Inspection on 14/04/09 for Gables Nursing Home

This inspection was carried out on 14th April 2009.

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

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

Gables Nursing Home 15/10/09

Gables Nursing Home 14/01/09

Gables Nursing Home 23/12/08

Gables Nursing Home 21/08/07

Gables Nursing Home 06/06/06

Gables Nursing Home 16/09/05

Gables Nursing Home 25/05/05

Gables Nursing Home 19/10/04

Gables Nursing Home 13/05/04

Gables Nursing Home 03/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Key inspection report Care homes for older people Name: Address: Gables Nursing Home Barrows Green, Bradfield Road Leighton Crewe Cheshire CW1 4QW     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Joan Adam     Date: 1 4 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 26 Information about the care home Name of care home: Address: Gables Nursing Home Barrows Green, Bradfield Road Leighton Crewe Cheshire CW1 4QW 01270588952 F/P01270588952 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr William Preston care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: This home is registered for a maximum of 34 service users to include:- * Up to 34 service users in the category of OP (Old age, not falling within any other category) * Up to 5 service users aged 55 years and over in the category of PD (Physical disability) Date of last inspection Brief description of the care home The Gables is a care home providing accommodation and nursing care for 34 older people, 5 of whom may be aged between 55 and 65 years of age. The service is located in an extended, detached two storey property, situated in its own grounds in a semi-rural setting on the outskirts of Crewe. The home is easily accessible from Nantwich, Winsford, Middlewich and Sandbach. It is served by local transport and is close to railway networks, being two miles from Crewe station. Bedroom accommodation is situated on both floors and is provided within single bedrooms. All bedrooms are provided with wash hand basins, but there are no en-suite facilities. Day space consists of three lounges, one of which is a smoking area. A separate dining Care Homes for Older People Page 4 of 26 Over 65 34 0 0 5 2 3 1 2 2 0 0 8 Brief description of the care home room is also available. There is a passenger lift and staircase providing access to the first floor. The home is registered for nursing and personal care for persons with general physical frailty. The fees range from #353.91 per week for personal care only to #415.72 per week for those requiring nursing care. Care Homes for Older People Page 5 of 26 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: zero star poor 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: We made an unannounced visit to The Gables on 14 April 2009. This was to assess if peoples needs were being met at the home. During the visit we spoke to the acting manager,general manager, some staff members and some residents. Some of the comments we received and the information is detailed in this report. Feedback was given to the acting manager and general manager at the end of the visit. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: 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 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 7 of 26 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 8 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home have had their need assessed before they were admitted so that they knew their need could be met. Evidence: There have been no people admitted to the home since November 2008. The preadmission details for this person were looked at during the last visit to the home in January 2009 and were found to completed. this standard was not assessed on this visit. Care Homes for Older People Page 9 of 26 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. The health and personal care of people are not fully met however, the recording of actions by staff has improved. Evidence: There were new care plans in place at the home which had been provided by a consultancy company. Training had been given by the company to trained staff prior to them being used. These had all been completed and staff spoken with said that they were easier to use than the previous ones. The care plans were completed well and the assessed needs of people living in the home were identified and written guidance was given to staff as to how to look after the person. Daily records had improved and contained more detail as to how the person had been on a day to day basis. However, the care plans in place regarding meeting hygiene needs stated that the people who live in the home had regular baths given to them. On speaking with the acting manager it appeared that no one had received a bath for some time as this service was offered but people had refused. Some people who live at the home are unable to make a choice as they have dementia. The care plans did not make this clear, daily notes written stated that hygiene needs had been met but it was not Care Homes for Older People Page 10 of 26 Evidence: indicated that bed baths were given , not general baths. Care plans had not as yet been evaluated as they had only just been completed. Although the care plans had improved they did not fully reflect the care that was being given. Care plans for one person who was poorly did contain guidance as to how often they were to be checked and their position changed and charts were completed by staff. Risk assessments were in place for bed rails and these had been signed by families, however, some of the beds had rails in place that