Care Home: Fair Glen, Gate House & Maurice House

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What the care home does well Many of the people spoken to said that they enjoyed living at the home, and that the staff are kind, caring and treat them with respect. The care staff observed during the day were kind and cheerful. People are able to partake in a range of activities within the local community, and are supported to maintain contact with family and friends. Most of the people using the service feel that they can come and go as they please and have been provided with keys to support this independence. The home has liaised with outside agencies for support and provided people with information about advocacy services. What has improved since the last inspection? Information provided by the manager prior to the inspection confirmed that four bedrooms and the communal sitting room in Fairglen have been redecorated during the last 12 months. What the care home could do better: Information about the home and service provided should be available in range of formats. This will ensure that people are able to make an informed choice about where they live and the services they receive. The care plans in the home should be a working document. They should be reviewed regularly, and focus on how people will develop their skills and consider their future aspirations. Any limitations on facilities in the home must only be agreed if in the individuals best interests and must be regularly monitored and reviewed. Peoples skills and needs relating to leisure opportunities and finances should be documented and reviewed as part of the care plan process. Any support and arrangements should be specific to the individual, regularly reviewed , and flexible to meet peoples changing needs, choices and wishes. Meals must be well- balanced, nutritional and cater for the dietary needs and personal preferences of each person living in the home. People should be supported where possible to be independent and involved in activities of daily living. This should include, taking responsibility for shopping, planning meals and meal preparation. The homes complaints procedure must be reviewed to ensure that people feel safe and supported to share any concerns about their well-being, protection and safety. The homes current training and development plan for staff should be reviewed to ensure that staff feel they have sufficient training and skills to meet the needs of the people they support. The provider should ensure that all systems and procedures in the home promote the rights, well being and independence of people using the service. The way people are supported should focus on individual needs and personal preferences. People should be provided with information in a format that they can understand, this will ensure that people are able to make informed choices about their lifestyle. Information about peoples needs and the way they are supported should be reviewed and updated on a regular basis. Key inspection report Care homes for adults (18-65 years) Name: Address: Fair Glen, Gate House & Maurice House Lancaster Gardens Whitleigh Plymouth Devon PL5 4AB     The quality rating for this care home is:   one star adequate 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: Wendy Baines     Date: 1 6 1 2 2 0 0 9 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things 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 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Fair Glen, Gate House & Maurice House Lancaster Gardens Whitleigh Plymouth Devon PL5 4AB 01752770358 01752770358 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Santee Sawock Purgaus,Mr Gyaneshwar Purgaus Name of registered manager (if applicable) Mr Gyaneshwar Purgaus Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Age 18 - 65 The home may accommodate two service users named elsewhere who have mental health needs Date of last inspection Brief description of the care home 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 unadopted 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 Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 22 Brief description of the care home 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. However this house is currently unoccupied. The home is staffed 24 hours a day with sleep in staff in each house at night. Care Homes for Adults (18-65 years) Page 5 of 35 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: one star adequate 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 peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced and took place over two days on the 15th and 16th December 2009. Mr Purgaus, the Registered manager and owner of the home was available throughout the visit. The Inspector completed a tour of the building and spoke with people who live in the home. A sample of records relating to the people who live in the home and the running of the service were examined. The inspector was able to observe and speak with all of the staff on duty. A sample of surveys were sent out to staff and people who use the service and information contained in this feedback has been included in this report. Care Homes for Adults (18-65 years) Page 6 of 35 The inspector was able to speak to six professionals from other agencies who have been involved with the service and people who live there. Prior to the inspection the provider sent information to the Care Quality Commission about the service, and some of this information has also been included in this report. