Inspection on 01/12/05 for The Gables

This inspection was carried out on 1st December 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 no outstanding requirements from the previous inspection report, but made 25 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gables 11/09/07

The Gables 12/12/06

The Gables 17/05/06

The Gables 16/02/06

The Gables 11/02/05

The Gables 07/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 The Gables 2/4 Blackheath Park Blackheath London SE3 9RR Lead Inspector Mrs Susan Hall Unannounced Inspection 1st December 2005 10:00 The Gables DS0000006760.V279817.R01.S.doc Version 5.1 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 The Gables DS0000006760.V279817.R01.S.doc Version 5.1 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 Adults 18-65. 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. The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Gables Address 2/4 Blackheath Park Blackheath London SE3 9RR 020 8852 8799 020 8297 2782 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) londonroad@tiscali.co.uk Milbury Care Services Limited Mrs Audrey Grehan Care Home 27 Category(ies) of Learning disability (24), Learning disability over registration, with number 65 years of age (3) of places The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 places registered for LD(E) are for named service users only. Date of last inspection 11th February 2005 Brief Description of the Service: The Gables consists of 2 linked houses which were built in the late 19th Century, and are situated in a pleasant residential area of Blackheath. They are located within walking distance of Blackheath village, near to shops and other amenities. A railway station and local bus routes are easily accessible. The Gables is one of several care homes owned and run by Milbury Community Services Ltd., all of which are located in the London Borough of Greenwich. The houses are divided internally into 4 flats - 2 on the ground floor, (flats 3 and 4) and 2 on the first floor (flats 1 and 2). One of the ground floor flats (flat 3) was formally used for service users receiving respite care, but the respite service has now been transferred to another unit in Greenwich. The other flats have different numbers of bedrooms (4, 5,and 6), and therefore allow space for up to 15 service users. Each flat is entirely self-sufficient, with it’s own lounge, dining-area, kitchen, laundry area and bathrooms. There is a large garden at the rear of the property which is available for all service users. The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place between 09.40 – 16.05. The Manager was present in the home throughout this time, and assisted the Inspector with locating documentation, showing her around the home, and introducing her to other staff and service users. The Inspector met 5 Service Users and was able to chat with some of these, but had limited communication with others due to their learning disabilities. Other service users were attending day centres. The Inspector also talked with the nurse on duty and 2 support workers, and met other staff briefly during the day. A number of CSCI comment cards were received back: 5 from service users – which were all positive in their content; 10 from relatives and visitors, and 7 from health professionals. These were all helpful in confirming the Inspector’s own findings. Most were positive responses, and indicated improvements in care during the year. Flat 3 had previously been used as a respite service. This has now been moved to another location, and flat 3 was currently vacant. The Manager was looking forward to the opportunity of offering different bedrooms to some service users who either had shared rooms or small rooms, and redeploying the space for improving the home for service users. Registration was previously approved for up to 27 service users. Now that the respite service has been moved, there is the opportunity to allow service users to have larger rooms where possible, and to have single rooms (where this is their choice). In the light of changing circumstances, the registered number of service users will need to be reviewed with the providers. What the service does well: The Inspector received positive comments from 2 service users during the day, and from several comment cards, stating that the staff are kind and caring, and service users mostly appeared happy and content. Staff recruitment files showed good procedures were in place, with all required information obtained prior to confirmation of appointment. The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 6 General risk assessments for the home were detailed and comprehensive, and had been reviewed and updated during September 2005. What has improved since the last inspection? What they could do better: The Inspector found many areas which require improvements in order to meet national minimum standards, and these will be itemised in detail in the rest of the report. The premises have been allowed to deteriorate over a number of years, and apart from redecorated areas appeared to have been badly neglected. None of the flats were in a satisfactory state of upkeep. One flat had been painted, and this looked much better, but the carpets still needed replacing. Carpets throughout the home were in very bad condition, with many stained areas, and some rucked and damaged, which could