Fairglen Residential Home in Plymouth has seen its overall rating drop from good to inadequate, following an inspection by the Care Quality Commission (CQC) in November.
Fairglen is a residential care home that provides personal care and support for up to 12 people with a learning disability, autistic people, or people who have complex needs associated with their mental health. CQC carried out an unannounced focused inspection to look at how safe and well-led the service was after receiving concerns about the overall management and leadership, the management of risk and people’s personal care needs, insufficient staffing levels and staff training. At the time of the inspection, there were 10 people living at the service. During the inspection, further concerns were identified, so the decision was taken to carry out a comprehensive inspection to look at how effective, caring and responsive the service was.
Following the inspection, the overall rating for the service has dropped from good to inadequate. The ratings for all five key questions: safe, effective, caring, responsive and well-led, have also dropped from good to inadequate. The service is now in special measures, which means it will be kept under review and will be re-inspected within six months. If sufficient improvements have not been made at that point, CQC will take further enforcement action to ensure people are safe.
Debbie Ivanova, CQC deputy chief inspector for people with a learning disability and autistic people, said:
“We expect health and social care providers to guarantee people with a learning disability and autistic people the safety, choices, dignity, and independence that most people take for granted. Yet when we inspected Fairglen Residential Home, we were very concerned that the people were not safe in their own home. As a result, we took immediate action to protect people from harm, and the service is now being supported by the local authority safeguarding team.
“There were not enough staff to keep people safe and staff didn’t have the right training to support people with complex needs. For example, two people living there had epilepsy, but staff had not received any training on how to manage an epileptic seizure. One person had regular hourly checks during the day, but these stopped at night when staff were sleeping. One person was prescribed urgent medicine to take if they were having an epileptic seizure, but staff didn’t know it was available until it was found by the inspection team. This put them at risk of prolonged seizures.
“When incidents occurred, the registered manager did nothing to ensure that appropriate action was taken. One person said they had been physically abused by a member of staff. The manager was aware of the complaint but failed to report it to the local authority and investigate it further. Another person had suffered an injury as a result of a fall and was taken to an accident and emergency department. The manager should have notified CQC but did nothing about it. This was very concerning, as the service was not learning from incidents and making improvements when things went wrong, which meant they were likely to keep happening.
“In addition, staff used disrespectful and outdated language when talking about the people who lived there. We also found evidence of a closed culture, which is when institutionalised practices are used and increase people’s dependence on the manager and staff. Staff did not encourage, support or empower people to make their own decisions or to develop life skills and increase their independence. We saw a member of staff take a person’s plate of food away from them without asking them, then tipping half the contents onto another person’s plate. We also found hand towels in the toilets and bathrooms had been bolted to the walls. The manager said this was because one person kept taking them. Instead of exploring this person’s sensory needs, restrictive measures were put on everyone living in the home.
“We have told the provider that it must make a number of improvements and we will monitor the service closely to ensure that these are made.”
Inspectors found the following:
- There were not enough staff with the right skills, training. Some people’s needs had increased over time, yet staffing levels stayed the same as the manager had not assessed how many staff were needed to meet people’s needs safely
- Safeguarding systems and processes did not operate effectively in relation to reporting and investigating of allegations of abuse. Systems were either not in place or robust enough to demonstrate accidents and incidents were effectively monitored and reviewed
- There were no individualised care plans to guide staff, so they knew what medicine to give people when they needed it. This meant people may not receive their medicines when they needed them and could be in prolonged pain. In addition, the dose, or the exact time that medicine was given to people, was not always recorded, so staff could not be sure that they were giving people medicine that was safe and effective
- Care records did not outline strategies and de-escalation techniques for dealing with behaviour that may challenge other people
- There was no system in place to alert staff to an emergency, such as a call bell or emergency pull cords. This put people at an increased risk of harm
- People were not always supported in line with their care plans to ensure risks associated with eating and drinking were managed. Some people had lost weight, but staff did not know if they had been referred to a healthcare professional to review their weight loss
- People were not always supported to make their own decisions or helped to do so when needed. Inspectors found some people were prevented from leaving the service to attend meaningful activities in the wider community. In addition, the registered manager was managing the finances for two people, even though they had not been assessed to determine whether they had the capacity to manage their own money.
Full details of the inspection are given in the report published on our website.
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