Inspection on 16/02/06 for Bedrock Court

This inspection was carried out on 16th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 16 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 14/06/06

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 Melanie Edwards Unannounced Inspection 16th February 2006 09:45 The Gables DS0000003366.V283627.R01.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.V283627.R01.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.V283627.R01.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.V283627.R01.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. 11th October 2005 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 two people with mental health needs. Presently the Home does not have a manager who is registered with the Commission for Social Care Inspection. The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The purpose of the visit was to monitor the progress to the requirements from the last inspection in October 2005 and review care provided to residents. Due to the number of requirements made at the last inspection, and the number of concerns from this inspection the inspector was not able to review all requirements from the last inspection. Priority was given to reviewing requirements that directly impact on resident’s safety. The inspector met four residents and also spent time sitting in the lounge observing residents and staff. All of the staff on duty were consulted. The staff were asked about their roles and responsibilities, training needs, and how they support residents and carry out their duties. A range of records relating to the day-to-day running and management of the home were inspected. A selection of resident’s care records was also reviewed. In addition, the Commission for Social Care Inspection received an anonymous complaint and this was partly investigated during the inspection process. The following requirements from the last inspection in October 2005 were not followed up on this inspection, but will be focused on at further inspections of the services, 1. The registered person is required to amend and update the Statement of Purpose to include all the details listed in Schedule 1 of the Care Homes Regulations. A copy to be sent to the Commission for Social Care Inspection. 2. The registered person is required to develop and implement a quality assurance system to measure, audit and improve the quality of the services, care and support provided to the Home. (Outstanding since 1/6/05) 3. The Home must review the policy on restraint to ensure compliance with current guidelines. 4. A regulation 37 notification to be sent to the Commission for Social Care Inspection of all incidents where restraint is used or where service users are hurt. 5. Review the use of the key code on the front door taking advice from the fire officer. Consideration to be taken to install an automatic door opener The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 6 in the event of a fire. A risk assessment must be in place demonstrating the decision process of the locking of the front door. 6. Install a doorbell to the front door unless a risk assessment demonstrates otherwise. 7. The Home must keep the fire risk assessment under review. 8. The Home must ensure that the fire checks are completed in accordance with the fire officer’s advice. 9. All staff to attend a fire drill every six months. 10. For staff to only commence in post once a POVA/criminal record check has been undertaken. For staff that do not have a CRB check, this is to be requested within seven days and evidence provided that this has been done. 11. For staff to only commence in post once two references have been received. 12. For the Home to develop a training plan for all staff to include mental health, epilepsy, ongoing health and safety training. Training to be delivered by a competent person. A copy to be sent to the CSCI. 13. All risks must be clearly documented including COSSH, 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 individual. 14. For the lounge area of the Home to be decorated. Due to the failure of the Home to demonstrate that the many requirements from the last inspection in October 2005 have been met, much of the last report has been reprinted in this report. What the service does well: What has improved since the last inspection? A new manager has been recruited and has very recently commenced working at the Home. The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 7 New laundry facilities have been developed in one of the outbuildings. A hairdresser continues to visit the Home to attend to resident’s hair. What they could do better: The Home has failed to demonstrate compliance with a significant number of the requirements from the last inspection. The Commission for Social Care Inspection is taking this seriously and is closely monitoring the home and has required the provider to devise an Improvement Plan. From this visit there are a number of requirements that the Home must address to ensure the safety of the residents and the staff. There has not been a registered manager for the last two years. This has had an effect on practices in the Home; on record keeping including full detailed reviewing of care plans and other related documentation. Following the last inspection enforcement action was being considered and statutory notices of compliance were sent to the Home. One of the enforcement notices related to reviewing of care plans. Included in residents care plans on this inspection was the signature of a member of staff and some residents had also signed their care plans. The date this had been recorded was for November 2005.There was no other evidence of a detailed review and update of each residents needs made available at the inspection. Residents would benefit from plans of care which clearly describe how they should be supported, including with challenging behaviours, and the strategies that staff should undertake to best support residents. Residents