contribute to falls. The Manager stated that the whole of the home was in the process of being redecorated and re-carpeted. The Statement of Purpose needs to be updated with revised information regarding the management and responsible individual; and with an outline of the staff employed at the home. The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 7 The requirements will include further work to be done to improve care planning and behavioural guidelines, and more detail in respect of ongoing assessments for health needs (such as nutritional and dependency assessments). Charts for items such as fluid balance need to be better maintained. There are 3 requirements regarding medication. The Inspector found a number of out of date items in 2 medicine cabinets, and creams and eye ointments not dated on opening. The home does not have a sensory room, and one of these would be of benefit to the service users. There is a recommendation to set a room up as a sensory room while the home is being refurbished. The Inspector noted that some radiators and heaters were not appropriately guarded. This had been a particular problem due to one of the boilers breaking down. It is of paramount importance that heating appliances do not cause increased risk to service users. 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 Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 9 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 the following standard(s): The home provides sufficient detail to enable service users and relatives to make an informed choice prior to admission. Service users are provided with terms and conditions of residency. EVIDENCE: The home’s Statement of Purpose is set out in line with standard 1.1, and Schedule 1 of the Regulations. It is well presented, and includes most of the required information. However, details of the Manager and Responsible Individual have not yet been updated, although they were appointed several months ago, and there is a requirement to amend this. Staff details had also become out-dated and will need to be altered accordingly. The service users’ guide contains all relevant information, and is produced in larger print and with several small pictures. The complaints procedure is produced in a simple picture format, and a copy of this is provided in each flat, as well as in the service users’ guide. The home has not had any new admissions during the last year, but may be in a position to admit new service users in the next few months, after redecorating is completed. There is a recommendation to produce a simplified format for a service users’ guide, (e.g. a series of laminated photographs), so that prospective service users might be given some idea of the home prior to visiting. (Photographs of any current service users would have to be taken with permission.) The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 10 The Inspector viewed several pre-admission assessments in service users’ care plans, and these were very detailed, and showed that sufficient information had been recorded before a decision was made to offer a placement to the service user. The assessments indicated that information was taken in regards to different aspects of daily living, communication needs, and social preferences, and included health needs and evidence of assessing compatibility with other service users. The Manager stated that the admission procedure would be carried out slowly, according to the needs of the service user and their understanding. Relatives and the Care Manager would probably visit first, and then a visit would be arranged with the service user. This would enable them to meet staff and other service users, and possibly stay for a meal. A successful visit would be gradually followed by an overnight stay or a weekend visit, prior to arranging placement for a trial period. All service users had their accommodation and personal/nursing care provided by the local authority, and in line with Regulation 5.3, a copy of the agreement had been added to each care plan. The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 6 – 10 The service users’ care plans were unsatisfactory, and did not contain up to date and relevant information about service users. There was no indication of service user and family involvement with these plans. Risk assessments for service users were inadequate, and were not easily accessible for staff to check prior to any activity or outing. EVIDENCE: The Inspector examined 4 care plans (2 from each of 2 flats), and was concerned to find that they did not set out clear objectives for service users. Those examined contained some very out of date assessments and care plans (going back as far as 1998), and were muddled and difficult to follow. Care plans are stored in individual folders, and have an index and different sections. However, the sections did not contain much of the necessary information. The home’s Statement of Purpose states that the home uses the recognised “John O’Brien 5 accomplishments of ordinary living” for learning disabled service users, but there was nothing to indicate this in the care planning. The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 12 Health assessments (e.g. for nutrition, waterlow score, and continence care) were found to have been completed on admission (sometimes several years previously), but with no indication that