Inspection on 06/12/07 for Gables (The)

This inspection was carried out on 6th December 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 (The) 06/12/08

Gables (The) 16/08/07

Gables (The) 30/01/07

Gables (The) 05/10/05

Gables (The) 06/05/05

Gables (The) 28/09/04

Gables (The) 22/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Gables (The) The Gables Pembroke Road Woking Surrey GU22 7DY Lead Inspector Andrea Leverett Key Unannounced Inspection 6th December 2007 13:30 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 (The) DS0000013649.V353560.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 (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gables (The) Address The Gables Pembroke Road Woking Surrey GU22 7DY 01483 828792 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) Mrs Deoranee Boodia Mr Jugmohan Boodia Mrs Deoranee Boodia Care Home 16 Category(ies) of Learning disability over 65 years of age (14), registration, with number Mental disorder, excluding learning disability or of places dementia (2) Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age range of persons accommodated will be: 2 aged 45 to 64 years. 16th August 2007 Date of last inspection Brief Description of the Service: The Gables is a family owned and managed residential care home providing personal care for up to 16 Older People with learning difficulties or mental health needs. The home is a large detached house in a residential part of Woking, and is accessible to the main motorways and public transport. The facilities include large communal rooms, single bedrooms and an activities room. Car parking is provided to the front of the house. Residents have access to the garden at the rear of the home. The fees for the home range from £329 to £750 per week. Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 1:30pm and was in the service for 5 hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner/manager, and any information that CSCI has received about the service since the last inspection. This unannounced Key inspection took place on the 6th of December 2007. 4 people who use the service were spoken with as well as 2 staff, and the owner manager. A partial tour of the premises was undertaken during the site visit and 4 people who use the services files were inspected as part of a case tracking process. Judgements about quality of life and choices were taken from direct conversations with and observations of people who use the service, followed by discussion with support staff, the manager and evidencing records held at the home. Feedback from people spoken to has been taken into consideration and comments have been reflected in this report. Feedback from people who live at The Gables was very positive about the care and support provided by staff. The Home is decorated and furnished to a good standard and a good standard of food is provided. The inspector concluded that people are given an adequate service at The Gables. The Home still needs to make improvements in a number of key areas such as assessment and care planning and staff training. On the whole progress towards meeting requirements and recommendations made at previous inspection has been good. What the service does well: People who use this service feel they are treated with dignity and respect and their right to privacy is upheld. People living in the Home are supported to maintain contact with families. Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 6 People living in the Home receive a wholesome and appealing diet in pleasing surroundings but more needs to be done to evidence that people’s independence is being promoted in this area. People who use this service benefit from living in a Homely environment, which is well maintained and clean. People living in the Home are protected by appropriate staff recruitment procedures. What has improved since the last inspection? What they could do better: More needs to be done to ensure that people who use this service can always be confident that their needs will be assessed fully before they move into the Home and that the Home is able to meet their needs. More needs to be done to ensure that people who use this service benefit from having comprehensive risk assessments and care plans that are kept up to date and are reviewed regularly. Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 7 More needs to be done to ensure that people living in the Home are supported to maintain as much independence as possible in that access to the kitchen is risk assessed and if appropriate encouraged. More needs to be done so that people who use this service can be confident that their needs will be met by staff that are trained and competent to carry out their role. 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 (The) DS0000013649.V353560.R01.S.doc Version 5.2 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 (The) DS0000013649.V353560.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service experience adequate quality outcomes in this area. Some improvements are needed to ensure that new people interested in moving into the Home can be confident that they will receive all the information they need and will have their needs properly assessed before they agree to move in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s admissions policy and procedure has been reviewed and on the whole was found to meet this standard and ensure people have the right information to evidence that a prospective service users needs can be met and that they have all the information they need to make an informed decision about living in the Home. However the admissions procedure needs to include the giving of the service user guide and access to most recent inspection Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 10 report. The procedure must also ensure that provisional care plan and any risk assessments needed are in place before the person is admitted. The home’s assessment format has also been improved and on the whole covers all areas that would be needed to identify a prospective service users needs. It is recommended that the format is further developed allows for a specific assessment of the prospective service users mobility and nutritional needs and identify any risk assessments needed in these and any other areas. No new person has moved into the Home since the last inspection and so the inspector was not able to evidence how the improved admissions and assessment procedures work. Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experience adequate quality outcomes in this area. More needs to be done to ensure that all the people that live in the Home have appropriate care plans and risk assessments in place and that these are reviewed. People can be confident that they are protected by the homes policies and procedures for administering medication. People know they will be treated with respect and their right to privacy will be upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of the home’s new risks assessment and care planning documentation was seen. These documents gave more detailed information and clear directions on how a persons needs should be met. It was also evident that these documents were now being reviewed on a monthly basis. Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 12 The manager explained that the new care planning and risk assessment formats are not in place for everyone as yet. The manager is seeking the support of an adviser to develop these documents further before implementing it fully across the service. Records showed that people who live at The Gables have good access to routine and specialist health services in keeping with their needs. People spoken to confirmed that they had access to a range of health care professionals. An inspection of the home’s medication administration system was undertaken. Records seen and observation on the day of the site visit showed that medication was being administered, monitored and stored appropriately. All staff who administer medication are currently undertaking a 6 month course on the management and Safe handling of Medicines run by Guilford College. People who use the service spoke very positively about the staff support provided. The manager and staff were observed interacting with people in a sensitive, respectful and dignified manner. People felt they are treated with respect and their choices and views are respected. Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People who use the service experience adequate quality outcomes in this area. More needs to be done to evidence those activities are consistently provided that are in keeping with people’s needs and wishes. People can be confident that their dietary needs and wishes will be met, however more needs to be done to encourage and support people to maintain their independence in this area with appropriate support as needed. People can be confident that they will be supported to maintain relationships with families and friends. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although record keeping was not consistent records seen and discussions with people who use the service showed that the Home identified and met peoples social, religious and cultural expectations. People are supported to access a range of activities both in the Home and in their local community. Some Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 14 people went out independently and this was supported and encouraged by the Home. An inspection of the home’s kitchen and food stocks showed that a range of good quality food was purchased. Menus seen and care records showed that individual specialist diets are catered for and people’s individual choices and preferences are respected. However it was noted that people are not allowed in the home’s kitchen and have no opportunity to cook and prepare their own food and drinks. The need to ensure that access to the home’s kitchen is risk assessed and restrictions are only in place when risk assessment identifies that this is appropriate was discussed and a requirement has been made. Visitors are welcome at any time and people spoken to felt that the Home supported them to maintain relationships with families and friends. Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People who use the service experience adequate quality outcomes in this area. People who use this service can be confident that their concerns and complaints will be listened to and acted upon. People can be confident that the Home has appropriate systems in place to protect them from abuse but more could be done to ensure staff have up to date information in this area by ensuring their training is current. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager informed the inspector that the Home had had no complaints since the last inspection and the commission has not received any complaints about the service in the last 12 months. People spoken to say they felt able to raise concerns and would speak to the manager if they had any problems. People who live at the Home are also encouraged to attend monthly meetings, to discuss their views about the Home. The home’s Adult protection procedure has been reviewed and has clarified the roles and responsibilities of different agencies and local Authority. The Home now has a Whistle Blowing procedure and policy in place. All staff undertook adult protection training in 2005 and the Home is now in the Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 16 process of booking refreshers. One staff member is booked on a refresher course so far. Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 17 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 People who use the service experience good quality outcomes in this area. People who live at The Gables know that the Home will be clean and maintained to a good standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An inspection of the property was undertaken. The Home was cleaned and decorated to a high standard and maintenance records showed that equipment and facilities are being maintained appropriately. The boxes have now been removed from the hallway of the unused part of the building and all fire exits seen were free from obstruction. The fire equipment was last serviced on the 18/06/07, portable electrical appliances inspected on the 01/11/07, Gas Certificate 01/03/07 and an electrical worthiness certificate issued in 2007. The home’s fire logbook recorded alarm checks and fire drills. People who use the service have their own rooms, which are spacious and homely. The Home has several communal spaces including a conservatory and garden. Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. People who use the service experience adequate quality outcomes in this area. People who use this service can be confident that their needs will be met by sufficient number of staff but more needs to be done to ensure that staff are trained and competent to carry out their role. People living in the Home are protected by appropriate staff recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the site visit there were 2 staff on duty including the manager. Discussions with staff and people who use the service evidenced that 2 staff are on duty most of the time with 3 staff at key times to support specific activities. A sample of staff files were inspected and requirements from the last inspection re Criminal Records Bureau checks were followed up. Records showed that all documentation including Criminal Records Bureau checks are now in place for all staff. Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 19 The home’s improvement plan from the last inspection agreed to complete all mandatory and specialist training for staff by April 2008. So far staff have undertaken a 6-month training course in the Management and safe Handling of Medication at Guilford College. No new staff have been employed since the last inspection but the Home now has an induction procedure in place that will also look at the common induction standards. 2 staff have undertaken refresher Moving and Handling training since the last inspection and 4 are booked to undertake this training. All staff need Fire Safety training, 2 are booked on a course so far. In addition staff need to undertake training in mental health. Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36 and 38 People who use the service experience adequate quality outcomes in this area. An experienced and qualified manager manages the Home but more needs to be done to ensure that the Home is run well. On the whole people can be confident that their health safety and welfare are promoted and protected but more needs to be done in the areas of staff training and assessment and care planning to ensure that the Home is run in their best interests. This judgement has been made using available evidence including a visit to this service. Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 21 EVIDENCE: The owner manager is a qualified mental health nurse with 22 years experience of working with this client group. Evidence seen at this site visit showed that the manager has made good progress towards meeting requirements made at the last inspection and that generally a good standard of care is provided. However shortfalls in key areas such as staff training and care planning and reviewing are undermining this. It was clear that the manager has taken these issues on board and is working to resolve them. The services of an outside consultant have been sought to recommend improvements to care planning and reviewing systems and advise on staff training. The manager who is also the owner works full time in the Home and knows the people living in her care very well. Observation and discussion with people showed that she worked sensitively and therapeutically to meet peoples needs. Feedback from people who use the service and staff was very positive about the manager and they felt very supported by her. The Home now has a quality assurance system in place that involves seeking the views of people who use the service and other professionals involved in their care. Responses seen indicated a high level of satisfaction with the service. In addition the Home undertakes annual reviews and monthly residents meetings and records are kept to evidence these. A recommendation has been made that the Home records any action they have taken as a result of feedback given about the Home. COSHH records include brief guide to regulations and risk assessments are in place for this and infection control, fire and hot water. The Home was tested for Legion Ella on the 17/08/07 and certificate shows that none was found and appropriate monitoring controls are in place. Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 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 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 3 X 2 Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 13 (4) (c) Requirement The Registered Person must ensure all risk assessments are reviewed on a regular basis. This will make sure members of staff are aware of and know what to do to reduce known risks to the people who use the service. Timescale from the 27th January 2007 not met. Timescale from 28/09/07 not fully met but significant progress has been made towards meeting this requirement. 6. OP7 OP8 15,13(4) (c) Care plans and risk assessments must be reviewed and revised to make sure all the details needed are accurate and detailed. This will make sure members of staff know the care and support needed and how the care and support must be provided. Time scale from the 28/09/07 not fully met but significant Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 24 Timescale for action 25/02/08 25/02/08 progress has been made towards meeting this requirement. 11. OP28 18(1)(a) (c)(i)(ii) Mandatory and specialist training must be provided to all members of staff including the management of the home. The training must include the following: Mental health, learning disabilities, formal induction programme for new staff, manual handling, food hygiene, fire safety, administration of medication, health and safety and risk assessment, adult protection and restraint (if restraint policy remains in place) and qualifying training. The commission must be informed in writing of the dates for training and the training to be provided and to whom. This will make sure people who use the service are supported by trained competent members of staff. Timescale of 12/10/07 not fully met but the home’s improvement plan states that this requirement will be met by 2008. 25/02/08 Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 25 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 OP15 Good Practice Recommendations It is strongly recommended that people living in the Home are supported to maintain as much independence as possible in that access to the kitchen is risk assessed and if appropriate encouraged. It is recommended that the homes admissions procedure specifies at what point that the service user guide will be given and initial risk assessments and care plans are in place before probationary period begins. 2 OP3 Gables (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South East Regional Contact Team The Oast Hermitage Court Hermitage Lane Maidstone, Kent ME16 9NT 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 (The) DS0000013649.V353560.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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