CARE HOMES FOR OLDER PEOPLE
Five Gables Care Home 32 Denford Road Ringstead Kettering Northants NN14 4DF Lead Inspector
Irene Miller Unannounced Inspection 3rd May 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 DS0000012614.V291032.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. DS0000012614.V291032.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 460414 01933 622807 5gables@gmail.com 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 DS0000012614.V291032.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) 12th January 2006 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 cares 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. The fees range from £288.45 to £348.55 per week. DS0000012614.V291032.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 on this occasion involved tracking the care of three residents, through reviewing care records and general discussion with residents, visitors and staff. A limited tour of the building and grounds was conducted, and records relating to the maintenance and upkeep of the building were looked at, along with records in relation to the management and administration within the home. The inspection visit was unannounced the acting manager was available throughout the whole of the inspection, which took place over a period of five and a half hours following approximately two hours preparation, that included reviewing previous inspection reports, and other documentation in relation to the home. What the service does well:
The lifestyle in the home meets the resident’s needs and expectations; the home has a flexible approach to residents individual routines, this was demonstrated within the care plans and daily reports viewed. Visitors said that the staff are excellent and that they are fully informed and involved in the care of their loved ones, saying that the home is run in a very professional manner, always with the residents best interests in mind. One visitor said that whenever they visit their relative, they are always made welcome by the staff and that her relative always looks well cared for, comments were received such as “the home has given me back my life” and staff go that extra mile. The home endeavours to seek information on residents past lifestyles, interests and hobbies, records are available to facilitate staff in providing suitable activities for residents based upon their individual lifestyle and preferences. The staff are knowledgeable of individual residents medical conditions and work closely with health care professionals to ensure that the medication administration is appropriate for each of the individual residents needs. Rigorous staff recruitment procedures ensure that residents are in safe hands at all times. DS0000012614.V291032.R01.S.doc Version 5.1 Page 6 The registered provider conducts periodic quality audits with residents and visitors to continually improve on the quality of care provided at the home, records were seen of the most recent quality audit. 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 contacting your local CSCI office.
DS0000012614.V291032.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 DS0000012614.V291032.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): 1,2,3,4 & 5 Standard 6 is not applicable to this service. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The admission process enables prospective residents to make a fully informed choice as to whether the home will meet their needs and expectations. EVIDENCE: The statement of purpose, service user guide and copies of inspection reports are readily available to all prospective and existing residents. In addition an information booklet has been introduced outlining the services that the home offers, such as hairdressing, optician, chiropody and aromatherapy. Detailed pre assessments are conducted and each prospective resident is encouraged to visit the home prior to moving in to ensure that the home can fully meet their needs.
DS0000012614.V291032.R01.S.doc Version 5.1 Page 9 One relative spoken prior to moving into the home only went that they could fully to said that the pre assessment of their mothers needs the home was exceptional, and that it was reassuring that ahead with the admission when it had been established meet their mothers needs. DS0000012614.V291032.R01.S.doc Version 5.1 Page 10 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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The information contained within the care plans, ensures that resident’s needs have been identified and can be met. EVIDENCE: The care plans viewed, demonstrated that much work has taken place on ensuring that the information contained within them was current to residents health and personal care needs. Within the care plans the input from other professionals such as the district nurse and general practitioner was recorded, and the treatment and action taken to address any health care needs was recorded. Within the care plan of one of the resident’s case tracked, it was identified that the residents was at risk of falling out of bed, a falls risk assessment was in place and bedside rails had been introduced. Where it was not possible for the resident to give their consent, the involvement of the next of kin had been