would benefit from a refurbishment plan for the Home. Also where residents are restricted access in the Home there must be robust documentation based on residents’ consultation supporting the decision process, in the form of a detailed risk assessment. Where residents are at risk there must be safeguards in place to protect them from harm, including activating `protection of vulnerable adults’ procedures. The Home must cease locking the bedroom door of all residents at night. The inspector was informed that this is done to prevent the risk of harm to one resident from another resident going into their room. The Home must effectively manage this situation with actions and strategies that minimise the risk of harm to the residents. The rights and dignity of all residents must not be compromised by the practice of locking them in their room. The Home must be able to demonstrate that they can meet the care needs of the residents individually and collectively. Where one resident is causing harm to others the placement must be reviewed by the placing authority to ensure The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 8 that it continues to meet the care needs of the resident without compromising the care of the other residents living in the Home. To better protect residents’ rights and freedom of movement. The practice of locking bedroom doors during the day and restricting residents’ access, and also locking residents wardrobes must be reviewed, and residents must be fully involved in the review process. Residents would benefit from an urgent review of the staffing levels to ensure that they are meeting their individual and collective care needs. The member of staff who is on duty at night must not be sleeping while on duty because this is clearly unsafe and does not protect residents. The Commission for Social Care Inspection will monitor the staffing levels and practices at night as part of further visits to the Home. Cease the practise of providing ‘day care’ to residents in Homes across the company unless residents who live in the Homes give informed consent. Also there must be measurable evidence that residents attending day care in this way benefit. Residents must be safeguarded by the safe administration and recording of their prescribed medication and having competent staff involved in this process. Residents’ dignity would be better maintained if the sign in the entrance hall telling residents to `use the toilet and get back on the bus’ were removed. 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.V283627.R01.S.doc Version 5.1 Page 9 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.V283627.R01.S.doc Version 5.1 Page 10 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): 2,3 Residents assessed and changing care needs are not being met. EVIDENCE: To find out how residents’ needs are currently being assessed three residents assessment records were inspected. There was some information in place about resident’s physical, social and psychological needs. However assessment records did not give sufficient or accurate information on how residents’ care needs are met, including supporting residents with challenging behaviours. There were no up to date records available on the restraint used, even though from speaking with staff and from other evidence this is a regular occurrence for one or two of the residents. As was required at the last inspection, the Home must document each occasion when residents are restrained, as detailed in the Department of Health’s guidance on restraint. The plans of care should include what method of restraint is to be used and in what circumstances and agreed within the boundaries of a multi-agency approach. There were concerns raised at this and the last inspection that some methods of supporting residents with challenging behaviour were no longer based on current good practice. These included the use of sanctions and timeout. There was no accurate, up to date documentation to support the decision process or agreements involving a multi-agency approach or a record of when this was undertaken. At a previous inspection it had been noted that a social worker The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 11 had stated in an assessment that seclusion could be used. The Home does not have the facilities to offer this method of dealing with residents’ behaviours. Also this must only be used if agreed within a multi-agency approach, as this is not based on good practice. The placing authority must review the needs of this resident to ensure the Home is suitable. In discussion with the inspector all the staff on duty conveyed a willingness to want to support and care for residents to the best of their ability. However staff were not aware of the content of care plans and did not fully understand them. The inspector when reading the care plans also found them hard to understand and difficult to follow. The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 12 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): 6,7,9 Residents’ plans of care fail to reflect assessed and changing needs. Residents are not being fully involved in the planning of their care. Residents are not safeguarded within a risk assessment framework and approach. EVIDENCE: Three residents care plans were reviewed. As was applicable at the last inspection 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 that staff are to follow. As already mentioned, there is a lack of accurate objective, and easy to follow information to support residents with their needs. As was also applicable at the last inspection residents’ care plans were similar in content for all three people and lacked any real person-centred approach pertinent to the individual. Reviews should provide evidence of what was discussed detailing any amendments to the plan, which contributed to the review including the perspective of the resident, and the outcome. This was lacking for all care plans seen. From talking with staff the provider had completed the reviews and The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 13 had removed the care documentation to enable this to happen leaving no guidance for staff to follow. From conversations with staff it is clear that residents are restrained by staff in response to challenging behaviour, on a regular basis. However there were no individual records available during the inspection that detailed when this was used, how it was used, for how long, and the outcome of its use, and the wellbeing of the resident after the occurrence. 