Inspection on 14/06/06 for Bedrock Court

This inspection was carried out on 14th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bedrock Court 11/11/08

Bedrock Court 27/11/07

Bedrock Court 05/06/07

Bedrock Court 07/11/06

Bedrock Court 16/02/06

Bedrock Court 11/10/05

Bedrock Court 24/03/05

Bedrock Court 02/12/04

Bedrock Court 28/01/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 The Gables 3 New Road Stoke Gifford South Glos BS34 8QW Lead Inspector Paula Cordell Key Unannounced Inspection 14th June 2006 09:15 The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Gables Address 3 New Road Stoke Gifford South Glos BS34 8QW 0117 9798746 01454 772171 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr John Michael Gay Mrs Angeline Linda Gay To be appointed Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (1), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (1) The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 6 persons aged 19-65 years requiring personal care only May accommodate up to 1 person with Mental Disorder who may be under 65 years or over. 16th February 2006 Date of last inspection Brief Description of the Service: The Gables is one of three homes operated by Nightingale Care Homes. All three homes are owned and operated by the proprietors, Mr and Mrs Gay. The other homes within the group are Bedrock Lodge and Springfield. The Gables is a mature detached house and is registered with the Commission for Social Care Inspection to provide personal care and accommodation for six people with a learning disability aged between 18 and 65 years of age with one person over the age of 65. In addition the home may accommodate one person with mental health issues. The home is situated within close proximity of the Avon Ring Road. There are bus routes approximately 300 yards from the home. There are local shops and the home is within easy reach of Bristol Parkway railway station. Accommodation is on two floors. The registered manager is Ms Angela Lake. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection. The purpose of the visit was to monitor the progress to the requirements and recommendations from the last unannounced site visit in February 2006 and review the standard of care provided to the residents at the Gables. The focus of the site visit was on the general care of a sample group of residents and the environment, including an extensive tour of the premises. This provided a good opportunity to observe residents as well as allowing for informal conversations with individuals and the staff supporting them. Three members of staff were spoken with during the inspection, in addition to the registered manager. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the residents and these were used as a focus for the site visit along with the pre-inspection questionnaire completed by the home, relatives (3) and residents (6). The home was required to develop an improvement plan in response to continual failure to demonstrate compliance to requirements from previous inspections. This was used to plan the inspection process and followed up during this visit. The site visit was conducted over a period of 7 hours. What the service does well: What has improved since the last inspection? There is now a registered manager in post, which has evidently improved the support to both the residents and staff. Each resident has a plan of care, however these had not been formally reviewed since November 2005. This is an outstanding requirement. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 6 Residents now benefit from a plans of care which clearly describe how they should be supported, in relation to their challenging behaviour and the strategies that staff should undertake to best support residents. The home has ceased locking the bedroom door of one of the residents at night ensuring that is human rights are not infringed. Residents are now safeguarded by the safe administration and recording of their prescribed medication and have competent staff involved in this process. Residents dignity is better maintained now the sign in the entrance hall telling residents to “use the toilet and prior to getting on the bus” has now been removed. Residents have benefited from one of the lounges being redecorated. What they could do better: The home has failed to demonstrate compliance with ten of the requirements from the last inspection and the improvement plan drawn up in consultation with the home and the Commission for Social Care Inspection. The Commission for Social Care Inspection is taking this seriously and is closely monitoring the home. The Commission will again devise an Improvement Plan with the providers and is taking further enforcement action in relation to the care planning processes and the lack of formal reviews. Residents would benefit from clear information about the home prior to admission to ensure that it is appropriate including a statement of purpose, a contract of care and an up to date service user guide. This remains an outstanding requirement. Residents would be assured that they were appropriately admitted to the home if the policy on admissions reflected the registration of the home. Residents must be assured that there is a clear plan of care, which details all their care needs, for staff to follow and this is kept under review. Residents must be involved in the decision process. This has been an outstanding requirement and enforcement action is being taken. To better protect residents’ rights and freedom of movement bedroom doors and wardrobe doors must not be locked unless a risk assessment is in place demonstrating the reasons why. This remains an outstanding requirement. Residents should be assured that they would have access to health care including dentists. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 7 Residents must be protected by risk assessments that cover all aspects of their daily living and these are kept under review. This remains an outstanding requirement. Residents should be assured that the home is comfortably furnished and homely in appearance and a safe place to live. This remains an outstanding requirement. Residents must be protected by robust procedures in protection from abuse and staff must be competent to respond appropriately to an allegation of abuse. Residents must be protected by a robust recruitment process ensuring their safety. Competent staff must support residents and a training plan must be developed for the team and individual staff addressing statutory training and training relating to the care needs of the residents. Residents must be assured that staffing is appropriate to their identified care needs and staff are working appropriate amount of hours without compromising the safety of the residents. Where a resident requires waking nights as part of their contract of care it is unsafe for staff to sleep. Residents must be assured that staff are competent to respond to all health and safety emergencies including fire and where first aid is required. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home has failed to demonstrate that there is information available to prospective residents and that there is robust admission processes in place. Residents assessed and changing care needs are not fully being met. EVIDENCE: The home is in the process of updating and amending the statement of purpose in respect of the new registered home manager. The manager stated that the provider is presently completing this. A copy must be sent to the Commission for Social Care Inspection within one month. Residents had a copy of the home’s service user guide within their care file. This requires updating to reflect the changes in management and staffing. In addition there was a contract of care however this had not been fully completed as it lacked information relating to the fees paid. There is one vacancy in the home. As part of this inspection the admission process was reviewed. The home has a policy to guide staff on the process and information is included in the statement of purpose. However, the policy focused on the needs of individuals with mental health needs and individuals detained under the mental health act. The policy detailed a criteria for The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 10 individuals, which did not reflect the registration of the home and must be amended. Presently the home is registered to support individuals with a learning disability and two individuals with mental health needs. The home has an established group of residents with one vacancy. The home must ensure that the home could meet the needs of any new resident ensuring that this does not compromise the care of individuals already placed and that the staff have capacity and the skills to support the new individual. For the foreseeable future this will need to be reappraised at forthcoming inspection as concerns have been raised relating to the complex and varied care needs of the residents living in the home. A clear criteria should be developed to ensure that potential residents are appropriately placed. Residents are offered a trial period of three months to ensure the home is suitable and that the individuals care needs can be met. The manager stated that they along with the provider would complete the initial assessment. As part of this process the home obtains a copy of the plan of care and assessment drawn up by the individual’s social worker. It was evident from discussions with the manager that this process had commenced and copies of care plans were being sent to the home. All the residents are presently being reassessed by their placing authority (social worker) to ensure that the home continues to meet the care needs of the individuals. The manager stated that this process is near completion and is waiting for the outcome and copies of the amended plan of care. The home has failed to demonstrate that residents changing care needs are being reassessed with plans of care being reviewed at appropriate intervals. Information in care plans was not fully being recorded or undertaken. These will be addressed further in this report under the appropriate standard. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The residents’ plans of care seen failed to reflect assessed and changing needs. Residents are not fully involved in the planning of their care. These residents are not safeguarded within a risk assessment framework and approach. EVIDENCE: Two residents care plans were reviewed. As was applicable at previous inspections residents care plans do not clearly describe residents care needs and how to meet those needs. Care plans continue to resemble an assessment rather than a clear plan of care that staff can follow. There was no evidence of a formal care review in the last six months which detailed any amendments to the plan or who contributed to the plan. The manager was unsure of her role in the development of the plans and was led to believe that this was the role of the provider. There is an outstanding requirement for the registered person to ensure that actions to meet the residents’ care needs and their outcomes were fully documented and to ensure that all residents care plans are fully reviewed and evaluated at least six The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 12 monthly. This is outstanding