Fairglen Residential Home

About the service

Fairglen Residential Home (hereafter Fairglen) is a residential care home that provides personal care and support for up to 12 people with a learning disability, autism or who have complex needs associated with their mental health. At the time of the inspection there were 10 people living at the service.

People’s experience of using this service and what we found

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

People were not supported to have maximum choice and control of their lives and staff were not supporting people in the least restrictive way possible and in their best interests. The registered manager and staff had deprived people of their liberty without the legal authority to do so. This meant the care and support model at Fairglen did not maximise people’s choice, control and independence.

Right care:

People were often described by staff as having behaviours that could challenge themselves or others. However, there was limited information within peoples care records to determine what the behaviours that may challenge others were and what staff should do to support people effectively through this. The language used by staff to describe people within their care notes and on occasion when speaking with us, was disrespectful. This meant people’s care was not person-centred and did not promote their dignity.

Right culture:

Institutionalised practices, in the form of exercise times, mealtimes and money management had helped to create a ‘closed culture’ at Fairglen. A ‘closed culture’ is a poor culture that can lead to harm, including human rights breaches such as abuse. In these services, people are more likely to be at risk of deliberate or unintentional harm. Fairglen increased people’s dependence on the registered manager and staff who had limited understanding of how to support people effectively.

The failure to meet the underpinning principles of Right support, right care, right culture, meant we could not be assured that people who used the service were able to live as full a life as possible and achieve the best possible outcomes.

Although some relatives told us people were safe living at Fairglen, some relatives did not have confidence in the service and told us they did not feel their loved ones were safe or well looked after.

People were not always protected from the risk of avoidable harm. Where risks had been identified, sufficient action had not always been taken to mitigate those risks and keep people safe.

Safeguarding systems and processes were not always followed. The Registered manager did not always report and investigate safeguarding concerns. As a result of this inspection we made six safeguarding referrals to the Local Authority to ensure people were safely protected from harm.

There were insufficient numbers of suitable qualified, competent or skilled staff on duty to meet people’s needs safely. We were not assured the service was following safe infection prevention and control procedures.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Good (published on 20 September 2018)

Why we inspected

We received concerns in relation to the management of risk, staffing levels, staff training, the management and leadership within the service and people’s personal care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. However, further concerns and risks were identified so a decision was made to carry out a comprehensive inspection to include the key questions effective, caring and responsive.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Fairglen Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified breaches in regulation in relation to safe care and treatment, safeguarding people from abuse, staffing, consent, dignity and respect, person centred care, notifications of other incidents and governance. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We will meet with the provider following this report being published and work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner

Fairglen residential Home provides care and accommodation for up to 12 people. On the day of our inspection there were 10 people living at the service. The home provides residential care for people with a learning disability.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager is also the provider.

At the last inspection on the 12 February 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Why the service is rated good:

People were not all able to fully verbalise their views and staff used other methods of communication, for example pictures or visual choices. We met and spoke with all 10 people during our visit and observed the interaction between them and the staff.

People remained safe at the service. People were protected from abuse as staff understood what action they needed to take if they suspected anyone was being abused, mistreated or neglected. Staff were recruited safely and checks carried out with the disclosure and barring service (DBS) ensured they were suitable to work with vulnerable adults. There were adequate numbers of staff to meet people’s needs and help to keep them safe.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Staff assessed and understood risks associated with people’s care and lifestyle. Risks were managed effectively to keep people safe whilst maintaining people’s rights and independence.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff undertook regular training and competency checks to test their knowledge and to help ensure their skills in relation to medicines were up to date and in line with best practice.

People were supported by staff who had received training to meet their needs effectively. Staff meetings, one to one supervision of staff practice, and appraisals of performance were undertaken. Staff completed the Care Certificate (a nationally recognised training course for staff new to care). Staff confirmed the Care Certificate training looked at and discussed the Equality and Diversity and the Human Right needs of people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's health was monitored by the staff and they had access to a variety of healthcare professionals. The registered manager worked closely with external health and social care professionals, to help ensure a coordinate approach to people’s care. Some people’s end of life wishes were documented and included information on people’s wishes when needed.

People’s care and support was based on legislation and best practice guidelines; helping to ensure the best outcomes for people. People’s legal rights were up held and consent to care was sought as much as possible. Care records were person centred and held full details on how people liked their needs to be met; taking into account people’s preferences and wishes. Overall, people’s individual equality and diversity preferences were known and respected. Information recorded included people’s previous medical and social history and people’s cultural, religious and spiritual needs.

People were treated with kindness and compassion by the staff who valued them. Staff had built strong relationships with people who lived there. Staff respected people’s privacy. People, or their representatives, were involved in decisions about the care and support people received.

The service remained responsive to people's individual needs and provided personalised care and support. People’s communication needs were known by staff. Staff had received training in how to support people with different communication needs. The provider had taken account of the Accessible Information Standard (AIS). The AIS is a requirement to help ensure people with a disability or sensory loss are given information they can understand, and the communication support they need.