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 evaluated and updated at least six monthly. This has been outstanding and commented upon following inspections in July 2004, December 2004, March 2005 and October 2005. There were now signatures recorded on care plans dated November 2005 and one resident had signed their care plan. Following the last Inspection an enforcement notice was issued for these to be completed within a short timescale. At an additional visit to the home the Inspector was satisfied that compliance had been achieved however at this inspection the care plans seen did not meet the standard expected. The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 14 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): 11,13,17 Residents are supported to continue to be a part of the community however there is little evidence of choice around in house activities and day care that is being provided. Residents are offered a healthy and well balanced diet. EVIDENCE: There was evidence from discussions with staff and with one resident to demonstrate that opportunities are provided for residents to maintain and develop practical and personal skills both in and out of the Home. 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. A small group of residents were observed being driven to various day care activities. However there is no evidence of choice documented in care records for residents for example, if they do not wish to attend a day care activity. Also safety is not being fully risk assessed when residents engage in activities. An example of this involved one resident who had been swimming earlier in The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 15 the week. It was reported the resident had hit a member of the public. On the day of the inspection the resident concerned was going swimming again. The suitably of repeating this activity should have been risk assessed, in the absence of a registered manager by a senior member of staff, or the registered provider who knows the resident well. However, no such a risk assessment took place. Five of the residents receive day care through the organisation and one person attends a day centre independent of the Home. Two residents from another Home were at the Gables on the day of the inspection. The inspector was advised that the two residents were there for a day care session called `hair and beauty’. There was no evidence to demonstrate that the two residents had chosen to take part in this activity or to want to leave their Home for the day. The practice of providing day care by running activities for residents in Homes across the company must be reviewed and ceased unless there is demonstrable evidence that residents choose to do this and they gain some sort of benefit from it. There must also be clear evidence that the residents who live in the Gables are actively choosing for other residents to come to their Home for such activities. This was also a requirement made following the inspection of the Home in May 2005. Residents menu planning was discussed with the staff on duty. The menu being followed for the week of the inspection demonstrated that residents were offered a nutritious diet. However residents are not offered choices of dishes. There is a record of resident’s likes and dislikes on the kitchen wall. However one resident, for who it was written did not like salad, was offered pate and salad sandwiches for lunch. A weekly shop for bulk purchases is carried out and this is in addition to daily shopping for smaller items for example vegetables, bread or milk. The Home was awarded a Food Safety Award from the environmental health officer in August 2005. However on the day of this, and the last inspection, Food was not being dated in the fridge. The Gables DS0000003366.V283627.R01.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): 18,20 Residents’ personal and health care needs are not being fully met. Residents are not safeguarded by the Home’s practices for administration storage and disposal of medication. EVIDENCE: Care plans that were in place included what was termed a `personal care statement’ relating to bathing. There was no record of personal care given to ascertain the frequency of how often residents were being assisted or supported. Of the three care plans seen all were similar in their content. As was applicable at the last inspection, the inspector was concerned that all encouraged the use of a cup of salt in the bath to assist with cleanliness. It is advised that this practice be reviewed and a more personalised approach be adopted. Residents’ care plans included some information about visits to the specialists and health care professionals. However, these lacked sufficient information in some cases to determine the outcome, for example a routine eye test, but no outcome was reported. The bathrooms are lockable and can be overridden in the event of an emergency. The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 17 The consultant psychiatrist is reviewing Residents’ health needs. However there was no evidence that the reviews include any depth of discussion on matters relating to the residents’ behaviour. As was also applicable at the last inspection, there were a number of serious concerns relating to medication practices. There was a lack of staff signatures on a number of administration charts to demonstrate if medication has been given. Also medication charts included