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Inspection on 26/01/06 for Five Gables Care Home

Also see our care home review for Five Gables Care Home for more information

This inspection was carried out on 26th January 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

A clean, well-maintained environment is provided that suits the needs of service users. Care is planned with service users and their relatives. Service users appear satisfied with the lifestyle within the home and are encouraged to make their own decisions. They were very complementary about the care given by staff and sufficient staff are provided to meet their needs.

What has improved since the last inspection?

Risks of falling and of developing pressure sores have been assessed and recorded with care plans with planned action to reduce risks.

What the care home could do better:

Improvements must be made immediately in the way medicines are stored and more care should be taken in recording and verifying changes and additions to prescribed medicines. There was no written record of money that was held on behalf of a service user and this must be immediately rectified. Care was planned, but the way this was written down was not consistent. Clear directions of what action staff should take to meet needs should be written down in a consistent way whatever forms are used. Generally, the home is well maintained, but the laundry flooring should be replaced to give a surface that can easily be kept clean.

CARE HOMES FOR OLDER PEOPLE Five Gables Care Home 113 Victoria Road Kirkby In Ashfield Mansfield Nottinghamshire NG17 8AQ Lead Inspector Meryl Bailey Unannounced Inspection 26th January 2006 11:00 X10015.doc Version 1.40 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 Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 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 Older People. 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. Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Five Gables Care Home Address 113 Victoria Road Kirkby In Ashfield Mansfield Nottinghamshire NG17 8AQ 01623 752 512 0115 9340910 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 Alan Peter Pearce Mrs Lesley Pearce Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2005 Brief Description of the Service: Five Gables provides residential care for up to sixteen service users and is discreetly positioned close to the town centre of Kirkby-in-Ashfield. There is ample on road parking and some spaces available to park in the home’s own car park. The gardens are private, well kept and have a pleasant water-fall feature, with many areas to chose from to sit out when the weather permits. Accommodation is provided over the ground and first floor, with the choice of a passenger lift and period style staircase. Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and conducted by one inspector during one day. 16 current service users were at home and some service users gave their views about the care provided. The communal areas of the home were seen and one bedroom. Other evidence was gained from examining written records and from the providers, who were both present during the day. What the service does well: What has improved since the last inspection? What they could do better: Improvements must be made immediately in the way medicines are stored and more care should be taken in recording and verifying changes and additions to prescribed medicines. There was no written record of money that was held on behalf of a service user and this must be immediately rectified. Care was planned, but the way this was written down was not consistent. Clear directions of what action staff should take to meet needs should be written down in a consistent way whatever forms are used. Generally, the home is well maintained, but the laundry flooring should be replaced to give a surface that can easily be kept clean. Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 6 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. Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this inspection. EVIDENCE: Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Care is planned to meet needs and health needs are met, though records of reviewing and monitoring are not maintained to ensure all needs are fully met. Current practice regarding the storage and handling of medicines could give rise to errors in giving people the wrong medication. Service users feel they are treated with respect. EVIDENCE: Three care plans were examined and, generally, needs were addressed with some information and instruction to staff, but this was not always clear. There was evidence that both the service user and the relatives had been involved in the drawing up of the plans and they were appropriately signed. Various forms were being used to clarify action to be taken to meet needs, but these were not consistently completed with many left blank. There were no written records of plans being reviewed or updated on a regular basis, but daily notes had been written by staff and these gave a more up to date account. There were some risk assessments relating to health risks, such as falls and pressure sores. There were also records of visits from district nurses and doctors. There were no monitoring charts for a service user cared for in bed Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 10 and, when nurses advise turning a person regularly, it is recommended that charts be kept to monitor this. Most medication in tablet form was prepared by the pharmacist into dosage packs for each service user. However, on examination of the storage of medicines, it was noted that there were some strips of unnamed tablets in two open plastic boxes. Additionally, there were some handwritten entries on the Medicine Administration Record (MAR) sheets that did not clearly state the name of the medicine, the amount or times it should be taken. These handwritten additions were not signed or verified. The existing policy did not contain directions about changes to the MAR sheets and amendment is recommended. Four service users spoken with were very complementary about the care given by staff and said that all staff were very respectful at all times. Preferred names were recorded clearly on their care plans and privacy was respected. Staff were observed knocking on doors before entering. Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 Service users are satisfied with the lifestyle within the home and are encouraged to make their own decisions. EVIDENCE: Individual interests were recorded within assessment and care planning documents. Some regular activities were provided. Two service users said they had regular meetings to discuss where to go on outings and could choose what to do. One service user had donated a video collection for other service users to benefit from and this was developing into a video library. The manager confirmed that service users meetings were held every two months and there were plans to have meetings of a panel made up of three service users, family representative and staff representative to plan activities and monitor the service (see also standard 33). Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The complaints procedure needs some amendment, but complaints are acted on and service users are given protection. EVIDENCE: No complaints have been raised with the Commission. One complaint was recorded at the home since the last inspection. The complainant was listened to and the complaint had been appropriately dealt with, but the final outcome was not made clear in the record. The complaints procedure as displayed on the notice board did not give the timescale for responding to complaints, but was otherwise clear. All staff had received training regarding awareness of signs of adult abuse and how to protect. It is recommended that the manager seek further training in the use of the Nottinghamshire Committee for the Protection of Vulnerable Adults policy and procedures. A copy of the procedure was available with the appropriate amendments. There had been no concerns raised about protection and some money was held securely, though some action is needed to ensure financial matters are appropriately dealt with (see under standard 35). Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 A clean, well-maintained environment is provided that suits the needs of service users. EVIDENCE: The home was found clean, well maintained and comfortable with assorted seating in a choice of sitting areas. All internal areas were accessible to wheelchair users. Service users spoken with were satisfied with the environment and said they felt comfortable in the home. Two domestic workers are employed to keep the home clean at all times. The laundry was well equipped, but the floor was showing signs of wear and it is recommended new flooring be provided. Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Sufficient staff are provided to meet the needs of current service users. The recruitment procedure ensures appropriate checks are made and training is given, though some records of this need updating. EVIDENCE: Care staff work twelve hour shifts and at least two staff are provided at all times. An additional care assistant is provided each evening from 5pm to 7pm and through the night one is awake and one asleep unless needed. Four staff had completed at least level 2 of the National Vocational Qualification in Care. Two of these had attained level 3 and one further staff member was in the process of completing level 2. Training records were not up to date, but the manager gave information about various training undertaken by staff, including Adult Abuse Awareness, Equality and Diversity, Dementia Care and some medication training. Supervision meetings had taken place between individual staff and manager, but not on a regular basis. Other staffing records were well maintained and there were two references and evidence of checks with the Criminal Records Bureau for each of the staff. Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 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 and 35 The home is managed by one of the providers who is pursuing management training. The lack of full financial records does not appropriately protect vulnerable service users from financial abuse. EVIDENCE: The manager is one of the providers and was currently undertaking National Vocational Qualification level 4 in management. Her tutor was present during this inspection. There was money being held in the safe with no records held, though the manager explained that it belonged to a service user and there were plans to open a bank account. No other money was held on behalf of any service user. The manager explained that charges for chiropody are included in the care fees and residents or their families pay the hairdresser direct. Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 16 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 1 X X X Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? No 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. 3. Standard OP7 OP9 OP9 Regulation 15(2) 13(2) 13(2) Requirement Ensure all care plans are kept up to date. Ensure all medicines are kept in original packaging, which is properly labelled and named. Ensure handwritten instructions on Medicine Administration Record sheets are full, accurate and are signed and verified. Ensure full records are kept of any money held on behalf of service users. Timescale for action 28/02/06 25/02/06 25/02/06 4. OP35 17(2) 25/02/06 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. 2. 3. 4. Refer to Standard OP7 OP7 OP8 OP9 Good Practice Recommendations Develop consistent care planning to give clear directions of what action staff should take to meet individual needs. Keep written records of monthly reviews of care plans. Maintain charts of care given to any service user cared for in bed. Amend the Medication policy to give directions about how DS0000008677.V271763.R02.S.doc Version 5.0 Page 18 Five Gables Care Home 5. 6. OP16 OP18 7. 8. OP26 OP30 changes should be made to the printed Medicine Administration Record sheets. Amend the Complaints procedure to include an assurance that complaints will be dealt with within 28 days. The registered manager should obtain training in the use of the Nottinghamshire Committee for the Protection of Vulnerable Adults policy and procedure. See www.nottsadultprotection.org for training information. Replace the laundry flooring to ensure the surface is impermeable. Update staff training and supervision records. Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Five Gables Care Home DS0000008677.V271763.R02.S.doc Version 5.0 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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