were unsuitable. Staff were checking on these people more often and profiling type beds had been ordered. Medication management was looked at and this appeared to have improved. All medication administration sheets had been signed so that staff would know if people had received their medicines. A check sheet was in place for the ordering and receipt of medicines so that staff could check if the correct amount had been delivered to the home. The prescribed supplements had all been entered on the white board in the satellite kitchen so that all staff were aware which supplements belonged to which person and how often they were needed. There was a weekly audit system in place so that problems could be highlighted and acted upon quickly. Care Homes for Older People Page 11 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are on offer but these may not be suitable for the people living at the home. Evidence: There was evidence of some activities taking place such as pictures that had been coloured in by the people who live at the home. Some craft boxes were being made by a few people but the majority of people who live at the home have some degree of confusion and it was discussed with the proprietor and acting manager if the activities on offer were appropriate to the age and client group. They said that this was to be reviewed in the near future as the activities activities co-ordinator was going on maternity leave and a replacement staff member would need to be employed. Some choices had been recorded in the care plans, however, the acting manager was still having discussions with relatives and residents as to the type of things people would like to do. The supply of food at the home has improved with more stock in the store room and freezers. The cooker and grill had been replaced with reconditioned ones. The cook has commenced home baking and has a recorded cleaning schedule in place so that staff would know what to do in her absence. A partition wall has been knocked down so that there is more room to work but this has meant that a part of the flooring needs to be replaced. The flooring in the doorway of the kitchen has still not been Care Homes for Older People Page 12 of 26 Evidence: replaced. This was discussed at the last visit and by the environmental health officer during her visit. Care Homes for Older People Page 13 of 26 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. Complaints are recorded and staff have received training on safeguarding of people. Evidence: The general manager has commenced a complaints log and two complaints received in the home had been recorded. The action taken was also recorded. Staff have received some training regarding safeguarding of adults in the form of a twenty minute video by Mulberry training. Staff spoken with appeared to know what to do if there was suspicion of abuse. The trained staff have a more detailed training session booked in May with the PCT regarding abuse. . Care Homes for Older People Page 14 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home still needs work to improve the environment for people who live there. Evidence: The new shower which will assist staff to shower people safely and comfortably is almost complete. This has been an outstanding requirement from the last three key inspections. The sluice machine has been mended so that staff can dispose of waste safely. Some new radiators have been put into some bedrooms which are low touch temperature so that people who live in the home are not at risk of burning themselves.The call bell system has been repaired so that people can call for help when they need it. The home and furnishings in general look shabby and although work is on going this appears to be lacking in organisation and this was discussed fully with the general manager and acting manager. The patio area has not as yet been repaired to make it safe for people to go outside as the builder feels it would be better to wait for better weather. It was observed that only three people who live at the home used the dining room and the rest stayed in the lounge area with a table in front of them. This was discussed with the general manger and acting manager and they said that people were asked but preferred to stay in the lounge to eat. The dining room has plastic type table cloths in place and this detracts from a homely appearance. Some empty bedrooms on the ground floor had personal items which had not been taken out such as photographs, ornaments, dressing gowns and slippers. Although the Care Homes for Older People Page 15 of 26 Evidence: home looked clean some bedrooms and bathrooms had a musty smell to them. Care Homes for Older People Page 16 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training needs to be improved so that staff can develop and improve the care given Evidence: Staff were observed during the day and they appeared to have enough time to meet peoples needs and not rush them. The duty rota showed that there were enough staff on duty and there has been a reduction in the amount of agency staff used at the home so that people who live at the home know the staff. Some staff training has taken place and staff have watched a twenty minute video from Mulberry training regarding safeguarding adults. Staff training is now being recorded so that the management know who has received training and when. A planned training programme is in place so that training sessions can be booked. However, only three staff members have received training in moving and handling so that they can move people safely. This was a requirement at the visit in December and has not been met. No