these had been completed again since, and properly reviewed. Some had been signed as “reviewed” and dated in the last 12-18 months, but did not accurately reflect the changes needed with the care for that service user. Communication guidelines were found to be out of date, and a speech therapist assessment for swallowing and dietary needs was out of date. These assessments form the basis for the plan of care, and so accurate care plans had mostly not been implemented. There were one or two exceptions found where a nurse had recently updated care plans for moving and handling, personal hygiene care and care of asthma for 1 service user. It is important for staff to recognise the importance of maintaining up to date care plans, and to be able to show that service users’ wishes, and the views of their relatives or advocates, have been taken into account. Life plans were seen in place for some service users, but had not been updated and reviewed appropriately (e.g. longer than 6 months since updating had taken place.) However, daily report books - provided for each service user - had been completed much more successfully. They are written at the end of each shift, and provided a record of daily occurrences, visits, behaviour and care given. The Inspector was able to note that these records had improved over recent weeks, and this change appeared to be in response to a report writing seminar which many staff had attended. The Inspector was unable to clarify how much opportunity is given to service users to participate in the day to day running of the home, and to contribute to it’s development. Processes should be set in place where service users meet with staff, and have opportunity for sharing their thoughts and feelings about the home in ways which are applicable for them and their ability to understand and communicate. However, each service user is allocated with a named nurse and a keyworker, in order for them to build relationally with these staff. Care plans viewed contained minimal risk assessments for items such as use of kitchen equipment, or risk of hazards or falls. Some had “Waterlow” assessments for dependency levels and risk of developing pressure sores, nutritional assessments and mobility assessments. Most of these had not been updated since 2004. Some other individual risk assessments were seen in a general folder, and included items such as service users who need escorts when going out. The Inspector was concerned to note that some risk assessments were included in individual folders, and some in with the general risk assessments for the home. Risk assessments for each individual service user must be easy for staff to access, and should include items such as their ability to leave the home unaccompanied; use of electrical equipment in their rooms; management of any aggressive behaviour towards other service users, and risks for using different areas in the home e.g. toilets and bathrooms. Risk The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 13 assessments were generally very inadequate, and is another aspect of documentation which needs to be fully addressed. Service Users’ plans and other information about them was generally kept out of sight, and not breaching confidentiality. Service Users were aware of their individual daily report books, and knew these contained their own records of daily care. The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 11-16 Service Users are enabled to take part in the local community, and have satisfactory opportunity for developing their educational and occupational abilities. There was insufficient evidence to show that they are able to develop independent living skills, and behavioural guidelines were not available to help them to learn to modify inappropriate behaviour. EVIDENCE: Service users are allocated places at different day centres for mostly 2-5 days per week. There were no records seen in individual care plans to show specific areas where service users are being encouraged to develop, and which skills they are being assisted with. It would seem advisable for programmes of day care to be added to each care plan, so that any practical life skills being encouraged at day centres are also encouraged in the home. Similarly, there was evidence of difficult or inappropriate behaviour from some service users (screaming, stripping off clothes, playing radio very loudly), which was documented in daily report books. However, there were no guidelines in place for staff to know how they should be working with the service user to understand this behaviour is unacceptable, and how to promote The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 15 change. There are 2 requirements in respect of these for standard 11. One clear set of guidelines was seen for 1 service user, and this had been developed with the assistance of a psychologist. Unfortunately this was undated, so the Inspector had no way of knowing if this was up to date or not. Service users had been assessed and placed at different day centres. The care plans did not show how decisions had been made for which day centres they were to attend. They merely stated arrangements for e.g. “Mondays, Tuesdays and Fridays”. It would also be helpful for service users to have weekly planners in place, in a format which they understand, so they have some idea of where they are going on a day to day basis.