and commented upon following inspections in July 2004, December 2004, March 2005 and October 2005 and February 2006. The care plans seen were similar in content and lacked any real person centred approach pertinent to the individual. However, since the last inspection the home has developed individual plans on the management of challenging behaviour detailing the triggers and the strategies to be used. Staff consulted during this inspection stated that there has been a reduction of the challenging episodes for one individual and that this is now managed more appropriately. Whilst records noted a reduction it was apparent that staff were not always recording information on to behaviour charts. It was noted that an individual had information recorded in daily records and this had not been transferred to the behaviour monitoring record. One plan of care made reference to an epilepsy chart that could not be found in the record of care, another made reference to health checks there was no record to confirm this had been completed (see standard relating to health). The care plans in the individual resident’s file did not correspond with the plan of care in a central file and could lead to confusion for staff. It was pleasing to see that staff are ensuring the safety of one of the residents and this individual is now encouraged to sit in the main lounge separate from one of the other residents. Staff confirmed that this was a new approach and the individual was much more settled. However, this had not been recorded in the plan of care ensuring a consistent approach. Another example was that furniture that was previously removed now remains in an individual’s bedroom during the day, whilst this is seen as positive this again is not recorded. Risk assessments were seen. These were dated 2003 there was no evidence that these had been kept under review and lacked a staff signature. There were no risk assessments demonstrating the rationale behind the lack of furniture in some of the bedrooms or for the locking of some of the wardrobe doors. Or one, specific to an individual, relating to toiletries and cleaning products being kept in their bedroom when there is a risk that they could swallow or eat them as they have a condition known as PICA. The home has a new policy on resident participation, which makes reference to a resident committee and regular resident meetings. The manager stated that it is her plan to organise regular resident meetings. This will be followed up at the next site visit. Views of residents, their relatives and professionals were sought via an annual survey. This is good practice. Resident and relative feedback was overall good. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents have available to them a varied timetable of activities, however records did not adequately reflect that these were happening in practice. Residents are supported to maintain contact with family and friends. Residents are offered a nutritious and varied diet. EVIDENCE: Each resident has a daily activity timetable. Each timetable was different to reflect the different interests of the residents and included arts and crafts, cooking, visiting shops and swimming. One of the individuals attends a day centre. Whilst activities were happening on the day of the inspection this did not correspond with the individuals’ activity timetable. Staff spoken with during the inspection stated that there has been an increase in activities available to residents and a commitment to ensure that activity timetables are followed since the manager has been in post. However, daily reports lacked any The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 14 description of activities that individuals attend. Two of the completed resident surveys stated that there was lots of things to do and four stated sometimes. The home has access to a mini bus, which the residents help to fund by contributing their disabled living allowance to the provider. Documentation was available explaining this to residents. Residents were observed being given a choice whether they wanted to participate in the arranged activities and where residents had refused their wishes were respected. Again concern was raised about the activities that residents undertake and the lack of risk assessments. A member of the public complained about an individual with a medical condition when they recently visited a local swimming bath, there was no risk assessment relating to the activity or the medical condition. The resident has been stopped from participating in the activity. There were no records confirming consultation with the individual’s doctor, no updated risk assessment or alternatives explored relating to the individuals activity plan. Two residents from another home were at the Gables on the day of the inspection. One was involved in a gardening group and the other was sat in the lounge watching television, as they did not want to assist with the gardening. This practice must be reviewed to ensure that the resident would not prefer to remain in his own home and that the activity is appropriate. Residents living at the Gables, relatives and one professional have been consulted about residents from the other two homes spending time in the home as part of their day care programme and have signed to say that they are happy with this arrangement. This is in response to a requirement from the previous inspection. It would be recommended that this is made clear in the statement of purpose to ensure that prospective residents are aware of this. In addition residents should be reminded about being respectful for example ringing the door bell rather than just walking in. Family