staff have received training with regard to fire safety.This means that staff may not know what to do in the case of a fire. This was a requirement at the visit in December and has not been met. The home had a visit from the fire officer in April and she requested that all staff have full evacuation training due to an area in the loft of the home needing a fire safety curtain to be fitted. Some staff supervision has taken place and this has been recorded. The staff that work in the kitchen have received safe food handling training and all staff at the home Care Homes for Older People Page 17 of 26 Evidence: are to undertake this training. We were informed that no new staff have been employed at the home since the last visit. Care Homes for Older People Page 18 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management needs to improve to ensure the safety and welfare of the people living at the home. Evidence: The home has an acting manager at present who has been recruited from an agency. She has experience in nursing home management. She been interviewed and has been offered the post subject to recruitment safety checks. Relative meetings are still taking place with social services in attendance to keep people informed as to what is happening in the home. The proprietor and general manager are meeting with relatives for coffee mornings to discuss any problems they may have. Questionnaires have been developed so that formal views of people who live in the home can be gained. These have not been finalised as yet but it is the intention to send them out as soon as possible. Staff training needs to take place with regard to fire safety so that staff will know what to do in the case of a fire. Training needs to take place with regard to moving and handling so that staff are aware of how to move people safely. These were unmet Care Homes for Older People Page 19 of 26 Evidence: requirements from the last visit and will be repeated. The acting manager is trained to teach staff how to move people safely and she will commence staff training in the near future. More structured visits are taking place from the proprietor in the form of a regulation 26 visit and copies of these reports can now be seen. Risk assessments were in place for bed rails and these had been signed by families, however, some of the beds had rails in place that were unsuitable.We were informed that profiling beds had been orded to rectify this problem. Care Homes for Older People Page 20 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 12 16(2)(n) People who live at the home must be given access to more activities to enable them to be mentally stimulated. The patio areas outside the home must be made safe . So that the people who live in the home can use the gardens safely. 31/10/2007 2 19 13 31/03/2009 3 21 23(2)(j) A shower must be provided 31/12/2007 at the care home to enable the people who live there to be given a choice of bathing. ( Timescale of 6/12/06 not met) A shower which can be used 28/02/2009 by people who need assisitance must be provided Timescale of 6/12/06 and 31/12/07 not met. So that people who live in the home can be gien a choice of bathing. 4 21 23 5 28 23 All staff working at the home 28/02/2009 must undertake training in fire safety So that they know what to do in case of fire Care Homes for Older People Page 21 of 26 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 6 29 13 All staff working at the home 28/02/2009 must undertake training in moving and handling . So that people who live at the home can be moved safely. Care Homes for Older People Page 22 of 26 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 1 7 13 Care plans must fully reflect 29/05/2009 the actual care given to people who live at the home. Especially with regard to meeting hygiene needs. So that peoples hygiene needs are fully met. 2 12 16 Activities must adequately 29/05/2009 reflect the age group and mental capacity of the people living at the home. So that people are kept stimulated. 3 31 10 The home must have a manager in post who is registered with CQC So that the fitness of the manager has been assessed. 30/09/2009 4 38 23 All staff who work at the 29/05/2009 home must have fire safety training as requested by the fire authority. Unmet requirement 28/02/09 So that staff know what to do in case of fire. 5 38 13 All staff must receive training 05/06/2009 with in moving and handling of people. Unmet requirement 28/02/09 So that people who live at the home can be moved safely. Care Homes for Older People Page 23 of 26 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 19 23 The patio areas must be made safe. Unmeant requirement 28/02/09 So that people who live in the home can access the garden areas safely. 05/06/2009 2 30 23 All staff who work at the home must have fire safety training as requested by the fire authority. Unmet requirement 28/02/09 So that staff know what to do in the case of a fire. 29/05/2009 3 30 13 All staff must receive training with in moving and handling of people. Unmet requirement 28/02/09 So that people who live at the home can be moved safely. 05/06/2009 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 19 It is recommended that the work being carried out at the home is more structured so the work is carried out more efficiently. It is recommended that the plastic tablecloths be removed Page 24 of 26 2 19 Care Homes for Older People 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 from the dining room tables so that a more homely atmosphere is presented. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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