(e.g. morning, afternoon and evening). Conversation with staff and service users confirmed that service users are enabled to access the local community, and were used to visiting local pubs and cafes, shops and leisure centres. Visitors are welcomed at any time, but are encouraged to make arrangements first in case the service user has gone out. A pay phone is available for service users, and they are able to take incoming calls on the home’s main phone line. There were some current difficulties with the phone system which were being dealt with. Staff take service users out to shows (such as pantomimes), and day outings, but this is limited due to transport arrangements. The company have provided a car, but this means that only 1-2 service users can go out at any one time. This is insufficient for a home with 15 service users, and there is a requirement to review the transportation available for the home. In-house activities were not deemed to be sufficient by some of those who completed CSCI questionnaires, and some staff also felt that they were not sufficient for all service users. Once service users have returned from day centres, there is not a clear plan of action in place for their leisure time. The Manager was considering implementing such items as a “pampering day” for when service users were not attending day centres. All service users were being offered one week’s holiday per year, and one of the service users talked about this very positively. Daily routines were not clearly documented, but it was apparent that service users are given a choice for joining in with activities or not. Some care plans contained risk assessments showing that service users were unable to manage their own door keys. Arrangements for taking responsibility for housekeeping tasks were not clearly identified, and should form part of the care planning. Each flat has it’s own kitchen and own budget for food. Menus are planned together in the different flats according to the preferences of those service users. Alternative meals or snacks are available for those who may change their minds. Kitchens were appropriately stocked with a variety of food. The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 16 The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 17 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 the following standard(s): 18,19,20 Care plans did not include necessary information to confirm that service users were having adequate personal or healthcare support. Some of the medication practices and procedures were unsatisfactory. EVIDENCE: Daily report books specified some daily care given, and included details of when service users got up/went to bed, how they slept etc. Some also stated if a bath or shower was taken. Admission assessments included information about how much assistance is needed with personal hygiene, and may have a risk assessment for using the bath or shower. Those viewed did not contain updated information, and this was the same for most healthcare plans. Some good initial assessments were seen for catheter care, moving and handling guidelines, mental health reviews, nutritional needs, management of epilepsy and “Waterlow” scores. Some of these had not been updated since admission, or as far back as 2003. Each service user should have a clear plan in place to denote their preferences with management of personal care needs; specifying baths, showers, nail care, shaving etc. Health needs must be clearly itemised, with up to date guidelines in place for such items as nutritional needs and weight, moving and handling The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 18 needs (and if this includes hoisting); practical guidelines for management of epilepsy; management of incontinence or catheter care. Service users’ plans included records of input from other health professionals. Some of these included letters from psychiatrist or psychologist, or input from speech therapist or physiotherapy. The Inspector also saw records regarding chiropody, dental care, optician visits and GP visits. These indicated that health professionals are appropriately contacted, but ongoing care is not clearly specified. The home is registered for service users who need nursing care, but nursing care in the plans viewed was poorly presented. Weight charts had not been completed, and fluid balance charts had not been added up – showing a lack of understanding of how to apply the information recorded, and the purpose for which it is taken. Medication procedures were inspected in 2 of the flats. Medication is properly stored in locked metal cabinets, in safe areas in each flat. External medication was stored separately from internal medication. Medication Administration Records (MAR charts) were examined, and showed that medication is recorded when it is received into the home. MAR charts included a photograph of each service user, and a record of any allergies. Signatures had been well completed, but handwritten entries had not been signed and dated. Medication is administered by trained nurses, and a list of signatures was included at the front of each file. The monitored dosage system is used for medicines where possible. The Inspector found an opened tube of fucidin cream prescribed in 2004. There was no indication when this had been commenced. Some procyclidine tablets were found which had been prescribed in 2003. If