Inspection on 05/04/05 for High Gable House

This inspection was carried out on 5th April 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

High Gable House 10/10/07

High Gable House 19/10/06

High Gable House 22/06/05

High Gable House 04/10/04

High Gable House 30/04/04

High Gable House 01/04/04

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Edenvale

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Chatsworth Care - Tudor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 HIGH GABEL HOUSE 292 & 295 Lincoln Road Enfield Middlesex EN1 1SY Lead Inspector Georgia Chimbani Announced 5th April 2005 @ 10:00 am 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. HIGH GABEL HOUSE Version 1.00 Page 3 SERVICE INFORMATION Name of service High Gabel House Address 292 & 295 Lincoln Road, Enfield, Middlesex, EN1 1SY 020 8804 1115 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 V Kowlessur Mr K Kowlessur Care home 9 Category(ies) of Learning Disability (9) registration, with number of places Conditions of registration Date of last inspection Yes 4th October 2004 Brief Description of the Service: High Gabel House is a private care home of two separate semi-detached houses located on either side of Lincoln Road, Enfield. One house has four registered places (no. 295) and the other has five (no. 292). Both houses have similar ground floor layouts, a lounge and dining area with kitchen attached to the rear. Each of the houses has a small front garden and a larger back garden that is partly paved and accessible to users. The home is close to a good selection of shops, restaurants, transport links and other community facilities located along the A10 and within Enfield Town. HIGH GABEL HOUSE Version 1.00 Page 4 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place over one day and lasted a duration of five hours. Present at this inspection was the registered person Mr Kowlessur. The registered manager was not available and was said to be off sick. The pharmacy inspector visited the home the two days later to carry out an inspection of medication. Her findings are detailed under standard twenty in the body of this report. The inspector was able to interview three service users during the course of the inspection. The remaining five were attending a day centre and had not returned at the conclusion of the inspection. Feedback from service users and observations made by the inspector confirmed that the home is well run and is successfully meeting service user’s needs. Part of this inspection was used to confirm compliance with matters identified at previous inspections. Twenty-five requirements were issued at the last inspection, fourteen are met and eleven are restated with shorter timescales. A further fifteen requirements are made following this inspection bringing the total number of requirements to twenty-six. What the service does well: Service user comments confirm that the home provides a good standard of care and makes every attempt to meet their needs. Service user’s opinions and decisions regarding their care are recorded and respected and this gives them confidence that any concerns they may have will be listened to. The home has enabled service users to maintain close links with a variety of community groups/organisations and visitors are welcomed at the home. HIGH GABEL HOUSE Version 1.00 Page 5 What has improved since the last inspection? What they could do better: Six immediate requirements were issued at this inspection relating to supervision of the manager, staff recruitment checks and training, monthly visits to the home by the registered person, quality assurance and handling of service user finances. The registered person is encouraged to ensure compliance to avoid enforcement action by the CSCI. Recruitment practises at the home need great improvement to ensure that service users are fully by staff who have been subject to the full range of required checks. Induction and training in areas such as dealing with difficult/challenging behaviour is essential to provide staff with the relevant skills and knowledge to confidently meet service user’s needs. As a way of evaluating the effectiveness of the service, the home must seek the views of service users and other concerned parties regarding the quality of care offered by the home. Procedures and records of handling service users’ funds must be reviewed to ensure transparency. Recording and receipt of medication in the home must be improved to ensure a clear audit trail of medication received, administered and returned. HIGH GABEL HOUSE Version 1.00 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. HIGH GABEL HOUSE Version 1.00 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection HIGH GABEL HOUSE Version 1.00 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 and 5 The statement of purpose and service user guide provide service users with useful information about the home that gives them an insight into life at the home and enables them to make informed choices. Preadmission assessment information was not consistently available and it without it, it is questionable whether service user’s needs and aspirations would be fully met. Staff have not been equipped with the necessary training and skills to meet the needs of service users with challenging /difficult behaviour therefore service users needs are not being fully met. It is unlikely that service users can comprehend the content of their contracts/terms and conditions as they are not written in a format appropriate to their needs. EVIDENCE: Following the last inspection the home has revised it’s statement of purpose and service user guide and it now gives clearer information about the home to prospective service users. The