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Information about the home and service provided should be available in range of formats. This will ensure that people are able to make an informed choice about where they live and the services they receive. The care plans in the home should be a working document. They should be reviewed regularly, and focus on how people will develop their skills and consider their future aspirations. Any limitations on facilities in the home must only be agreed if in the individuals best interests and must be regularly monitored and reviewed. Peoples skills and needs relating to leisure opportunities and finances should be documented and reviewed as part of the care plan process. Any support and arrangements should be specific to the individual, regularly reviewed , and flexible to meet peoples changing needs, choices and wishes. Meals must be well- balanced, nutritional and cater for the dietary needs and personal preferences of each person living in the home. People should be supported where possible to be independent and involved in activities of daily living. This should include, taking responsibility for shopping, planning meals and meal preparation. The homes complaints procedure must be reviewed to ensure that people feel safe and supported to share any concerns about their well-being, protection and safety. The homes current training and development plan for staff should be reviewed to ensure that staff feel they have sufficient training and skills to meet the needs of the Care Homes for Adults (18-65 years) Page 8 of 35 people they support. The provider should ensure that all systems and procedures in the home promote the rights, well being and independence of people using the service. The way people are supported should focus on individual needs and personal preferences. People should be provided with information in a format that they can understand, this will ensure that people are able to make informed choices about their lifestyle. Information about peoples needs and the way they are supported should be reviewed and updated on a regular basis. 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 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 9 of 35 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 10 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides current and prospective residents with information about the service. However, this information needs to be provided in a range of formats to help people make an informed choice about where they live and the services they receive. Procedures are in place to ensure that peoples needs are fully assessed before they move into the home. This ensures that the home does not admit people whose needs they cannot meet. Evidence: The home has had no new admissions since the last Key Inspection. However, discussion with Mr Purgaus the Registered Manager confirmed that there are written procedures in place should a new referral be made. The home has a written Statement of Purpose and service user guide. This is a detailed document, which includes information about the service, the environment and support available. Currently this information is only available in a written format, which may not be suitable for people with specific communication difficulties. The Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: home should ensure that this is available in a range of formats so that people are able to make an informed decision about where they live and the services they receive. Mr Purgaus said that following a referral an assessment of need would be completed and arrangements made for the person to visit the home. This would ensure that the home and the individual have the time and information they need to make a decision about the suitability of the service. Mr Purgaus said that consideration would be given to the needs of the current people living in the home when considering any new admissions. He gave an example of a recent referral involving a person with complex care needs and challenging behaviour and said that due to the specific needs of the individual and the detrimental effects this may have on people currently living in the home the referral was declined. Care Homes for Adults (18-65 years) Page 12 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes care plans do not provide sufficient detail about peoples skills, needs and goals. Without this information the home cannot demonstrate that people are making real choices or having the opportunity to fulfill their goals, wishes and aspirations. The homes care plan process does not ensure a regular system of review. Without this the home and staff cannot be sure that needs are current or being sufficiently met. People are provided with information about advocacy services and can attend meetings to discuss issues relating to the home. Evidence: A sample of records relating to the people who live in the home were examined during the inspection. Each person had a separate file, which contained a range of information about their needs, the support provided to them by the home and involvement of other services. Some people had a Social Services care plan which detailed peoples needs at the time Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: of them moving into the home. The manager said that care plans are reviewed by Social Services and that several were due to be updated. Mr Purgaus said that he regularly contacts Social Services to request reviews of the people currently living in the home, but has not always had a timely response from these agencies. The home had also completed a care plan for each person, which the manager said would assist staff to understand peoples needs and how they should be supported. Although the care plans covered different areas of need including, health, independence, social and leisure needs some of this information was very limited and in some cases where a need had been identified did not demonstrate how the need would be met. One example of this was a statement regarding the need for one person to go out more often and another to develop personal care skills. The care plan did not describe the support arrangements to meet these identified needs. The manager said that staff are aware of the current needs of people living in the home, however most of the care plans seen during the inspection had not been reviewed for over 18 months. Several of the people spoken to during the visit, talked about their thoughts and wishes for the future. For some people this included the possibility of one day moving from the home into their own flat or other more independent accommodation. Feedback from other agencies confirmed that support had been provided in the past to some of the people at Fairglen who had expressed a wish to move, however some of the feedback raised concern that the home had not followed through the support people needed to