Inspection on 09/06/09 for The Gables

This is the latest available inspection report for this service, carried out on 9th June 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: The Gables 195 Ashby Road Scunthorpe S Humberside DN162AQ The quality rating for this care home is: two star good 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: Jane Lyons Date: 0 9 0 6 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 38 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) 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 38 Information about the care home Name of care home: Address: The Gables 195 Ashby Road Scunthorpe S Humberside DN162AQ 01724 749090 01724 277788 andreagoacher@castlebeck.com www.castlebeck.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Castlebeck Care (Teesdale) Limited Name of registered manager (if applicable) Miss Andrea Marie Goacher Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 12 0 0 0 0 0 0 0 care home 12 learning disability mental disorder, excluding learning disability or dementia physical disability sensory impairment Additional conditions: The maximum number of service users who may be accommodated is 12 The registered person may provide personal care (including nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following category: Learning Disability (Code LD) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 38 A bit about the care home The Gables is a new care home for twelve adults with learning disabilities, including those with complex needs. The home has been developed in partnership with North Lincolnshire local authority and primary care trust to enable people from North Lincolnshire to return to their local area and to receive care and rehabilitation support enabling greater independence and integration back into the local community. It is found in the Ashby area of Scunthorpe, which is within walking distance of the town centre and also close to local shops and amenities. It is a detached building providing accommodation and facilities over two floors with lift access to the first floor. Care Homes for Adults (18-65 years) Page 5 of 38 Each person living there has their own bedroom with ensuite shower room. Two of the first floor bedrooms are set in apartment style living arrangements, each with a lounge area and kitchen to promote independent living. There is a range of communal areas on both floors, an activity room is provided in a separate building in the grounds. The people living at The Gables have the use of a mini bus. The home is set in mature grounds; a kitchen garden has been developed. There is ample parking provided. At the time of this visit the fees for a person staying at The Gables were three thousand, two hundred and fifty pounds per week per person. Care Homes for Adults (18-65 years) Page 6 of 38 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: two star good 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 Care Homes for Adults (18-65 years) Page 7 of 38 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 stars. This means that the people who use the service experience good quality outcomes. This inspection included an unannounced site visit carried out by Mrs Jane Lyons on the 9th June 2009. This inspection report is based on information received by the Care Quality Commission (CQC) from the last six months including information gathered during a site visit to the home which took approximately seven and a half hours. Page 8 of 38 Care Homes for Adults (18-65 years) The home opened in December 2008 and this was the first inspection visit following registration therefore all the National Minimum Standards have been assessed. During the visit we observed peoples experiences of living at The Gables so that we could understand what it is like for people who live at this service. We spoke with the manager, operations director and staff members on duty on the day of the site visit, we also met all the people who live there. We looked at the environment and checked maintenance records to make sure the house is safe and well maintained for the people who live there. We checked documents Care Homes for Adults (18-65 years) Page 9 of 38 that relate to peoples care and safety. These included needs assessments, daily records, care plans, risk assessments and staff supervision records, recruitment and training records. Before the visit the registered manager had completed an Annual Quality Assurance Assessment report (AQQA). This report provides information about how the service operates. We have used some of this information within the report. People who use the service were given surveys (in picture formats) six were returned. Staff that work at the service were given surveys and six were returned. Placing social workers and health care professionals were given surveys and five were returned. Care Homes for Adults (18-65 years) Page 10 of 38 Comments and views from everyone have been included in relevant parts of the report. We would like to thank the people who were staying at The Gables, the staff team and the management for their hospitality during the visit and also thank the people who spoke with us. This was a very positive and enjoyable visit. We have reviewed our practice when making requirements, to improve national consistency. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 11 of 38 What the care home does well Admission to the home is well planned and people are supported in their move to the home. People are helped to make choices about how they spend their time and helped to be more independent. People living in the home are supported to keep in touch with their families and friends. The home is good at making sure staff are trained to support people in the right way. Care Homes for Adults (18-65 years) Page 12 of 38 People’s health needs are well met at the home. Staff and managers know that they have to keep people safe from harm. People receive a healthy diet and their likes and dislikes are also taken into account. The Gables is a very pleasant and homely place for people to live. The registered manager knows and does her job very well. Care Homes for Adults (18-65 years) Page 13 of 38 What has got better from the last inspection What the care home could do better Peoples individual plans, risk assessments and some key policies should be produced in an easy read format. The care staff need to have more regular supervision to make sure they know how to do their jobs properly. Care Homes for Adults (18-65 years) Page 14 of 38 Provide up to date records of staff training in each staff members file. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Jane Lyons CQC Yorkshire and Humberside Citygate Gallowgate NEWCASTLE UPON TYNE NE1 4PA 03000 616171 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 set out on page 4. Care Homes for Adults (18-65 years) Page 15 of 38 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 16 of 38 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 17 of 38 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have good information about the home which helps them decide whether the service is right for them. Admission to the home is well planned and puts the persons needs and wishes at the heart of the process. Evidence: The home has a statement of purpose and service user guide in place, which ensures that people considering using the service have helpful, accurate and up to date information. The service user guide has been provided in an easy read style, with photographs and pictures supporting the written information. Each person admitted to The Gables was assessed fully beforehand and had an individual transition plan developed to enable a smooth process of admission that suited that individual. All the individuals currently residing at the service have been transferred from other services and all out of the area, the opening of this service in Scunthorpe has enabled individuals to return to this area to be close to their relatives and friends. Staff visited people in their previous placements to get to know them and invited them to The Gables for visits and overnight stays before moving in to give them time to express Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: their feelings about living there. One person living at the home told the inspector that she had felt well supported during the move and given plenty of time and opportunity to see if she liked it. The returned surveys show people were given choices about their move to the home and were given enough information prior to their admission. Comments included Happy with the move and I was invited to come and look round the home before I made my decision. Copies of peoples contracts and statements of terms and conditions are held in their care files. There is a comprehensive and ongoing programme of training for staff which is tailored to the care and support needs of this client group. Discussions with staff and training records indicate that the home has the requisite range of skills and abilities with which to meet the needs of the people residing at the home. We looked at two peoples care files, these contained assessments and care plans from the placing authority and the service had developed full and informative service user plans from their detailed assessment processes. Discussions with the manager confirmed that the service carefully considers all referrals to the home and only following a thorough assessment process and consultation with the individual and or their representative would a decision be made, it is clear from the admissions to the service to date that suitability to the service is essential, in that the individuals needs can be met fully at the service and consideration is given as to how the individual will fit in with life at the home. Care Homes for Adults (18-65 years) Page 19 of 38 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assisted and supported by staff to make decisions and choices about all daily living needs. Detailed plans, risk assessments and guidelines are in place to guide staff in how to meet peoples complex needs and keep them safe. Evidence: As part of this inspection, the records relating to two people and the outcomes for those people were looked at in detail. Both files included an initial overview of the person, their history, needs, likes and dislikes. The assessment information is comprehensive and peoples individual plans show that staff have translated the assessments into good working plans for daily life. The plans are detailed to ensure staff are aware of all their needs and are able to provide appropriate and consistent care to meet their needs. Peoples preferences for ways to be supported were clear and their usual routines and patterns were seen to be incorporated into individual plans. It was clear that peoples needs were being met and there were good diary records to indicate what care had been delivered on a daily basis. Care Homes for Adults (18-65 years) Page 20 of 38 Evidence: People said they were aware of what was in the care plans and said they participated in regular reviews with staff and health professionals. One individual chose to show us their care file and told us what they talked about with their care coordinator and at the review meetings. Another person told us that the staff help them to read through their care plans. Risk assessments for individuals show that consideration is given to ensuring people have opportunities to be active and experience new things, while full consideration is given as to how this may be done safely. It was evident that these documents are regularly reviewed with the involvement of the individual. Where people display behaviours that can be difficult to manage, behaviour management strategies and techniques to be used were detailed in a behaviour support plan. Information provided in the AQQA and discussions with the management evidence that they plan to make the care plans and risk assessment documentation more user friendly and more easily understandable by the