Inspection on 06/12/08 for Gables (The)

This inspection was carried out on 6th December 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gables (The) 06/12/07

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Gables (The) The Gables Pembroke Road Woking Surrey GU22 7DY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Robert Pettiford     Date: 0 6 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Gables (The) Pembroke Road The Gables Woking Surrey GU22 7DY 01483828792 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Mrs Deoranee Boodia,Mr Jugmohan Boodia The registered provider is responsible for running the service care home 16 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The age range of persons accommodated will be: 2 aged 45 to 64 years. Date of last inspection Brief description of the care home 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 GBP329 to GBP750 per week. Care Homes for Older People Page 4 of 28 Over 65 14 0 0 2 Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection took place on 6th December 2008. We agreed and explained the inspection process with the manager present at the time of the inspection . The focus of the inspection was to assess The Gables in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Older Persons. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. We used a varied method of gathering evidence to complete this inspection, preCare Homes for Older People Page 6 of 28 inspection information such as the previous report and discussion and correspondence with the registered provider/manager was used in the planning process to support the inspector to explore any issues of concern and verify practise and service provision. The home has completed an annual quality assurance assessment questionnaire (AQAA), which was received on time. This provided us with information relating to What the home considers it does well, What we could do better, What has improved within the last 12 months and plans for improvement. The judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable the CSCI to be able to make an informed decision about outcome areas. Further information can be found on the CSCI website with regards to information on KLORAs and AQAAs. Documentation and records were read. Time was spent reading a sample of written policies and procedures, reviewing care plans and records kept within the home. Other areas viewed included risk assessments, pre-admission assessments, rotas, training records and recruitment records. In addition an environmental tour took place. We identified several residents for case tracking. In addition the inspector had the opportunity to speak with several of the residents and a number of staff. Additional evidence was gained to inform judgements following the observation of many of the residents and their interactions with staff. What the care home does well: What has improved since the last inspection? What they could do better: Training shortfall were noted. The manager has provided a training plan subsequent to the inspection and dates are now booked for training. The commission is confident that this shortfall will shortly be addressed. We requested that the home reviews it care planning system to ensure it has a more holistic approach is person centred and includes in more details the residents hope fears and aspirations. The manager was receptive to this and stated that this would be addressed. Some further recommendations were made during the inspection process which the manager stated would be implemented Care Homes for Older People Page 8 of 28 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents know that their needs will be properly assessed prior to moving to the home. Intermediate care is not provided. Evidence: The standard relating to the assessment of residents prior to them moving into the home were partially met at the previous inspection. The manager confirmed that the issues identified previously had now been addressed. Records showed that residents have an assessment, which identifies their individual needs prior to or on admission to the home. This is then reflected into the care plans and these are developed in agreement with the individual where possible. The AQAA also confirmed detailed information with regard to ensuring that the home Care Homes for Older People Page 11 of 28 Evidence: can meet the needs of residents. The assessment process as shown in the AQAA recognises cultural needs and the importance of promoting equality and diversity rather than just meeting needs in a reactive manner. We recommended that the manager reviews the homes equalities and diversity policy and ensures that all of the information and policies relating to residents are inclusive to all members of the community. It was also recommended that the home considers giving staff and management Equality and Diversity training. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having clear individual plans that are comprehensive, identify their needs and are specific to the individual service user. However further evidence that residents are fully involved in the process and contribute towards setting their hopes aspirations and goals needs to be evidenced. Residents can feel confident that they are fully supported with their healthcare needs however limited evidence was seen within the care planning process. Residents can be confident that they will be treated with respect and dignity and their rights to make decisions about their lives is respected and they have the opportunity to be consulted on, participate in, all aspects of life within the home as they wish or their capacity allows. However this was not fully evidenced within the care planning system. The resident can feel confident that his wellbeing will be protected by the homes policy and procedures with regard to the handling and administration of medication. Care Homes for Older People Page 13 of 28 Evidence: The staff of the home are committed to supporting all residents including those to make informed decisions, understand the range of options which are available to them and have the right to take responsible risks. Evidence of this was gathered through taking to the residents, staff, and the manager. The inspector viewed and discussed with the manager the care records relating to several residents at The Gables. In the care plans viewed there were guidelines in respect to support needed. The home undertakes regular reviews. Formal reviews involving significant professionals where possible are also undertaken. The homes care plans do not currently use a wholly socially