files of two service users admitted to the home since November 2004 were examined. One contained a preadmission assessment from the placing authority while the other did not. The file with no preadmission assessment contained weekly reports covering a period of a month that had been compiled to monitor the service user’s placement and show that their needs were being met appropriately. No review information was available at the end of the four weeks to confirm that the placement was meeting the needs of this service user. HIGH GABEL HOUSE Version 1.00 Page 9 A discussion with this service user revealed that he was settling in very well in the home although he had very strong opinions on staff he liked and those he did not like for reasons such as entering his room without knocking and asking him not to play his guitar loudly. These issues were raised with the registered person who initially appeared dismissive of the service user’s concerns but was reminded that they were clearly real concerns for the service user and must be taken seriously. There was evidence of a recent review of another service user’s placement by the placing authority that stated that their needs were being appropriately met. Attempts to confirm this with the service user concerned were unsuccessful due to his low levels of verbal communication. However the inspector observed that the service user was well maintained, he seemed comfortable in his home environment and showed no apparent signs of distress of discomfort. The inspector is concerned that despite requirements at two previous inspections, staff have still not received training in dealing with difficult and challenging behaviour especially as some service users living at the home sometimes exhibit challenging behaviour. The registered person advised that staff were in the process of doing long distance learning that would be followed by a face-to-face one-day session with the tutor before completion of their course. The registered person anticipates that this will be completed by the end of April. An immediate requirement was issued for the registered persons must ensure that staff complete training in dealing with challenging/difficult. This requirement must be complied with to avoid enforcement action by the CSCI. Of the three service user files examined, all contained signed and dated contracts/statement of terms and conditions however these did not specify the room number occupied by the service user neither were they in a format that could be easily understood by service users. The registered person must ensure that the contracts/statement of terms and conditions are revised to ensure that they contain the room number occupied by the service user and are in a format appropriate to the needs of service users. HIGH GABEL HOUSE Version 1.00 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 and 9 Service user care planning documents now give a much more comprehensive and accurate picture of service users’ needs and how these are being met but lack of consistency has resulted in some individual care needs not being documented and met. There is recognition of most but not all potential risks to service users, resulting in some unmet needs. The opinions of service users are valued by the home as their views are sought, the decisions they make are respected and recorded and information given to them is presented in appropriate formats. EVIDENCE: There has been great improvement in the content and layout of service user care plans used in the home. Care plans are now more detailed and contain information relating to various aspects of the service user’s health and welfare. Of the three care plans seen there was evidence that two out of three service users had been involved in discussions relating to their care. All files contained a risk assessment but while a recent review by the placing authority described a service user as being overweight and the need for a healthy diet, this was not mentioned on the service user’s care plan or risk assessment therefore no appropriate action was being taken to address this particular need. Of the files HIGH GABEL HOUSE Version 1.00 Page 11 examined only one contained a photograph of the service user. The registered persons must ensure that all service user files contain a photograph of the service user and that care plans and risk assessments show evidence that service users have participated in decisions relating to their care. It was apparent that service users’ rights to make decisions were respected. For example staff had respected and documented a service user’s reluctance to participate in activities of daily living such as cooking and cleaning. In a positive move to encourage service users to be involved in the running of the home and in making decisions regarding their care, documents such as the statement of purpose, service user guide, complaints policy, menus and activities programme have been written in appropriate formats using pictures and makaton signs. HIGH GABEL HOUSE Version 1.00 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 15, 16 and 17 Service user dietary needs and tastes are well catered for by the home and menu options are presented in a pictorial format that encourages service users to make informed choices on what they would like to eat. The home supports service users to engage in a variety of activities in the community and to maintain a regular network of friends and family however visitors to the home must be recorded to avoid placing service users at risk. EVIDENCE: Service users living at the home are actively involved in attending a variety of community activities such as day centre, church and other group activities. Most service users attend a local day