Inspection on 15/10/09 for Gables Nursing Home

This inspection was carried out on 15th October 2009.

CQC found this care home to be providing an Adequate 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 14/04/09

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 16/02/2010.

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:   one star adequate 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 5 1 0 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 21 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 21 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 Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 34. 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 Care Homes for Older People Page 4 of 21 Over 65 34 0 1 4 0 4 2 0 0 9 Brief description of the care home space consists of three lounges, one of which is a smoking area. A separate dining 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 21 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: We made an unannounced visit to the home on 15th October 2009.This visit was just one part of the inspection. Other information received was also looked at. Some weeks before the visit the manager was asked to complete a questionnaire called an Annual Quality Assurance Assessment (AQAA) telling us what they thought they did well, what they needed to do better and what they had improved upon since the last visit, to provide us with up to date information about the services provided. This helps us to determine if the management of the home see the service they provide in the same way we do and if our judgements are consistent with home owners or managers. During the visit various records and the premises were looked at. People that use services, relatives, staff and manager were spoken with and gave their views about the service. Care Homes for Older People Page 6 of 21 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 21 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 21 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. People have their needs assessed before admission to the home so they know that those needs can be met. Evidence: We looked at the assessments of two people who had recently moved into the home. The manager told us that either she or one of the registered nurses carry out these assessments so these are done by someone who has the correct knowledge and skills. One person had been admitted as emergency admission so an assessment had not been carried out, however ,documents had been provided by the previous home and social services so that a judgement could be made by the home to make sure their needs could be met . There was sufficient information about both people to enable staff to draw up a care plan detailing how the home would meet their needs. Care Homes for Older People Page 9 of 21 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. Care plans need to be kept up to date so that staff know the changes in care. Medication administration sheets must be signed and dated by two staff if they are handwritten Evidence: We looked at the care plans for five of the people who live at the home in detail. Where this was possible we spoke to the people who had been admitted. Various risk assessments were written so that any identified risks could be monitored. The care plans were not always written in a way that focused on the individual so they were not person centered. One person with a pressure sore had conflicting information as the care plan for skin integrity stated that the person did not have a pressure sore, the evaluation in August stated that a pressure sore was present but this care plan had not been updated to reflect the current care needs. This means that staff would not be aware of the up to date care needed to look after these people. A new care plan had been written in October which showed that a pressure sore had been observed on their return from hospital. This showed that the wound had been treated and a wound chart was in place to detail the improvement and a visit from the tissue viability nurse Care Homes for Older People Page 10 of 21 Evidence: had taken place. The care plans for this person had not been evaluated since August and we were informed that the staff member responsible had been on holiday and was now off sick. A care plan audit should have taken place to identify this problem so it could have been rectified immediately. A second person with a pressure sore which was present on their return from hospital had a care plan in place, however a wound chart was not present to record the progress of the wound. Evaluations that had been recorded were not always detailed so that staff would know what changes if any had taken place. Records showed that, where appropriate, advice was sought from a variety of health care professionals such as GPs, specialist nurses and other professions allied to health. The privacy and dignity of people living in the home was maintained. Care staff approached people in a gentle manner and gave them assistance in a supportive and caring way so they were well looked after. We also looked at the way in which medication was being managed. Drugs are being recorded as to when they are being received in to the home and are stored appropriately. We identified a medicine administration sheet that had been handwritten, however, two staff members had not signed the entry so that they could be sure that the type of drug, dose and time of administrating the drug was correct. An audit system is in place for medications but this had not been completed monthly so that any errors are highlighted quickly so the home can demonstrate that it has taken reasonable steps to ensure that people receive their prescribed medication. Care Homes for Older People Page 11 of 21 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. People living in the home will enjoy a good quality of life through the provision of a varied programme of activities and a nutritious diet. Evidence: Activities in the home have improved. The general manager is providing activities at present and a variety of things are on offer. When people have taken part this is recorded in the care plan. A social history has been taken from people so that the home knows what type of thing thye are interested in. A life history for each person is being compiled which will contain photograghs and stories told by the person or their families. Pet dogs have been brought in to the home by staff members and most peolple enjoyed seeing them. One person said they were lovely and well behaved People have been on a trip to Stavely water gardens palm cafe. One person said it was really nice to get out A staff member brought in vegetables grown in their