users said they had agreed to the staff administering their medication. One service user said they “could do my own tablets” and another said “staff do my medication as I’m not allowed to do it own my own”. None of the service users administer their own medication and no risk assessments are in place to state why this was not possible. All the staff spoken to said they had received medication training. And two said this training was carried out by the homes Registered owner and Senior Care staff. The Senior Care staff said she had completed medication training with a local chemist but that it was some time ago and now has updates with the owner training using videos. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22/23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most of the service users can be confident that any complaints or concerns raised will be listened to. EVIDENCE: Many of the service users were aware that the home has a complaints procedure and some remembered seeing this procedure. The home has a complaints book in each home for the service users to record any concerns or complaints. One of the books was examined and it held details of a complaint made by a service user. Details were recorded on the date the complaint was made and the date and outcome and action taken. However most of the service user said they were happy to approach the staff or the owners if they had any concerns or complaints. Some service users felt that the staff and owners did not listen to them and their views are not acted upon. One service user said that the owner was aware they were not happy at the home and some of their reasons why but “nothing had changed after I told them”. The result is that the provider has given the service user 28days notice to leave the care home. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 22 The Commission received one relative feedback comment card, though no comment was made, they had ticked yes that they were aware that the home has a complaints procedure and no they had not made any complaints. The Senior Carer stated that she had completed the Plymouth Adult Protection training. The two other staff spoken with had completed in house training on adult protection with the assistance of the senior carer and training videos. Two of the service users informed the inspector that some staff shout at them and that the owner says, “Your talking rubbish” and he bullies me. The owners denied this allegation and also state that no service user had approached them about staff shouting at them. The owner also said if the service users informed them of any such allegation then an investigation would be carried out. These two service users have been referred to the placing authority Service Manager. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24/30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some service users benefit from a homely, comfortable, clean and wellmaintained building that is appropriate to meet their needs. EVIDENCE: The premises are accessible to all the service users and are comfortable and clean. All bedrooms are single rooms and each bedroom is decorated to reflect the personality of the occupant, with many personal possessions. The premises were found to be clean, hygienic and free from odour during both visits to the home. The home employs a domestic to maintain the clean environment. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 24 Several staff spoken with confirmed they had completed Infection control training. One service user bedroom visited was cold and the bed had two quilts. The service user said that the window in this bedroom was always blowing open at night. The inspector examined this window and found that the closure was loose. This was reported to the owners who said they would look at this window. One service user said that the heating goes off at 10pm and comes on again at 6am. Two other service users bedrooms visited both had large damp patches and were cold. One of the service users confirmed that the heating was on a timer and the heating went off at night. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 33/34/35/36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Caring staff supports the service users. However, insufficient staff on duty places service users at risk. Not all staff files contain the required pieces of information to protect service users. EVIDENCE: The homes pre-inspection questionnaire stated that the home currently employs 9 care staff and presently 5 have gained a NVQ at level 2 or above. The owner confirmed that no staff are presently undertaking a NVQ qualification. Staff files were examined during the inspection process. These files confirmed that not all relevant checks were undertaken prior to employment. One new staff member’s files did not have a new CRB (Criminal Record Bureau). The CRB held on file was dated 2003 and brought from their previous Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 26 employer. Another staff members file only held a photocopy of a CRB. The owner confirmed that they had not seen the original. Two other staff were employed via an employment agency. Both references for these staff were photocopies of testimonials and therefore not references obtained by the registered provider. All staff files and discussion with the staff confirmed that regular and updated training is carried out. And the owner confirmed that they use training videos to carry out in house training. Some newly appointed staff members had receive Induction training. This is recorded on individual staff files which was examined during the inspection. During a period of 3 ½ hours on the first day of the inspection there was one senior care staff on duty with 11 service users. This staff member needed to carry out medication administration and preparing lunch while caring for 11 service users over 3 houses. One of the owners said that usually there are 3 staff on duty including himself but he had been away on leave for 4 weeks and another staff had escorted a service user to a hospital appointment. The staff rota showed that when the owner has been on holiday the home had only 2 staff on duty until 3pm. Therefore the home does not always have sufficient staff on duty to meet the needs of the service users currently living at the home. All the staff spoken to say they had received induction training and regular updated training arranged with the registered owner of the home. This included medication training, fire safety and health and safety training. One staff comment card sent to the Commission stated under the, if you could change one thing to improve the way the care works what would it be wrote “To have NVQ training set up soon”. This staff member went onto say under the, is there anything that the care home does really well wrote “All staff work well together to promote the service users independence and social skills”. A second staff comment card stated under any other comments, “The management is always there for staff and service users to give a full support when needed at any times day or night”. Staff meeting minutes examined showed that the owner discussed issues raised by staff concerning service users. Staff records and staff confirmed that they receive regular supervision. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37/39/42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users benefit from having a manager who updates his training. However areas of health and safety including the provision of front door keys for all service users would promote service users independence. EVIDENCE: A recommendation from the previous inspection for the registered owner/manager to have the Plymouth Adult Protection training has been completed. The home has quality assurance forms in place. And last years results were available during this inspection. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 28 Most comments were positive. The manager said that all results are discussed at service users meetings or individually if any major concerns were raised. The owner has devised a self-assessment format to evaluate, monitor and update their own practices including updating policies and procedures. The homes fire alarm log was checked and showed that the weekly test had not been carried out since the 15/12/06. The owner confirmed that this was not carried out while he was away and the handyman was off sick. The owners confirmed that each night the main doors of the buildings are locked and the exit key is held with the staff. They said that each home has a fire exit that does not require a key. However whilst this may be a way of any of the service users leaving the care home, they would be unable to get back in. Records showed Environmental visit and gas certificates were updated. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 2 3 LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 30 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA7 Regulation 12 Requirement Health and welfare of service users. (2) The Registered person shall so far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. Restrictions on rules of going to bed, going out for a cigarette and having a front door key must to limited only through the assessment process. Further requirements to health and safety. (3) The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practical ascertain and take in account their wishes and feeling. Risk assessments and guidelines must be in place to protect service users and staff. Facilities and services. 16. (2) The registered person shall DS0000036285.V302634.R01.S.doc Timescale for action 31/03/07 2 YA9 12 31/03/07 3 YA13 16 31/03/07 Fair Glen & Gate House Version 5.2 Page 31 having regard to the size of the care home and the number and needs of the service users(M). consult service users about their social interests, and make arrangements to enable them to engage in local, social and community activities and to visit, or maintain contact or communicate with their families and friends. Service users must be able to access the community at a time suitable to them. Facilities and services. 16. (2) The registered person shall having regard to the size of the care home and the number and needs of the service users(N). consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. Service users must have access to a range of age appropriate activities. Facilities and services. 16. (2) The registered person shall having regard to the size of the care home and the number and needs of the service users(M). consult service users about their social interests, and make arrangements to enable them to Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 32 3 YA14 16 31/03/07 4 YA15 16 31/03/07 engage in local, social and community activities and to visit, or maintain contact or communicate with their families and friends. Service users must be able to choose who they want to see and when, and choose who they want to invite as visitors to their rooms. Health and welfare of service 31/03/07 users. 12(4). The registered person shall make suitable arrangements to ensure the care home is conducted: (a) in a manner which respects the privacy and dignity of service users All service users must be offered a front door key. All service users must have unrestricted access to the home unless assessed otherwise. Facilities and services. 16. (2)The registered person shall having regard to the size of the care home and the number and needs of the service users(h) Provide adequate facilities for service users to prepare their own food and ensure that such facilities are safe for use by service users. (i) provide, in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such times as may reasonably be required by service users. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 33 5 YA16 12 6 YA17 16 31/03/07 7 YA23 13 Service users must be given information that makes it clear that they have access to kitchen facilities so they can prepare snacks and hot drinks when they wish. Further requirements as to health and welfare. (6) The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The owners must investigate any incidents of abuse. Staffing (1)The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users(a) ensure that at all times suitably qualified, competent and experience persons are working at the care home in such numbers as are appropriate for the health and welfare of service users: Based on the needs of the service users the Registered Provider must review the care staffing levels at the care home and if necessary increase care staff numbers. A copy of the review must be sent to the Commission. Fitness of workers (1)The registered person shall not employ a person to 31/03/07 8 YA33 18 30/04/07 9 YA34 19 31/03/07 Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 34 work at the care home unless— (a) the person is fit to work at the care home; (b) subject to paragraphs (6), he has obtained in respect of that person the information and documents specified in paragraphs 1 to 7 of Schedule 2; The home must operate a through recruitment process and obtain all original documents required to meet this standard. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA10 Good Practice Recommendations The home should agree with service users what information should be keep confidential and what can be passed onto a 3rd party. Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fair Glen & Gate House DS0000036285.V302634.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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