lead model. The care planning approach needs to move away from a clinical / medical base to one with includes social and personal goals including hopes and aspirations in more detail. The home needs to introduce a person centred care planning system that has a holistic approach. Limited involvement of the residents was evidenced within the care planning system. However evidence from discussions with residents would suggest that this is not the case. No statutory requirements have been made at this time. The inspector viewed a sample of care records and specific health care records relating to several residents. Records viewed confirmed residents had access to a range of health care input as and when required and as part of regular health checks. This included access to their chosen G.P (where possible), Dentist, Optician and Chiropodist in addition to identified specialist health care input. The Home facilitates Residents keeping hospital appointments and seeing their own GP. Evidence was seen of regular healthcare checks in all areas to promote healthcare of residents within the care plans viewed. It is evident through talking to members of staff at the home that the emotional health of the residents is of a high priority to the home and that staff are pro-active in maintaining and supporting residents with their emotional needs in order to maintain their quality of life. It was confirmed in discussions with many of the residents who lived at the home and feedback received from comment cards returned that they felt well supported and that the staff treated them with respect and dignity. Some residents spoke of the support they received and the activities they enjoyed. Risk assessments were reviewed within the home and discussed with the manager. Assessments seen detailed how to support residents to minimise risks for personal safety and had been updated and reviewed. Access to the kitchen was also additional risk assessed to maintain safety. This now meets with the standards and was a outstanding requirment from the previous inspection. We visited the home at 9:30AM. During the inspection the inspector noted that residents were seen making choices about their lives and were seen to be part of the Care Homes for Older People Page 14 of 28 Evidence: decision process and a relaxed atmosphere was noted with the residents interacting with staff. The inspector viewed the storage arrangements and some records including Medication Administration Record (MAR) sheets, and the protocols for the administration of PRN/As Required Medication. The medication was seen to be stored appropriately and administered in accordance to current guidance. The manager confirmed that all staff who dispense medication have received appropriate training and that the recording and administration of medication follows The Royal Pharmaceutical Society guidelines. Daily records were not wholly comprentaneous however in that they had gaps and full names of staff were not seen. It was strongly recommended that the home follow the Nursing and Midwifery Council guidance: Guidelines for records and record keeping. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that they are offered a wide range of opportunities for personal development and feel part of the wider community. Residents engage in a higher than average level of activities which are appropriate to their needs and capabilities and are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. The residents benefit from the appetising meals and balanced diet offered at the home. Evidence: Discussion residents confirmed that the level of activities were of a high level and that they enjoyed a good level of stimulation through leisure and recreational activities both inside and outside the home. We joined residents at 9:30am while they were getting ready for the day ahead. The inspector had the opportunity to speak to several of the residents who expressed their opinion of the home and the activities they participated in and enjoyed. Other Care Homes for Older People Page 16 of 28 Evidence: residents were observed participating and interacting with staff. Residents have been enabled to and encouraged to participate in hobbies and activities which they had an interest in, such as maintaining and building on personal collections and specific recreational activities. The service actively encourages and provides imaginative and varied opportunities for Residents to develop and maintain social, emotional, communication and independent living skills at The Gables. The staff have a strong ethos and focuses on involving Residents in all areas of their life, and actively promotes the rights of individuals to make informed choices, providing links to specialist support when needed. Evidence of this was observed from direct observation and comments made within the completed surveys received. It was confirmed that residents are enabled to maintain contact with relatives and friends where they wished to do so. Residents were consulted with regard to whom they saw and when and were under no compulsion to accept visitors should they not wish to do so. From observation, records viewed it was evident that residents were offered a choice of menus that meet their dietary needs and individual preferences. Meal times are flexible to suit the residents activities and schedules. Residents are able to choose where to eat, and also have facility to make drinks, meals and snacks for themselves and others with staff support should they wish. Residents on evidence seen have had been involved in planning and choosing what to eat where possible. One service user explained the menus to the inspector and how his choice and preferences influenced the menu. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can feel confident that their concerns and complaints are taken seriously. Residents are are protected from the risks of abuse. Evidence: A copy the complaints procedures was reviewed. The procedure included details of how to complain, timescales for response and information for referring a complaint to the service provider. However the complaints procedure is not readily available in different formats. Residents within the service have an understanding of how to make a complaint as their capacity and understanding allows. No complaints have been received from information contained within the AQAA. Systems are in place to ensure that these are dealt with appropriately. The homes Policy for the Protection of Residents and staff Whistle blowing procedure was discussed. These include procedures for the reporting of suspicion or evidence of abuse with a format for the recording of any allegations and action to be taken. Full training has been provided for staff and was evidenced at time of inspection. The home promotes an open culture where residents feel safe and supported to share any concerns in relation to their protection and safety. Care Homes for Older People Page 18 of 28 Evidence: The manager stated that Criminal Record Bureau Checks (CRB) had been obtained for all staff . Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from living in an excellent well maintained environment which provides a homely warm atmosphere with safe access to comfortable indoor and outdoor communal areas Residents are protected by the homes infection control procedures and policies Evidence: We observed that the home is well-maintained. The manager stated that the home meets with the requirements of both Fire and Environmental Health Departments. It was apparent that the individual and collective needs are being met in a comfortable environment. The standard of internal decoration and fixtures and fittings are well maintained and of a high quality. Building work is currently in progress to build additional storage and fire exits. This does not impact of the comfort of the home whilst in progress. The home benefits from a wide selection of communal areas thus affording residents space should they so wish desire. The premises are kept exceptionally clean, hygienic throughout. The manager stated that systems are in place to control the spread of infection, in accordance with relevant legislation, published professional guidance and the purpose of the home. The inspector observed that the home is set in well-maintained gardens. Care Homes for Older People Page 20 of 28 Evidence: An environmental risk assessment has been carried out to maximise the safety of residents. This was confirmed by the manager. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents care, social and emotional needs are promoted by the employment of caring staff in such numbers to support their needs who put the interests of the residents first. However shortfalls were noted with regard to ensuring staff were trained appropriately. The standard relating to staff recruitment procedures was not inspected. Evidence: From discussions with the manager, observations and reviewing the staff rotas more than sufficient staff were on duty at the time of inspection to meet the residents needs. Staff are receptive to residents needs and work together as a team. The home is not at present full, the number of residents is reflected in current staffing. The manager stated staffing levels are always under review to ensure the needs of the residents are met. The staff training records indicated planned and undertaken training for many of the staff. Core training in Infection control, Moving and Handling, Basic Life support, fire training, food hygiene, and Adult protection has been provided. However not all staff have recieved the required updates to training and have completed all of the core training. Care Homes for Older People Page 22 of 28 Evidence: A requirment from the previous inspection stated that this should be addressed. It currently remains outstanding. The manager was aware of the shortfall and has subsequently provided a training plan to the Commission. The manager therefore was able to evidenced that individual and group staff training needs had been identified and that courses are booked. The Commission is therefore confident that any shortfalls will shortly be addressed. Staff have achieved NVQ qualifications in Care to level 2 or above, thus meeting with the required standards. The manager confirmed that the home has a development programme for all new staf. however it does not currently meet with the Sector Skills Councils workforce training targets. The manager is aware of this shortfall and will contact Skills for Care for full details of the required induction standards. The inspection of the recruitment files at the previous inspection evidenced that the required checks had been carried out and that the standard was met. The manager stated all staff have CRB (Criminal Record bureau Checks). Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are currently being met, enjoy good outcomes with regard to the quality of care and can be confident that the home is managed appropriately. However the quality assurance systems of the service needs to be improved. Evidence of health and safety safety checks were not fully inspected on this occasion. Evidence: The manager is actively involved in the day-to-day management of the home and works with staff and residents. She has many years of experience caring for others. Outcomes for the quality of care are good. Residents expressed a great deal of satisfaction of the care provided and the staff are very supported of the manager and have a positive ethos. There is strong evidence that the ethos of the Home is open and transparent. The views of both residents and staff are listened to, and valued. Quality assurance was discussed and the views and opinions of many of the residents Care Homes for Older People Page 24 of 28 Evidence: and stakeholders sought. The residents spoken with confirmed a great deal of satisfaction living within the home and felt confident that their views and opinions were valued by both staff and management. The manager is also the registered provider along with her husband. A quality assurance / auditing system also needs to assess through a cycle of quality assurance with regard to compliance with the national minimum standards. The system currently in place seeks the views of residents and stakeholders but was not sufficently developed as previously stated. The manager stated that this would be addressed. A statutory requirment has not been made at this time. Evidence of health and safety safety checks was not inspected on this occasion. However it was met at the previous inspection and no evidence would suggest that it does not continue to be monitored. The manager stated that she ensures that all the required safety checks are carried out. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 30 18 The provider shall ensure 31/03/2009 that staff receive the required training and updates to remain current to ensure that residents needs are supported by suitably trained staff. Failure to meet with this standard following previous requirements dated 25/02/08 could result in formal enforcement action. To ensure residents are supported by suitably trained staff Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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