The PIR records; “One resident who has dementia has lost all abilities to communicate but we use pictures to communicate with him. We also talk to the person in a soft tone, slowly so that he picks up the words and do sign language as well.”

Staff adapted their communication methods dependent upon people’s needs, for example using simple questions. Information for people with cognitive difficulties and information about the service was available in an easy read version for those people who needed it.

People could make choices about their day to day lives. The provider had a complaints policy in place and it was available in an easy read version. Staff knew people well and used this to gauge how people were feeling.

The service continued to be well led. People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff told us the registered manager and management team were very approachable and made themselves available. The provider had monitoring systems which enabled them to identify good practices and areas of improvement.

People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the provider to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service, as well as the ongoing quality and safety of the care people were receiving.

Further information is in the detailed findings below

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and staff were relaxed throughout our inspection. There was a calm, friendly and homely atmosphere. People were supported to take part in a range of activities which reflected their interests. Staff were knowledgeable about the people they were supporting and had an in-depth appreciation of how to respect people’s individual needs around their privacy and dignity. People’s risks were managed well and monitored.

Staff responded quickly to people’s changing needs and relatives were involved in reviewing people's needs and how they would like to be supported.

People’s preferences were identified and respected. Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and staff focused on people rather than on tasks.

People’s medicines were managed safely. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, social workers, learning disability nurses and occupational therapists.

All staff had undertaken training on safeguarding vulnerable adults from abuse and demonstrated a good knowledge of how to identify and report any concerns. Staff described what action they would take to protect people from harm. Staff felt confident any incidents or allegations would be fully investigated.

People were protected by safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment. Staff received a comprehensive induction programme and were trained to carry out their roles effectively.

People and those who mattered to them knew how to raise concerns and make complaints. Complaints had been recorded, investigated and the outcome fed back to the complainant. Where appropriate, regular checks were then made to ensure the complainant remained happy.

Staff understood their role with regards to the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards. Applications were made and advice was sought to help safeguard people and respect their human rights.

There were effective quality assurance systems in place which were used to enhance the service. People, their relatives and staff described the management as supportive and approachable.

We observed that people were treated respectfully and were encouraged to make choices and develop their skills when possible.

We found that people had the opportunity to partake in regular discussions about the service and the running of the home. Residents meetings took place on a regular basis, and covered issues such as decoration of the home, meals and holidays.

People told us that they had been involved in discussions about their care and support and that they had copies of their support plans.

Recording procedures and support plans had been developed and improved to ensure that staff had sufficient information to meet people's needs.

The provider had worked closely with other agencies to improve systems within the home and to ensure that people's individual care needs were being met.

Improvements had been made to the way the provider assessed and monitored the quality of the service. Formalised procedures were in place to monitor and check the quality of the environment, and people who lived in the home, relatives and other agencies had the opportunity to provide feedback on the quality of services provided.

We spoke to the staff about how people make choices about their food. We were told that people came to the kitchen area at lunchtime to choose their meal. The staff also said people were asked about their food preferences and these were included into the home's new menu. This information was recorded into each person's care plan and people had recorded what they had eaten each day.

People were encouraged to use the dining area to eat their meals. We were told by people living in the home and the staff on duty that tea, coffee, drink and snacks were always available throughout the day.

The registered provider showed us an example of the new menus which, showed a choice of healthy food options with vegetables and a mixed salad provided each day.

During our inspection we saw that staff spoke to people respectfully. Some people were able to make choices about their lifestyle, however, some of the systems in the home did not promote people's autonomy, choice and independence.

People we spoke to said they were happy living at Fairglen. People's support plans had been updated and people had been involved in this process.

People were supported to access local health services and a record had been kept of health appointments. However, we found that when health needs had been identified some plans were not in place to show how these would be monitored and managed by the service. We saw that one person who had identified health needs in relation to their weight did not have the necessary information to make choices about their care or sufficient access to a healthy and well balanced diet.

People were supported by a consistent staff team.

Insufficient systems were in place to gather people's views about the quality of the service.

People we spoke to said that they liked living in the home and that the staff were nice to them.

People we spoke to said that they could decide what they wanted to do each day, however, the homes care planning process did not demonstrate that everyone using the service had the opportunity to participate in decisions about their care and lifestyle.

We were told that reviews took place on an annual basis. However, the service did not have a formal review process and it was not evident how people were involved in discussions about their care and lifestyle.

Most of the people using the service were able to access the community independently. People told us about a range of leisure opportunities they enjoyed. However, it was not evident how the home ensured that activities remained appropriate or met individual needs and preferences.

Staff had received appropriate training on how to recognise abuse and keep people safe.

Staff were not available in sufficient numbers to ensure that people's individual care needs and choices of activities could be met.

People told us that they had opportunities to discuss issues concerning the home. However, the provider did not have a sufficient system in place to regularly review and monitor the quality of the service provided.