centre Monday to Friday and the weekend is devoted to activities such going for walks, to the cinema and shopping. As part of the process of promoting service user independence all service users have been provided with keys to their bedrooms. During a tour of the home there was evidence that most service users preferred to leave their rooms unlocked with the key in the door. A service user interviewed confirmed that he had been given a key to his room although he was unable to locate it at that particular time. HIGH GABEL HOUSE Version 1.00 Page 13 The inspector was satisfied that service users maintain links with their friends and family. At the time of the inspection a member of staff accompanied a service user to visit his mother who lives locally. Through discussions with a service user and staff it was apparent that service users receive frequent visitors however no records are kept of visitors in the visitors book as the last two entries were made by this same inspector on the occasions that they visited to inspect the home in April and October 2004. The registered person must ensure that records are maintained of all visitors to the home. A tour of the kitchen revealed that there were sufficient quantities of both fresh and frozen food. There was evidence of fresh and frozen food in the home. The menu offered to service users appears nutritionally balanced and is varied to suit service user tastes, for example a combination of light or hot evening meals as some service users prefer a hot evening meal while other prefer a lighter option. HIGH GABEL HOUSE Version 1.00 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 and 21 While some service user’s health care needs are met, this is not evidenced in a consistent way as record keeping and monitoring is not accurate or properly monitored. Service users are at risk owing to failures in properly applying the home’s medication policy and procedures. The wishes of some service users in relation to illness or death are recorded. EVIDENCE: Service users have regular access to a variety of health care professionals through visits arranged at the home or at local hospitals. Files seen indicated that a service user had been regularly attending anger management classes at Chase Farm hospital and meeting with a Psychologist whilst another service user had been seen by a GP four times this year for a variety of ailments. Weight monitoring records were viewed. On these files one record indicated that a service user had lost one kilogram in weight although their weight was recorded as being the same and there was no evidence of a change in diet. Policy and procedures were found to be complete but they were not being properly applied. No agreement and assessment form for self-administration had been completed for this service user. There were no signed records for the receipt of medication in the home and there were some gaps in the administration records so it was not known whether the medication had been administered or why it had not been administered. The printed medication HIGH GABEL HOUSE Version 1.00 Page 15 administration sheets for service users, supplied by the pharmacist contained some items that had been discontinued by their GP. The home had crossed these out on the sheets to prevent confusion. The storage conditions were satisfactory and safe except that in one of the houses the key to the medication cupboard was in an open key cupboard instead of on the person in charge of the shift. If a service user goes on social leave for a short period, staff decant the medication for that service user into a compliance aid but no signed and checked record of this process was found. Medication training has taken place within the last six months. Service users’ consent, where possible, to take medication had not been recorded in their individual care plan. Two out of three files seen showed that service users had been consulted about their wishes in the event of their death but one file examined did not have a record of this information. The registered person advised that he was aware of this and was planning to discuss this with the service user’s family when they next visited the home. This is required. HIGH GABEL HOUSE Version 1.00 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The complaints process in the home has been presented in a way that makes it accessible to all service users and service users have confirmed their confidence in the complaints procedure. A lack of detail in financial records and the provider acting as appointee for a service user increases the risk to service users of financial abuse. EVIDENCE: The home now has a complaints policy that is in a format appropriate to the needs of service users. The home has received no complaints since the last inspection and service users interviewed stated that they had no concerns and if they did they would discuss them with the registered person. The adult protection procedures have been reviewed to ensure that staff are aware of the procedure they should follow if an allegation of abuse is made by a service user. The inspector was unable to confirm this with staff but is confident that staff are aware of adult protection procedures as they received training in the last six months. There has been little progress in the way in which service user finances are handled. The registered person is still appointee for one service user despite discussions at previous inspections that this responsibility be transferred to the service user’s family. An immediate requirement was issued for this to be addressed. Service users are now given their personal allowances weekly and sign to indicate receipt but financial records do not show their contributions to their