contact was noted in care plans. A member of staff stated that this is part of the role of the key worker (a nominated member of staff) to assist residents with maintaining contact. All residents’ surveys stated that they were happy with how the home supports them to make contact with family and friends. Three relative surveys confirmed that the contact with the home was good and that they were made to feel welcome and that they could visit their relative in private. A relative stated that “they always found the staff to be both welcoming and friendly. The home has a happy atmosphere and the individual is well cared for and is happy”. Another relative stated “the Gables has been by far the best home for their relative and cannot think of any improvements” The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 15 The residents have available to them a nutritious and varied diet. Residents consulted indicated that they enjoyed the food and alternatives were available. A record was seen demonstrating that variations were offered. Food was stored appropriately in response to the last two inspections. Satisfactory records were being maintained of fridge/freezer and food temperatures in accordance with the principles of food hygiene. Residents were assisting in a house shop as part of their daily activities. Staff stated that the home completes a weekly shop for bulk purchases in addition to daily shopping for smaller items for example bread and milk. A resident stated that they can request drinks whenever and can access the kitchen, which is locked, with staff assistance. The main meal of the day is had in the evenings and staff stated that this fits in with resident activities. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Resident’s personal care needs were being met. However, resident’s health care needs are not fully being met. Residents can be assured that the medication systems are safer than they have been in the past. EVIDENCE: Personal support is recorded. Morning and evening routines for personal hygiene are detailed, stating how and when the residents need assistance. It was noted that these were not dated or signed so it was difficult to determine how current the documentation was. The manager, in response to a previous recommendation has recently amended these. A cup of salt is no longer added to the bath and more personalised approaches are being adopted. Individuals had a distinctive style demonstrated by their choice of haircut and style of clothes. Staff stated that as part of the key worker role individuals are supported to purchase clothes. The home organises a woman’s group where nails and make up and a hairdresser visits the home, female residents from Bedrock Lodge attend this group. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 17 Residents’ care plans included information about the monitoring of their physical health. However, it was evident that regular appointments were not being made for individuals to see a dentist. Evidence was provided that appointments had been made and cancelled due to staff shortages. It was difficult to determine how the home was meeting individual’s health care needs. The manager stated that this is recorded in the daily records. This made it difficult to determine, as information was not easily accessible from the day-to-day information about an individual’s wellbeing. The manager stated that some of the information had been archived when asked to clarify if an individual had attended an appointment with a specialist about a medical condition. This information must be retrieved, as it is pertinent to the individual now. In addition this must be reviewed with the appropriate professional to ensure that the condition has not deteriorated. Residents where relevant, were being reviewed with the consultant psychiatrist. Letters were seen confirming this. The home has responded to four previous requirements relating to medication. The manager has introduced a new system, which evidently is benefiting the residents and is clearer for staff working in the home. Staff were signing medication records as part of the administration process. All medication was recorded on the medication record. Medication is no longer being given covertly to one individual; this was confirmed in documentation seen and discussions with staff. The home now maintains a record of incoming medication. In addition there were regular stock reviews. It is recommended that the medication returns book contain two staff signatures, the reason for the disposal, the medication, the dose, the amount and the name of the individual it is prescribed for. Staff are trained to administer medication through an in-house procedure of observations and the manager stated that this is reviewed three monthly and this has recently been undertaken for all staff working in the Gables. Since the last inspection all staff are in the process of completing a distance learning pack from the pharmacist. This is good practice and will be followed up at the next inspection. Each resident had a medication profile detailing the medication, their use and the side effects and a photograph. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents are not protected from the risk of harm or abuse by the procedures and practices in the home. EVIDENCE: The home has recently reviewed the complaint procedure. Residents’ questionnaires confirmed that three individuals knew who to complain to and two stated they were unsure; one of the residents is unable to articulate their views. However, staff spoken with indicated that body language was interpreted to assess whether the individual was happy or not. Another person had a communication dictionary to assist with interpreting the individual’s needs and feelings. According to the home’s record of complaints the home has had one complaint since the last inspection relating to a recent swimming trip for one individual. The home has responded to the complainant, a member of the public. However, the care plan, risk assessments or the daily activity plan had not been amended and there was no evidence that the individual had been seen by a medical practioner. These are serious concerns. The home has recently implemented a new policy on protection of residents from abuse. This makes reference to the home completing an investigation without consultation with Social Services. This must be reviewed and amended to ensure compliance to the Department of Health’s “No Secrets”. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 19 Staff were questioned on their knowledge of POVA, one staff member stated that they would try and resolve and then pass to the manager and another stated that they would “sort it with no mention of handing this information to the provider or the manager. Training must be given to staff to ensure that they are aware of the principles of ensuring protection and the role of Social Services in accordance with Department of Health’s “No Secrets”. The manager was unaware when training was being given to staff, but was aware that staff would at some point be attending the Local Authority’s training on protection from abuse and that this forms part of the induction. This will be followed up at the next site visit. The majority of the staff team commenced in post after February 2006 and the Commission for Social Care Inspection has required that a training plan is devised for the home and individual members of staff. The home maintains a record of restraint. It was noted from records and conversations with staff that this has been reduced for the one individual. The home must review the policy on restraint to ensure it is based on current good practice. Guidance was given to the home in November 2005. The manager stated the provider is in the process of seeking clarification from the training provider. The home has a policy on restraint dated May 2006 however, this focuses on falls and bed rails and is not relevant in full to the service provided at the Gables. Staff receive training on supporting individuals that challenge, however, there was a lack of certificates and staff files to fully assess when or if this was completed. The staff training overall review form was incomplete and gave the impression that no staff member had attended. However, two staff stated that they had completed the course. It is a shame that the records did not fully reflect the training that is available. One of the residents has been referred and reassessed by the placing authority as part of a protection referral in response to a requirement from the last inspection; the placing authority in respect of this individual is seeking a new placement. Confirmed at the time of the inspection by the manager and a letter from social services. Finances were not explored on this occasion. The home is in the process of being audited by South Gloucestershire Social Services as part of an ongoing protection strategy for the three homes. However, it would have been difficult to audit individual finances as these are held at the main office for the organisation and the manager has available to them only a petty cash budget. The home should review this system to ensure that the residents have readily available to them their finances. The manager was not aware of the savings each individual has. This could make it difficult for many reasons when supporting individuals with larger purchases and budgeting skills. Care plans included information on who was the appointee. The provider is the appointee for all the residents and has day-to-day control over the individuals’ The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 20 finances. There was evidence that families and residents had been consulted in providing additional expenditure for the snoozelen. It was not clear from this how much individual residents contributed or what would happen if a resident moved from the home and how they would be reimbursed. One resident had refused to contribute. This could not be followed up as the financial records were held at Bedrock. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents would benefit from more attention paid to making the Gables a more homely place to live. Residents would be assured of their safety if the tumble dryer were maintained regularly. EVIDENCE: The Gables is a detached property in keeping with the local neighbourhood. There are shops and local amenities within walking distance. The home is situated within close proximity of the Avon Ring Road. There are bus routes approximately 300 yards from the home. The home is within easy reach of Bristol Parkway. Accommodation is on two floors. Since the last inspection some works have been undertaken on the property including the completion of the new laundry facilities and the redecoration of the two ground floor lounges. The environment was viewed throughout. The residents have a single bedroom. These were different in shape and size and decorated to reflect the different tastes of the individual. However, as was applicable at the last two The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 22 inspections a number of wardrobe doors were locked and not all rooms contained furniture as per the standard. There was no documentation to support the decision process or the infringement of individuals’ rights. The manager stated that she was in