DS0000012614.V291032.R01.S.doc Version 5.1 Page 11 sought for the equipment to be in place, and a risk assessment for the suitability of the bedside rails in relation to the bed occupant was in place. The storage, administration and recording of residents medication was well managed, the home had recently had a pharmacy inspection and all stock medication was stored securely. A medication training pack was looked at which the home plans to introduce, to further develop the knowledge and skills of staff that are charged with the responsibility of administering medication to residents. Staff were observed treating residents in a respectful and courteous manner. Residents were addressed by their preferred name; residents said that they were very happy with the care they received at the home, saying that staff are always willing to help in any way that they can. Relatives spoken to said that “the staff go that extra mile”, and that “the staff really care about the residents living at the home”, visiting relatives said that they were always consulted and fully informed whenever there is any changes in the health of their relatives. DS0000012614.V291032.R01.S.doc Version 5.1 Page 12 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The lifestyle in the home meets the resident’s needs and expectations. EVIDENCE: Residents were observed moving around the home independently as they wished, chatting with staff and visitors, choosing were to spend their time. Records within care plans contained information on resident’s individual and social preferences in relation to activities, and records were retained within the resident’s daily records of the individual activities undertaken by the residents. Information was available within the homes newsletter on items purchased from the amenity fund such as, a filter coffee maker, and a pump and tropical for the fish tank that had been donated to the home. Staff and residents said how much they had enjoyed organising and participating in the homes Easter celebrations, which included a raffle that raised funds for items to be purchased for the home to provide extra comforts
DS0000012614.V291032.R01.S.doc Version 5.1 Page 13 for residents, ideas for items to be purchased where foot spas, and a bird table for the patio. Activity material was available such as reminiscence books, the home has put together a ‘pictures for thought’ book which contains cuttings from magazines on a range of themes such as home baking, gardening, scenes of the countryside, the book serves as a tool to strike up conversation and memories of residents hobbies and interests. Resident’s quizzes take place and outside musical entertainers visit the home on a regular basis. Residents are facilitated in pursuing their own interests. Staff were observed welcoming visitors into the home. Provision is available for residents who wish to worship according to their faith; a church service takes place on the last Wednesday of each month. The home has a flexible approach to the times of day that residents get up and go to bed, this was demonstrated within the care plans and daily reports viewed. The care plans demonstrated flexibility in accommodating the individual routines of residents The home has invested in Dementia Care Mapping training, however this is yet to be put into practice to further develop on the person centred care that the home endeavours to provide. Resident’s weights are closely monitored and dietary preferences recorded within the care plans, eating and drinking care plans for residents who require extra support were detailed and individual to the residents needs. There is a four week menu in place and the meal on the day of inspection was chicken casserole with potatoes and mixed vegetables, followed by sponge and custard. There was fresh fruit readily available, and a range of home made cakes of which a selection where suitable for diabetics. Residents said that they are very satisfied with the meals however if something was on the menus that they disliked, they could choose an alternative. The kitchen was viewed, which was clean and tidy, with a well-stocked larder, systems were in place to demonstrate that food safety standards are followed and that the kitchen is managed to a high standard. The lounge/dining room was clean and pleasant and tables were nicely decorated. DS0000012614.V291032.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be confident that any concerns they may have about the service will be taken seriously and acted upon. EVIDENCE: There is a complaints procedure in place and is incorporated within the homes statement of purpose and service user guides. Procedures for addressing any concerns or complaints are followed. The Commission for Social Care Inspection has not received any concerns or complaints about the service since the last inspection-taking place. Training on the protection of vulnerable adults takes place during induction training and refresher training. Staff said that they would know how to report any suspected or actual abuse should there be a need to. The home has a copy of the Northamptonshire Inter Agency Policies and Procedures available should any suspected or actual abuse be reported. DS0000012614.V291032.R01.S.doc Version 5.1 Page 15 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): 19,20,21,22,23,24 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents living at the home are provided with a pleasant, homely and comfortable environment. EVIDENCE: Records in relation to fire and building upkeep were looked at and demonstrated that the necessary fire, electrical, water and gas checks are taking place. Fire system checks are conducted weekly on random days, to ensure that all staff are involved in the fire training during the course of their working week. On a day-to-day basis the staff record any faults or repairs, which they come across that require attention by the maintenance worker, for example