these were no longer required, they should have been sent for disposal. An opened tube of chloramphenicol ointment was not labelled with the name, or dated on opening. There are requirements to ensure that medication procedures are adhered to in line with the Royal Pharmaceutical guidelines for the Administration of Medicines in Care Homes, and in line with nurses’ responsibilities set out by the Nursing and Midwifery Council. The Inspector did not check that new arrangements had been put in place for the disposal of medication from nursing homes. This will be checked at the next inspection visit The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 19 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 the following standard(s): 22,23 The home has a satisfactory complaints system in place. Adult protection procedures and prevention of abuse are included in staff training programmes. EVIDENCE: The complaints procedure is included in the service users’ guide, and is also on display in the main entrance hall to the flats. It has been complied in a picture format, to enable service users to have some understanding of how to initiate a complaint, and who to go to if they are concerned about any issues. No formal complaints had been received since September 2004. A complaints log included some details of the action taken in response to complaints, and confirmed that the complaints had been upheld. This log did not contain comprehensive details of interviews held, conversations with complainants, or how the matters were resolved, - although it did specify that complainants were satisfied with the outcome. There is a recommendation for the management of future complaints to be recorded in greater detail. Staff training records showed that some staff had attended training courses for POVA (protection of vulnerable adults), and non-violent crisis intervention training. The Inspector did not check at this visit if all staff had received this training, and will assess this more fully at the next visit. Staff recruitment files had good evidence of CRB (criminal record bureau) checks. The Manager stated that no new staff are allowed to commence work or have their appointment confirmed until satisfactory POVA and CRB checks have been completed. The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 20 The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 21 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 the following standard(s): The standard of upkeep, maintenance, décor, furnishings and fittings is extremely poor, - except for where redecoration of flats 1 and 3 had been commenced. Some of the quality of furnishings and fittings could be potentially harmful to service users (e.g. damaged carpets). Improvements had been commenced but should be treated with the highest priority. The Manager was fully aware of the current state of the property, and stated that she had alerted the Providers accordingly. The Inspector had not previously visited this home and found the state of the environment to be unacceptable. EVIDENCE: Redecoration of the walls had been commenced in Flats 1 and 3. As this is an old building, there are many wires and pipes on the walls, which are not conducive to a homely environment, and cause delay for the decorators in painting these areas. One of the decorators confirmed that many walls were damaged, and needed filling in before painting could be done. The Manager stated that the whole of the premises were being redecorated, and there is a requirement for the Providers to ensure that this is carried out. The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 22 Many furniture and fittings were unsatisfactory – especially carpets. Some of these were becoming hazardous, e.g. the carpet in Flat 1’s dining room. Much of the furniture in lounges and dining rooms was old and outdated, and although some of this was still serviceable, (e.g. Flat 1 lounge), the Inspector would consider that service users deserve better quality than this. Curtains were missing in some areas, and kitchen units need replacing in Flats 1 and 4. The kitchen units should be replaced soon in Flat 2, but these kitchen units were not in such a poor state as the kitchen units in Flats 1 and 4. A list of items is included at the end of this section. Some bedrooms in Flat 4 were small and cramped, and no longer provided sufficient space for nursing and other equipment needed for service users. The Manager was looking forward to discussing the availability of larger rooms which had been vacated from Flat 3, since the respite unit had been moved elsewhere. Re-assessment of some service users’ rooms should be carried out to ensure that they meet the service users’ needs, and moves to other rooms arranged after appropriate discussion with the service users, relatives, care managers and occupational therapist (as applicable). Individual bedrooms varied in size and décor. Those painted in Flat 1 were in satisfactory condition except for the carpets, and had personalised items which made some rooms look pleasant and homely. One bedroom door had a broken hinge, and the wood for the door surround is so old that the hinge will need to be fixed on a different part of the door frame. Flat 2, room 2 has window frames in very bad condition, and these need to be repaired or replaced. The en-suite bathroom for this room (a shared room), has a shower