the process of reviewing the locking of some of the wardrobes and has asked staff (evidenced in meeting minutes) to not lock bedroom doors. This remains an outstanding requirement. Access to the home is via an intercom system from the gate. Both the gate and the front door are key coded. There is documentation supporting this and consultation with the fire brigade has confirmed that they are happy with the arrangements relating to fire safety. This should be kept under review as new residents move to the home. In response to a requirement from the last inspection, the sign relating to the use of the toilet prior to going out has been removed, as this did not respect resident’s dignity. Residents have access to a lounge and dining room to the front of the house leading to a small conservatory and a second smaller lounge. Consideration is being taken by the manager to make these more homely. This will be followed up at the next inspection. In addition consideration should be taken to making the hallway more welcoming. Presently this contains a metal cabinet, piles of shoes and coats. In addition residents have access to out buildings one housing the laundry and the other a snoozelen room. The home has adequate bathrooms to meet the needs of the residents. These were clean and contained soap, hand towels and toilet rolls. Areas of the home were found to be clean and free from odour except for the one bedroom on the ground floor. This was rectified on the day of the inspection. There were a number of light bulbs not working in the home. In addition one of the sofas in the smaller lounge was torn and worn. The manager stated that the provider was addressing these. There was no documentation to support this. It is recommended that the home maintain a record of repairs with dates of when these are reported and responded to. There was no record of water temperatures ensuring that residents’ safety is not compromised. The manager stated that the water is regulated to 43°c. The manager stated she completes daily checks on the premises however there was no record confirming this. The home has access to a team of maintenance staff who support the home. The laundry facilities were inspected on this occasion. Staff stated that it was adequate for the needs of the home. However, a serious concern was raised The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 23 that the filters contained a lot of fabric fluff, and could pose a fire risk. The manager dealt with this immediately. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. There has been an improvement in the support and guidance given to staff with the recruitment of a new manager. However, there are serious concerns remaining about support to residents at night and with the competence and training of staff. EVIDENCE: The rota was viewed for the home. This demonstrated that the home is staffed with a minimum of two staff with additional staff working Monday to Friday to provide day activities. The manager stated that the home has reviewed the night cover to ensure that waking staff cover is provided and staff no longer go to sleep. The manager stated that the bed that staff used is due to be disposed of. This was a requirement from the last two inspections. A member of staff confirmed this. However, it was noted that staff work the shift prior and after the night and the staff rota stated that this was a sleep in role. The manager stated that the provider has told staff they can “cat nap” during the night. The home has a contract with social services for one individual to provide night waking staff. The home is in breach of their contract and is not meeting the assessed care needs of the individual living in the home. This remains an outstanding requirement. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 25 Staff were positive about their roles and the commitment of the new manager. All staff consulted with during the site visit stated that the manager was supportive. It was pleasing to see that two staff meetings had taken place since the manager took up post in February 2006. The manager stated that she plans to arrange staff meetings every 6-8 weeks. In addition she is planning supervision for all staff, however, this has not been undertaken as yet. This will be followed up at the next site visit. Four care staff records were viewed. All staff had a completed POVA first check and or a Criminal Record Bureau check. However, one member of staff did not have two references as per the National Minimum Standards and has been in post since February 2006. Training is provided in house, and by external providers including South Gloucestershire Council. Evidence was provided that staff are inducted in line with the “Skills for Care Standards” and progress to complete an NVQ in care at the appropriate level. The manager stated that two staff have an NVQ 2 in care and a further three staff are either in the process of completing or enrolling. The team are all relatively new, evidence was not consistently found for all staff regarding their training. It was noted that there was no formal confirmation that staff had obtained a certificate in food hygiene. However, the manager stated that they had a valid certificate but this was not available for inspection. A member of staff stated that the provider covers this during their induction, which includes completion of a questionnaire. There was no evidence that this was updated periodically. In addition only 3 out of the 9 staff have a first aid certificate. The home’s overall plan of training was not complete from this information it looked as if no member of staff had completed training in protection from