Inspection on 07/11/06 for Bedrock Court

This inspection was carried out on 7th November 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 14/06/06

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 7 and 8thNovember 2006 09:45 th The Gables DS0000003366.V319456.R01.S.doc Version 5.2 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.V319456.R01.S.doc Version 5.2 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.V319456.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address 3 New Road Stoke Gifford South Glos BS34 8QW 0117 9798746 01454 772171 angelinegay@gmail.com 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 Miss Angela Joy Lake 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.V319456.R01.S.doc Version 5.2 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 65 years or over. 14th June 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.V319456.R01.S.doc Version 5.2 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 on addressing the requirements and recommendations from the previous site visit in June 2006 and to 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. Two members of staff were spoken with during the inspection, in addition to the registered manager and a senior member of staff from one of the other homes within Nightingale Homes. 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 monthly provider report in respect of regulation 26. Questionnaires were not sent routinely as part of this site visit as these were completed in June 2006, which included consultation with relatives, residents and professionals. 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 8 hours on two separate site visits. What the service does well: What has improved since the last inspection? Residents now benefit from clear information about the home prior to admission. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 6 Residents now benefit from an admissions policy that reflects the home’s certificate of registration. Residents now benefit from parts of their plans of care being reviewed at frequent intervals; however there are still significant gaps in the recording of areas of needs and that care plans are being followed by staff. There has been some improvement in the documentation of restrictions imposed on residents by the locking of the front door, bedroom and wardrobe doors. However, where a risk assessment is not in place confirming the use of the locking of these areas for example wardrobe doors and bedroom doors the locking device must be removed. These must be kept under review to ensure this level of action is appropriate. Residents have now benefited from seeing a dentist. Residents now benefit from robust procedures in protection from abuse and a training plan has been developed to ensure staff attend training and how to respond to an allegation. Residents now benefit from waking night staff, which is in accordance with one individual’s plan of care and assessment drawn up by social services. Staff are now receiving regular fire training and the majority of the team now have a certificate in first aid. What they could do better: Whilst there has been some improvement in the plans of care, these still lack detail for staff to follow and for an effective review to take place. Residents must be offered opportunities to participate in meaningful occupation and leisure activities in the evening and weekends. This social need was clearly identified in the care plan for one individual with no evidence that this was being implemented. Residents should be encouraged to participate in the running of the home including resident meetings, assistance with meal preparation within a risk assessment process and offered more meaningful choice on activities, menu planning and holidays. There has been an outstanding requirement for staff to attend training in protection procedures in the event of abuse. Whilst training dates have been identified by the home this was not within the timescale. So therefore this remains a requirement to ensure compliance and timescales have been extended till February 2007. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 7 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. An immediate requirement was left with the home to address cleanliness in the home. Some progress was made with this over the two-day inspection period. Where there is a locking device on wardrobe doors and bedrooms doors in the form of a star key lock and no documentation in place to support the presence of this device, then this must be removed to ensure that residents have access to their personal space and possessions. A serious concern was raised during the inspection about the use of the chain and padlock to the front gate. This must be removed; in addition the side gate must be made secure if this is required to ensure the safety of the residents. This must be undertaken on the advice of the fire brigade to ensure that safety is not compromised. Residents must benefit from robust quality assurance audits being completed to ensure that the home is meeting National Minimum Standards ensuring that quality outcomes are in place for the residents. Residents should be assured that clear records are maintained demonstrating that staff are competent in the administration of medication. In addition residents would benefit if medication were dated when opened to enable a stock check to be completed ensuring the safety of residents is not being compromised. Where requirements remain outstanding following the next inspection, notices will be drawn up and served. 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 summary of this inspection report can be made available in other formats on request. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 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.V319456.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been some improvement in this area and residents now have information available to them about the service provided at the Gables. There is an admission procedure in place to guide staff and prospective residents. There are still improvements required in relation to the planning of the care and the documentation to meet the National Minimum Standards. EVIDENCE: This standard has been assessed on previous site visits and a number of requirements were made to ensure that the home is working within the National Minimum Standards. These requirements were followed up during this inspection and there has been an improvement. However, this will need to be followed up at future site visits in relation to the filling of the resident vacancies to make a full judgement on how the service is applying the improvements. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 10 The home now has a statement of purpose and a service user guide. This describes the service provided and includes information as detailed in the Care Home’s Regulations and National Minimum Standards. The home has a policy on admissions which describes how this must be completed and now has more meaning to the residents the home intends to support. This has been amended in response to a recommendation from the last site visit. The home has two vacancies and progress was discussed in relation to the filling of the vacancies. It was evident that the manager was aware of the criteria of registration and whom the home can admit and offer support and those that fall outside the category of registration. The manager stated that two prospective residents social service’s plans of care have been sent to the home and neither fitted the category of learning disabilities. The home has an established group of residents, the home must ensure that the home could meet the needs of any new resident ensuring this does not compromise the care of the residents already placed and that the staff have the necessary skills to the support the new individual. In addition prospective residents need to be made aware of the restrictions that are imposed on them for example the locking of the front door and the kitchen. From previous site visits it was evident that the home offers residents a trial period of three months to ensure that all parties are happy and that the home is suitable to meet the care needs of the individual. It was evident from discussions with the manager that they would obtain as much information about the prospective resident including speaking with professionals, the individual and or their relatives where appropriate which would inform the assessment process. All residents have recently been reassessed by Social Services to ensure the home continues to be suitable. The manager stated that this has been completed and three out of the four have received an amended and updated assessment and care plan from Social Services. The inspector had an opportunity to read two of the plans sent from social services and it was noted that in one individuals plan as drawn up by the home there were some inconsistencies. This will be discussed later on in this report. Again it was noted that the home’s care plans were not fully being undertaken. All these standards will continue to be a focus of future inspections in light of the two vacancies. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst there has been some improvement in the review and planning of care, care plans continue to resemble an assessment of need and lack sufficient detail to guide staff on the support needs of the residents in a way, which is person-centred. In addition staff are not following care plans consistently. Risk assessments also lack the necessary detail to promote support or direction in a clear way. EVIDENCE: Three care plans were reviewed in full. Whilst there has been some improvement in reviewing the plans of care there still remains gaps. Care plans continue to resemble an assessment rather than a clear plan of care for staff to follow. In addition from discussions with staff and reading daily records care plans were not being followed consistently. Care plans seen remain similar in The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 12 content and lacked any real person centred approach pertinent to the individual. Examples where plans of care did not include clear information or were not being followed included-: 1) One residents wardrobe to be locked – this was unlocked during the inspection. Staff spoken with were not consistent in their approach to the locking of wardrobe and bedroom doors. Residents must have access to their bedroom and their belonging unless a risk assessment clearly states otherwise and this must be kept under review. Staff stated in the case of one individual that it was locked because the individual pulled out all their clothes; this does not appear an appropriate reason to lock a wardrobe and could suggest that there are insufficient staff to support them. Where locking devices are fitted to wardrobe doors and/or wardrobes and these are not documented in the plan of care then these must be removed. 2) Another resident attends church on a Sunday independent of staff and either the pastor or a member of the congregation provides transport. However, the plan of care and all risk assessments including the placing authority’s plan of care states that the individual must be supported in the community at all times by care staff. There was no risk assessment supporting this activity or that the nominated person in the church responsible for the transport was aware of the risks to the individual and the general public. A senior carer from another home stated that this has been discussed with the church pastor but the registered manager was unaware that this had been undertaken in the past or of documentation in place supporting this decision process. 3) Two plans made reference to training to enable the staff to support the individuals, one relating to communication and the other challenging behaviour. The manager stated that they had not received or delivered such training on communication pertinent to the individual to the staff team. A member of staff stated that they learnt as they went along and from observations from other staff. The other care plan stated that all staff must attend training in challenging behaviour prior to staff supporting them, however three out of the seven staff have only recently attended this training although they have been in post in excess of four months. One staff has worked in the home since February and had not received this training. 4) Another care plan made reference to the staff encouraging an individual to stay up later but there were no guidelines in place to ensure a consistent approach taking into considerations the choice of the individual. In addition the plan states that a healthy sleep pattern is going to bed at 8pm and getting up at 8am. Statements like this do not promote an individual’s choice or demonstrate that this is based on any research. This particular individual has a plan depicting the individual’s routine, which states the individual prefers to get up at 7.30am. This could lead to confusion for staff and does not offer the The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 13 individual any continuity of care as this is left to the interpretation of the staff member. Whilst care plans contained lots of valuable information about an individual the statements tended to be broad and lacked clear directions for staff to follow ensuring a consistent approach thus making the plan difficult to review. For example an individual requires firm boundaries but the plan lacked detail what the firm boundaries should be. Another plan states for the individual to have meaningful activities but fails to state how these are to be organised, the frequency and by whom. Risk assessments were in place and covered a range of activities