residents. This will certainly benefit people using the service to help ensure that they are more involved with and better understand the recording aspect of their care support. Weekly review meetings are held with the staff and the multi disciplinary team, including the psychiatrist, senior care practioner and a locum G.P., records show individuals health, welfare and social care is thoroughly monitored. Care co-ordinators review peoples progress monthly and this is written up in files. These reports gave a flavour of how people were over the month. They are linked to goals set in the review meetings and progress is carefully tracked. A care manager involved in the service who responded to the survey question what does the service do well? said: The service provides person centred services for the most challenging and complex individuals on the local Learning Disability register. People are provided with good access to a range of Learning Disability professionals. Care Homes for Adults (18-65 years) Page 21 of 38 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 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 services are able to make choices about their life style, and supported to develop their life skills and maintain relationships with friends and family. Evidence: The people living at The Gables have only been there for a short time but health and social care professionals have been very positive about the way that opportunities have been opened up for people. One survey detailed: There is good integration into the community, excellent holistic health and social care provided by a dedicated staff team and another care manager wrote Wide and varied activities on offer to the residents. People have the opportunities to develop practical life skills and social skills and make the most of their abilities. Daily routines within the home are flexible and individual, for each person who uses the service. People who use the service have developed some friendly, yet professional relationships with staff, and clearly enjoy the interaction that goes on. Individuals are open and honest in their accounts of how things are, and their relaxed attitude is seen in their body language and their willingness to become involved. As well as trips out people are encouraged to take part in daily activities such as numeracy and Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: literacy, arts and crafts, looking after their own rooms and helping with cooking, shopping and gardening, as far as possible. Twice a week individuals are involved in a lunch club, where they plan a meal, do the shopping and they are then supported to cook the meal. This was planned for the day of the inspection however due to events that morning this was rescheduled for tea time, we saw people involved in preparing beef burgers and enjoying this activity. None of the current individuals residing at the home are employed or attending work placement schemes, the AQQA details that one individual is to be supported to attend a preparation for work course over a three month period. As well as the structured activity plan, people have the opportunity to participate in events and social activities in the community and wider afield. For example one person loves Thomas the Tank Engine and a trip to York Railway Museum had taken place the previous week. Records show people regularly take part in visits to shops, swimming, walks, bowling, DVD evenings and cinema etc. It was evident that staff try hard to offer a wide variety of activities to enrich and develop peoples lives. The people who use the service and staff benefit from the provision of an activity room which is a separate building in the grounds, it has been equipped with a therapy kitchen and computer equipment, evidence from discussions and records show this facility is used daily. The people who use the service have also been supported to develop a large kitchen garden, where they are growing a wide range of vegetables. One person told us that they enjoy working in the garden. The home has its own minibus which facilitates easy access for individuals within the community and for trips out. Information provided in the AQQA detailed Within The Gables the residents hold a weekly service user forum, which all residents attend. During this meeting the residents discuss their past week, high points and low points, if any, any outings or activities they would like to plan are discussed as well a any ideas anyone may have for future day service sessions. The meetings are also used to plan the menus for the week ahead. Records of these meetings are clearly maintained with evidence that peoples views are taken into consideration. The manager said that the provision of the home in Scunthorpe had enabled people to return to the area which has improved the level of contact they have with their families and friends and that maintaining those relationships is vital to peoples well being. She and the staff team therefore make every effort to keep links or to promote those that may have lapsed in the past. Family and friends are welcomed to the home and people can telephone to keep in touch if they wish with free access to a portable telephone. One person, who spoke with the inspector, said they were really pleased they had moved to the home as they could see their friends again. There is evidence that people have the opportunity to take holidays and staff said that they had planned the first holiday to Cayton Bay, near Scarborough this summer. Care plans show peoples religious affiliations, all individuals residing in the home are nonpracticing. People were observed to move around the home as they wished. The pace of the day was Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: unhurried and staff undertook individuals daily routines in a professional manner. Files showed that individuals preferences around food were recorded and menus have been developed in consultation with people who use the service. The cook told us that they have a healthy