Inspection on 22/04/09 for Five Gables Nursing and Residential Home

This inspection was carried out on 22nd April 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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... 12/05/05

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 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Five Gables Nursing and Residential Home 32 Denford Road Ringstead Kettering Northants NN14 4DF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Irene Miller     Date: 2 2 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Five Gables Nursing and Residential Home 32 Denford Road Ringstead Kettering Northants NN14 4DF 01933460414 01933622807 fivegablesnh@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Jade County Care Homes Limited care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be admitted to the home is:43. The registered provider may provide the following category of service: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary needs on admission to the home are within the following categories: Old age, not falling into any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Five Gables Residential Care and Nursing Home can accommodate up to 43 older people, some of who have dementia and/or physical disabilities. The home is situated in the rural village of Ringstead. Residents are accommodated in one of three units 0 3 1 0 2 0 0 8 43 0 Over 65 0 43 Care Homes for Older People Page 4 of 28 Brief description of the care home depending on their needs. The Villa, at the rear of the property, caters for mainly nursing residents, and has a small dementia unit within it. The Lodge, at the front of the property, accommodates those needing residential care only. The Villa, dementia unit, and most areas of the Lodge are accessible to people with limited mobility. The grounds include a car park, mature gardens, and patio areas. The fees at the time of the last key inspection ranged from 380 pounds to 400 pounds per week. Further information about the home is available from the Registered Manager. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report contains reference to The Commission for Social Care Inspection (CSCI) and the Care Quality Commission (CQC). Regulatory responsibilities under the Care Standards Act 2000 transferred to CQC on 1st April 2009. The focus of all inspections undertaken by the Care Quality Commission are based upon seeking the outcomes for people using the service and their views of the services provided. This visit was unannounced and focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. The care records of people using the service were sample checked which involved Care Homes for Older People Page 6 of 28 looking through written information available on their care, such as their individual care plans (a care plan sets out how the home aims to meet the individual service users personal, healthcare, social and spiritual needs). During the visit people using the service were consulted on how they view the care provided at the home, and discussions with staff gave an insight into the support and training provided at the home. Observations of care practices and discussions with people using the service gave an indication on the quality of the service provided at Five Gables. Records in relation to the homes management and administration systems, quality assurance, staffing and general policies and procedures were viewed. Prior to this visit we sent out to the provider an Annual Quality Assurance Assessment (AQAA) this document allows the provider to supply us with information on how they view their own performance, such as what they do well, what they could do better and plans for future improvements. The AQAA was returned to the Care Quality Commission CQC within the timescale set, and gave an insight into how the home quality assess their own performance. In addition prior to the inspection CQC sent out to the home a number of satisfaction surveys for people using the service, relatives, staff and healthcare professionals to complete and return, comments received from the surveys have been included within this report. What the care home does well: What has improved since the last inspection? What they could do better: Assessments and associated care plans need to be implemented without delay following admission of people into the home and these documents need to be reviewed as and when peoples needs change. Nutritional screening needs to be undertaken upon admission to the home and subsequently on a periodic basis, this includes keeping records of weight gains and losses and appropriate action taken. Care Homes for Older People Page 8 of 28 Where monitoring charts are in use such as fluid monitoring charts staff must ensure they accurately record when fluids have been offered, received or refused. Some of the comments received via the satisfaction surveys and comments from people during the inspection about the variety of foods available at the home indicated that consideration should be given to reviewing the menu in consultation with people using the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in completing the pre admission assessment would ensure clarity on whether the persons needs can be met at the home. Evidence: Within the care plans viewed there was evidence of pre admission assessments having been carried out which had identified the current health, personal care and social needs of the individuals, however within one of the assessments viewed the outcome of the assessment had not been completed therefore it was unclear as to whether the home could meet the persons needs, in addition it had not been signed or dated by the person carrying out the assessment nor by the person being assessed or their representative. On the day of inspection a person was admitted for a short respite stay and was able to bring her dog with her, she confirmed that prior to admission the registered manager had visited them within their own home to carry out a pre admission Care Homes for Older People Page 11 of 28 Evidence: assessment. In discussion with the person they stated that they had been looking forward to staying at the home and were pleased they were able to bring their dog with them. Comments received within the surveys returned to the Care Quality Commission indicated that not many of the people living at the home were aware of having a contract in place and placed trust in their relatives to deal with such matters. People were asked had they receive enough information about the home prior to moving in. comments were as a family no, we have always asked to be kept in the loop, the loop as in information from the home, I could have done worse, my mother as very ill when she moved in so the family had to make the decision, 5 Gables was the only home that would take her. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Risk assessments and monitoring documentation is not being consistently used, this places people using the service at risk of their health and personal care needs not being fully met. Evidence: We looked at the care plan for a person who was recently admitted into the home, the pre admission assessment was available within their care plan and based upon the information within the assessment some risk assessments had been completed and some had been partially completed. A falls risk assessment had been completed on admission as the person had been admitted to the home due to being at risk of falls, the assessment identified the person at medium riskof falls. However the person had sustained another fall since admission into the home and this had not been reflected within the falls assessment by means of a review. Since admission into the home the persons nutritional intake had began to decline Care Homes for Older People Page 13 of 28 Evidence: there was several references within the daily notes where the person had at times refused meals, the person was prescribed food supplements and was observed to have been offered the supplement during the inspection. In discussion with the registered manager they confirmed that the person had lost weight since their admission into the home, and that their general practitioner had been to visit them on several occasions. However there was no formal record available such as a nutritional assessment to demonstrate that the persons dietary intake was being monitored. In discussion with the staff they confirmed that the person had been weighed on admission however no record of weight was available to view. Staff confirmed that a fluid observation record had been put into place for the person, however there was scant recording therefore it was difficult to establish when fluids had been offered, taken or refused. We visited the person within their bedroom, it was noted that a fruit juice drink and an open carton of their prescribed nutritional supplement drink were available within reach. There was records of the person having been seen by their general practitioner on four occasions since their admission into the home and of being re-admitted back into hospital for further assessment. We looked at the care of people requiring pressure area care and observed that pressure relieving equipment was available and in use. We looked at the medication administration records and medication storage facilities which appeared to be well managed. Comments received from people using the service during the inspection were in the main positive all spoken with said they were pleased with the care and support provided by the home, one person said that the home employs a lot of foreign staff saying that sometimes the communication can be a little difficult but the girls have a heart of gold and will do for them anything for them. The following comments were received from the surveys returned to the Care Quality Commission, the staff do care for the clients, the clients become more dependent therefore meeting their needs takes more time to be spent on them, we do not have enough staff to give the clients the time they need. The following comments were received from within the surveys returned from health care professionals that visit the home were being in care is not anyones first choice, I have not encountered any issues where health care needs are not met, no problems with medication, good personal care, they make the residents as happy and contented as possible, the home has improved recently under new personnel, we Care Homes for Older People Page 14 of 28 Evidence: have a close relationship with the local GP surgery who monitor health needs. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in the provision of activities is having a positive effect on the lives of people using the service. Evidence: The home has appointed two activities coordinators, in discussion with one of the activity persons they spoke of the development of an activity program to meet the individual and social needs of people using the service, they confirmed that training was to be provided for them to gain a greater knowledge of activities that are suitable for people living with dementia. An emphasis is placed on people using the service having opportunities to be in contact with the local community. Monthly talks have been introduced form outside speakers and on the day of the inspection a speaker came to give a talk on Local Heroes. On the notice board in the dementia care unit there was dates and information available of a clothing party taking place and an invitation from Raunds Infant school for some people using the service to visit during their assemmbly. Outside entertainers and specialist services come to the home to include music for health, hairdresser and aromatherapist, singers musicians and the people from the Care Homes for Older People Page 16 of 28 Evidence: local church. Regular meetings are held with residents and feedback is encouraged in order to ensure the activities provided at the home are suitable. Comments received from relatives with regards to activities indicated that perhaps communication could be improved to ensure that all relatives are aware of the activities taking place. Comments such as, we assume that there are activities arranged by the home, but really are not informed of any activities. The meal on the day of the visit was a choice of Cauliflower Cheese or Sausage Casserole, when people were asked about the standard of the food available one person said the kitchen do a good job, but the foods is a bit monotonous another person said we seem to get allot of stews. The following comments were received through the surveys returned to CQC the feedback from my mother is that she thoroughly enjoys her food, it always smells good, I feel that the standard of cooking and meal planning has deteriorated, I would like more variety of meals. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their concern and complaints will be listened to and acted upon. Evidence: Since the last key inspection we received one complaint about this service which prompted an unannounced random inspection on 3rd October 2008, all areas of the complaint were looked at and requirements were made in relation to medication administration records and the provision of activities. At this inspection there was seen to be improvements in both these areas. Records of concerns and complaints made at the homes level were viewed and demonstrated that the service aims to respond to any concerns or complaints brought to their attention to bring about improvements to the home. Meetings take place on a regular basis with service users and their representatives to enable open dialogue. The complaints procedure is on display throughout the home and all residents and their representatives are given a copy of this. Staff are trained in safeguarding during their induction and ongoing safeguarding training provided. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean and homely environment. Evidence: Since the last key inspection improvements have taken place to include the redecoration of rooms and the replacement of carpets to communal areas. All of the beds have been replaced with new profile (nursing) beds and new dining tables have been purchased, work on improving the environment is ongoing. Bedrooms viewed during the inspection were individually decorated and personalised and all the communal areas were clean and tidy. Within the annual quality assurance assessment (AQAA) the provider has identified that within the next twelve months they are to replace chairs in the lounge area and install new lighting and the outside of the home to undergo drive and pathway improvements. Longer term plans for improvement are to continue with the redecorating and refurbishment programme and plans for building works to connect the lodge and the Villa to incorporate a new laundry, office and a larger dining room and for the Lodge to have upstairs access via an elevator lift instead of a stair lift. Care Homes for Older People Page 19 of 28 Evidence: Some work has begun on altering the grounds to improve safety and better accessibility for the people using the service. Comments received through the satisfaction surveys were in the main positive about the environment, one survey showed dissatisfaction of the cleanliness of the home which has been brought to the attention of the registered manager to enable further investigation into the areas of concern. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service benefit from having a staff team who are appropriately trained to meet their needs. Evidence: On the day of inspection there was sufficient staff on duty to care for the number of people using the service. In discussion with people at the home they all expressed a fondness for the staff who provide their care. All comments were praising such as we can have a laugh with the staff, they really listen to what we say, sometimes I find it hard to understand some of the foreign staff, but I ask them to speak a little slower to me then I can understand them, they will do anything you ask and are always willing to help. We looked at the recruitment files of three staff and all had the relevant documentation to demonstrate that pre employment checks were carried out prior to taking up post to include checks with the criminal records bureau (CRB) and the protection of vulnerable adults register (POVA first) and written references obtained. We looked at the recruitment files of three staff and all had the relevant documentation to demonstrate that pre employment checks were carried out prior to taking up post to Care Homes for Older People Page 21 of 28 Evidence: include checks with the criminal records bureau (CRB) and the protection of vulnerable adults register (POVA first) and two written references obtained. Within the files viewed there was records of individual staff training, initial induction training is provided through the use of training video packages covering health and safety, moving and handling, fire awareness and food hygiene. All staff are currently working toward or hold a National Vocational Qualification level 2 and 3. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run in the best interests of residents by an experienced Manager. Evidence: The registered manager is a qualified and experienced nurse and has completed the Registered Managers Award (a recognised professional qualification for people who run care homes). All the people spoken with during the inspection said that they have regular contact with the manager and the new owners of the home. Records of staff supervision were made available to view, and indicated that supervision generally takes place in the form of staff meetings, more opportunities for staff to be individually supervised is needed. this will ensure that staff have the opportunity to discuss their personal development needs. Quality Assurance systems are in place to regularly audit health and safety and Care Homes for Older People Page 23 of 28 Evidence: satisfaction surveys are given out to people using the service and families annually. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Pre admission assessments must be signed and dated by the person carrying out the assessment and the person being assessed, or where this is not possible by a representative of the person. The pre admission assessment must indicate the outcome as to whether the persons needs can be met by the home. This will ensure that the pre admission assessment process is robust. 15/07/2009 2 7 15 Care plans must be based 15/07/2009 on an assessment of peoples current needs, kept under review and updated as peoples needs change. This will ensure that all staff are fully aware of the level of support required for each person using the service. Care Homes for Older People Page 26 of 28 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 8 13 Nutritional screening must 15/07/2009 be undertaken upon admission into the home and records kept of the actions taken where weight gains and losses are identified. This will ensure that appropriate action is taken to meet individuals nutritional needs. 4 8 13 Risk Assessments must identify the current risks for individuals and be reviewed on a continual basis or sooner as and when peoples needs change. This will ensure that staff are fully aware of the actions needed to ensure the health, safety and welfare of people using the service. 06/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 15 The registered manager should consider reviewing the menu in consultation with people using the service. This will enable the people using the service to choose what they would like to see on the menu. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!