both in the home and the community. Whilst the assessment acknowledged risks they failed to fully guide staff again making broad statements and lacked in some cases actions that could be taken to reduce or minimise the risk. Staff were asked about the content of the plans of care and how useful they were in supporting the individuals. It was evident that staff were not following the plans of care, one member of staff stated that they had read a couple and there was some useful information but they had learnt a lot from the other staff. This does not blend to the staff being consistent in their approach. Care reviews were discussed with the manager and the staff. The manager stated that residents are involved in the reviews and invited in all cases, participation varies less evident was family involvement. Review records seen showed that the resident, the manager, and the key worker were present at the review meetings. From the review record it was not clear the discussions that took place or whether any amendments had been completed to the plan of care. The home has a review form, which details amendments to the plan but these tended to focus on medical reviews with the doctor, dentist or other health professionals. The manager stated that she has read all the care plans and risk assessments devised by the home but as yet needs to read some of the care plans drawn up by the placing authorities. It was evident that the manager has to have some ownership in the writing of the plans of care and developing a system that works for the residents, the staff and the home including developing an audit system to ensure that plans of care form part of the daily structuring of the home. The manager stated that the provider writes all the care plans, however the manager and the staff team complete reviews. At the last inspection it was noted that the home had a new policy on resident participation, which made reference to a resident committee and regular resident meetings. The manager stated at the last site visit that it was her intention to introduce these whilst it has been discussed at a staff meeting in August 2006 residents have yet to have a resident meeting. The manager is The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 14 exploring options in light that the residents communicate using non-verbal communication. This again will be followed up at the next key inspection. These potential serious shortfalls in the documentation on the home’s plan of care and risk assessments highlight that there is a training need for the individual drawing up the plans. Care plans have been subject to scrutiny over the last four years leading to requirements being repeated and enforcement action being taken at the last inspection. Whilst there has been some improvement there are still serious areas of concern and further enforcement action could be considered if these shortfalls in the home’s plan of care are not addressed. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst there has been some improvement across these group of standards and residents have available to them some meaningful activities, there is little activity offered at weekends and in the evenings. The senior management team is making some fundamental decisions that residents can make about their lifestyles. 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 and relaxation in the multi-sensory room. One resident attends a day centre four days per week. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 16 It was evident that activities were now happening as described in their timetable during the week and during office hours. Residents were seen on both days completing activities with staff including accessing the local shops, swimming and a communication session with staff. One resident was supported in the multi-sensory room, a member of staff stated that the individual likes to spend much of their time in this area. There has been an improvement in the recording of activities in the individual’s daily diary, which further demonstrated that daily activities were now taken place. A member of staff stated that there have been some changes to the plan of activities to reflect choices. Two of the residents were clearly stating that they no longer enjoyed going to dance and music therapy and this has now been changed to a shopping and a café trip. This is good practice. Daily records demonstrated that residents were supported with social activities during the day but there was little evidence that activities were taken place at the weekends and in the evenings. Staff spoken with confirmed this however, stated that they were keen to support individuals but due to lack of staffing and finances this rarely happened. It was clear from one individual’s plan of care that they should be encouraged to participate in activities and social events on the evenings and weekends but lacked direction for staff to follow in relation to with whom and when. Staff stated that they were unaware of the finances for individuals, which made it difficult to plan cinema or bowling trips, activities that some of the residents may enjoy. The home has a minibus, which the residents help to fund by contributing their disabled living allowance to the provider. Documentation was available explaining this to residents. A member of staff stated that whilst residents are supported with their activities, these are planned from Bedrock Lodge and it can be frustrating that when activities are organised that these may have to change to accommodate other residents from the other homes by a single phone call from staff at Bedrock. An example was given where a recent swimming trip had been planned, including the allocation to specific staff working in the Gables when this had to change as some of the residents from the other home were to go with one staff from the Gables and one staff from Bedrock. This suggests activities are service led rather than resident led. Staff spoken with described how they supported residents making choices on a day-to-day basis. It was evident that residents were involved in choosing their clothes, where and when to go out depending on abilities and whether to eat or not. However, all residents could evidently make a choice to refuse activities including personal care and their wishes were respected. A member of staff was very clear that resident’s wishes were respected and in relation to bathing it was evident that the member of staff would offer again later at a time that was more convenient or staff on the next shift would assist. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 17 Family contact was noted in the plans of care. At the last site visit in June 2006 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. One resident has recently been supported to go on holiday close to their relatives to enable them to visit. This is seen as good practice. Residents have an annual holiday this year all the residents had a holiday together, along with two residents from Bedrock. Given the high dependency needs of residents, the inspector was concerned with the decision and planning processes in relation to the compatibility of the group, the mixed abilities of the residents and only being supported by three staff. Whilst staff stated it was a successful holiday it was evident that residents had little choice on the holiday. The menu was viewed. Whilst these demonstrated that residents were offered a varied and healthy diet. The provider drew these up in consultation with a nutritionist. It was difficult to ascertain how residents can be involved in the menu planning although the manager was very clear that if there were anything that a resident did not like an alternative would be provided. A record was maintained confirming that alternatives were offered to the planned menu. A concern was raised that the night staff had prepared the sandwiches for the lunchtime. This does not promote residents having choice or involvement in the making of their lunch. The manager could not give a reason for these being made the night before. As there are only four residents this practice should cease ensuring residents can have choice and some level of involvement. During both days of the site visit two residents from another house were seen relaxing in the lounge. When staff were questioned it was not clear why the individuals were in the home, other than they did not want to go to Bedrock for day care and their home has no staff during the day. This is not acceptable practice: residents should be able to remain in their own home with staff support should they choose and adequate staff must be in place to support this. This has been an ongoing debate with the provider, and documentation is in place confirming that residents of The Gables had been consulted on other residents from the Nightingale Homes accessing The Gables. It would be recommended that the group of homes clarify and document the reasons when it is appropriate for residents to use the other homes as a day facility, this would ensure an open and transparent practice and offer consistency. This must reflect choice for the resident and ensure staffing is appropriate to meet the needs of the individual without compromise to the residents living in the home concerned. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 18 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. 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 this service. There has been some improvement in this area with all residents attending dental appointments. There remains a concern that residents are not seeing the doctor promptly. Whilst personal care needs are being met the documentation lacked a person centred approach or evidence that some information recorded in the plan of care was based on current good practice guidelines. Residents are safeguarded by the homes improved system of administration of medication, however the home should fully demonstrate that staff are competent in this area. EVIDENCE: Personal support is recorded. Morning and evening routines for personal hygiene are detailed, stating how and when the residents need assistance. These were similar in content: however when speaking with staff it was evident that individual preferences were being recognised. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 19 Care plans and risk assessments provided insufficient detail in relation to specific health conditions and how staff were supporting or minimising the risk. An individual care plan made reference to bedsores, which is an inappropriate statement and a more appropriate term would be pressure sores/care. The plan failed to detail the action on the prevention. Another made reference to an “autistic bowel” again not a medical term with any clarification or how staff can support and minimise risks. 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. Residents’ care plans included information about the monitoring of their physical health. In response to a requirement from the last inspection residents have all seen a dentist: this was confirmed in care records. A social worker had voiced a concern about the delay in a resident being seen by a doctor for a medical condition and was told that this was due to lack of staffing. Records seen confirmed that they had been a significant delay in an individual seeing a GP and the manager confirmed that this was due to lack of staffing. This is unacceptable. However this had been rectified prior to the inspection as seen in the individual’s records. The manager was organising a follow up appointment. This again highlighted a serious concern in relation to the home’s response to ensuring residents have access to appropriate medical professionals as highlighted at the last inspection with the lack of attendance at dental appointments. Residents, where relevant, were being reviewed with the consultant psychiatrist. Letters were seen confirming this. It was pleasing to hear that the home was liaising with a psychologist to assist with behaviour and ensure that the approach was based on current good practice for one individual. This will be followed up at the next inspection. The manager has introduced a new medication and administration 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. The home maintains a record of incoming medication. In addition there were regular stock reviews. In response to a recommendation the medication returns book contains two staff signatures, the reason for the disposal, the medication, the dose, the amount and the name of the individual it is prescribed for in accordance to a recommendation from the last site visit. 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. However, The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 20 from these records it was not clear when and if staff had been signed off as competent. All staff are in the process of completing a distance learning pack from the pharmacist, with three staff having completed this. 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. Residents are supported to take regular vitamins as part of ensuring their general well being, this has been done in consultation with the individual’s GP. It would be helpful for staff to have access to the research on why specific vitamins are used and these are kept under review. Staff were not able to articulate why one male resident had been prescribed evening primrose, which is used mainly with women and how this assists in the reduction of the individual’s challenging behaviour. The home has agreed to forward the research. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been some improvement in this area ensuring that there are clear guidelines for staff to follow in the event of abuse. EVIDENCE: The home has a complaints procedure and a complaints record. There have been no complaints raised since the last inspection in respect of the service provided. There has been one referral to the Adult Protection Team last November and part of this inspection was exploring how the home has ensured the ongoing safety of the residents and responded to the requirements from the previous site visit. The home has a policy on dealing with allegations in response to a requirement from the last inspection. In addition staff have copies of the No Secrets Guidance and the local authorities policy on protection and the procedure to follow in the event of allegation of abuse. All staff spoken with were aware where these were kept. Staff were questioned about their knowledge of abuse and all were aware of their responsibility to inform their line manager or to contact Social Services directly. Staff training on abuse is planned over the next four months with the local authority in response to a requirement from the last two inspections. The The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 22 manager stated that this had been cancelled by the trainer hence why the home has not complied with the requirement within the timescale. This remains as a requirement to ensure that this is reviewed at the next inspection with an extended timescale till the end of February 2007. Staff minutes confirmed that abuse had been a topic of discussion including the procedure to follow. A member staff stated that abuse was discussed during their induction, which included the completion of a questionnaire and a video on abuse. In response to the investigation in November 2005 there is now a record of restraint. It was noted that no form of restraint has been used since the last inspection. This was confirmed in conversations with staff and the manager. It was clear that the staff team in supporting the individuals that challenge were adopting more positive methods. In addition the home has reviewed and amended the policy on restraint to ensure that it complies with new guidance from the Department of Health in response to a previous requirement. One of the residents has been referred and reassessed by the placing authority as part of a protection referral and the home was deemed as not meeting the individual’s needs. The manager confirmed that the local authority is still actively seeking a placement for the individual. Staff were receiving training in dealing with challenging behaviour. However one resident’s care plan stated that all staff should have this training when supporting them. It was noted that three staff out of the seven had to wait in excess of four months prior to receiving this training. It is recommended that a standard be adopted that staff complete this training as part of their initial induction to enable them to fully support the residents living at the Gables in line with the individuals care plan. Finances were not explored on this occasion. The home has recently had an audit as part of protection strategy completed by the local authority. The provider has been asked to respond to the areas of concern identified and this is still within the timescale. All residents’ finances are dealt with and records kept of expenditure at the main office. Consideration should be taken for these to be kept in the home of the resident to enable residents to have more control. Information was left with the home on the recent change to the legalisation on the capacity of consent in relation to individuals living in the home making decisions. It was noted that in regards to medication the provider stated that they have locoparentis. This must be amended to reflect legislation relating to consent for individuals who are unable to consent for themselves, as this is not a legal statement relating to role of the provider. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents would benefit from more attention being paid to the environment to make it a more homely and pleasant place to live. Environmental restrictions, which are reported for reasons of safety, must be reviewed to ensure that residents rights are not compromised. Standards of cleanliness were very poor. EVIDENCE: The Gables is a detached property in keeping with the local neighbourhood. However, access is by a set of double gates which are padlocked with a doorbell attached to the wall. This not only detracts from the property but give the general public a false perception of the service provided. It took two staff to remember the code for the padlock, which could pose a serious risk to the welfare of the residents in the event of an emergency. An immediate requirement was left with the home to remove the padlock. Concerns were raised by the manager on the safety of the residents in relation to road safety The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 24 and as part of the immediate requirement the home must make the side access secure. The front door is fitted with a key code so in theory residents cannot leave the building unsupervised. Documentation was in place in the form of individual and organisational risk assessments on the use of the keypad for the front door. In addition the locking of the front door is now written in to the home’s statement of purpose in response to written correspondence from the Commission for Social Care Inspection. The home has two vacancies and discussions were had with the manager about the criteria in place for prospective residents. It would be poor practice to admit an individual who was independent in both the community and the home due to the locking of the front door and the kitchen. Concerns were raised by the inspector about the restrictions that are imposed on residents in relation to the locked kitchen and wardrobes. This has been an ongoing requirement. Whilst there was some documentation in place supporting the decision process not all staff were following the guidelines. All bedrooms and wardrobes are fitted with a locking device where a risk assessment is not in place these must be removed and all restrictions must be kept under constant review. It was evident that the organisation’s risk assessment clearly stated that all front doors and the kitchen must be locked at all times however this must link to individual risk assessments. The requirement from this visit is to remove all star lock keys from wardrobes where there is not clear documentation to support their use and all bedroom doors. Where bedrooms are lockable consideration should be taken to fit a suitable locking device which can be opened and locked by the individual when they are in their bedrooms. All other locking devices should be removed. The hallway has been redecorated since the last inspection in response to a requirement from the last inspection giving this area a more homely feel. In addition the provider has made a skylight in the upper hall to give this area more light, this was seen as a positive. Concerns