Inspection on 16/09/05 for Gables Nursing Home

This inspection was carried out on 16th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Gables Nursing Home 15/10/09

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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Gables Nursing Home Barrows Green, Bradfield Road Leighton Crewe Cheshire CW1 4QW Lead Inspector A Gillian Matthewson Announced Inspection 16th September 2005 09:30 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 Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 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. Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Gables Nursing Home Address Barrows Green, Bradfield Road Leighton Crewe Cheshire CW1 4QW 01270 588952 01270 588952 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) Mr William Preston Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users must not exeed 34 No more than 34 service users may be accommodated in the category OP - Old age - not falling within any other category Within the maximum number of 34 OP, 5 service users may be aged 55 years and above The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care 25th May 2005 Date of last inspection Brief Description of the Service: The Gables is a care home providing accommodation and nursing care for 34 service users over 65 years of age. The Gables is also registered to provide accommodation and care for a maximum of 5 other service users aged 55 years and above.The service is located in an extended, detached two storey property, situated in its own grounds in a 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.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 within these bedrooms. All rooms have a T.V. point, and nurse call system. Day 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 due to their general physical frailty. In accordance with statutory requirements Registered General Nurses are on duty at all times. Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The lead inspector spent two hours planning the inspection by reviewing previous inspection reports and the service history over the last twelve months. The inspection took place over five hours and included a tour of the building, inspection of records and discussion with six residents and five staff. Comment cards were received from seven residents, three relatives and ten health or social care professionals who visit the home. Comments were generally positive. GPs were very positive, with comments that included ‘I have great confidence in the home’ and ‘I feel that The Gables offers an excellent standard of care’. One relative said ‘The Gables is first class’ and another said ‘the whole staff were wonderful to my husband and very caring of myself’. A resident said ‘I love it here and feel very safe’. Feedback was given to the Home Manager and registered person at the end of the inspection. What the service does well: All residents are provided with the information they need to make an informed choice and have a full assessment of need by a care manager prior to admission, to ensure that the home can meet their needs. Residents are given access to a full range of health care professionals as required. Residents’ privacy and dignity are maintained and they may receive any visitors they wish at any time. The home is clean and well maintained. There is investment in staff training for all levels of staff to equip them and enable them to maintain the skills necessary for providing good quality care. There is a quality assurance system in place, which includes seeking the views of residents and relatives on how the home is performing and how it could improve. Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: More attention is needed in relation to care planning to ensure that all residents health care needs are addressed in the care plan, thus ensuring that staff have access to comprehensive instructions for all the care each resident needs. To improve residents’ protection, the registered provider must obtain appropriate references and a Criminal Records Bureau Disclosure for all staff prior to employment. Also, staff must all be trained in the recognition and reporting of abuse. The choice of bathing facilities could be improved by converting one of the bathrooms into a shower room. Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 7 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. Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 8 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 Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 9 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 Prospective residents are provided with the information they need to make an informed choice about whether they wish to reside in the home. They also undergo a full assessment of need prior to admission to ensure that the home can meet their needs and are provided with a written contract. EVIDENCE: The home had a satisfactory statement of purpose and a comprehensive service user guide, which contained all the required information prospective residents would need to make an informed choice. Each resident was provided with a statement of terms and conditions or contract at the point of moving into the home. However, this did not include a breakdown of the fees payable and by whom or the period fees would be payable for after death. See Recommendation 1. Case tracking was carried out for three residents. Pre-admission information was available with regard to the residents prior to admission. This included all the basic information required for the initial assessment to be carried out. PreGables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 10 admission assessments had been carried out by one of the home’s care managers to ensure that the home would be able to meet the residents’ needs. Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 11 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 & 10. The care planning system does not provide staff with all the information they need to satisfactorily meet the residents’ needs. Residents’ social care needs are now addressed but further work is needed to ensure that all residents’ health care needs are addressed in the care plans. However, residents are referred to the appropriate health care professionals when necessary. Residents’ privacy and dignity are maintained. EVIDENCE: Three care plans were examined. They were presented in individual ring binders. All areas of personal care needs were covered in the care plan, together with a life history and a record of residents’ social interests. Residents’ health care needs were recorded and showed that GPs, psychiatrist, continence adviser and tissue viability nurse specialist had visited residents. Arrangements were in place to afford residents access to a dentist, optician and chiropodist. However, two residents had identified health problems for which there were no care plans and one resident had a care plan for a leg ulcer that did not identify that the wound was infected. Also, the care plan did not Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 12 contain any evidence of objective wound assessment, such as length and width of wound, to determine whether it was improving or deteriorating. See Requirement 1 & Recommendation 2. These deficiencies were pointed out to the home manager, who produced a care plan audit tool that she had obtained and intended to use on a monthly basis in the future. Discussion with residents and observation of staff practice confirmed that residents privacy and dignity were maintained. One resident said that the staff were ‘really lovely people’ and another said ‘they come like a shot when I call for assistance’. Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 13 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 The social activities programme provides stimulation and interest for people living in the home. Residents are helped to exercise personal choice in their lives and maintain contact with family and friends. EVIDENCE: The weekly activities plan was seen and this included bingo, musical entertainment, arts and crafts, a church service, a visiting hairdresser, films, reminiscence, board games, dominoes and cards. Residents spoken with said they were satisfied with the range of activities available. One lady said she would like to go out shopping for clothes and the manager said that plans for this were already in hand. Residents confirmed that they could receive visitors as and when they wished. A local vicar also visited the home on a regular basis. One resident spoken with said that she regularly went out with her son. Residents’ rooms were personalised with their own belongings, such as photographs, pictures, ornaments and small items of their own furniture. There was documentary evidence that residents were consulted about their care plans and that their personal preferences were taken into account in relation to all activities of daily living. Residents confirmed that they could make decisions Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 14 and choices in relation to their daily lives. The service user guide informed residents that they had this right and also contained information about arrangements for advocacy for those not able to speak for themselves. Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 15 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): 18 The current lack of adult protection training does not ensure that people living in the home are protected from abuse. EVIDENCE: The home had a satisfactory adult protection procedure in place, which included whistle blowing, but not all staff had received training in what constitutes abuse, how to recognise it and how to report it. This was a requirement of the last inspection. The manager had arranged for her and the deputy manager to attend training on 20th October and 8th December respectively. They intended to cascade the training to all other staff. See Requirement 2. Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 16 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, 21 & 26. EVIDENCE: A partial tour of the home was undertaken during this inspection, which included the whole of the first floor and the lounges, dining room and two bedrooms on the ground floor. The areas seen were clean and free from offensive odours. Since the last inspection the lounges and dining room had been redecorated and new carpets provide in the lounges. The home had six bathrooms, three with standard baths and chair hoists, and three with standard baths without hoists, one of which was used for storage. It was recommended that the latter be converted into a walk in shower, as this would significantly improve the choice of bathing facilities on offer. See Recommendation 3. Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 17 The garden area was neat and tidy. It was accessible to residents and was laid in a formal style of a lawn with mature beds and a raised patio area and fishpond. Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 18 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): 28, 29 & 30. The recruitment procedures do not ensure protection for residents. There is investment in staff training to ensure that they are competent to care for the residents. EVIDENCE: Three staff files were examined. All had completed an application form, provided evidence of identity and had an interview. References had been obtained, but these did not include a reference from their last employer. Also, the registered provider had not obtained a current Criminal Records Bureau Disclosure for any of them prior to employment. See Requirement 3. Induction training had been given to all staff. At the last inspection it was recommended that this be reviewed in line with the Skills for Care and Development induction specification. At this inspection it was identified that the home’s induction did not cover all the specified induction standards. See Recommendation 4. However, in the previous twelve months staff had received training in care planning, safe handling of medicines, dementia awareness, continence management, nutrition, communication, tissue viability and diabetes. They had also received training from visiting physiotherapists, occupational therapists and speech and language therapists. Ten of the care assistants had an NVQ Level 2 in Care, including four who had also attained NVQ Level 3. Another care assistant was working towards NVQ Level 2 and two more were working towards Level 3. Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 19 Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 20 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 & 36. The manager ensures that there is an open, positive and inclusive atmosphere in the home. The home regularly reviews aspects of its performance through a programme of self-review and consultations with residents and relatives. There is a satisfactory system in place for looking after residents’ monies and valuables handed over for safekeeping. Staff are appropriately supervised and trained in maintaining residents’ health and safety. EVIDENCE: Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 21 The manager is a Registered General Nurse, with previous experience of managing a care home. She has submitted an application for registration with the Commission for Social Care Inspection and is undertaking an NVQ at Level 4 in management, which she anticipates completing by December 2005. The management approach at the home was open and created a positive and inclusive atmosphere. This was evidenced on the day of the inspection when the inspector observed the manager interacting with residents, staff and visitors in a positive manner. Residents stated that they felt they could and would approach the manager if they had any concerns. These positive comments were also directed towards Mr Preston the registered provider, who is regularly present within the service. The home carries out an annual customer satisfaction survey and a quality assurance audit that includes resident care, information and care development, quality improvement and organisational fitness. The registered provider is present in the home most days and completes a monthly report on the conduct of the care home. In addition to the above, the manager carries out monthly audits of accidents and pressure sores. She intended to expand the monthly audits to include care plans and medication. Records of the current audits were available for inspection. During this inspection the monies held for residents were checked. This examination evidenced a robust system that was subject to periodic audit by the manager. However, it was noted that the monies were kept in a portable locked box, which could be carried around the home. Monies would be more secure if the box was affixed to a wall. See Recommendation 5. Supervision records were examined and evidence was found to confirm that staff received supervision on a regular basis.. Conversations with staff supported the documentation. Staff had received training in safe working practices, including fire safety, moving and handling, food hygiene and infection control. A letter from the Environmental Health Officer confirmed that there were no contraventions of the Food Safety Regulations. Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 22 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X 3 X X X X 3 STAFFING Standard No Score 27 X 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 3 Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard OP7 OP18 OP29 Regulation 15(1) 13(6) 19 Requirement The registered person must ensure that care plans address all health care needs. The registered person must ensure that all staff receive training in adult protection. The registered person must ensure that a reference from the last employer and a Criminal Records Bureau Disclosure are obtained prior to the employment of any member of staff. Timescale for action 16/10/05 16/01/06 16/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP2 OP8 Good Practice Recommendations The residents’ contract should include a breakdown of fees payable and by whom and the period fees are payable for after death. Evaluations of wounds should be carried out using an objective wound assessment tool. DS0000018725.V252350.R01.S.doc Version 5.0 Page 24 Gables Nursing Home 3 4 OP21 OP30 The registered person should consider replacing one of the baths with a wheel-in shower. The home’s induction programme should be reviewed to ensure it covers all the Skills for Care induction standards. Gables Nursing Home DS0000018725.V252350.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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