CARE HOMES FOR OLDER PEOPLE
Five Gables Care Home 268 Station Road West Moors Ferndown Dorset BH22 0JF Lead Inspector
Trevor Julian Key Unannounced Inspection 5th September 2007 09:40 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 DS0000066590.V350434.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 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 DS0000066590.V350434.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Five Gables Care Home Address 268 Station Road West Moors Ferndown Dorset BH22 0JF 01202 875130 01202 861174 mail@fivegablescarehome.com www.fivegablescarehome.com Mrs Julie Hawkins Mr Brian Hawkins Mrs Julie Hawkins Care Home 13 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) Category(ies) of Old age, not falling within any other category registration, with number (13) of places Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th January 2007 Brief Description of the Service: Five Gables is a small family run care home registered with the Commission for social care Inspection to accommodate a maximum of 13 older people for whom personal care may be provided. Mrs and Mrs Hawkins own and manage the home and live in the adjoining premises. The building is a converted family house on a corner plot. It is situated close to shops and other amenities including library and churches in the village of West Moors. A local bus service operates from outside the home into the centres of Poole, Bournemouth and Ferndown. A ramp provides easy access to the front door. The accommodation is provided on the ground and first floor, which are linked by a stair lift on the main staircase. There are seven single bedrooms on the ground floor along with the communal lounge/dining room, lounge and separate quiet room. The remaining 5 bedrooms including one double are on the first floor. Each floor has a conventional bathroom most bedrooms are en-suite. To the front of the property is a small well maintained garden with a pleasant patio to the rear. Fees range from between £450-£650 per week See the following website for further guidance on fees and contracts. http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on 5th September 2007 between 09:40 and 17:30. During the inspection key National Minimum Standards were examined. Before the visit, Mr and Mrs Hawkins had returned an Annual Quality Assurance Assessment (AQAA) giving details on the general management and care needs catered for in the home. During the visit, further information was gathered through discussion with residents, visitors, a community nurse and the owners. Other evidence for this report was found through a tour of the premises and through the home’s records. At the time of the visit, the home was at full occupancy with 13 residents. What the service does well:
This was the second inspection of Five Gables since Mr and Mrs Hawkins took over the home. Since taking over the home, improvements have been made to the premises and procedures. One person commented that the home was always good but improvements have made it even better. A visitor added that the staff were attentive to the needs of all residents, they were considerate and treated people with dignity and respect. The home had care plans and records, which informed the staff how needs, were to be met. Medication was safely stored and administered. A community nurse said that the staff called for assistance as appropriate. The new owners and staff had improved choice and there had been more activities offered. Recently the home had held joint activities with a nearby care home. Residents had enjoyed shopping trips with the owners and there were plans to hire a minibus for day trips. The local paper reported 100th birthday celebration for one resident attended by 50 guests. Another resident said that the owners had helped her to visit a friend to celebrate her birthday. Residents praised the food and the owners had introduced choice at supper time. People were able to take their meals in the dining room or their own rooms. People said they were able to raise concerns with the owners and staff; one complaint had been investigated and responded to by the owners. All staff had received training in responding to allegations and signs of abuse and they were clear about their responsibilities. Access to the home had been improved and there were plans to redecorate the lounge. There was a programme to replace some of the windows and those on Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 6 the first floor were to have restrictors fitted. Hot water and surface temperatures were regulated to reduce the risk of scalding and burns. Staffing levels had been reviewed and improved. Most staff had worked at the home for a number of years providing very good continuity of care. Two staff had been recruited and there was documentary evidence that the required checks and clearances had been obtained. Residents and visitors were full of praise for the work and dedication of the staff at Five Gables. The home was well managed and it promoted the independence and choice of those living in the home. The views of the residents and visitors were obtained through meetings, surveys and general discussions. Staff were also consulted by surveys and staff meetings. The home did not manage finances for any of the residents but some people deposited cash to cover additional expenditure. The records and receipts held matched the balances held. What has improved since the last inspection? What they could do better: 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
Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 8 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 DS0000066590.V350434.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process helps to ensure that the home is suitably equipped and staffed to meet the assessed needs of the individual. EVIDENCE: The files of three people were examined each showed that there had been a pre-admission assessment and visit to the home had taken place before a place was offered. Letters held on file showed that written confirmation had been provided stating that the home had the resources to meet the identified needs of the individual. Most of the residents seen during the visit could not recall their admission to the home although one person said he had visited several homes and knew it was going to be a “home from home” as soon as he stepped inside.
Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 10 Another said she had been helped to choose the home by her family and had settled very well. Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and reviews inform the carers how assessed needs are to be met to ensure the wellbeing of those living in the home. Medication is safely managed to ensure the residents receive theirs correctly. EVIDENCE: Care plans were in place for the three files seen. The care plans contained information about the tasks needed to meet the care needs of the individual. There was evidence of nutritional assessments being completed and Mrs Hawkins had recently attended a training course on the use of a nutritional assessment tool. Good food and fluid intakes were encouraged for all residents with special attention given to those whose intakes were reduced. There was evidence that the home worked closely with healthcare professionals to meet any health needs. The home has a visiting chiropodist offering a service to those not accessing the NHS service.
Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 12 During the visit a community nurse was attending a resident to provide wound care. She said that she did not often attend the home but found the standards were good when she visited. She felt the home called for assistance at an appropriate time and that staff acted on any professional advice given. The residents said that the staff were helpful, supportive and attended to all their needs. The AQAA stated that in the past year the home had focused on greater involvement of the residents in their individual care planning and recording their life story. The home uses a monitored dosage system for the management of medication. The supplying chemist was in the process of auditing the system. Items were securely held and the records clearly identified quantities of stock held. Information sheets were available for the medication held. There were also medical reference books to help the staff. Where handwritten amendments were made to the medication records they were not signed by a second person and this could result in transcription errors. Photographs of the residents were available to assist staff with medication administration. Several residents commented that the staff took care to ensure they had the correct medication. During the visit, the staff were seen knocking on bedroom doors before entering. Residents confirmed that the staff were respectful and considerate. Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Daily life in Five Gables ensures that people are able to take as much control of choices as their own circumstances allow. EVIDENCE: Mr and Mrs Hawkins had introduced twice weekly armchair exercise sessions for the residents and most now regularly joined in. They had also purchased a more suitable vehicle allowing residents to have trips out. The home has had entertainers coming into the home but several people commented that they enjoyed making their own entertainment and there were often sing along sessions in the afternoons. The home had also teamed up with a nearby care home to offer joint events; two held so far had been a good success. Residents said the home was relaxed and they were able to make choices about their daily lives. Some people liked to get up early other returned to their beds after breakfast, they said they were able to go to bed at their preferred times. On the Friday before the inspection, one resident was celebrating her 100th birthday and the home had hosted a party for 50 family and friends. Local press covered the event. Residents said that they enjoyed
Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 14 the garden during warmer days and there was enough going on to keep them from being idle. They were able to give ideas for activities at residents meetings. A barbeque had been a great success earlier in the summer. Visitors said they were always made welcome by Mr & Mrs Hawkins one said that special arrangement made by Mrs Hawkins had enabled her friend to have a very special birthday, she added that nothing seems too much trouble. Residents praised the food provided in the home. At evening meals they had a choice of meals. The midday meal was appetising and well presented. Portions were varied according to the preferences of the individual. People were able to choose where they took their meals with most having their main meal in the dining area. Most had breakfast in their own rooms, the trays were laid out overnight but the foodstuffs were not added until the trays were being taken to the residents. The AQAA showed how meal times were given greater flexibility at the request of residents to make mealtimes more sociable and allow people to take longer to enjoy their food. There were also plans to hire a minibus three times a year to take more residents out on excursions. Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems in place to allow residents and visitors to the home to raise their concern. Staff were trained to respond to allegations or signs of abuse to protect the residents living at Five Gables. EVIDENCE: Information about how residents and visitors could make complaints is given to all as part of the admission process. The residents said they were able to raise concerns without any fear. They can also raise general issues in surveys carried out in the home. There was a complaints register; one had been recorded and acted on promptly. There was a record of many compliments received during the same period. All staff have received recent training in recognising and responding to signs or allegations of abuse. Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, safe and homely environment for the benefit of the residents and staff. EVIDENCE: During the past year, Mr and Mrs Hawkins have been busy upgrading access to the home as well as replacing flooring in the kitchen and improving infection control procedures by installing extra paper towel dispensers. Windows were being replaced and restrictors were being installed shortly on the windows on the first floor. Hot water temperatures are regulated and there are thermometers in the bathrooms to check the devices are working correctly. Radiators are covered or have low surface temperatures to reduce the risk of burns.
Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 17 All rooms seen were comfortable and clean, each had been personalised by the occupant using photos and pictures. The home’s laundry is sited away from food preparation and storage areas. Residents said that the rooms were comfortable and kept at a suitable temperature throughout the year. Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff were competent and well trained to ensure that they were able to carry out their roles effectively. The robust recruitment process helps to protect residents from unsuitable applicants. EVIDENCE: Mr & Mrs Hawkins had retained the majority of staff in the home which had helped to maintain continuity of care. The home employed a cleaner which allowed the staff to concentrate on care tasks. The home was appropriately staffed for the needs of the residents and Mrs Hawkins was clear that staffing levels would be increased to meet changing needs. The residents said that the staff were attentive and if they called for assistance they did not have to wait too long. Two new staff had been recruited and the files showed that the required checks and clearances were obtained before starting work. One file contained a testimonial and there was evidence that Mrs Hawkins had carried out checks to ensure it was valid. The home had worked hard to update training for staff. Courses completed recently included, recognising abuse, moving and handling, infection control, health and safety, fire safety and dementia awareness.
Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 19 The home had completed a staff survey and the results were very positive. Staff were kept informed with regular staff meetings and they were able to discuss general issues at those meetings. Throughout the visit, it was clear that the residents and staff were mutually respectful and there was a very friendly rapport between them. Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Competent owners and staff run the home for the benefit of the residents helping to provide a safe and comfortable environment for both residents and staff. EVIDENCE: Mrs Hawkins has the required qualifications and experience to manage the care home. The home is run in an open manner with Mr & Mrs Hawkins being readily accessible to residents, staff and visitors. Mrs Hawkins works some shifts in the home to retain a close relationship with the residents. Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 21 One person commented that the home was always good but improvements have made it even better. The home has regular meeting with the residents to discuss ideas for the menu and activities. The meetings are recorded and any actions followed up. There had been a survey to seek the views of the residents, their friends and family and the staff. This had been used to devise an improvement programme including redecoration of the lounge. A check was completed on two people whose personal allowance was deposited with the home to cover additional expenditure. There were clear records and receipts available and the transaction records matched the balances held. Since the last inspection the gas installation has been modified and retested by a competent person. The electrical installation has a current five year certificate. Portable appliance testing in the home was completed in December 06. Fire safety checks and training was up to date. Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 22 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Five Gables Care Home DS0000066590.V350434.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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
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