and a bath, but no toilet. This does not meet the needs of these service users, and a recommendation is given to replace one of these items with a toilet. Other bathrooms contained assisted baths and showers, and after redecorating, will provide satisfactory bathroom facilities. Flat 4 has a shower room which needs attention to the skirting board area. Most communal areas had pictures and photographs, but Flat 1 did not have any pictures in the lounge. The Manager said that these had been discarded as they were old and outdated, and were not in keeping with service users’ wishes. There is a recommendation to ensure that these are replaced with alternative pictures. Only one flat (flat 2) had communal rooms satisfactorily presented, and the other flats will need replacement furniture and fittings to provide a homely environment. The home includes some pressure-relieving mattresses and cushions for 2 older service users; bedrails and nursing beds; handrails, raised toilet seats, and hoisting facilities. Some rooms have overhead tracking facilities (mostly in bathrooms), which are very helpful. However, there is no sensory room in the home, and other sensory equipment was not seen to be available. There is a The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 23 recommendation to set aside one room as a sensory room, as this could be identified and fitted during this time of refurbishment. The home did not appear to be generally clean, although it was clear that staff were working to keep rooms tidy where possible. The poor décor, carpeting, kitchen units and furniture items have not contributed towards an overall effect of cleanliness. Laundry facilities are sited in each flat. These are very cramped in Flat 1, with a tumble dryer on top of the washing machine. This is not very satisfactory, as there are no hand washing facilities, and baskets of dirty clothing have to be stored in the corridor. This is another situation which should be discussed during the refurbishment. The laundry area in Flat 4 is much larger, and there is a separate sink used for cleaning commode buckets. As this home includes nursing in the registration, consideration should be given to the purchase of a sluicing disinfector. Washing machines contained a sluicing facility, and tumble dryers were commercial models and suitable for their purpose. The following is a list of identified items for attention: Flat 1 Replace lounge and dining room carpets as a priority. Kitchen units to be replaced. Fridge to be replaced. New pictures to be provided for lounge. Replace old furniture in lounge. Curtains to be purchased and hung in rooms where there are no curtains. Flat 2 Re-fit hinge on identified bedroom door. Replace kitchen units. Window frames to be repaired or replaced in Room 2. Room 2 – alter en-suite to include a toilet instead of the shower or bath. Flat 4 Refurbishment of dining room and lounge – including new furniture. Kitchen units to be replaced. Review bedroom furniture and replace as needed. Chest freezer to be replaced (the current freezer does not lock). Shower room to have skirting boards repaired. Review the products used for carpet cleaning – the current products are ineffective in one identified bedroom. Review placement of service users in rooms which are too small to meet their needs. Consider the possibility of fitting a sluice disinfector. Arrange for old discarded items outside to be tipped. The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 24 The home has a large garden at the rear of the property, and a newly – employed maintenance man has plans to improve this during the next year. The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 25 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31-36 After a time of instability due to staff maternity leave, the staff team was becoming more settled. Staff showed an awareness of their different levels of responsibility, and the need to assist each other. Staffing levels were in accordance with previously discussed targets, but the Inspector was unable to clarify if staffing levels were sufficient to meet all Service Users’ needs. EVIDENCE: Throughout 24 hours, there is one nurse on duty to cover the needs of the whole home. The nurse is available to help out with care in any of the flats. Nursing staff are mostly trained in Learning Disability, and 1 nurse is a Registered Nurse (RN1) and another nurse has training in Mental Health. These are able to assist other staff in understanding different aspects of care. Each flat has separately designated support workers, so that they can learn the details of care for the service users in that flat. Flat 1 has 4 service users, and 1 support worker is allocated to manage care. Flat 2 has 5 service users, and 2 support workers are allocated to manage care. Flat 4 has 6 service users, and 3 support workers are allocated to manage care. The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 26 Support workers are allocated to a flat for 5-6 months at a time. The plan is that they will change to different flats every so often, after staff discussion meetings, so that they can develop more ability by caring for other service users. The Inspector was concerned that as some service users have high dependency levels, staff sometimes need to work in pairs to give care; this leaves only 1 or 0 staff to oversee other service users during