eating approach at the home, which the menus reflected, she said that individuals have enjoyed eating the salad they have grown. Once a month people enjoy a take away, one person told us that its usually a Chinese meal which is always nice. There are plans to introduce theme days which will include speciality menus such as Indian and Hawaiian menus. The inspector was present for one meal, which was a relaxed affair with people eating at their own pace and supported by staff in a discreet and respectful way when this was needed. Fresh fruit was available in the dining room. Care Homes for Adults (18-65 years) Page 24 of 38 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health needs are well met by the provision of health screening, regular reviews, care planning and good recording of outcomes. Medication is well managed. Evidence: Two care files were examined as part of the inspection process and this evidenced that peoples health care needs were being well met. Health action plans have been developed by the staff and incorporated into the overall care planning system. Castlebeck employs a number of consultant psychiatrists and one of these is allocated to The Gables, he attends the service at least weekly and reviews each individuals mental health needs. Weekly multi- disciplinary meetings are held at the home and attended by the consultant psychiatrist, a senior care practioner from the local authority and often a locum G.P., also employed by the company. Each individual is registered at a local health centre, where the G.P.s oversee each persons general health. Health care needs are well documented on the files and records of the MDT meetings well written up so that progress could be tracked. Routine health screening such as dental and optical appointments were also seen to be covered. We spoke with the consultant psychiatrist prior to the visit who confirmed that he was very satisfied with the level of support individuals received at the home, many of the individuals display a range of challenging behaviours which he considered had been very well managed given the relatively short period of time the service had been opened. Nursing staff told us that the medical support at the home was very good, Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: alongside the regular visits by the psychiatrist they also operate a duty system and staff can contact them at any time. One person had fallen that morning and had been taken to hospital where it was identified that they had sustained a fractured collar bone. This was managed well and the person had been well supported. There was good evidence of monitoring for food/ fluid intake, weight, seizure activity and for one person with severe epilepsy a separate care plan had been developed to support their needs. Risk assessments are in place to identify any risks and how they can be managed. These assessments involve people who use the service, their representatives and other professionals. Records show that they are reviewed regularly. The manager told us that each persons care plan and risk assessments are currently being reviewed and will be produced in a more user friendly document for individuals to understand better. People are positive about the level of care and support they receive at The Gables and made comments such as: The staff are really friendly here. Staff are nice to me, sometimes Im a bit grumpy, especially in the mornings, but they are still very nice and kind. I like it here, the staff help me when I need it. The management of medication was found to be good. The nursing staff are responsible for all medication administration, there are written policies and procedures in place for staff to adhere to regarding administration of medication. A sample of three peoples medication was checked during the visit. This showed there to be good systems in place for the recording, storing, administration and disposal of medications. The medication record sheets were neat, tidy and easy to follow. There were no controlled drugs in use the home has systems in place to support the safe management. P.R.N. (as required) medication protocols are in place however records and discussions with staff show they are seldom needed. Checks on room and fridge temperatures were all in place. There was good evidence that individuals have their medication reviewed regularly. Care Homes for Adults (18-65 years) Page 26 of 38 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Gables are protected by the service and listened to. Evidence: The home has a clear complaints procedure. It would be beneficial to the people who use the service if this information was provided in an easy read format, although there is evidence from meeting records and discussions with individuals that they know how to voice their concerns. People said if they had any concerns they would feel comfortable in speaking to the staff about them. One person who spoke with the inspector said they felt that staff listened to them when they had something to say but did not have any complaints about the home whatsoever. The home has received one complaint since it opened, records showed this was managed properly, the issues were not founded. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of money and financial affairs. Staff have completed protection of vulnerable adults training and understand their responsibilities within this. All staff have received training in managing challenging behaviour. This helps to ensure people who use the service are safe and protected. Some people have small amounts of personal money that is held safely at the home by staff. Records are available to show when money is deposited on behalf of people. The Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: records show the individual cash balance for each person and how their money is used on their behalf, including receipts for goods and items purchased. Two peoples finances were checked during the visit and were found to be correct. These financial systems will be audited periodically by staff from the companys head office. Records show that some staff have accessed training in the Mental Capacity Act and the new Deprivation of Liberty Safeguards legislation, further training is being rolled out to the remainder. Care plans include capacity assessments which ensures that the mental capacity of individuals is properly considered to protect individuals living there. Care Homes for Adults (18-65 years) Page 28 of 38 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment at The Gables offers a good homely place for people to live. Evidence: The building was previously used as a care service, it has been completely renovated, redecorated and refurbished to provide a bright, cheerful and comfortable home. As the home only opened in December last year it still has a fairly new and clean ambiance. The decor and furnishings throughout the building are of good quality and reflect a contemporary style, providing very comfortable and pleasant accommodation. The dining room and lounge appeared to be the focal points for the group with most people gravitating to these areas. Accommodation is over two floors, there is lift and stair access to the first floor. The home can provide support for up to twelve people, there are two self contained flats on the first floor which can accommodate people who have developed more independent living skills. The home provides a range of communal rooms, there is a dining room, separate activity room and sitting rooms on the ground and first floor. All bedrooms are for single occupancy offering en- suite facilities, which includes a wet shower room. They are suitable for peoples needs, pleasantly decorated and personalised where possible. Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: There was evidence of TVs, games consoles, music systems and photographs etc. There is also a range of separate bathing and toilet facilities on each floor. On the day of this visit it was seen that all areas of the home were very clean and tidy. Staff have received training in infection control. The laundry has a commercial washing machine installed, which has a sluice facility for dealing with soiled linen. This area appeared tidy and well managed. To ensure the safety of the people who use the service a key coded access facility to the building ensures people cant leave the home unsupervised. There is an attractive garden with mature plants and trees. Staff and people who use the service are developing a lovely kitchen garden, there is a wide variety of vegetables growing and the manager told us there are plans to develop the remaining area and provide a greenhouse. There is ample parking space provided at the rear of the home. There is good access to local transport and amenities. Overall the facilities provided at the home are very good. From surveys received and from speaking with people during the visit it was evident that they are very happy with the facilities at the home. Care Homes for Adults (18-65 years) Page 30 of 38 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 good 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 a dedicated and skilled staff team. Recruitment policies are followed ensuring the safety and protection of people who live at the home. Evidence: The management at the home started recruiting the homes staff prior to the home opening, occupancy has steadily increased with seven people residing in the home at the time of the visit. On the day of the visit enough staff, were observed, to be available to meet peoples needs in a relaxed and calm manner. There is a qualified nurse rostered each shift. The staff work twelve hour shifts rotating on day and night duty, the staff told us that the rotation on day and night shifts worked very well. Staff also told us that they generally felt there were enough staff on duty but as the numbers of residents had increased, the levels would now benefit from review. Three staff surveys detailed that there were usually enough staff on duty and three surveys detailed always. This was passed onto the management, who confirmed that recruitment was underway and there are systems in place to continually review the staffing levels. The home has received support from the CAST (Coping and Support Team) team, Care Homes for Adults (18-65 years) Page 31 of 38 Evidence: employed by Castlebeck, since opening. This is a dedicated experienced group of staff who have worked alongside staff at The Gables from induction to date, to support and develop the new staff team. The home has experienced some problems with staff sickness and delays in recruitment and the provision of this team has clearly been of huge benefit to both individuals at the service and the staff group. The consultant psychiatrist told us that the support from the CAST team had been invaluable, and he felt had contributed greatly to the new residents settling into the service so well. The atmosphere throughout the visit was very calm, people were observed to be very settled and all interactions with staff were very positive. The home also employs a team of ancillary staff who are highly motivated ensuring that the standards relating to food, cleanliness, laundry, maintenance and administration are fully met. People who use the service are protected through robust recruitment procedures. Staff recruitment records sampled during the visit are well maintained and up to date. Safevetting procedures are followed these include taking up written references and carrying out checks through the Criminal Records Bureau before appointment, the company policy is that new staff can only commence work following receipt of the CRB disclosure. All staff files contain a photograph, proof of identification, a contract and terms and conditions of employment. The manager confirmed that two of the people who use the service have been involved in staff interviews. Before The Gables opened in December 2008, the staff had the luxury of a period of time in training and preparation for the admission