inaccurate dosages for medication and did not include all prescribed medications, and instructions were not written in full. An immediate requirement was issued to the Home to respond within 24 hours. Evidence at this inspection was that only two staff had completed a learning pack on medication. Staff stated that the manager had showed them but no formal training had been offered. The Commission for Social Care Inspection is reviewing the enforcement process in respect of medication practices in the Home. At the last inspection a requirement had been made concerning residents not being administered their medication covertly in food. It was required that this practice must be reviewed with the GP and the pharmacist and clearly documented in the plan of care, evidencing a multi-agency approach to the decision process. Based on evidence from this inspection this requirement has not been fully met. There was some information written that refers to the resident concerned preferring their medication to be taken in this way. This is not sufficient to demonstrate that a full multi disciplinary review that is regularly monitored has been undertaken of this practice. The Gables DS0000003366.V283627.R01.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): 23 Residents are not protected from the risk of harm or abuse by the procedures and practices in the Home. EVIDENCE: At the inspection it had been required that the Home must improve the records to detail all incidents of challenging behaviour; strategies used to support the individual and the outcome. It had also been required that forms of restraint or restrictions must be documented in the daily care plan and agreed within a multi-agency approach. It had been further required that where a resident is causing harm to another resident the Home must instigate the protection of vulnerable adults procedure. Based on the evidence from this inspection there was no evidence that demonstrated these actions have been addressed. This is a matter of serious concern and places residents at risk. There is little evidence that residents are actively involved in the running of the Home. There are no resident meetings and documentation was not accessible in the form of policies and procedures. Residents were observed lounging and sleeping in the lounges. There were risk assessments in place but these did not clearly state how best to maintain the safety of the residents during the wide range of activities that residents may take part in. The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 19 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 The Home environment does not meet residents’ needs. Residents would benefit from routine cleaning being completed on a regular basis. EVIDENCE: The Gables is a detached six-bedroom 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. There are local shops and the home is within easy reach of Bristol Parkway railway station. Accommodation is on two floors. Since the last inspection residents’ benefit from new laundry facilities, which have been developed in one of the outbuildings. The environment was viewed throughout. Resident’s bedrooms were different in shape and size and decorated to reflect the different tastes of the individual. However as was applicable at the last inspection there were concerns raised that a significant number of wardrobes and bedroom doors were locked and residents did not possess a key to open them and some had minimal furniture which did not meet the National Minimum Standards. The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 20 There was no documentation supporting the decision process in the form of a risk assessment for these infringements of their rights. This practice must be reviewed within a risk assessment framework. New flooring has been installed however consideration should be taken to make these more homely and comfortable. The latter being part of a risk assessment framework, as acknowledging the different personalities and the levels of challenging behaviour. On a wall of the entrance hall by the front door there is a sign that includes a picture of a toilet telling residents to `use the toilet before they get on the bus’. This sign does not respect residents’ dignity and as such it should be removed. Access to the building is via the front door. There is no doorbell compromising the privacy of the residents. In addition, to leave the building staff had to use a key code. There was no documentation supporting the locking of the front door. Shared space consists of a lounge and dining room to the front of the house leading to a small conservatory and a second smaller lounge. These require redecoration and consideration to making them more homely for the occupants. The outbuildings have now been reviewed in respect of their use and one has been changed from a storage area to house the laundry and another was being demolished and the third is a snoozelen room for the use of the residents. Bathroom areas were clean and contained soap, hand towels and toilet rolls. However, bedrooms and communal areas were dusty and required cleaning. The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 21 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): 31,33,36 Staff, whilst dedicated to their roles as carers, lack knowledge and insight into behaviours that challenge and the care needs of the residents. The Home has failed to demonstrate that staff are supported in their roles. EVIDENCE: The Home must be staffed to meet the assessed care needs of the residents. Staff on duty stated that there was always three staff working in the home during the day and from 5pm there were two, with one member of staff providing a waking night cover. However staff also said that they sleep-in at night and the registered provider had told them this was acceptable. This is unsafe and the staffing levels during the night must be reviewed and adjusted as an urgent priority. This was also a requirement from the last inspection. During