that time. The staffing numbers also appear insufficient for enabling service users to go out with the appropriate support. There is a recommendation to review staffing levels, and be able to demonstrate that they adequately meet the needs of the home. The Inspector was able to talk with one nurse and 2 support workers. Staff said that mandatory training needs are well supplied by the company, and they are able to attend training according to the updates that they need to complete. The Inspector did not see a staff training matrix at this inspection, and so was unable to confirm that all staff were receiving required training on time. 3 more support workers had completed NVQ 2 training, and were waiting for their certification. This provided 9 staff with NVQ 2 training. Certificates in staff files showed evidence of mandatory training for basic food hygiene, health and safety, moving and handling, fire awareness, and communication skills. Moving and handling training included use of hoist facilities. Other training courses included epilepsy awareness, non-violent crisis intervention and report writing. Training is carried out within the Company, and also by accessing external training for some subjects. The Inspector examined 3 staff recruitment files. These showed that good procedures were in place, and included the requirements set out in Schedule 2 (Amended) of the Regulations. Each staff file contained a recent photo, a proof of identity, equal opportunities monitoring, 2 written references, completed application form with previous job record, a signed contract, and a satisfactory Criminal Record Bureau (CRB) check. Any gaps in employment are discussed, and staff are not allowed to take up appointment until a satisfactory CRB and POVA check have been received. Nursing staff had confirmation on their files that their PIN numbers had been checked with the Nursing and Midwifery Council (NMC). Staff files included formal supervision records. Some staff did not appear to have had supervision for the recommended 6 times per year, but records were well maintained, and showed that staff have opportunity to raise concerns and ideas in an individual environment. The Inspector could see that processes had been set up to manage supervision, and considering that, and the change of management, has not given a requirement or recommendation in this respect. The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 27 The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 28 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 41,42 The Manager has a clear understanding of the improvements needed in the home. She is supported by senior staff in providing leadership throughout the home, and enabling staff to appreciate their different roles and responsibilities. It was apparent that she had already implemented many changes in the home, and was aware of the many areas for continued development. EVIDENCE: The Manager was interviewed by CSCI earlier in the year, and has been given formal registration as a Registered Manager. Talking with other staff enabled the Inspector to see that she is well respected in the home, and providing a lead to other staff in the many changes needed. Although the Inspector has identified many areas for improvement, the Manager was fully conversant with these, and has taken steps to implement change in most areas. The Inspector appreciates that changes in care planning, completing risk assessments and behavioural guidelines will take some time to process, and this work is hampered by the amount of alteration and refurbishment needed with the environment. Most of the items specified in the requirements and The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 29 recommendations for the environment had already been identified on a “wish list” sent to the senior management, and the Inspector’s findings were consistent with these. A number of items specified regarding the environment are becoming health and safety hazards (e.g. carpets becoming a trip hazard). These have already been highlighted in standards 24-30. Hot radiators must be covered with guards, and have risk assessments in place for service users. Policies and procedures were not viewed at this visit, but the Manager confirmed that these had been reviewed during 2004, and some had been written in 2005. These will all need to be reviewed in 2006, to ensure that they are up to date with the changes in the home. Staff training courses showed that mandatory training is being carried out, and that staff are aware of safe working practices. General maintenance repairs are itemised in a separate notebook each day in individual flats. A new maintenance man had just been recruited, and was working hard to deal with the issues raised. General risk assessments for the home were very detailed, and had been reviewed in September 2005. Fire drills were being carried out 4 times per year for night duty staff, and more frequently in the day times. A fire inspection was due to be carried out a week after this visit. The Inspector noticed that dates for servicing on fire extinguishers were for 2004, but the Manager stated that the fire extinguishers had been serviced during the previous week. She said that she would follow this up with the fire servicing company, and ensure that the correct dates were written on. Accident records were completed using the forms recommended by the HSE, and consistent with the Data Protection Act 1998. These contained satisfactory information, and there was evidence of some audits being carried out. The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 30 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. 