allotment and these were used as a discussion and then cooked and eaten. Another staff member cooked an authentic indian meal for the resident/relative lunch which was enjoyed by about twenty people. This lunch takes place every month with the proprietors and staff sitting down to eat with residents and their families. Relatives spoken with said it is a really good idea, we cant take our relative out ot lunch now and it gives us time to talk to the owners this is a great idea and makes the home Care Homes for Older People Page 12 of 21 Evidence: feel more homely A halloween hot pot supper is being arranged and relatives are helping with the arrangements. A childrens fancy dress competitian will be held. A residents forum has been started and surveys in a user friendly format has been compiled so that the views of people with communication difficulties can be gained. A monthly newsletter is also produced to give people up to date information and news. The menus at the home have been updated and improved to offer a more varied choice. The standard of catering at the home is good. The cook has a recorded cleaning schedule in place and all areas of flooring in the kichen have been replaced. A visit from the environmental health officer has awarded the home three stars for cleanliness. The dining room has been redecorated and has fresh cotton tablecloths in place which gives a more homely feel. Care Homes for Older People Page 13 of 21 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 well managed and up to date training means staff are fully aware of their responsibilities and so people living in the home are protected. Evidence: The registered manager provided us with evidence that complaints had been fully investigated and appropriate action taken following these complaints. This means that people would know their concerns are listened to and taken seriously. We also looked at the safeguarding adults policy and this provided clear information about the correct procedure to be followed and whom to contact if an allegation of abuse was made so that in the absence of the manager the appropriate action was taken. We also spoke to several staff members who had recently received training regarding adult abuse and knew who to contact other than the manager if they suspected someone was being abused. Care Homes for Older People Page 14 of 21 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 Gables is well maintained so that people live in comfortable and homely surroundings where their health and safety is promoted. Evidence: Most areas of the home have now been redecorated and new carpets and furniture have been purchased. The patio area has been relaid so that it is safe to use. The shower room is now in use and care plans stated whether people wanted a bath or shower.The home was clean, smelled fresh and measures were in place to prevent to the spread of infection. There was also a variety of equipment provided to support people with varying degrees of disability so their needs would be met. Profiling beds have been purchased for all of the people who have nursing needs so that the staff can care for people safely and comfortably. Care Homes for Older People Page 15 of 21 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. The home has adequate trained staff so that the needs of people who live there are met Evidence: We spoke to several staff during our visit. All said they enjoyed working at the home, one staf member said things have really improved another said the home is a good place to work. We looked at staffing levels in the home and these were sufficient to meet the needs of people living in the home. We looked at the recruitment records of two people and these were of a good standard. The home had obtained all necessary information about employees, including security checks so that people living in the home were fully protected. The manager showed us the induction records of new staff which were fully completed so that staff had received the necessary training to start work at the home. The home has a training matrix so that it is known when staff are due to undertake refresher training in various mandatory subjects such as safe moving and handling. The registered manager told us that nearly all the carers working at the home have achieved a minimum NVQ2 in care qualification so are skilled to carry out their role. The remaining staff are being supported to complete their NVQ training during the coming months. Care Homes for Older People Page 16 of 21 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To ensure that The Gables is well managed the quality assurance procedures in place to monitor the standards of care at the home should be completed more regularly. Evidence: The manager of the home is a registered nurse and has applied to be registered with the Care Quality Commission. She has achieved NVQ4 in management and is an experienced manager. The proprietors meet for lunch with residents and their families each month as a social event and to discuss any areas of care or improvement to the home. Relatives meetings take place on a monthly basis and minutes are taken and ciculated. A monthly newsletter has been produced to keep people up to date with news. Survey forms have been sent out to relatives and comments such as homely atmosphere were made with most questions answereed as positive. We looked at fire safety records and these were satisfactory. The manager told us that several issues raised by the fire officer had been put right. The manager told us in the AQAA that the homes equipment and facilities had been serviced and maintained on a regular basis so that people living and working there are protected. However , the audits in place Care Homes for Older People Page 17 of 21 Evidence: should be completed on a monthly basis so that errors are picked up quickly and acted upon. Care Homes for Older People Page 18 of 21 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 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 Care Homes for Older People Page 19 of 21 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 7 15 Care plans need to be up dated So that staff are aware of up to date care needs. 04/11/2009 2 9 13 Medication administration records that are hand written must be checked by two staff members who sign the record. So that they are sure the correct drug, dose and time of administration is correct. 03/11/2009 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 7 Evaluations need to be more detailed so that staff are aware of what changes if any have taken place. Care Homes for Older People Page 20 of 21 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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