fulfill these goals. Care plans and Person Centered plans seen during the visit did not include this information or details of peoples long- term goals and aspirations. Observation, discussion and care records confirmed that most people living in the home are able to attend to daily tasks and access opportunities inside and outside the home with minimal support from staff. Several of the people spoken to said that they are able to make choices about their lifestyle and are encouraged to be independent. One person said that everyone now has a key to the front door and can go out and arrive home whenever they choose. However, there were some daily living skills that people said they were able to do, but were unsure if they would be allowed to do independently. One person said that they were able to make a sandwich for a snack but did not think they would be allowed to do this in the homes kitchen. Care plans did not include sufficient detail about peoples daily living skills or arrangements in place to develop skills and independence. Money is held in the main office and several people were observed coming into the office to request money from the manager or senior care staff. Several people were making plans for trips out and Christmas parties and spoke with the manager about the money they would need for these events. The manager said that money is usually given to people at the end of the week although they can request it whenever they Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: choose. Care plans did not include details about peoples skills relating to their finances or how arrangements had been agreed to provide support. The manager said that people are provided with access to advocacy services and several examples were given of when people had used this service to assist them with decisions concerning their care and lifestyle. Residents attend regular meetings and are encouraged to raise any issues about the home and the support they receive. Risk assessments were in place for activities inside and outside the home and guidelines were available for staff regarding the management of one person who may at times display difficult and challenging behaviours. Staff had made recent observations of changes in one persons mood and behaviour and had contacted the specialist learning disability services for advice and support. Care Homes for Adults (18-65 years) Page 15 of 35 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. People are supported to access opportunities in the local community and maintain contact with family and friends. Information about peoples daily living skills are not documented in sufficient detail within service user plans. The absence of this detail could mean that people are not being fully supported to maintain and develop their skills. Peoples preferences regarding food and diet are not always taken into account. Although the more able people are making some decisions about what they eat, others have very little choice and limited opportunity to be involved in shopping or preparing food. Some people are not being supported to make an informed choice about receiving a well balanced and healthy diet. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: When the Inspector arrived at the home there was pleasant and welcoming atmosphere. Several people were getting ready to go out for the day and others were relaxing around the house or in their bedrooms. Two people were watching television together and having coffee in their bedroom, which they said they liked to do each morning. People were keen to tell the inspector about their plans for Christmas celebrations and three people were starting to put up the decorations in the communal lounge. There was plenty of talking, laughing and socialising between the people who live in the home as well as with the staff. One person in Fairglen had recently purchased a rabbit and others were pleased to show the Inspector two budgies belonging to the people who live in the Gatehouse. The manager said that some of the people who live in the home are able to access opportunities outside the home with little or no support from staff. He said that although some people have regular activities that they attend some may also choose to make their own arrangements on a day to day basis. Discussion confirmed that some people attend regular activities such as college courses and cookery classes. Others said that they liked to make their own plans and this could include being at home or going to the local shops, cinema and other social trips out. Activity charts were available in peoples files, however these contained very little information and care plans did not document peoples social and leisure needs or how these were being monitored and reviewed. The manager and staff said that where possible people are encouraged and supported to be involved in daily tasks, such as cleaning, shopping and laundry. People were observed tidying around the house during the inspection and three people were enjoying putting up the Christmas decorations in the communal sitting room. One person said that he likes to clean his own room but can ask staff for help if necessary. Two people said that they were able to buy some items of food shopping but didnt generally get involved in the planning or preparation of meals. Another said that although they knew how to make a sandwich as a small snack they were unsure if they would be allowed to do this in the main kitchen. Care plans had very little detail about peoples daily living skills, and did not provide information about how peoples skills should be maintained or developed. All of the people spoken to said that they were able to visit family and friends at any time and were also able to invite people to visit them in the home. The manager said that they supported people to maintain contact with family and had also involved Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: advocacy services in the past to support people with any issues relating to these relationships. All the people spoken to were asked their views about the quality of the food in the home and about their involvement in the planning and preparation of meals and mealtimes. Some of the people