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 1 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 1 25 2 26 1 27 2 28 1 29 1 30 1 STAFFING Standard No Score 31 3 1 2 2 1 3 LIFESTYLES Standard No Score 11 1 12 2 13 1 14 2 15 3 16 2 17 3 2 3 3 3 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 2 X 3 3 X X 3 2 x The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 31 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 YA1 Regulation 4 Requirement To update the home’s statement of purpose with the identified information. Care plans must be updated to reflect changing needs. All care plans should be reviewed to ensure they have been appropriately updated. Risk assessments must be completed for all aspects of risk for each individual service user, and appropriately reviewed and updated. To ensure that service users are being offered appropriate opportunities for developing practical living skills. To put behavioural guidelines in place in order for staff to assist service users to understand how to modify unacceptable behaviour. To review the transportation available to take service users out for leisure activities. DS0000006760.V279817.R01.S.doc Timescale for action 31/01/05 2. YA6 15 31/03/06 3. YA9 13 (4) 31/01/06 4. YA11 12 (1)(2) 31/01/06 5. YA11 12 (1) 28/02/06 6. YA13 16 (2) 31/03/06 The Gables Version 5.1 Page 32 7. YA18 12 (1-3) To ensure that care plans specify in detail the personal and nursing care that needs to be given. To ensure that healthcare needs are properly monitored, and ongoing care is given as advised. 1.) Handwritten entries on Medication Administration Records (MAR charts) must be signed and dated for accountability. 2.) Creams and eye drops must be dated on opening. 3.) Medication cupboards should be checked at regular intervals, and out of date medication sent for disposal. Flat 1 - replace lounge and dining room carpets Flat 1 - replace kitchen units and fridge Flat 2 - replace kitchen units Flat 2 - replace hinge on identified bedroom door. Flat 2 - repair or replace window frames in room 2. Flat 4 - replace kitchen units Flat 4 - Chest freezer to be replaced Flat 4 - Shower room to have skirting boards repaired. Arrange for the disposal of old discarded furniture items stored outside. DS0000006760.V279817.R01.S.doc 31/01/06 8. YA19 12 (1) 31/01/06 9. YA20 13 (2) 31/12/05 10. 11. 12. 13. 14. 15. 16. 17. 18. YA24 YA24 YA24 YA24 YA24 YA24 YA24 YA24 YA24 13 (4) 23 (2)(b) 16 (2) (g,h) 16 (2) (g,h) 13 (4)23 (2) (b) 13 (4) 23 (2) (b) 16 (2) (g,h) 23 (2) (c) 23 (2) (b) 23 (2) (o) 31/12/05 31/03/06 30/06/06 31/12/05 28/02/06 31/03/06 31/01/06 31/01/06 31/12/06 The Gables Version 5.1 Page 33 19. 20. 21. 22. YA24 YA24 YA24 YA25 23 (2) (b,d) 16 (2) (c) 13 (4) 23 (2) (f) To ensure completion of decorating for all internal areas. To ensure all areas in the home have suitable curtains or blinds 31/03/06 31/03/06 To ensure re-carpeting is 31/03/06 completed for all assessed areas. To reassess all service users with 31/03/06 nursing needs, and ensure that the size and layout of their rooms suit their needs. Review bedroom furniture and replace as needed. To review products used for carpet/floor cleaning, and check their effectiveness. Hot radiators or heaters must be fitted with guards, and risk assessments put in place for service users. 31/03/06 31/01/06 23. 24. YA26 YA30 16 (2) (c) 16 (2) (k) 25. YA42 13 (4) 31/12/05 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. 2. Refer to Standard YA1 YA7 Good Practice Recommendations To prepare a service users’ guide in a simplified format which is relevant to prospective service users. Documentation should include information to show that service users are enabled to make their own decisions where possible. Service users should be given opportunity to participate in DS0000006760.V279817.R01.S.doc Version 5.1 Page 34 3. YA8 The Gables the day to day running of the home, and documentation should supply evidence of this. 4. YA12 To provide each service user with a weekly planner, in a relevant format, so that they can see where they are going each day To increase the range of leisure activities available for service users. To include areas of responsibility for housekeeping tasks in service users’ individual plans. To ensure that full details are recorded of any future complaints, showing how the complaint has been resolved. Flat 1 lounge - to replace old furniture, and purchase new pictures. Flat 2, room 2 - en-suite facility - to replace either the shower or bath with a toilet. Flat 4 - to replace old furniture in the lounge and dining room. To consider fitting a sluice facility, or a sluice disinfector. To review staffing levels, and be able to show that these are sufficient to meet the needs of service users. 5. 6. 7. 8. 9. 10. 11. 12. YA14 YA16 YA22 YA24 YA27 YA28 YA30 YA33 The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 35 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 The Gables DS0000006760.V279817.R01.S.doc Version 5.1 Page 36 - 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. 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