the day staff stated that some of the residents are out at day care. However, on the day of the inspection four people were meant to be engaged in day care and were seen in the lounges. Two residents were from another Home to attend the `health and beauty group’ already referred to. Due to the absence of the person in charge the inspector had no access to supervision records. Staff were positive about caring for residents and all staff were helpful during the inspection process. The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 22 As was also discussed at the last inspection staff reported that one resident `smears’ faeces on a regular basis and this person was encouraged to go to their room to complete the act. There was no evidence to demonstrate staff had a clear understanding of the resident or the reasons why this took place. The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 23 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): 40 41,42 Resident’s health and safety is not being protected and generally the Home’s record keeping and policies and procedures fail to safeguard residents. EVIDENCE: As was also applicable at the last inspection, regulation 37 notices were discussed with the staff on duty. It was evident that the Home continues to fail to inform the Commission for Social Care Inspection of incidents that affect the well-being of the individuals living at The Gables. It was evident from information and evidence gained throughout the Inspection that the Home lacks clear direction on the management of aggression and that staff felt it difficult to deal with one of the residents. Staff confirmed that they have been locking the bedroom door of one resident at night to protect them from risk of harm from another resident. This must cease with immediate effect. An immediate requirement notice was left for the register provider. The Home must be run in such a way that protects all residents and does not compromise their basic human rights. As already referred to while viewing the Home it was also observed that the majority of The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 24 residents rooms and wardrobe doors are locked and they do not have access to them. This must also be reviewed and actions taken to ensure that residents can access their rooms and their clothing if they so wish. The Home is registered to provide personal care and if resident’s needs cannot be met any other way then through such restrictive practise their placement at the Home must be reviewed. The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 25 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 X 2 2 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 3 28 2 29 X 30 2 STAFFING Standard No Score 31 1 32 X 33 2 34 X 35 X 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 2 X LIFESTYLES Standard No Score 11 2 12 X 13 3 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 x 1 X X X X 1 1 1 X The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 26 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. 2. Standard YA42 YA6 Regulation 13. (6) 15 (1) Requirement Cease locking residents inside their bedrooms. Care plans to be available for inspection that clearly describe levels of challenging behaviour and individual responses for staff to follow, which have been agreed within a multiagency approach for each resident. Where a resident is causing harm to others a protection of vulnerable adults referral must be made (with immediate affect) and a reassessment of their needs, by the placing authority, to ensure the home is appropriate. Staffing levels and skills mix must be reviewed and adjusted to ensure residents care needs are met and that they are safe. Residents must be provided with furniture as per the minimum standard unless risk assessments demonstrate otherwise and DS0000003366.V283627.R01.S.doc Timescale for action 16/02/06 16/05/06 3. YA3 13(6) 16/02/06 4. YA33 18. (1)(a) 16/03/06 5. YA24 23(1) 16/03/06 The Gables Version 5.1 Page 27 6. YA24 12. (4)(a) 7. YA42 23.4(b) 8. 9. YA20 YA41 13.2 37 10. YA20 13. (2) 11. YA20 13. (2) 12. YA20 12. (3) 13. YA24 12.(1),(2),(3),(4) 14. YA33 12.(2),(3),(4) these must be kept under review. Remove the sign by the door telling residents to use the toilet before they get on the bus. The Home must ensure that all doors are adequate to withstand fire, offering the individuals living in the home protection. All prescribed medication to be documented on the medication record. A regulation 37 notice to be sent to the Commission when appropriate for all residents. Ensure that staff administering medication sign the record of administration. Medication must not be given covertly or crushed or changed from its original form unless there is clear documentation supporting this and only within a multi-agency agreement. This must be kept under review. Medication records to include clear information on when it should be given, the amount and frequency. Consult residents and review the locking of resident’s rooms, and the locking of their wardrobes doors. Cease providing ‘day care’ to residents in Homes across the company unless residents who live in the Homes give informed consent. Also there must be measurable evidence that 16/03/06 16/03/06 16/02/06 16/02/06 16/02/06 16/02/06 16/02/06 16/03/06 16/04/06 The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 28 15 YA6 15 residents attending day care in this way benefit. The registered person must 16/04/06 ensure that all actions to meet the service users’ needs and their outcomes are fully recorded. (Outstanding 2.12.04) All restraint used in the Home must be recorded in the plan of care agreed within a multi-agency approach and recorded as per the Department of Health’s guidelines. 16/04/06 16 YA23 13.(7),(8) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Gables DS0000003366.V283627.R01.S.doc Version 5.1 Page 29 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. 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