spoken to said that they liked the food and could have a choice about what they ate. Others said that they had chosen to buy basic items such as tea bags, bread and butter as the Tesco Value items purchased by the home does not have any taste. This issue has been raised in previous Inspections and the last report recorded that Mr Purgaus would find out what people preffered and purchase these items for them. The Inspector was able to observe a meal time in the home, look at the daily menu and look at the food currently available in the home. The majority of the food items available were Tesco value and the choice of snacks and fresh food was very limited. Discussion with staff and people in the home suggested that food shopping for the home is undertaken by staff each week and people have little involvement in this task. People spoken to said that drinks and snacks are offered at set times of the day, and that they would not usually help themselves to snacks outside of these times. Care Homes for Adults (18-65 years) Page 18 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to health care services within the local community. Health needs are monitored and appropriate action taken to address any concerns. The home has a medication policy which is accessible to staff, medication records are up to date, and medicines received, administered and disposed of are recorded. People who are able to do so are given the support they need to manage their own medication. Evidence: On the day of the inspection two members of staff from the Specialist Learning disability services were visiting the home. The manager said that a referral had been made to request advice and support regarding changes in one persons mood and behaviour. Guidelines were in place to advise staff about how to support people who may at times present difficult behaviour.The manager said that when necessary they have liaised directly with the challenging Behaviour services to ensure that guidelines are Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: appropriate. Discussion with people who live in the home confirmed that they visit the dentist regularly and see doctors and other health and social care professionals when required. Discussion with the manager, staff and people who use the service confirmed that most people are able to attend to daily personal care tasks with minimal support. However, one of the care plans seen stated that the person needed to develop these skills but did not say the support needed by the home to meet this need. The home uses a blister pack system for medication and a local chemist is used to assist with staff training. Medication is stored safely and records are well maintained. Currently two people manage their own medication and risk assessments and monitoring systems are in place. Care Homes for Adults (18-65 years) Page 20 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to voice their concerns and make formal complaints regarding the home and their care. However, the current systems for making a complaint does not ensure that people feel safe to raise their concerns in confidence. The policies and procedures for safeguarding adults are available to staff and give clear guidance about what to do if they believe someone in the home is at risk. Evidence: The home had a written complaints procedure and a book for recording all complaints or concerns raised about the service. The homes complaints book was seen and discussion took place with the manager about the importance of keeping this information safe so that people feel they can raise their complaints and concerns in confidence. People spoken to said that they knew how to make a complaint and would also usually feel happy to discuss any concerns with the manager or their keyworker. The manager said that staff frequently check out with people that they are happy and have no concerns and also support people to raise any issues during residents meetings that are held in the home each month. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: Concern was expressed within feedback from other agencies that communication aids for people who are less able in the home are limited, which could prevent some people being able to understand information or communicate their views clearly. The manager, and the deputy manager have attended the Local Authority safeguarding training and said that staff receive training relating to abuse as part of their induction and monthly training plan. Records confirmed that the manager has followed the correct procedures and alerted outside agencies when it was felt that an individuals safety and well-being may be at risk. Care Homes for Adults (18-65 years) Page 22 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Fairglen and The Gatehouse benefit from an environment that is clean, tidy and safe. On-going maintenance and further improvements in some communal areas and external parts of the property would ensure that a good standard of accommodation is maintained. Evidence: A tour of both houses, Fairglen and The Gatehouse took place during the inspection visit. Several people living in the home were happy to show the Inspector their bedrooms and communal parts of the home where they relax, eat their meals and spend time with others. Three people were enjoying putting up Christmas decorations in the communal lounge in Fairglen with some support and guidance from staff. During both days of the inspection the communal parts of the home were very cold. People using the service and staff commented that this was often the case although peoples bedrooms were always warm. The standard of decor in both houses was of a reasonable standard although some attention was needed to the some of the communal areas and bedrooms. The carpet Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: in the main entrance of Fairglen was in poor condition and needs attention to prevent any tripping hazards. Information received prior to the inspection stated that four bedrooms and the communal sitting room in Fairglen had been redecorated during the last 12 months. Each person has a single bedroom with sufficient space for individual needs and lifestyle. In the Gatehouse these are all on the 1st