abuse, mental health or supporting individuals that challenge. Whilst staff stated there was training for supporting individuals that challenge not all certificates were available and the review record had not been completed for any of the staff. One member of staff stated that they had worked in the home since February 2006 and had completed this in May 2006. Not all staff had a file containing certificates or evidence that they had completed their induction. It is recommended that a review takes place of the recording of staff training and the home must develop a training matrix for the home and each individual member of staff. It’s a shame that the home has available to them a vast array of training and this is not fully recorded to provide evidence. Recruitment records were viewed for four members of staff. It was pleasing to see that all staff had a POVA first check and three out of the four had a CRB. The home and applied for this and was waiting for the results. However this person did not have a second reference as required by the Care Homes Regulations. It was evident that the home had made a second request. This The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 26 member of staff has been working in the home since February 2006. This did not demonstrate a robust recruitment process and the home could have considered requesting another reference from another source of made telephone contact to see if there was an issue. There was no evidence that this had been completed. The home must ensure that all documentation is in place prior to a member of staff commencing in post. Staff spoken with during this inspection were positive about their roles in the home and the care provided to the individuals living at the Gables. The manager stated that the team are all relatively new and still settling in. However, it was clear that the team evidently were feeling supported and valued. The manager stated that individual members of the team are being delegated specific responsibilities and these were being reviewed and discussed at team meetings. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40, 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents and staff now benefit from having a registered manager. Residents can be confident that their views are sought on an annual basis. However, this would be enhanced if regular meetings were set up for residents. Resident’s health and safety is not being protected in relation to the competence of staff. EVIDENCE: The home now has a registered manager. Ms Lake has been in post since February 2006 and was registered with the Commission for Social Care Inspection in May 2006. Staff spoke positively about the new manager and her ‘open door’ approach and support she gives to them as a team and individually. The home has a quality assurance tool, which seeks the views of the residents, their relatives and other professionals. This is completed annually. In addition The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 28 the manager has completed an audit on some of the systems in the home. There is no business plan for the home to address the issues or move the home forward. The home has however devised an improvement plan as required of them by the Commission for Social Care Inspection. This identified key areas for the home to improve practices to ensure compliance to the Care Homes Regulations. This included the registration of a manager, a review of the staffing (nights), review and develop medication systems, improving how the home manages challenging behaviour, ensuring care plans are in place and reviewed, ensure that protection procedures are in place, ensure residents privacy and dignity is respected, to ensure day care takes place, ensure premises are safe and clean, and reporting of incidents that effect the wellbeing of the residents are reported to the Commission for Social Care Inspection. Some of these remain outstanding as detailed in this report and a further improvement plan will be completed with the provider to address the shortfalls from the last inspection in February 2006 and this site visit. Health and Safety policies had been reviewed and newly implemented since the last inspection. These were not viewed on this occasion. As already discussed the policy relating to the admission process and abuse needs to be reviewed to ensure it reflects the services provided and guidance from the Department of Health in relation to protection of vulnerable adults. However, it was pleasing to see that the home has policies covering a range of areas relating to care of the residents, staff management and health and safety. These had been reviewed in May 2006. Not all the policies were read on this occasion. The focus of the health and safety on this visit was fire – the home completes checks on the fire equipment in the home, the home had missed two out of the last four months, however, this had been completed in June 2006. This will be monitored at future site visits. It was evident that the manager was ensuring staff take part in a drill every six months. Fire training was apparent for 6 of the nine staff however, this had not been transferred to the fire training record. The last fire training recorded in the fire record was dated May 2005. This did not provide sufficient evidence that staff were attending training every three months for night staff and six monthly for day staff. Concerns have been raised about the periodic training of staff in issues relating to health and safety including food hygiene, health and safety and fire. Whilst this is covered in induction with the provider there was no evidence that this is updated at regular