of people to the home. During this period staff completed their Learning Disability Award Framework training (LDAF). This was a good foundation for the staff to gain a clear understanding of the work they were to undertake when the home opened. Courses in Personal Safety and Conflict Management (MAYBO) were also provided during this time. Staff have also completed basic skills courses in areas such as fire safety, moving and handling, food hygiene, health and safety, adult protection, first aid and infection control. Courses in service specific areas such as communication, autism and epilepsy have also been provided. Castlebeck have taken the decision not to provide their staff with certificates on completion of in house training courses, the service therefore relies on evidence from computerised records, which need to be fully maintained. The home currently employs eighteen care staff, four staff have NVQ level 2 qualification or equivalent, seven of the care staff were enrolled on the course in June. It was seen that support systems for staff were generally effective. There are staff meetings as well as additional meetings where issues arise in between if needed. Supervision records show that the majority of staff have accessed two sessions since the home opened, however to meet the standard in this area, staff should receive supervision approximately every two months. Care staff told us that they receive good on the job, Care Homes for Adults (18-65 years) Page 32 of 38 Evidence: informal supervision from the manager and nursing staff in terms of coaching and role modelling approaches with individuals. Appraisals are scheduled to take place within the first twelve months of employment. Staff who responded to the inspectors survey confirmed that they felt they had had good training and preparation for their roles and that they felt supported by the management within the home. Comments include The training programme is very good and I found the courses on autism and epilepsy very helpful. In two of the staff surveys returned staff had detailed communication in the section what could the service do better?. This was discussed with the staff during the day, who felt that this wasnt particularly an issue for them at present, they received regular handovers, attended staff meetings and had opportunities to discuss issues daily. Staff meetings had been held in January and May. The management confirmed that they had been made aware that there were some issues around communication which they were addressing. Care Homes for Adults (18-65 years) Page 33 of 38 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run in the interests of the people who live at The Gables. Evidence: The manager of The Gables, Andrea Goacher, was registered by the Commission in December 2008. She is very well experienced, and qualified to run the home, holding the Registered Nurse Mental Handicap qualification, Degree in Health and Social Care, the NVQ 4 in Management and a range of post graduate qualifications. She has had the benefit of being involved in setting up the home from the very beginning and this has had a positive effect on how the home has begun its operation. The management at the home have an open door style of approach, which was evident throughout the visit. Staff told us that they enjoyed working at the home and the manager was very supportive. The manager provided us with information about the home in their Annual Quality Assurance Assessment (AQQA). This information let us know about the service and what they are doing to improve the outcomes for people who use this service and about improvements they intend to make to continue with this. A system of monitoring the quality of the care provided at the home has been implemented including regular monthly visits by the responsible individual for the company, regular audits carried out by the Care Homes for Adults (18-65 years) Page 34 of 38 Evidence: manager and feedback from people who use the service, families and professionals. The home has appointed a quality champion and has the support of a clinical governance team from head office. Evidence from the returned service and CQC surveys show that people are more than happy with the service. The homes business and financial plan and insurance arrangements are in place and were submitted to support the homes registration in December 2008. Health and Safety is managed well. There are good systems to ensure that routine maintenance is carried out such as checks on equipment and water temperatures, detailed records are well maintained. There are also good risk assessments in place to minimise risks within the home. Fire safety is good, the system is new and meets current standards. The home carries out and records weekly checks on the fire safety systems and equipment, and undertakes and records regular evacuation drills. Care Homes for Adults (18-65 years) Page 35 of 38 Are there any outstanding requirements from the last inspection? Yes  No  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 36 of 38 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 Description 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 Description Timescale for action 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 2 6 32 Peoples individual plans and risk assessments should be produced in a format which is accessible to them. Continue to ensure care staff have access to NVQ level 2 courses to meet the standard of having 50 of care staff with this qualification. Continue to review staffing levels to ensure enough staff are rostered at all times to meet the dependency needs of the people who use the service. Staff files should contain up to date records to confirm the training they have accessed. Ensure staff are on target to receive formal supervision at least six times a year. 3 33 4 5 35 36 Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 03000 616161 or 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. 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