floor and in Fairglen they are on the ground and 1st Floors. All the bedroom doors are fitted with appropriate locks that can be locked from the inside by people who live in the home and locked from the outside using a key. Most people have their own key and some said that they always lock their door when they go out. All the bedrooms contain wash hand basins but none of them have en-suite facilities. Bedrooms are individually furnished and personalised by or for the person whose room it is dependent on their wishes. The manager said that bedrooms are repainted every four years and each person is supported to choose their own color scheme and decor. Two of the bedrooms seen during the visit had patches of black damp on the ceilings and this was pointed out to the manager for attention. The bathrooms and toilets are in good condition and are fitted with locks to ensure that people can use these facilities in private. The windows in both properties both require attention to improve the general appearance and quality of accommodation provided. A designated staff member is responsible for maintenance, and the home also has a cleaner who works in both houses and assists people with daily cleaning tasks. Care Homes for Adults (18-65 years) Page 24 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by caring staff who have a good understanding of supporting them on a day- to- day basis. However, opportunities for more specialised training that is updated on a regular basis would ensure that staff have the skills and understanding required to meet the specific care needs of each person living in the home. Evidence: On the first morning of the inspection there were two care staff on duty. In addition there was also the Registered Manager/owner, a cleaner and maintenance man. The owner said that as well as the manager it would be usual to have two care staff on duty in the morning and three in the evening. One staff member would also be available in the morning and evening to support people in the Gatehouse. Fairglen has two sleeping night staff and The Gatehouse one staff member who sleeps in. There was a nice rapport between the staff and people living in the home and staff spoken to were familiar with peoples daily support needs. All of the people spoken to said that the staff were kind, caring and treated them with respect. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: One staff member was observed speaking in a sensitive and caring manner when dealing with resident who was upset and distressed. Examination of a sample of staff files confirmed that all had the required preemployment checks, including CRB ( Criminal Records Bureau Disclosure) in place ensuring as far as possible that unsuitable staff are not employed in the home. Training records were available for each staff member and confirmed that staff undertake Induction training when they commence work and Mandatory training such as Health and Safety, Food Hygiene and Medication. However, staff had not attended any recent training relating to the needs of people they support. Staff spoken to said that they felt the training they received was not sufficient in detail and did not cover specific topics relating to the needs of people living in the home. Staff said that they felt well supported by their colleagues and had opportunities for 1:1 supervision with the manager. One staff member said that training was not discussed as part of the planned supervision sessions. Care Homes for Adults (18-65 years) Page 26 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the staff and management support people on a day- to- day basis some of the systems and procedures relate to the service and not the specific needs of each individual. The homes current assessment, care planning and review process is not person centered and does not ensure that people are making real choices about their lives and lifestyle. Evidence: Mr Purgaus has owned and managed Fairglen and The gatehouse for a number of years. He was available throughout the inspection along with a deputy manager and care staff on duty. Mr Purgaus said he was regularly in the home and people were seen throughout the day asking him for advice and guidance regarding their plans for the day and Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: Christmas activities. Some of the people spoken indicated that they felt the need to ask permission to partake in some activities and tasks in the home. There were no requirements made in the last key inspection although some previous concerns raised by people living in the home about the quality of the food was again raised as a concern during this visit. Care records and records relating to staff and the running of the home were available during the inspection. Although care plans were completed some of these were not sufficient in detail to ensure that staff understood the specific care needs of the people they support. Some of the care plans seen had not been reviewed for 18 months therefore it was not possible to confirm if the information about peoples needs was current and accurate. Although some of the people spoken to were clear about their goals and aspirations the homes assessment and care planning process did not in all cases evidence that these had been recognised and supported. As mentioned in a previous section of the report ( Individual needs and choices) feedback from other agencies raised concern that some people who had expressed a wish to live more independently had not been fully supported by the home to fulfill their goal. Quality assurance surveys are completed by people using the service on a annual basis. The manager said that when necessary advocacy services have supported people to complete these forms.This information is used to make changes and improvements in the home and information received prior to the inspection said that there had been changes made to the environment and menu as a result of listening to people views. However, some people using the service and staff continued to express concern about the quality of the food provided. Sampling of servicing records indicated that most equipment is serviced regularly. Certificates were available for all health and safety