accommodation. This is required. A random check of a service user’s finances showed that receipts were available to confirm purchases made on their behalf and they were receiving their allowance on a weekly basis. HIGH GABEL HOUSE Version 1.00 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26 and 30 The home provides a clean and comfortable and safe living environment but poor response to maintenance issues is causing unnecessary discomfort to service users. EVIDENCE: The home is brightly decorated and well furnished and is a pleasant and comfortable environment. Bedrooms have individual décor and following the last inspection a double bedroom had been redecorated to suit the tastes of the service users currently occupying it. Lockable storage areas are now available in all rooms. The home was free from offensive odours on the day of the inspection. Although the home has an infection control policy staff have not received infection control training and this must be arranged. Some general maintenance issues identified in the home at the last inspection have been addressed while some are still outstanding. The water temperature in the bath at 295 Lincoln Road is still not hot enough. An under blanket is still required on the bed of the service user living on the top floor of 292 Lincoln Road as the mattress is currently covered with plastic sheeting with a sheet on top and no protection from the cold plastic covering the mattress. The room facing the rear garden on the first floor at 292 Lincoln road also requires an under blanket and the curtains require more curtain rings. The wardrobe in the HIGH GABEL HOUSE Version 1.00 Page 18 other bedroom facing the main road needs attention as it is not closing firmly. The registered persons must ensure that they give priority attention to the areas described above. HIGH GABEL HOUSE Version 1.00 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35 and 36 Recruitment practises at the home continue to deteriorate with little or no checks being carried out on staff, leaving vulnerable service users at risk. Records of staff training are inaccurate and misleading and do not identify staff training needs or opportunities for development. The current induction training is woefully inadequate and places newly recruited members of staff in a position where they are unaware of service users’ needs and unable to effectively meet them. It is encouraging that staff have now started to receive regular supervision. EVIDENCE: There have been two new staff recruited at the home following the last inspection. The files of the two new staff and that of another staff were examined. Evidence on file indicated that insufficient recruitment checks had been carried out prior to staff being recruited. One new member of staff had no references, no evidence of their eligibility to work, no health questionnaire on their fitness to work and CRB that had been transferred from a previous employer. There was not even a completed application form for this member of staff. Of particular concern to the inspector was the fact that this member of staff had started work the previous day and had gone out alone in the company of a service user with no knowledge of this service user’s needs or history of challenging behaviour. The registered person seemed unaware that CRB checks were no longer transferable. He advised that HIGH GABEL HOUSE Version 1.00 Page 20 he had sought references over the phone but had no documentary evidence to confirm this. He advised that he had seen a copy of the member of staff’s visa and it was due to expire in 2006 but when this member of staff was asked by the inspector he stated he had indefinite leave to remain and therefore was not subject to immigration control. The file of the second new member of staff showed that same level of discrepancies. Again there was no eligibility to work and there were two references. The reference from the most recent employer did not contain information on their job title and role, the duration of their employment and the reason they left this position. This reference had not been verified and when the inspector, in the presence of the registered person tried to ring the referee to seek clarification, the telephone number was “unrecognised.” Two of the three files contained appropriate CRB checks carried out by the home. The registered person must ensure that the necessary checks are carried out before staff commence employment. An immediate requirement was issued. Training records on four staff files were inspected. Records seen indicated that between them staff had completed training in the core areas such as food hygiene, first aid and moving and handling but only two staff had completed the full compliment of core courses. The recently recruited staff are between them still to receive training in adult protection, aggression, fire safety, basic first aid and infection control. The registered person advised that the member of staff who commenced work the previous day had received induction training although no records were available. A discussion with this member of staff revealed that he had received induction lasting 20 to 25 minute and he had been given no opportunity to read the care plans and other documents of service users he was currently working with. Staff training profiles were available on some files but due to their layout the information detailed was of little use. The individual training profile was designed in such a way that assumes [incorrectly] that the member of staff has received training in the core areas. The registered person must ensure that staff training needs are identified and accurately recorded on an individual basis and that all staff receive training in the core areas