intervals. However, it was difficult to determine as many of The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 29 the staff records seen at the Gables were for recently employed staff. No training plan was in place for this information to be determined. Evidence was provided that the home is sending in reports of incidents that are affecting the well being of the residents in response to a requirement from the last two inspections. After reviewing the records in the office it was noted that the home was not sending in monthly provider reports. A letter was written to the provider in May 2006. It was evident that this was being addressed and one report has been received. The manager stated that the provider had visited the home, however it was noted that the manager had completed the report. It must be stressed that this is a provider audit. This shall be continually monitored. The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 2 3 2 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 3 28 2 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 2 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 x 2 2 x 2 x The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 31 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 Sch 1 Requirement The registered person is required to amend and update the Statement of Purpose to include all the details listed in the Schedule 1 of the Care Homes Regulations. A copy to be sent to the Commission for Social Care Inspection. (Outstanding 28.4.04, 14/11/05) Timescale for action 14/07/06 2. YA6 12 (2) 14,15 The registered person must 14/08/06 ensure that all service users’ plans are appropriately reviewed. Reviews should be thorough and detail any progress made, or goals achieved by the person, changes in the person’s needs their circumstances and in their lives. Reviews should demonstrate aspects and issues in the plans discussed with the service user at review, who contributed to the review, the outcome of the review DS0000003366.V291577.R02.S.doc Version 5.1 Page 32 The Gables and amendments such as changes needed to support and services provided. (Outstanding since 28/7/04) 3 YA33 18(1)(a) The home must review the 14/07/06 staffing to ensure that they can meet the assessed care needs of the residents (social, communication, emotional, personal, health and psychological) ensuring the safety of all the residents collectively and individually. (Outstanding since 14/11/05) Ensure that residents have access to health care as per the plan of care including dental treatment. Consult residents and review the locking of resident’s bedrooms and the locking of the wardrobes. (Outstanding since 16/03/06) Residents must be provided with furniture as per the minimum standard unless a risk assessment demonstrates otherwise, which is kept under review. (Outstanding 11/05, 2/06) All risks must be clearly documented including social activities, use of minibus, accessing community, or any restriction imposed by the home for all residents detailing strategies for staff to follow to minimise the risks whilst encouraging independence of the 14/07/06 4 YA19 13 (1) (b) 5 YA24 12 (2) (3) (4) 14/07/06 6. YA26 16 (2) (c) 14/08/06 7. YA9 13 (4) (a) (b) (c) 14/07/06 The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 33 individual. (Outstanding since 12/05, 02/06) 8. YA42 23(4)(d) All staff must attend fire training every 3 months for night staff and six monthly for day staff. (Outstanding since 17/11/05) For staff to only commence in post once two references have been received. (Outstanding since 17/10/05) For the home to develop training plans for all staff to include mental health, epilepsy, ongoing health and safety training for the individual staff member and the home collectively. Training to be delivered by a competent person. A copy to be sent to the CSCI. (Outstanding since 17/10/05) Staff to have training on the Protection of Vulnerable Adults from an external provider. A plan to be sent to the CSCI within one month on how this is being addressed. The provider must review the policy on abuse to ensure that it complies with the Department of Health’s guidance on “No Secrets” The home must review the policy on restraint to DS0000003366.V291577.R02.S.doc 14/08/06 9. YA34 17(2) Sch 4.6 16/06/06 10. YA35 18 (1) (c) 14/07/06 11. YA23 13(6), 18(1)(c) 16/09/06 12. YA23 13 (6) 16/07/06 13. YA23 13(6) 14/07/08 The Gables Version 5.1 Page 34 ensure compliance to current guidelines. Outstanding since 14/11/05 – A copy to be sent to the CSCI. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA7 Good Practice Recommendations The manager should consider meaningful ways to enable the residents to extend their influence in the running of the home including regular meetings. Date and sign risk assessments and care documentation Medication return book to include two staff signatures, the name of the resident, the medication, the dose and the amount to be returned. Review admission policy to ensure relevant to the home as focus on care of individual with mental health The manager should consider ways to enable residents to have more control over their personal finances within the management of risk and that information and individual’s finances are held in the home. For the home to maintain a record of repairs. Explore ways of making home more homely within a risk assessment framework. 2. 3. 4. 5. YA6 YA20 YA2 YA23 6. 7. YA24 YA24 The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 35 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Gables DS0000003366.V291577.R02.S.doc Version 5.1 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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