equipment and electrical appliances were being routinely checked. There was an up to date Fire risk assessment, and checks on fire safety equipment was completed as required. Staff receive training in fire safety as part of their induction and mandatory training plan. Care Homes for Adults (18-65 years) Page 28 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 29 of 35 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, 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 Requirement Timescale for action 1 6 15 The homes care plans must set out in detail peoples current needs and how these will be met by the service. Care plans must be regularly reviewed and kept up to date. People using the service must be confident that there current and changing needs are understood by those providing care. Staff must have clear guidelines about how people need and prefer to be supported so that care can be delivered in an appropriate and consistent manner at all times. 28/04/2010 2 17 12 The provider must ensure that people receive a well balanced and nutritious diet that meets their personal choices and specific dietary requirements.The provider should demonstrate how people have been involved 28/04/2010 Care Homes for Adults (18-65 years) Page 30 of 35 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 Requirement Timescale for action in making these choices and preferences. The Registered provider must promote and make provision for the health needs of all people using the service. 3 22 12 The system for recording 02/03/2010 complaints must be reviewed to ensure that peoples rights and privacy is protected at all times. This will ensure that people using the service feel safe and supported to share any concerns in relation to their well-being, protection and safety. 4 32 18 The home must ensure that 02/04/2010 the training and development plan for staff includes opportunities to attend specialised training relevant to the needs of the people they support. This would need to include specialist areas of training such as Learning Disability, Challenging Behaviour, Communication skills, Mental capacity Act training. Care Homes for Adults (18-65 years) Page 31 of 35 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 Requirement Timescale for action Staff must have the skills and experience necessary to meet the needs of the people they support. 5 35 18 The Provider must ensure that the content of staff training is sufficient, and provides staff with the information and skills they need to meet the needs of the people they support. This will ensure that their is a staff team who are sufficiently trained and skilled to meet the current and changing needs of people using the service. 6 41 17 The Registered Provider 02/05/2010 must ensure that records relating to the care of people living in the home are kept up to date, and include details about peoples needs and how they will be met. Staff must have up to date information that is accessible and detailed. This will ensure that care is provided in a consistent and appropriate manner at all times, and that peoples rights and best interests are recognised and safeguarded. 02/04/2010 Care Homes for Adults (18-65 years) Page 32 of 35 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 1 Information about the service should be made available in a range of formats. This will enable people to make an informed choice about where they live and the services they receive. The homes care plans should be developed with and owned by the individual. It should be based on a full and up to date assessment of need. The plan should be person centred and focus on the persons strengths and personal preferences. Care plans should include information about peoples skills regarding their personal finances. Any support should be specific to the individual and should be agreed, documented and reviewed as part of the care plan process. The home should ensure that everyone in the home has sufficient communication aids and information in formats that they understand to support them to make decisions about their lives and lifestyle. People should have opportunities to develop their daily living skills. People should have access to the facilities and support to enable them to do this. Any limitations on facilities such as the kitchen should only be in place if it is in the best interests of the person involved and agreed and reviewed as part of the care plan process. Times for meals and snacks should be flexible and meet the needs and personal preferences of the individual. Opportunities for people to partake in educational and employment activities should be documented and reviewed as part of the care plan process. This will ensure that the home regularly checks that the outcomes for people using the service are positive , and that there is evidence that they are enjoying the life opportunities that they experience. Opportunities for people to participate in and be part of the local community should be documented and reviewed as part of the care plan process. Peoples leisure opportunities should be agreed, monitored and reviewed as part of the care plan process. This will ensure that any issues can be addressed and opportunities explored when necessary. Staff should have clear guidelines about how to support people to maintain or develop their personal care skills. Page 33 of 35 2 6 3 8 4 11 5 12 6 13 7 14 8 18 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 9 24 To maintain a good standard within the environment the provider should; - Replace or repair the carpet in the main entrance of Fairglen. This will improve the general look of the entrance area and prevent a tripping hazard. - Address the damp areas on bedroom ceilings. -Ensure that communal areas of the house are sufficiently heated. 10 38 Systems should be in place to ensure that people feel confident and safe to express their views about; the care they recieve and goals and aspirations for the future. People must feel safe to raise concerns and complaints and trust that their views will be treated in confidence. Care Homes for Adults (18-65 years) Page 34 of 35 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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