Fairglen Residential Home

Updated 24 February 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team was made up of two inspectors and a medicines inspector.

Service and service type

Fairglen Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We initially carried out an unannounced evening visit, and we returned the following day.

What we did before the inspection

Before the inspection we reviewed the information, we held about the service, including notifications we had received. Notifications are changes, events or incidents the provider is legally required to tell us about within required timescales. We sought feedback from the local authority. We used this information to plan the inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spent time with and spoke with six people living at the service, one relative, four members of staff, registered manager and the provider. To help us assess and understand how people's care needs were being met we reviewed four people's care records. We also reviewed a number of records relating to the running of the service. These included staff recruitment and training records, medicine records and records associated with the provider's quality assurance systems.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, policies and quality assurance records. We spoke with four health care professionals, a representative from Plymouth City Council's quality assurance and improvement team (QAIT) and safeguarding team and three relatives.

Updated 24 February 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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