Inspection on 25/05/05 for Gables Nursing Home

This inspection was carried out on 25th May 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 16/09/05

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 CW1 4QW Lead Inspector Gill Matthewson Unannounced 25 May 2005 09:30 th 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 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 F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Gables Nursing Home Address Barrows Green Bradfield Road Leighton Crewe CW1 4QW 01270 588952 01270 588952 Telephone number Fax number Email 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 with Nursing (N) 34 Category(ies) of Old age, not falling within any other category registration, with number (OP) 34 of places Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users must not exceed 34 2. No more than 34 service users may be accommodated in the category OP Old age - not falling within any other category 3. Within the maximum number of 34 OP, 5 service users may be aged 55 years and above 4. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Date of last inspection 19th October 2004 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 F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by two inspectors of the Commission. 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 six hours and included a tour of the building, inspection of records and discussion with five residents, one relative and ten staff. Feedback was given to the Home Manager and registered person at the end of the inspection. What the service does well: What has improved since the last inspection? Thirty new lounge chairs have been provided and ten bedrooms have been redecorated and carpets replaced where required. Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 6 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. Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Residents undergo a full assessment of need prior to admission to ensure that the home can meet their needs. EVIDENCE: Case tracking was carried out for six 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. Preadmission 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 F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7,8,9&10. The care planning system does not provide staff with all the information they need to satisfactorily meet the residents’ needs. However, the system for the administration of medication is good with clear arrangements in place to ensure residents’ medication needs are met. Also, residents’ privacy and dignity are maintained. EVIDENCE: Six care plans were examined. They were presented in individual ring binders. All areas of personal care needs were covered in the care plan, but in most cases social care needs were not addressed. Risk assessments were in place, but not all were up to date, particularly in relation to moving and handling. Also, one resident had a pressure sore. This had been referred to and assessed by the tissue viability nurse specialist but there was no written plan of care for treatment of the wound. Residents’ health care needs were recorded and showed that GPs, continence adviser, physiotherapist and tissue viability nurse specialist had visited residents. Although arrangements were in place to afford residents access to a dentist, optician and chiropodist there was no evidence in the documentation that any consultations had taken place. Care plans also did not contain any evidence that residents and/or their relatives were consulted about the plan of care. See Requirement 1. Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 10 Medication administration record charts were written up appropriately and the recording of medications administered was satisfactory. Discussion with residents and observation of staff practice confirmed that residents privacy and dignity were maintained. One toilet door lock was broken, but this was repaired before the end of the inspection. One bathroom door lock was out of order and the service provider gave assurance that it would be repaired. There were no locks fitted to bedroom doors and residents were unaware that they could have a lock fitted. See Recommendation 1. Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12,13&15. The social activities programme provides stimulation and interest for people living in the home but could be improved by taking more account of residents’ individual interests and hobbies. Residents are able to maintain contact with family and friends. Meals are nutritious and offer a balanced and varied diet. EVIDENCE: The weekly activities plan was seen and this included bingo, an entertainer each fortnight and arts and crafts. A bingo session took place during the afternoon of the inspection. Social care needs were not addressed consistently in care plans. Residents confirmed that they could receive visitors as and when they wished. Several visitors were observed in the home during the inspection. A local vicar also visited the home on a regular basis. Breakfast and lunch were seen during the inspection. The care manager stated that breakfast was between 8am and 11am. Lunch and dinner were at set times and supper was available in the evening. The menu was on a fourweek rota and seasonal variations were added as preferred. The menus were displayed on each dining table and a choice of main meal and dessert were on offer at lunch and dinnertime. A list was circulated during the morning so that residents could choose their meals. This list was seen. All the residents had Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 12 chosen the “Roast Beef” option. The inspectors shared the meal with the residents and found it to be well cooked and tasty. The cook stated that she spoke to the residents on a regular basis to check that they were happy with the meals. On discussion with residents after the meal they said that they had enjoyed it. The cook said that different diets were catered for such as diabetic, pureed and soft. She said that the meat and vegetables had been delivered by the same suppliers for many years. The owner brings fresh bread and milk into the home on a daily basis. Food stored in fridges, freezers and stock cupboards was adequate for the needs of the residents. The kitchen was clean and tidy, however, seams were opening in the flooring and one area had no flooring. This could cause food debris to collect underneath the flooring. See Requirement 2. Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16&18. The home has a satisfactory complaints system, but the lack of adult protection training does not ensure that people living in the home are protected from abuse. EVIDENCE: There was a comprehensive complaints procedure to support and guide residents and relatives. The home had received one complaint since the last inspection, which at the time of the inspection was unresolved. 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. See Requirement 3. Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19,21,23,25&26. The standard of the environment within the home is, in the main, satisfactory and provides residents with an attractive and homely place to live. EVIDENCE: A full tour of the home was undertaken during this inspection. It was clean and generally free from offensive odours apart from one bedroom, which had an offensive odour of urine. See Requirement 4. The carpets in the main lounges were badly stained. However, the manager showed us a refurbishment plan, which included replacement of these carpets in June or July. 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 2. Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 15 During the tour it was seen that bedrooms had been personalised with photos, furniture and mementos. Some residents had a TV and one had Sky. A random sample of water temperatures was taken around the home and these were within acceptable levels between 38 - 43 degrees centigrade. Radiators were either low surface temperature ones or guarded. 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. The laundry was clean and tidy. The laundress said that she had worked at the home for twelve years and that she enjoyed her job. She had completed health and safety and infection control training. Washing machines had appropriate sluicing facilities. Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28&30 Staffing levels are sufficient to meet residents’ needs and there is investment in staff training to ensure that they are competent. EVIDENCE: The staff team consisted of owner, manager, care managers, registered nurses, care assistants, cook, domestic staff, laundry staff, gardener and handyman. Care staff rotas demonstrated that there were seven care staff on duty in the morning, five in the afternoon and four at night. These numbers included two registered nurses in the morning and one throughout the rest of the twenty four hours. These levels were sufficient to meet the needs of the 33 people resident at the time of the inspection. Training files and copies of certificates were seen. Induction training had been given to all staff. It was recommended that this be reviewed in line with the Skills for Care and Development specification. The care manager stated that all staff had undertaken courses on medication, fire awareness and moving and handling. Some staff had also attended courses on wound assessment, diabetes care, nutrition and swallowing, first aid, infection control and incontinence. 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 F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,37&38. Leadership, guidance and direction to staff needs to improve to ensure that residents receive consistent, quality care and that their health, safety and welfare are promoted and protected. EVIDENCE: The registered manager is a Registered General Nurse, with previous experience of managing a care home. She is currently undertaking an NVQ Level 4 in Management and anticipates completion in September 2005. She has worked at the home for several years, but no application has been submitted to CSCI for registration as the manager. See Requirement 5. Staff spoken to said that they were well supported by the management team. Annual staff appraisals had been completed in February 2004 and were due to be reviewed. Staff were supervised on a day to day basis but documented Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 18 staff supervision had been ad-hoc, and only given to senior staff. None of the care assistants had received formal, documented supervision. See Recommendation 3. The home had failed to notify CSCI of 10 deaths that had occurred when the manager was on leave. Notifications were completed before the end of the inspection. Staff had received training in safe working practices, but manual handling assessments were not up to date and staff, when questioned, were not sure of the appropriate moving and handling procedure to be used for some residents. Also, the cleaning material cupboard did not have a lock. See Requirements 1&6. Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x 2 x x x 3 2 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 2 x x x 2 2 2 Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 20 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person must ensure that residentscare plans contain instructions to address all identified needs, that they are kept up to date and are drawn up in consultation with the resident or their representative. The registered person must seal the gaps in the kitchen flooring. The registered person must ensure that all staff receive training in adult protection. The registered person must ensure that the home is kept free from offensive odours. The registered person must ensure that the manager submits an application for registration with the Commission. The registered person must ensure that the cleaners store is kept locked at all times. Timescale for action 30.06.05 2. 3. 4. 5. OP 15 OP18 OP26 OP31 13(3) 13(6) 16(2)(k) 8&9 31.07.05 23.11.05 30.06.05 30.06.05 6. OP38 13(4) 30.06.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 21 Gables Nursing Home 1. 2. 3. Standard OP10 OP21 OP36 The registered person should include in the service user guide a statement that residents may have a lock fitted to their bedroom door. The registered person should consider replacing one of the baths with a wheel-in shower. The registered person should ensure that all care staff receive formal, documented supervision six times per year. Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Gables Nursing Home F51 F01 S18725 The Gables V225834 230505 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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