relating to their position. Another random sample of four staff files was selected and viewed. Information contained on these files confirmed that staff are receiving regular and documented supervision. HIGH GABEL HOUSE Version 1.00 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 40,41, 42 and 43 The confusion of roles between the registered provider and the registered manager leads to a service that is not well run. There is little evidence of service users views being taken into account or that they feel enabled to influence the day to day running of their home. Management is therefore unable to demonstrate its accountability. Delays in responding to actions identified by the fire authority place service users at potential risk to their safety. EVIDENCE: The home has a condition of registration requiring the registered person to give regular documented supervision to the registered manager until they have satisfactorily completed their NVQ level 4. The registered manager was away at the time of the inspection however when their supervision notes were inspected they indicated that they had last received supervision in August 2004. The registered person has not complied with requirements at previous inspection to provide supervision to the registered manager. The registered HIGH GABEL HOUSE Version 1.00 Page 22 person informed the inspector that the registered manager had completed their NVQ in December 2004 but there was no evidence confirming this. The inspector advised that supervision must continue until documentary evidence of completion of the NVQ has been made available to the CSCI as current levels of supervision and the absence of the registered manager at the last two inspections makes it difficult to be satisfied as to their competency. Furthermore the current supervision format where tick boxes are used is unsatisfactory and must be reviewed to give a clearer picture of issues discussed and any action to be taken. An immediate requirement was issued to ensure compliance with this requirement. The registered person is required under regulation 26 to visit the home once a month to carry out an unannounced inspection, following which a report must be prepared and sent to the CSCI. Only three reports have been received in the last year for the months of May and July 2004 and February 2005. An immediate requirement was issued requiring the registered person to ensure that these reports are sent to the CSCI on a monthly basis. The home has in the past made attempts to seek the views of service user regarding the quality of care offered at the home. However this information has not included the views of relatives and other professionals and has been filed in the relevant service user’s file. The registered person was advised that he is required to carry out an annual quality assurance system to seek the views of service users, relatives and visiting professionals. This information must be compiled and a report of the findings and action to be taken sent to the CSCI and to the participants. An immediate requirement was issued. The home has reviewed its policy on management of aggression or challenging behaviour to include information on service user risk assessments and the way in which this is used to manage the behaviour of service users. Documentation confirming that the following health and safety checks was seen; Portable appliance testing 19/08/04 Fire alarm, emergency lighting and fire equipment 24/03/05 Boiler servicing 24/03/05 Electrical installations 31/03/05 Insurance certificate is valid until 13/03/06 The fire officer visited the home in March and made recommendations that two fire doors are repair to ensure that they are self closing. The registered person advised that this was still being dealt with by the home. HIGH GABEL HOUSE Version 1.00 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 2 1 x 2 Standard No 22 23 ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x 3 x x x 2 Standard No 11 12 13 14 15 HIGH GABEL HOUSE x x 3 x 2 Standard No 31 32 33 34 35 36 Score x x x 1 1 3 Version 1.00 Page 24 16 17 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 2 Standard No 37 38 39 40 41 42 43 Score 1 x 1 3 1 2 3 HIGH GABEL HOUSE Version 1.00 Page 25 Yes 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 2 Regulation 14 Requirement The registered persons must ensure that there is a full assessment of service users needs before they are admitted to the home by persons competent to do so. The registered persons must ensure that all staff working in the home receive training in dealing with difficult and challenging behaviour in line with the learning disability award framework. [timescale of 15/1/05 not met] Timescale for action 15/6/05 2. 3 18(1)(c) (i) 30/4/05 Immediate requiremen t 3. 5 5(1)(c) This requirement is restated from the previous two inspections The registered persons must 30/4/05 ensure that service user contracts/statement of terms and conditions contain detaills on the room occupied and are in a format appropriate to the needs of service users. [timescale of 15/11/04 not met] This requirement is restated from the previous three insepctions The registered persons must Version 1.00 4. 