Inspection on 21/08/07 for Gables Nursing Home

This inspection was carried out on 21st August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 14/04/09

Gables Nursing Home 14/01/09

Gables Nursing Home 23/12/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Gables Nursing Home Barrows Green, Bradfield Road Leighton Crewe Cheshire CW1 4QW Lead Inspector Joan Adam Unannounced Inspection 10:00 21 August 2007 st 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.V338968.R01.S.doc Version 5.2 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.V338968.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gables Nursing Home Address Barrows Green, Bradfield Road Leighton Crewe Cheshire CW1 4QW 01270 588952 F/P 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 Elizabeth Forster Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34), Physical disability (5) of places Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 6th June 2006 Brief Description of the Service: 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 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. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit took place on 21st August and 7th September 2007 and took eight hours. It was carried out by an inspector of the Commission. The visit was just one part of the inspection. The home was not informed of the date the visit was to take place, but a few weeks prior to the visit the manager was asked to complete a questionnaire Annual Quality Assurance Assessment (AQAA)to provide the inspector with some information about the service. Questionnaires were sent to residents, relatives and health and social care professionals to help the inspector find out what they think of the home. Five responses were received from relatives. All were positive about the standard of care in the home. Comments such as “I am happy that my relative is living at the Gables.”” “the staff are very caring” “ A clean and comfortable home”. During the visit the inspector spoke with the manager, staff and residents. The premises and various records held by the home were looked at. Feedback was given to the registered manager on her return from holiday on 7th September 2007. What the service does well: The Gables provides information about the home so that prospective residents have enough information to make a choice about living at the home. All residents are assessed prior to admission so that the staff know they can meet their needs. Care plans are in place so that the staff know how to care for the residents. These are updated and reviewed on a monthly basis following discussion with residents and relatives. The home is staffed with people who are trained to look after older residents and training is given to all grades of staff. Residents are offered choice in their daily lives and the standard of catering is good. Residents are treated as individuals and their privacy and dignity is respected. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 Page 6 Recruitment procedures, staff training and staff supervision ensure that residents are protected from harm. Residents’ financial interests are also safeguarded. The home is clean and comfortable with a warm and welcoming atmosphere. 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. The summary of this inspection report can be made available in other formats on request. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 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 Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives are given sufficient information about the home and care costs so that they can decide if the home will meet their needs. Residents are fully assessed prior to admission so that care staff are able to meet their care needs. EVIDENCE: The Gables has updated its Statement of Purpose and Service User Guide, which are information leaflets about the home and its facilities, to inform prospective residents of the room sizes on offer at the home. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 Page 9 The assessments of two residents that had recently been admitted to The Gables were inspected. The registered manager or a senior nurse carries out assessments. The content of the assessments was good and contained all the information needed to provide care. This assessment included information about the resident’s social history and preferences in relation to daily living and diet. Residents spoken with said that they had been visited by a member of staff prior to them being admitted to the home. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs are met by staff who enable them to maintain their privacy and dignity. Medication is well managed to ensure that residents receive the medication they are prescribed. EVIDENCE: The care plans of three residents were looked at. Care plans identified areas of need such as pressure area care, mobility, continence, nutrition, tissue viability and general dependency. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 Page 11 The care plans contained concise information to provide care staff with the necessary information for them to look after a person’s needs. An improvement had been made in the care plan documentation for residents with pressure sores. These were more detailed to include mapping and measurement of the wound to enable staff to have a clear picture of the progress. Care plans were reviewed and up-dated monthly or when the needs of the residents changed. Referrals to other health care professionals were documented in the care plans such as visits by GP, dentist, opticians and podiatrists. The home had a warm and friendly atmosphere and the staff were seen to interact well with the residents. Staff were seen to knock on doors and wait before entering bedrooms and bathrooms. Residents spoken with said” the staff are lovely “ “ all the staff are really nice” “ the staff are very friendly”. Medication management and storage arrangements were looked at. Medication administration records were completed correctly and medicines were stored appropriately. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The routines of daily living are flexible and varied to suit residents’ expectations, preferences and capacities. The activities at the home need to improve to give residents mental stimulation. EVIDENCE: The home does not employ an activities organiser at present and the activities on offer are limited. The manager is to address this problem by reassessing her staffing and to allocate a member of care staff to provide an activities programme in the afternoons. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 Page 13 The hairdresser visits the home on a regular basis and some residents are given manicures. Outside entertainers are booked on a monthly basis. A church minister visits the home to give services to residents that want it each month. Residents could make choices of where they wanted to spend their day. Some were sitting in one of the lounges and some were in their bedrooms. Visitors were made welcome at any time. Menus in place at the home are varied and residents said that the food was good and wholesome. Comments made by residents are “ good food” “ no problems at all with the food. ” Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 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. 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. There is a complaints procedure in place and the residents are protected from abuse. EVIDENCE: The complaints procedure is displayed and residents said they would know how to complain. The complaints procedure is also contained within the Service User Guide (information leaflet) so that residents are aware of their rights. The home has received complaints since the last inspection and have dealt with them appropriately. Residents said they would feel comfortable talking to the manager if they had any problems regarding the home. The Gables has policies and procedures relating to the protection of vulnerable adults. The staff spoken with displayed a good understanding of adult protection procedures. Staff have completed a training course on adult abuse and these training sessions will continue for new staff. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a clean and comfortable environment for the people to live in. Bathing facilities need to improve to give residents more choice. EVIDENCE: A number of bedrooms were visited at this inspection. These were seen to be comfortably furnished and well personalised by people occupying them or by members of their family. The home provides bathing facilities for residents who are unable to get in and out of the bath unaided, however a shower can not be offered to any resident who prefers a shower rather than a bath. This was a requirement at the last inspection and has not been met. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 Page 16 The inspector spoke to the proprietor who said he would complete the work before the end of the year. All areas of the home were visited and found to be clean, tidy and free from unpleasant smells. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 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. 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. Staffing levels and skill mix are sufficient to meet the needs of the residents, Residents are protected by the home’s recruitment practices and staff training. EVIDENCE: There were adequate numbers of staff on duty to meet the needs of the residents living at the home. There is ongoing training in place at the home for staff. A training matrix was seen. Training provided included pressure area care, moving and handling, fire awareness, first aid and dementia care. The staff group at the gables have been continuing with their training, and are working towards reaching the target of 50 trained care staff trained in NVQ level 2 in care. The home has forty per cent of carers qualified and has five carers who are undertaking the training at present. At the previous two inspections it was identified that staff were being employed without having had Criminal Records Bureau checks before starting work in the home. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 Page 18 Staff files looked at for three new members of staff showed that all appropriate checks were carried out before they started work at the home to ensure that the safety of the residents was met. All staff received a detailed induction on commencement of employment. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of the service users are protected. The views of service users are obtained to influence the running of the home. EVIDENCE: The home has an experienced and competent manager who is registered with the Commission for Social Care Inspection. She is a registered nurse and has completed NVQ level 4 registered managers award. Residents and relatives said that they felt the home was well run and that the manager and staff were very welcoming and friendly. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 Page 20 They also said that the owner of the home is friendly and approachable and is regularly present within the service. The home has a quality assurance system in place and questionnaires are sent out to residents and relatives to gain their views on the service provided by the home. Audits take place on a monthly basis with regard to care plans, medication, staff files, resident’s finances, and health and safety. Supervision records were also examined. Staff were supervised as part of the normal management process on a day to day basis and more formal supervision was now taking place and was recorded. Staff records showed that staff received training in safe working practices, including fire safety, moving and handling, food hygiene and infection control. Accident records were reviewed. These had been completed appropriately and there had been no serious accidents since the last inspection. The pre inspection document the Annual Quality Assurance Assessment (AQAA) which was completed by the manager provided information to confirm that equipment and installations at the home are serviced on a regular basis. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 Page 21 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 X 3 X X 3 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 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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 Standard OP12 Regulation 16(2)(n) Timescale for action People who live at the home 31/10/07 must be given access to more activities to enable them to be mentally stimulated. A shower must be provided at 31/12/07 the care home to enable the people who live there to be given a choice of bathing. ( Timescale of 6/12/06 not met) Requirement 2 OP21 23(2)(j) 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 Refer to Standard OP28 Good Practice Recommendations Systems should be in place to enable 50 of staff to be qualified in NVQ level 2 to ensure that the residents are in safe hands at all times and to meet the government target. Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. Extracts may not be used or reproduced without the express permission of CSCI Gables Nursing Home DS0000018725.V338968.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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