were raised about the cleanliness of the home, there were coffee stains on walls, faeces in two of the bedrooms on walls and furniture and the multi-sensory room. The inspector was informed that both of the bedrooms had been cleaned. It was evident that some form of quality audit was required to ensure that these areas were acceptable. An immediate requirement was made at the time of the inspection to address the serious concerns and ongoing cleanliness of the home. There was a lack of cleaning schedules demonstrating that routine and deep cleaning is undertaken. Consideration should be taken to employ a domestic if this continues to be an ongoing issue as this has been identified in previous site visits (November 2005). The four bedrooms presently in use were viewed. Furniture was looking old and worn out. One of the wardrobes had no handles, as these had been broken. Three of the bedrooms were in need of re-decoration, one in particular The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 25 felt cold due to the lack of furniture and the choice of colour scheme and the flooring. The home must document the reasons for the lack of furniture and keep this under review. This remains an outstanding requirement. Two of the bedrooms had borders that were child like. Staff stated that the individual or their family had chosen the border. There is a risk that residents would be perceived not as an adult and in one individual’s situation does not promote choice, which has been made by his relatives. Consideration should be taken to make these areas more homely. Communal areas contained a mix match of furniture and lacked a homely feel. Whilst the inspector acknowledges that some of the behaviours that are exhibited by individuals could impose a risk, the organisation, the manager and the staff must ensure that the home is a pleasant place to live thinking creatively on how this can be achieved. Much research has been done about creating homely environments for individuals that challenge and how this has positive effects on the individual’s wellbeing. It was noted that curtains in the lounge and one of the bedrooms were hanging off hooks and a curtain pole in the lounge had no curtains. In addition the home has obscured one of the bedroom windows with plastic, which is hanging off and looks unsightly. There was no documentation supporting the reason for obscuring the glass. The manager stated that the sofa in the smaller lounge has been replaced with the one from the other lounge, which now contains new furniture. It was noted that the dining chairs are of a type, which would normally be found in the garden. Whilst the home has adequate toilet facilities on day one and two of the site visit the inspector had to request toilet rolls, soap and hand towels. Staff stated that the hand towels were in the wash and the areas had been cleaned. This provided evidence of the lack of systematic approach in that these should have been in place as part of the cleaning process and not some two hours later. It was noted that one ensuite bathroom had a strong damp smell and black mould patches on the ceiling and the grout on the tiles was discoloured. In addition there was a strong smell of urine in one of the toilets on the first floor. In response to a recommendation from the last inspection the home has introduced a repair book. This demonstrated that there was a good response to repairs. In addition staff stated that a number of areas have been redecorated. However one member of staff stated that concerns have been raised about the paint finish which is not washable hence stains can be still seen even though staff are cleaning on a regular basis. The laundry facilities were seen. Staff stated that they were adequate to meet the needs of the residents. However, one of the tumble dryers was broken and The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 26 the whole area was covered in fluff from the tumble dryers. This had been noted on the last inspection and could pose a fire risk. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been improvement in this area since the manager has commenced in post. There are systems in place for staff support and direction: however, less apparent is training relevant to the needs of the residents and supervision. EVIDENCE: Staffing for the home continues to be two staff during the day and evening with one member of staff providing waking night cover as evidenced via the home’s duty rota. A requirement from the last two site visits was for the home to review the staffing arrangements at night to ensure they are appropriate to the needs of the residents. One resident’s care plan stated that waking night staff must be in place but in fact a sleeping in staff was covering this. In addition it was noted that staff were working in excess of twelve hours working the late and the early prior and after the night shift. This has been reviewed and staff now work the late shift and then go home in the morning. There was no risk assessment in place: however, staff have signed an exemption from the The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 28 working time directive. In addition the foldaway bed that was in the lounge has now been removed which the staff had previously used at night. Records relating to staff recruitment, training and supervision are held at Bedrock the main office for the group of homes as agreed at a recent management review meeting with the provider and the Commission for Social Care Inspection. As part of this agreement the provider could be requested to ensure that records relating to staffing are available for the site visit at the Gables. However, it was agreed that these would be subject to an inspection at Bedrock Lodge. Discussions with staff indicated that they had completed an induction with the provider, which included videos, questionnaires and formal discussions on topics relating to the care of the individual. A concern was raised that staff had not completed a course on challenging behaviour within their induction period as detailed in the plan of care for one individual. Records were not seen on the induction process for staff as these are now kept at Bedrock in all but one staff’s case as this was still being worked through. Further information was received in correspondence from the manager after the inspection and these are and were held at the Gables. This will be followed up at the next inspection. There has been a significantly high staff turnover with the longest member of staff having only worked in the home for eleven months. From discussions with staff they had only attended basic training in health and safety as part of their induction. Less apparent was training on communication, epilepsy, mental health and autism, which would demonstrate that training was linked to the needs of the residents. This list is not exhaustive. The provider submitted a training plan but this lacked details to determine a standard for all staff on what courses they should and must attend with timescales within their employment. The plan detailed individual staff and courses they attended across the organisation. A quality standard should be developed to ensure that training is consistently applied and attended across the three homes and links with the identified needs of the residents in each home. The manager stated that all training is planned via the provider at Bedrock. Good practice would be for the manager to detail what training is relevant to the home based on the care needs of the residents. Good practice would be for staff to attend a values training course on areas of empowerment and advocacy which is delivered by an external provider. This could have a value within the organisation, which has many controlling and institutional systems which do not empower the residents or the staff. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 29 The manager stated that three members of staff are in the process of completing an NVQ 2 in care with one member staff already having obtained the award from their previous employment. It was noted at the last site visit in June 2006 that only three staff had a certificate in first aid and this has been rectified with a further two staff now being first aid trained. The manager stated that the two staff remaining are planning to do this in the New Year and this is completed with an external training provider. The manager stated that the provider completes all other training including NVQ. This will be explored further at the site visit of Bedrock Lodge in relation to ensuring training is based on current good practice. Staff spoken with during this inspection were positive about their roles in the home and the care provided to the individuals. In addition staff spoke positively about the support that the manager gives them in their day-to-day role. Regular staff meetings were occurring with minutes of discussions and actions being maintained. Less apparent was staff supervisions which are delegated to senior carers across the three homes. The manager stated that she is responsible for two staff working in the home and then two staff from Bedrock. One member of staff stated that they had not received a formal supervision session since commencing in post in March 2006. This must be addressed. Concerns were raised on how supervision can be carried out when staff are not working in direct contact and being observed at frequent intervals. A recommendation is that the present supervision system is reviewed and full responsibility is given to the registered manager of the home and clear records are maintained. Two staff were spoken with during this site visit. It was evident that they were questioning the support given to the residents and the poor environment. Positive suggestions were given in ways of improving the service and both staff stated that the manager was taking these on board. It was evident that these two staff were an asset to the team in shaping and moving the home forward along with the manager. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 30 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The newly appointed manager is making some positive improvements to the home and offering staff support. However, this would be improved if the provider and the manager developed a quality assurance system to monitor the quality of the care provision ensuring that the home is meeting the National Minimum Standards. EVIDENCE: Ms Lake the registered manager has been in post since February 2006 and was registered with the Commission for Social Care Inspection in May 2006. There have been some improvements since the last inspection in relation to the requirements that have been in her control have been met. In addition the The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 31 provider has ensured that policies and procedures and other organisational documentation to met with the changes in legislation and in accordance with the Care Homes Regulations is now in place. It was evident that the manager was exploring ways of the improving the service and it is strongly recommended that the provider and the manager devise an action plan to address the shortfalls identified in this report. This should include developing a quality audit tool, which ensures that the home is working towards the minimum standard and meeting the Care Homes Regulations. Whilst the provider has developed an improvement plan this addresses only the requirements from the previous site visit and not how the service plans to develop and move forward to meet the government philosophy of supporting individuals with a learning disability in a way which fully engages the individual, encourages independence and values the individual. There has been a significant improvement in the Fire Records. All checks and training is being recorded in accordance with the fire brigades recommendations. Policies and procedures have been through a process of review and newly implemented in May 2006. The provider has responded to requirements and recommendations from the last visit, which included a review of the admissions, and protection policy to ensure reflects the service provided and current legislation. These have been sent by post to the Commission for Social Care Inspection during the time between this and the last site visit and were seen in place during the site visit. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 32 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 3 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 1 26 1 27 2 28 2 29 2 30 1 1 X 2 X 1 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 X 17 STAFFING Standard No Score 31 3 32 3 33 3 34 X 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 1 X X 2 X Version 5.2 Page 33 The Gables DS0000003366.V319456.R01.S.doc 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 YA6 Regulation 15(1) Timescale for action Unless it is impracticable to carry 08/01/07 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. (Care plans must be expanded to ensure that they are measurable giving clear guidance to staff as detailed in this report, which will enable requirement 2 to be completed.) 2. YA6 15(2)(b) The registered person shall: Keep the service user’s plan under review; Where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan; Notify the service user of any The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 34 Requirement 08/01/07 such revision. (The registered person must ensure that all service users’ plans are thoroughly reviewed and detail any progress made, or goals achieved by the person, changes in the person’s needs and their circumstances and in their lives. Review documents must demonstrate who contributed to the review, the outcome of the review and amendments such as changes needed to support and services provided. (This requirement has been outstanding since July 2004) 3. YA6 10(2)(c) If the registered provider is a partnership, it shall ensure that one of the partners undertakes from time to time such training as is appropriate to ensure that he has the experience and skills necessary for carrying on the care home. (The provider to attend training in care planning and empowerment.) 