DS0000012614.V291032.R01.S.doc Version 5.1 Page 16 replacement light bulbs, adjustments to water and heating temperatures and minor furniture repairs. There is a repair and renewals programme in place; information on the dates and areas identified for redecoration and replacement of furnishings was available. The maintenance worker was busy redecorating the staff room on the day of inspection. A limited tour of the building was conducted and all communal areas were pleasantly furnished and welcoming. Residents rooms viewed were personalised, each resident has there own individual bed linen available, items such as televisions, radios, personal ornaments and small items of personal furniture were within residents own rooms. The bathrooms and toilets looked at were clean; however within the thirtybedded unit not all the bathrooms had aids and adaptations available, such as bath hoists to meet the physical dependency needs of residents. One of the bathrooms without a bath hoist was being used as a storage room. The occupancy of the home is approximately 50 , however should the home be at full occupancy the bathing facilities within the ‘Villa’ would not be sufficient to meet the needs of all thirty residents. The home has two hoists available to assist with the moving and handling of residents with limited mobility. The garden is well maintained and there was a pleasant patio area, with flower tubs, which had been planted with care and consideration that non of the plants had toxic or skin irritation risks, eradicating any potential harm to residents, especially those living with dementia. Bird feeders and nesting boxes have been introduced to areas visible from within the home, and residents have been showing a keen interest in the wildlife activity that has been generated. Within the dementia care unit, much work has taken place in providing an environment, which is stimulating, tactile/sensory boards have been introduced and bedroom doors have been personalised to include pictures relating to the occupants hobbies, interests and previous occupations. The home was clean and hygienic, however the carpet within the dementia unit lounge/diner had an unpleasant odour; which is thought to be due to food and drink spillages, the acting manager said that despite a rigorous cleaning regime in place and the use of various cleaning and deodorising agents to eliminate the odour this remains to be a problem. DS0000012614.V291032.R01.S.doc Version 5.1 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number and skill mix of staff meets the needs of residents. EVIDENCE: Staffing levels are sufficient to meet the current needs of the residents. There is a training plan in place and training records available, evidenced that staff receive mandatory induction training on moving and handling, food hygiene, fire procedure, health and safety and first aid. National Vocational Qualification training levels 2 and 3 is on going. Staff recruitment documentation seen, demonstrated that staff recruitment is thorough and robust. DS0000012614.V291032.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): 31,32,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is run in their best interests, the residents rights to choice, privacy and dignity and respect is promoted. EVIDENCE: The acting manager has recently completed National Vocational Qualification level 4 training to include the units required for the registered managers award. Having worked at the home for a considerable number of years she has an in-depth knowledge of the needs of the residents living at the home, and is well respected by residents, staff and visitors; it was evident through discussion and review of documentation that she is skilled, experienced and competent within her role.
DS0000012614.V291032.R01.S.doc Version 5.1 Page 19 There is an open and inclusive atmosphere within the home, staff said that they feel supported, and enjoyed working at the home, staff said that there was opportunities to develop their skills and training was available, training courses attended included moving and handling, dementia care and courses aimed at caring for the conditions of residents living within the home, such as Parkinson’s, diabetes and stroke care. During the inspection the acting manager and staff were observed communicating and interacting with residents and staff and visitors in a relaxed and courteous manner. Visitors said that the staff are excellent and that they are fully informed and involved in the care of their loved ones, saying that the home is run in a very professional manner, always with the residents best interests in mind. Residents, relatives and staff meetings are held on a regular basis and the registered provider conducts periodic quality audits with residents and visitors to continually improve on the quality of care provided at the home, records were seen of the most recent quality audit. The home has recently introduced a no smoking policy within the home and has achieved a diamond award through Northampton County Council. Resident’s confidential records and financial details are stored securely. DS0000012614.V291032.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 3 3 3 3 3 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 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 3 3 3 X 3 X X 3 DS0000012614.V291032.R01.S.doc Version 5.1 Page 21 No 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. 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 DS0000012614.V291032.R01.S.doc Version 5.1 Page 22 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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