Inspection on 12/05/05 for Five Gables Nursing and Residential Home

This inspection was carried out on 12th May 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

Five Gables Nursing and... 22/04/09

Five Gables Nursing and... 03/10/08

Five Gables Nursing and... 24/04/08

Five Gables Nursing and... 03/05/06

Five Gables Nursing and... 12/01/06

Five Gables Nursing and... 18/10/04

Five Gables Nursing and... 15/04/04

Five Gables Nursing and... 08/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Five Gables Care Home 32 Denford Road Ringstead Kettering NN14 4DF Lead Inspector Moira Mosley Unannounced 12 May 2005 10.00 th 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 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 C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Five Gables Care Home Address 32 Denford Road Ringstead Kettering Northants NN14 4DF 01933 622807 01933 622807 Telephone number Fax number Email 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 Home Limited Vacant Care Home 43 Category(ies) of OP Old Age (43) registration, with number of places Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 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 2. Service Users accommodated in The Lodge will be within the personal care only category 3. 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) Date of last inspection 18th October 2004 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 pasenger 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 C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place over four hours with two inspectors. The care of four residents was reviewed including their care plans, accident records, medication and discussion with the residents. Discussions were held with a further four residents and three members of staff to find out about the home. In addition comments were received from 19 relatives/visitors to the home via the pre inspection questionnaires. A tour of the communal areas on both floors in the Villa including four resident bedrooms and a bathroom formed part of this inspection. The registered manager position is vacant and the acting manager who was in post has recently left. Since the last inspection in October 2004 there have been two additional visits on the 09/12/04 and the 11/01/05 to monitor the compliance with requirements made. What the service does well: What has improved since the last inspection? What they could do better: Dementia care is not clearly planned and documented to meet the specific needs of those residents. Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 Page 6 The care plans do not contain sufficient information about the assessed needs of the residents or details about what actions are needed to provide the care. Healthcare assessments including nutrition and pressure ulcers were not fully completed and there was no evidence of action taken when residents had identified risks in these areas. There was no clear audit of medication from entering the home and does not account for refused medication that has been disposed. There is a lack of planned activity to stimulate the residents especially in the dementia unit. Staffing levels were raised as a concern by eight of the relatives/visitors who returned questionnaires to the CSCI. There was no evidence of staffing levels being calculated in response to the dependencies and needs of the residents. There was inadequate information, direction for staff and facilities for the prevention of cross infection in addition there were concerns about the health and safety of the residents with poor record keeping regarding manual handling and fire records, a lack of statutory training for all staff and concern about the maintenance of equipment and facilities. 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 C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 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 standard(s) 4 Residents with dementia are at risk of not having their needs met due to the inadequate systems in place for their care. EVIDENCE: The staff spoken to confirmed they have received training from the Community Psychiatric Nurse (CPN) about dementia care. Observations showed a good understanding of the staff on how to deal with some of the behaviours exhibited. However there was no programmed activity plan and the lack of staff meant that only basic care needs could be met. One residents daily notes showed evidence of frequent aggression towards staff and other residents with no specific care plans in place for dementia or behaviour. Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 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 standard(s) 7,8, 9 and 10 The residents are at risk of not having their needs met because care plans, healthcare assessments and medication records are insufficient to demonstrate action needed or to be taken by staff. EVIDENCE: Care plans do not contain sufficient information to direct staff in the care required. The staff spoke about one resident who was MRSA positive and the care she needed; however in the care plans there was no evidence of this. A resident with diabetes was seen to have blood sugar levels being monitored by staff with no evidence of training and agreement from the District Nurse responsible for his diabetic care. The care plan gave no details about his diabetic care and there was no diet care plan in place. Pressure ulcer assessments were not completed for all residents. One resident’s notes identified concern about red and sore skin and she was observed to be being cared for in bed. There was no evidence of any action to reduce the risk of pressure ulcer development. Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 Page 10 One resident identified had poor nutritional intake, with a nutritional assessment identifying her ‘at risk’. There were no weight records and no evidence of care plans or other interventions to monitor nutrition. One resident was observed to eat only vegetables with gravy at lunch, staff stated she would not eat anything else and had swallowing problems. There was no evidence of any action taken about concerns raised. Her weight records showed a steady weight loss over the past 10 months. There was no clear audit trail for the medication once it entered the home. One resident’s liquid medication showed a discrepancy of 100 millilitres that was believed to be due to previous stock not being accounted for. There was no evidence of how medication that is refused was disposed of. Residents were spoken to in their preferred form of address and staff were seen to relate well to residents. Residents spoken to said the staff were very kind and the comments where made on the questionnaires from relatives / visitors were very positive about the care the staff gave. Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 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 standard(s) 12 The lack of organised activity for residents is poorly managed and does not provide a stimulating environment to promote residents well being. EVIDENCE: Observations showed that the staff occupied the residents with conversation and looking at books and magazines. The activities on the notice board were very limited and on some days the only activity was the hairdresser or chiropody visit. There is no evidence of specific activity for residents with dementia and insufficient staff available to meet more than basic care needs. One relative commented in the questionnaire that there is a “lack of therapy/stimulation for residents in the dementia unit.” One of the residents spoken to said they spent their day either in their room or sat in the lounge and could not remember going out in recent weeks. Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 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 standard(s) None of these standards were assessed on this inspection. EVIDENCE: Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 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 standard(s) 19, 24 and 26 The lack of clear infection control procedures and facilities presents a risk to both staff and residents. EVIDENCE: The home is in general suitable for its stated purpose, providing spacious and homely accommodation in keeping with the local community. There has been a programme of redecoration to improve the environment for the residents. The resident’s bedroom showed evidence of personalisation and décor was generally good, however there was one bed that was seen to be in poor condition with a ripped base and furnishings were in a poor condition in several rooms. As identified within National Minimum Standard 38 there were concerns about some health and safety issues within the home. The bedroom doors have locks fitted that are unsuitable and although the staff state the keys are not used these remain available in the clinic area. Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 Page 14 There was a lack of clear guidance for infection control procedures. One resident identified as having MRSA had no specific care plan. Staff raised concerns about the lack of hand washing facilities when dealing with residents in the lounge area as the nearest facility was in a bathroom down the corridor. The bathroom contained no hand towels and no evidence of antibacterial hand wash. Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30. Staffing levels and training provided is insufficient to meet more than the basic care needs of the residents. EVIDENCE: There were three staff on duty to provide care for the 19 residents. One person was based in each of the two lounge areas with the third ‘floating’ between the two areas. There was no evidence of the staffing level being calculated in regard to the dependency levels of the residents and the level of needs they have. Staff spoken to confirmed that they can manage to provide basic care needs but are unable to run any programmes of activity and at times residents will have to wait for assistance when two staff are required for manual handling. Eight of the questionnaires returned by visitors/relatives raised concerns about the staffing levels and the lack of time of staff to attend to their relatives needs. The National Vocational Qualifications (NVQ) assessor was in the home and staff spoken to confirmed they were undertaking this training. At present there are 5 of the 28 staff members with NVQ at level 2. Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 Page 16 Staff spoken to confirmed they had recent training in dementia from the CPN and manual handling training. One carer stated she had not had fire training or food hygiene training since commencing this employment. Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36 and 38 The lack of a registered manager is severely impacting on the care of the residents. In addition the health and safety of the residents and staff is not being effectively managed to ensure their protection. EVIDENCE: The home has not had a registered manager in post over the last seventeen months. The most recent acting manager has left prior to registration. Many of the findings on this inspection are the same as found in the previous inspection. Observations and discussion with staff showed a lack of consistent clear leadership and management for the home. Staff spoken to stated they had started a programme of supervision but this has ceased since the acting manager left. Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 Page 18 Health and safety concerns were raised during this inspection: • • • • Manual handling plans within resident care files were not fully completed and did not give clear direction for staff as to the needs of the residents. Temperature recordings of baths were not maintained. The first aid box in the clinic contained dressings that had passed their expiry date. Staff were unsure of who the first aider on duty was. The bed rails on a residents bed had gaps over 120mm and were of an old style that had been subject to a medical alert in 2004 and should have been removed, an immediate requirement was made following this inspection. There was no evidence available of the records for fire drills or the routine checks on fire equipment and emergency lights. A member of staff spoken to had not received all statutory training, e.g. fire and food hygiene. • • Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 1 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 x COMPLAINTS AND PROTECTION 2 x x x x 2 x 1 STAFFING Standard No Score 27 1 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 1 2 x x x 1 x 1 Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 Page 20 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 4 Regulation 12(1) 12(4)(b) 18(1) 12(1)(a)( b) and 15 Requirement The needs of residents with dementia must be met with regard to best practice and clinical guidelines. (previous timescale of 20/12/04 not met) A care plan must be developed for all areas of assessed need and identify detailed action to be taken by staff. (previous timescale of 20/12/04 not met) All residents must be assessed for the risk of pressure ulcers and any action required evidenced. All residents must have their weight recorded and nutritional assessments completed with evidence of any action taken if risk identified. A clear audit trail of all medication in the home including didposal must be maintained. The activities programme must be reviewed to ensure that suitable activities are provided to include residents with dementia. (previous timescale of 20/12/04 not met) There must be clear procedures, Timescale for action 30/6/05 2. 7 12/7/05 3. 8 12(1)(a)( b) and 13(4)(c) 12(1)(a)( b) and 13(4)(c) 13(2) 17(1)(a) and schedule 3(3)(i) 16(m)(n) 30/6/05 4. 8 30/6/05 5. 9 30/6/05 6. 12 30/7/05 7. 26 12(1)(a) 30/6/05 Page 21 Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 13(3) 8. 27 9. 31 10. 36 11. 38 12. 38 13. 14. 15. 38 38 36 care plans and measures including provision of handwash facilities for infection control. 18(1)(a) Dependency levels of residents must form the basis of calculating staffing levels. A copy of the calculation to be submitted to the Commission for Social Care Inspection. 8(1) The registered provider must inform the CSCI of the arrangement to be made for the recruitment of a registered manager. 18(2) Staff must receive formal supervision at least 6 times per year.(previous timescale of 20/1/05 not met) 12(1)(a)( All bed rails must be checked for b) and compliance with safety 13(4)(a)(c regulations and replaced where ) necessary. (letter of serious concern issued) 18(1)(a)(c All staff employed in the home ) must receive statutory training to include food hygiene and fire training and a training matrix maintained to evidence current training. 17(2) Fire records must be kept up to Schedule date and show all checks and fire 4 (14) drills. 13(4) There must be an identified first aider on duty at all times. 10(2)(b) In order to demonstrate that he has the skills and experience to carry on the care home the responsible individual Dr (Mr) Thakkar, is required to undertake a 3-day introductory course in dementia care mapping through a recognised dementia care training organisation. Evidence of this must be forwarded to the Commission for Social Care Inspection. (previous timescale not reviewed on this inspection, a letter has been sent C51 S12614 Five Gables V223636 120505 Stage 2.doc 30/6/05 30/6/05 30/7/05 13/5/05 30/7/05 30/6/05 30/6/05 30/6/05 Five Gables Care Home Version 1.30 Page 22 to the registered provider to clarify action taken.) 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 24 28 28 32 Good Practice Recommendations Furniture including beds in resident bedrooms must be in good repair. The keys that are no longer required for resident bedrooms should be removed from the clinic. 50 of all care staff shoould be qualified with a NVQ at level 2 or above. A plan should be developed for the management of the home to assure clear leadership while a suitable registered manager is employed. Five Gables Care Home C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 Page 23 Commission for Social Care Inspection 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 © 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 C51 S12614 Five Gables V223636 120505 Stage 2.doc Version 1.30 Page 24 - 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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