CARE HOMES FOR OLDER PEOPLE
Five Gables Care Home 32 Denford Road Ringstead Kettering Northants NN14 4DF Lead Inspector
Irene Miller Unannounced Inspection 12th January 2006 10:00 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 DS0000012614.V273371.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000012614.V273371.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Five Gables Care Home Address 32 Denford Road Ringstead Kettering Northants NN14 4DF 01933 622807/460414 01933 622807 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) Jade County Care Homes Limited Vacant Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Lodge - registered for 13 service users in the category of OP of which 2 persons may be within the category of PD(E) Physical Disability over the age of 65 years Service Users accommodated in The Lodge will be within the personal care only category The Villa - registered for 30 service users in the category OP for the provision of personal care only. In the categories of Personal Care only up to 16 service users may have dementia over the age of 65 years DE(E) and up to 3 may have a physical disability over the age of 65 years PD(E) 19th July 2005 2. 3. Date of last inspection Brief Description of the Service: Five Gables is a care home registered to provide personal care for up to 43 residents aged 65 years and over. Of these 16 may have dementia and up to 5 may have a physical disability. The home is situated in the village of Ringstead and provides accommodation in three units both of which have two floors. The grounds include a car park and mature garden and patio areas. There is level access to all areas. The rear building, the Villa is registered for 30 residents, it is separated into 2 units, one of which is for residents with dementia. It provides accommodation in 26 single rooms and 2 shared bedrooms all with en suite facilities. There is a passenger lift and staircase for access to the first floor. The front building, the Lodge care for up to 13 residents, there are 9 single rooms of which 4 have en suite facilities and 2 double rooms of which 1 has an en suite. Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The primary method of inspection used was ‘case tracking’ which involved tracking the care of three residents, through a review of their records and discussion with them where possible. Observation of care practices, discussion with the deputy manager, residents, staff and a limited tour of the building. The inspection took place over a period of four and a half hours following approximately thirty minutes preparation, which included reviewing previous inspection reports, and other documentation. What the service does well: What has improved since the last inspection?
Within the Dementia care group improvements to the environment have been made, to include orientation signs and sensory equipment. The advice and knowledge gained from visiting other dementia care facilities has inspired the home to explore new methods to assist with orientation to time, place and person and provide a more stimulating environment for residents, improvements noted were: Pictographic signs on residents bedroom doors that capture the resident’s character, hobbies and interests. Mirrors have been introduced to the corridors and sensory stimulation boards are available for residents to touch and feel.
Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 Page 6 Within the lounge wall there was a simple clear and large calendar, which depicted the day, date month and year, a member of staff was changing the date and also verbally confirming to the residents this. One resident made a note in her personal diary, which indicated that the calendar was clearly serving a purpose for this individual resident. Soft toys which can provide reassurance and act as therapeutic tools are provided where the need has been identified. Staff hand washing facilities were available in the resident rooms and antibacterial liquid soap available in bathrooms and toilets. Personal protective clothing to include, disposable aprons and gloves are available within the laundry, bathrooms, toilets and domestic cleaning cupboards. Cleaning schedules are in place and Infection control policies were available for staff guidance. The laundry was seen to be well organised and the floor in this area had been painted with appropriate floor paint. Formal staff supervision is taking place. Staff fire drills take place at varied times of the day /evening to ensure that the whole staff group are trained in the fire procedure. A list was available of staff that had taken part in fire drills. Denture cleaning tablets were stored in locked cupboards. 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 contacting your local CSCI office. Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 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 DS0000012614.V273371.R01.S.doc Version 5.1 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): 4 Residents are assessed prior to entering the home. EVIDENCE: Information was available within the care plans that demonstrated that assessments had taken place by the operations manager and deputy manager prior to residents moving into the home. Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 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 & 10 To ensure that the full range of health and personal care needs of residents are met, the care plans need to be person centred and contain the specific needs of the individual resident. EVIDENCE: Two of the residents case tracked experienced disturbed nights, this was confirmed by the staff and recorded within the daily reports, however their care plans had no night support plan in place to identify what level of emotional and physical support the residents required, the third care plan looked at was very brief and did not fully reflect the current high level of support required at night by the resident. The care plans viewed did not reflect the full 24 hour care provided for residents, some additional information was required within the care plans for residents who have communication difficulties, who are unable to verbally express their needs and wishes. Through discussion with the staff it was demonstrated that they were very aware of the night care support required by all three of the residents, one
Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 Page 10 member of staff who had recently worked on a nightshift showed the inspector a letter that one of the residents had written during the night, which demonstrated that staff do provide meaningful activities to enable residents to express their feelings and emotions. The level of support required by one resident who had a urinary catheter fitted was not reflected within their care plan; there was no information contained within the care plan on catheter care or on cross infection procedures to prevent the introduction of urinary tract infections. Records of residents weight taken on admission to the home were not recorded within two the care plans seen, in particular one of the residents who was immobile and at risk of developing pressure sores, however pressure relieving equipment was identified within the care plan and the support and involvement of the district nurse on monitoring the pressure care required by the resident. All of the residents living at the home require staff to administer their medication; a member of staff was observed giving residents their the lunchtime medication, residents were treated with respect, the medication administration records looked at were all in order and medication was stored appropriately. The member of staff was knowledgeable of the individual residents in relation to their medication needs. Health and personal care information communicated between staff in relation to changes in residents care needs was conducted in a way that fully respected the resident’s privacy. The staff were observed to knock on doors before entering and addressing residents by their preferred names. Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 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): 12,13,14 & 15 The residents find that the lifestyle experienced within the home matches their expectations. EVIDENCE: The home endeavours to seek information on residents past lifestyles, interests and hobbies, records were available to facilitate staff in providing activities for residents based upon their individual preferences. Visitors were observed being made welcome into the home by staff, one resident who was case tracked goes out for daily walks with their relative, residents received their post in private. Visitors spoken with praised the home saying that the staff do a brilliant job. Residents were observed to move freely around the home, chatting with staff and each other, watching television or listening to the radio, the lunchtime meal was observed and residents were observed to choose were to sit for their meals. The meal consisted of Sausage casserole or liver casserole with mashed potatoes and fresh vegetables, pudding was sponge and custard/fresh fruit or yoghurt. A relative who was visiting during the lunchtime said that the meals
Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 Page 12 always looked appetising and was pleased to see that fresh vegetables were provided. The level of support required by one resident who are diabetic was not reflected within their care plan; there was no reference within the care plan on the provision of a diabetic diet or the frequency of blood sugar monitoring. Many of the residents who were in the Beech Lounge were unable to sit at the dining tables due to physical infirmity; individual tables were provided for their use, which were a suitable height to eat plated meals from. Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 Page 13 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): 18 Residents are protected from abuse. EVIDENCE: Staff training records demonstrated that the protection of vulnerable adult training is provided, in addition staff were observed to respect the wishes of residents and provide care with sensitivity. Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 Page 14 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): 19,20,23,24 & 25 In general the environment suits the needs of the residents living at the home. EVIDENCE: Improvements to the environment have taken place within the dementia care facility and within the residential facility, to include sensory stimulation boards and other equipment. Records were maintained of redecoration to bedrooms, emergency lighting, and gas and fire equipment checks. One emergency light had been identified for repair this was being addressed by the home owner. The garden was well maintained; a relative who was visiting the home said to staff that they would like to see a bird table available, as their father had enjoyed feeding the birds when he lived within his own home, the staff said that they would follow this up with the home owner to endeavour to have this facility made available.
Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 Page 15 A limited tour of the building was conducted; bedrooms viewed were personalised and clean. Bedside rails were seen to be fitted to the bed of one of the residents who was being case tracked, there was no documentation or risk assessment contained within the residents care plan to address the suitability of bedside rails or any associated risks which may have been present in their use for the individual. The home has purchased new bedside rail bumpers, and some new bedding. The carpet within the dementia care lounge had a slight offensive odour; during the inspection residents were observed to pour drinks onto the carpet, this was largely due to the perceptual difficulties that some people living with dementia encounter. Residents were encouraged to eat and drink as independent as possible and as a consequence, encouraging residents to exercise their independence in this area, would have some detrimental effects on the fabrics and furnishings within this environment, staff were observed to treat this behaviour with sensitivity and spillages were attended to promptly keeping spoilage to the carpet and fabrics to a minimum. Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 Page 16 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 & 30 The number and skill mix of staff in general meets the needs of residents. EVIDENCE: On the day of inspection the deputy manager was covering an emergency care shift due to staff sickness, the staff rota was looked at which demonstrated that the staffing levels were in the main 4 care staff (am) 3 care staff (pm) and 3 night care staff on shift. The home has resident vacancies and it is expected that staffing levels would increase as more resident’s move into the home and dependency levels increase. The staff training records demonstrated that recent training has been provided on pressure care, tissue viability, health and safety, fire safety, adult protection and the storage and administration of medication. In addition staff training is planned for 3 staff to embark on a dementia awareness distance-learning course and the home owner and administrator is booked to do a 3 day dementia care mapping course which is due to commence on 30th January through to 1st February 2006, it was anticipated that this course would have been undertaken in November 2005 and remains an outstanding requirement from the previous inspection visit. Staff who embark on training on the storage and administration of medication said that they are observed on at least 6 occasions and only signed off as competent once they can demonstrate that they fully understand the protocols
Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 Page 17 and procedures in this area of responsibility, the records of observation were available to view within the individual staffs induction files. Staff recruitment files looked at contained all the necessary screening documentation to ensure that residents are in safe hands at all times. Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 Page 18 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): 31,32,33,36,37 & 38 A registered manager needs to be appointed to ensure that essential records are maintained and that the home continues to make improvements on the care provided. The needs of residents are at risk of not being met due to vital records relating to their care, health, safety and welfare not being reviewed and updated. EVIDENCE: The homes deputy manager is experienced in the caring field and respected by the staff team, and with the support of the operations manager has been instrumental in significantly improving care practice, record keeping, residents needs assessments, risk assessments, care plans and environmental improvements. However in the absence of the operations manager this support needs to be consistently available for the deputy manager to effectively manage the home, to ensure that staff are managed appropriately and that
Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 Page 19 monitoring records relating to the care, health safety and welfare of residents are up to date and contain current information. Incidents that have a direct impact on the health, safety and welfare of residents living within the home need to be recorded and reported appropriately, for example an incident was discussed during the inspection which addressed the security measures required to protect residents who lack the capacity to leaving the building unescorted due to having advanced dementia. Risk assessment documentation was lacking in relation to the use of bedside rails for one of the residents case tracked. Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 Page 20 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 3 X X 3 3 3 X 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 2 3 3 X X 3 2 2 Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15 Requirement Residents care plans must contain sufficient information to enable staff to provide continuous 24-hour care, to include specific risks to residents at night. Residents who require the use of urinary catheters must have within their care plan instructions for staff to follow on catheter care. All residents must have their weight recorded and nutritional care plans implemented if risks are identified. Residents eating and drinking care plans must reflect specific dietary needs in relation to any medical conditions that require special diets and include the level of support required, to include any aids and adaptations required by the individuals, according to their needs and capabilities. The registered provider must inform the CSCI of the arrangement to be made for the recruitment of a registered
DS0000012614.V273371.R01.S.doc Timescale for action 28/02/06 2 OP7 15 28/02/06 3 OP8 12(1a&b) 13(4c) 15 31/01/06 4 OP15 28/02/06 5 OP31 8(1) 30/06/05 Five Gables Care Home Version 5.1 Page 22 6 OP33 10(2)(b) 7 OP38 37 (e) 8 OP38 13(4) (c) manager. Dr (Mr) Thakkar is required to 28/02/06 undertake a 3-day course in dementia care mapping. (Previous requirement of 30/06/05 and 30/12/05 not met) The registered provider must 31/01/06 inform CSCI of any events in the home that adversely affects the safety or well-being of any service user. A regulation 37 notification must be forwarded to CSCI following the incident of 05/01/06 Risk Assessments must be in 28/02/06 place and regularly reviewed for all residents who require the use of bedside rails 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 Refer to Standard OP26 OP27 Good Practice Recommendations To combat the build-up of offensive odours a suitable deodoriser should be available for staff to spot treat carpets where soiling has occurred. The deputy manager should not be included in care staff ratios. Five Gables Care Home DS0000012614.V273371.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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