4. YA6 10(3) The registered manager shall undertake from time to time such training as is appropriate to ensure that he has the experience and skills necessary for managing the care home. (The registered manager to attend training in care planning and empowerment.) 4. YA19 13(1)(b) The registered person shall make 08/11/06 arrangements for service users to receive where necessary, treatment, advice and other services from any health care DS0000003366.V319456.R01.S.doc Version 5.2 Page 35 08/02/07 08/02/07 The Gables professional. (The registered manager must ensure that residents have access to health care within a reasonable timescale and that this is kept under review.) 5. YA24 12(4) The registered provider shall make suitable arrangements to ensure that the home is conducted in a manner which respects the privacy and dignity of residents. (Where there is no documentation supporting the use of star key locks on wardrobe and bedroom doors, these must be removed. In addition residents must have a lockable door which can be opened from the inside by 08/02/07.) 6. YA9 13(4) (b), (c) 08/01/07 The registered person shall ensure that any activities in which service users participate are so far as reasonably practicable are free from avoidable risks; and unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (All risks must be clearly documented including social activities, use of minibus, accessing community, or any restriction imposed by the home for all residents. The documentation must detail strategies for staff to follow to minimise the risks whilst encouraging independence of the individual.) The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 36 08/12/06 (This requirement has been outstanding since December 2005) 7. YA24 13(4) The registered person shall ensure that all parts of the home to which service users have access are free from hazards to their safety. (Remove the padlock on the front gate ensuring that access is not restricted in the event of an emergency, and make the side gate more secure.) 8. YA27 23(2)(b) 08/02/07 The registered person shall having regard to the number and needs of the service users ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. (Investigate and alleviate the damp in the ground floor ensuite bathroom.) 9. YA30 23(2)(d) The registered person shall 08/11/06 having regard to the number and needs of the service users ensure that all parts of the care home are kept clean. Subject to regulation 4(3), the registered person shall not use premises for the purposes of a care home unless the premises are suitable for the purpose of achieving the aims and objectives set out in the statement of purpose; The registered person shall The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 37 08/11/06 10. YA23 23(1)(a), 23(2)(a) 08/01/07 having regard to the number and needs of the service users ensure that the physical design and layout of the premises to be used as the care home meet the needs of the service users. (The provider to develop a refurbishment plan to make bedrooms and the communal area more homely, taking advice from challenging behaviour specialists and within a risk assessment framework.) 11. YA35 18(1)(c) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training. (Develop training plans for all staff to include mental health, epilepsy, autism and communication and ongoing health and safety training for the individual staff member and the home collectively. Ensure staff receive this training within a reasonable timescale ensuring that this training is delivered by a competent person by 08/03/07.) (This requirement has been outstanding since October 2005) 12. YA36 18 (2) The registered person shall ensure that persons working at DS0000003366.V319456.R01.S.doc 08/01/07 08/01/07 The Gables Version 5.2 Page 38 the care home are appropriately supervised. 13. YA23 13(6), The registered person shall make 28/02/07 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. (Staff to have training on the Protection of Vulnerable Adults from an external provider.) (This requirement has been outstanding since August 2006) 14. YA27 13(3) The registered person shall make 08/11/06 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. (Ensure that there are adequate supplies of soap, hand towels and toilet rolls in the toilets and bathrooms at all times.) 15. YA39 24(1) (1) The registered person shall establish and maintain a system for reviewing at appropriate intervals; and improving, the quality of care provided at the care home. The registered person shall supply to the Commission a report in respect of any review conducted by him for the purposes of paragraph (1), and make a copy of the report available to service users. (3) The system referred to in paragraph (1) shall provide for consultation with service users and their representatives. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 39 08/02/07 (The home must develop a quality assurance tool which ensures the home is meeting the National Minimum Standards and has positive outcomes for residents.) 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 YA6 Good Practice Recommendations To consider exploring other options for the documentation of the planning of care that encourages a systematic review of the plans and blends to a more person centred approach. The manager should consider meaningful ways to enable the residents to extend their influence in the running of the home including regular meetings, menu planning and the planning of activities and holidays. Maintain staff records in relation to their medication competence in line with Nightingale Care Home’s Policy. Date medication bottles when opened to enable an audit of stock. 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. Review the use of the plastic obscure panel on a window in one of the bedrooms. Explore ways of making the care home more homely within a risk assessment framework. Ensure staff receive structured and recorded supervision at least six times per annum from a competent and relevant person. Devolve the responsibility for carrying out structured DS0000003366.V319456.R01.S.doc Version 5.2 Page 40 2. YA7 3. 4. 5. YA20 YA20 YA23 6. 7. 8. YA26 YA24 YA26 The Gables supervision to the registered manager. The Gables DS0000003366.V319456.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V319456.R01.S.doc Version 5.2 Page 42 - 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. 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