6 and 9 12(2)(3) 15/6/05 Page 26 HIGH GABEL HOUSE 15(1) ensure that all care plan and risk assessment documents contain information relating to their health and welfare and how these needs are to be met. Service users must be consulted and their decisions on the care offered to them recorded. Care plans must contain a recent photograph of the service user. The registered persons must ensure that records of all visitors to the home are maintained. The registered persons must ensure that weight monitoring records are maintained accurately. The register persons must ensure that all medication received into the home is checked, and signed for preferably on the medication administration record. The registered persons must ensure that the administration of all medication is signed for on the administration chart at the time of administration or the reason for non administration stated on the chart by means of a code. The registered persons must ensure that any medication decanted for a service user going on short term leave is checked by a second member of staff and the process recorded and signed for by both staff members. The compliance aid must be labelled with its contents. The registered persons must work with the pharmacist to ensure that medication that has been discontinued by the service user’s GP no longer appears on their medication administration Version 1.00 5. 6. 7. 6 15 19 8. 20 17(1)(a) Schedule 3 17(2) Schedule 4 para17 12(1)(a) (b). 17(3) Schedule 4 13(2) 15/6/05 30/4/05 30/5/05 30/5/05 9. 20 13(2) 30/5/05 10. 20 13(2) 30/5/05 11. 20 13(2) 30/5/05 HIGH GABEL HOUSE Page 27 record. 12. 20 13(2) The registered persons must ensure that the keys to the medication cupboards are always kept on the person[s] in charge of medication for the shift. The registered persons must ensure, that if the service users are able to give consent to medication it is recorded in their care plan. The registered persons must ensure that all service users are consulted about their wishes in the event of their death and that these are recorded. [timescale of 15/1/05 not met] This requirement is restated from the previous two inspections The registered persons must ensure that financial records clearly show service user contributions towards their accommodation. [timescale of 30/10/04 not met] This requirement is restated from the previous two inspections The registered persons must identify an independent person to act as appointee for a service user. [timescale of 15/1/05 not met] This requirement is restated from the previous two inspections The registered persons must ensure that the following areas are addressed; Under blankets must be provided on all beds. Water temperature in bathrooms must be maintained at or around 43 degrees celcius. Version 1.00 30/5/05 13. 20 13(2) 30/5/05 14. 21 12(3) 30/4/05 15. 23 13(6),17 Schedule 4 para 8 and 9 30/4/04 16. 23 13(6), 20 30/4/05 Immediate requiremen t 17. 24 16(2)(c) 23(2)(b) (j) 30/4/05 HIGH GABEL HOUSE Page 28 The wardrobe in the first floor room facing the main road at 292 must be repaired to ensure it closes firmly. The curtains in the first floor room facing the rear garden must be rehung. This requirement is ammended and restated from the previous two inspections The registered persons must ensure that all staff working in the home receive infection cotrol training. The registered persons must ensure that staff are subject to the proper checks before commencement of employement. Staff files must contain all the information detailed under schedule two of the the Care Homes Regulations. [timescale of 15/1/05 not met] This requirement is ammended and restated from the previous two inspections The registered persons must ensure that individual staff training needs are identified and clearly recorded. The registered person must ensure that staff working at the home are subject to recorded induction training within six months of the date of their commencement of employment. Staff recruited at the home since October 2004 must be given induction training and records must be maintained. The registered persons must ensure that all staff working in the home have up to date Version 1.00 18. 30 13(3), 18(1)(c) (i) 19 Schedule 2 30/6/05 19. 34 30/04/05 Immediate requiremen t 20. 35 18(1)(c) (i) 18(1)(c) (i) 30/05/05 21. 35 30/04/05 22. 35 18(1)(c) 30/06/05 HIGH GABEL HOUSE Page 29 training in the following areas; moving and handling, infection control, basic first aid, food hygiene, fire safety and adult protection. Records of staff training must be maintained on file. The registered person must ensure the fitness of the registered manager by ensuring that he receives regular and recorded supervision covering all aspects of his roles and responsibilities. [timescales of 15/12/04 not met] This requirement is restated from the previous two inspections. The registered person must ensure he seeks the views of relatives and other stakeholders in the home about the service provided. The views must be analysed to determine whether the aims and objectives of the home are being met. Evidence confirming implementation of this requirement must be sent to the CSCI by 30/04/05. [timescale of 18/10/04 not met. This requirement is restated from the previous three inspections. The registered person must send to the CSCI copies of reports of registered person visits conducted in accordance with Regulation 26 of The Care Homes Regulations 2001. This requirement is restated from the previous three HIGH GABEL HOUSE Version 1.00 Page 30 23. 37 9,18(2) 30/04/05 Immediate requiremen t 24. 39 24(3) 30/04/05 Immediate requiremen t 25. 41 26(5) 30/04/05 Immediate requiremen t inspections. 26. 42 23(4) The registered person is required to ensure, in accordance with recommendations by the fire officer that all fire doors in the home are self closing. This requirement is ammended and restated. 15/05/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations HIGH GABEL HOUSE Version 1.00 Page 31 Commission for Social Care Inspection North London Area Office Solar House, 1st Floor 282 Chase Road, Southgate N14 6HA 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 HIGH GABEL HOUSE Version 1.00 Page 32 - 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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