Inspection on 01/11/06 for The Gables

This inspection was carried out on 1st November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Gables 07/05/08

The Gables 13/06/07

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Gables Gravesend Road Wrotham Kent TN15 7QD Lead Inspector Justine Williams Key Unannounced Inspection 1st November 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address Gravesend Road Wrotham Kent TN15 7QD 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) 02086609953 Stargate Partnership Ltd Carmen Miranda MacInnis Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: The Gables is a large detached property set in well-maintained, extensive gardens. The home is registered to provide nursing care to 25 older people. There are 6-shared bedrooms and 13 single bedrooms, 10 of which have ensuite toilet facilities. The number of double rooms are being reduced, to provide larger single bedrooms for residents. Most of the bedrooms are overlooking the Kent countryside. The home has 2 lounges. The home is situated in a rural location close to the A20 and M20, public transport links are some distance, there is ample off road parking in the grounds of the home. The nearest shops are in Wrotham or Meopham, both are a couple of miles away. The home has recently been taken over by Stargate partnership Ltd, and the responsible individual and the new manager plan to extend, refurbish and redecorate the property in the future. Many of the bedrooms have already been refurbished. The current fees are £500.00 per week; newspapers hairdressing and chiropody not included in the fees. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service is deemed a new service as it has new ownership and a newly registered manager. As such the requirements and recommendations from the previous inspection made under its old management and ownership are not brought forward. An unannounced inspection was carried out on 1st November 2006 between 09.30 am and 4.00pm by regulatory inspector Justine Williams. During that time a number of residents, relatives and staff agreed to speak with the inspector. This report contains assessments made from observation, conversation and records. What the service does well: What has improved since the last inspection? Not applicable as this is deemed to be a new service. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,6 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Most new residents are confident their needs can be met in the home, however one newly admitted resident has a diagnosis which is outside the home’s categories of registration. Intermediate care is not provided. EVIDENCE: Residents admitted under the new management have had a reasonably thorough assessment and for those referred via care management, a copy of the joint assessment was on file. The assessment proforma should be reviewed to check that all the items such as dexterity, foot care etc are included in the assessment. The manager has reassessed all residents’ social history and has documented a “pen portrait” for each resident. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 9 One resident with a diagnosis of dementia has been admitted to the home, and this is outside the home’s categories of registration. The manager must apply for a variation of category. One newly admitted resident had no care plan or risk assessment despite the fact he was being restrained with a harness. The manager stated that this was what the family wanted and the family said this had been agreed with the care manager and GP, there was no documentation in respect of this. The manager attempted to contact the resident’s care manager to confirm the method and need for the restraint immediately. It is strongly recommended that residents displaying confusion and disorientation should be referred to the psycho-geriatrician, and be reassessed by the home and care management as necessary, to ensure the home can continue to meet the residents’ needs and that the home does not operate “out of category”. Intermediate care is not provided at The Gables. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents’ personal care and health needs are appropriately managed. Residents are protected by the medication practices at the home. EVIDENCE: All the residents have had a new care plan drawn up by the manager or deputy manager, these care plans have been regularly reviewed, and were comprehensive and detailed. Residents who are able should be involved in the revising and drawing up of their care plans and should be asked to sign their care plans to indicate their involvement. Care plans contained a falls risk assessment. The staff are recording any visits from and to healthcare professionals, with a brief synopsis of the outcome of the visit. Residents are assessed for their risk of developing pressure sores by trained staff, and evidence of reassessments were seen. The manager has purchased additional pressure relieving equipment as the PCT only provides a limited amount. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 11 Residents had a continence assessment, nutritional assessment, moving and handling assessment on file, all of which had been reviewed monthly. The medication policy is to be reviewed along with other policies, however the practices at the home were acceptable. The manager is looking into the use of a monitored dosage system, which she believes will reduce the margins for staff error. The medication room has been moved and now does not have a hand washing sink although alcohol hand-wash is used. Medicines were stored appropriately and a record is kept of medicines leaving and entering the home. Residents said they are treated with respect for their dignity and privacy and staff used the term of address they preferred. Evidence that residents have made a positive choice to share should be recorded. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities are now organised for the residents, though the programme and times are somewhat limited. Residents are able to exercise their own choices. Residents receive a balanced and appealing diet, though choice should be offered every day. EVIDENCE: The manager has employed a member of the care staff to organise and run activities for the residents, the staff member has 15 hours per week or 3 hours per day from Monday to Friday. The activity programme is displayed on the notice board and at present is a fixed programme for the week. Residents said they were enjoying the activities as they had had very few activities planned in the past, it is recommended that the activities planned and the hours designated be reviewed and expanded upon as the service develops. Service users may have visitors at any reasonable time though there is not a private room available other than the resident’s own bedroom, the manager stated that efforts would be made to provide a private room should they wish to use one. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 13 Residents said they are able to make choices, and have control over their lives, and residents handle their own finances for as long as they are able. The chef was recently employed by the manager and whilst he had limited experience in cooking for this client group, residents and relatives spoken with said the food was very good and had vastly improved. Residents said that meals were attractively presented and well cooked. The chef provides for special diets and a 3 week rolling menu is in place, with a choice of breakfast, 2 choices for the main meal and a hot or cold meal at 5 pm. The manager plans to review the menu in due course. It is recommended that snacks available after the evening meal be made more obvious so that residents are aware that they may ask for snacks. An area for making drinks is now in one of the lounges primarily for the use of relatives, or those residents able to help themselves. Hot and cold drinks are available at regular intervals for the residents. A choice of meal is not available for Sundays at present, the manager said that all residents like the roast and a choice is not necessary; this must be reviewed regularly. Robust and sustainable arrangements must be made to cover the chef’s days off, and to ensure the chef does not work excessive hours. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their complaints and concerns would be listened to taken seriously and acted upon. Residents are not protected from abuse as staff have not undertaken recent training and the home’s policy must be reviewed. EVIDENCE: The complaints policy must be amended to include the name of the new manager and remove the name of the old manager, in all other respects the policy is appropriate, clear and accessible. The manager has received no formal complaints since taking over, although a file with a proforma is in place. The manager said that minor complaints would be logged in the resident’s care plan, it is strongly recommended that these also be logged in the complaint file to better evidence the actions taken by the manager and for the purposes of tracking and quality assurance. The manager is aware of the need to arrange adult protection training for all the staff, although many staff have undertaken the training in the past. The home has an adult protection policy in place, and as with all the policies should be regularly reviewed. There are no adult protection alerts in respect of this home at present. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents will benefit from the refurbishment of the building being completed. Residents are at risk of infection control hazards. EVIDENCE: The layout of the building continues to present some challenges for staff, with some corridors being difficult to manoeuvre wheelchairs. The manager stated that the proprietor plans to widen these corridors once the building work gets underway. The communal areas and several bedrooms are in need of refurbishment and redecoration, although the bedrooms, which have been redecorated, were vastly improved, with new furniture, light matching curtains and bedspreads, and new carpets and paintwork. The manager stated that one of the lounges is to be refurbished and will become a dining room in the very near future. Other building work is planned within the next couple of years. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 16 The wooden handrail on the stairs to the patio is rotten and in need of repair, however the manager confirmed that this is not in use or a fire exit. The maintenance staff member is in the process of undertaking fire and general environmental risk assessments, these should be completed as soon as possible and regularly reviewed thereafter. Unlabelled toiletries were in the ground floor bathroom including sudocrem. Toiletries must be used for named individuals and not be “communal” or used for several residents due to infection control issues. The downstairs bathroom is also in need of refurbishment as the flooring is stained beneath the shower; the toilet bowl was very discoloured and should be deep cleaned or replaced. Carpets in the lounges were stained, though the home was generally clean. The laundry sink should be labelled as the hand washing sink provided it is not used for soaking clothing and other items, otherwise a hand washing sink should be fitted. Net underwear should be labelled for individual use to protect residence from infection control hazards and to promote their dignity. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by the number and skills of the staff. Residents will benefit once all the staff have undertaken the planned training. EVIDENCE: The manager is currently reviewing the skill mix of staff on duty, and the staffing notice was discussed, as historically the home has worked with less than the number of RGN’s required by the health authority. The staff rota must include all staff members on duty including ancillary staff, and must include surnames as well as the initial or first name. The manager has recently recruited some care and ancillary staff. The number of care staff having attained NVQ 2 training is almost 50 this includes the 3 members of bank staff. The personnel files of 3 members of newly recruited staff were looked at, 2 of the 3 files contained all the required items, the 3rd did not contain the POVA check or the previous employer’s reference, however this member of staff is still working in a supervised capacity. The manager confirmed that the POVA check had been requested. The manager must ensure that she complies with the newly amended regulations, in relation to the information required on file. It is also The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 18 recommended that a transcript of questions asked and notes of candidates responses be kept, as well as verifying written references. The manager has arranged various training and training updates in a variety of subjects for all the staff. though as previously mentioned adult protection training is yet to be arranged. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The manager is fit to be in charge and she continues to improve the quality of life experienced by residents at the home. Residents’ views are sought. Measures are being taken to protect and promote the health and wellbeing for residents and staff. EVIDENCE: The manager successfully completed the “fit persons” process and has been registered with the commission recently. The manager is a registered general nurse and has worked in a variety of senior roles both in this country and abroad, most recently as deputy manager of a nursing home. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 20 The manager is undertaking the Registered Manager’s Award in the near future. The manager plans to look at putting into place robust quality assurance processes once she has completed other more pressing work such as updating residents’ files, policies etc. The gables does not accept any responsibility for or manage any residents’ finances, and uses an invoicing system. The information received in the pre-inspection questionnaire indicates that the required servicing and maintenance of equipment is up to date. An environmental risk assessment has been undertaken but is not sufficiently detailed. The maintenance person is currently undertaking fire training and then plans to update the fire risk assessment. All core training is being arranged for staff to ensure they are up to date and the manager plans to draw up a matrix to ensure staff stay up to date with core training. Some staff require food hygiene training, and better measures to protect residents’ safety with respect to infection control is needed. A risk assessment is urgently required in respect of the hot water urn in the lounge. The manager is aware of her responsibilities for reporting incidents under RIDDOR . The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X 2 X 1 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NA 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 OP3 Regulation 13 (8) Requirement Timescale for action 02/11/06 2 OP4 12 (1)(b) 3 OP26 13 (3) On any occasion on which a service users is subject to physical restraint, the registered person shall record the circumstances, including the nature of the restraint. The registered person shall 15/12/06 ensure that the care home is conducted so as to make proper provision for the care and , where appropriate, treatment, education and supervision of service users, in thatresidents who fall outside of the homes category for registration are not admitted without first making application to vary the conditions of registration. The registered person shall make 30/12/06 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home, in thatToiletries and in particular topical creams be used for individual use only and not shared. Net underwear marked and used for the individual only and not shared. That a dedicated hand washing DS0000067669.V312794.R01.S.doc Version 5.2 The Gables Page 23 4 OP29 19 (b)(i) 5 OP38 12 (1)(a) sink be provided in the laundry That stained flooring and the stained toilet be made good or replaced. The registered person shall not employ a person to work at the care home unless subject to paragraph 6 he has obtained in respect of that person the information and documents specified in paragraphs 1 to 6 of schedule 2 The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service user, In that detailed environmental and fire risk assessments are produced as soon as possible A risk assessment specific to the hot water urn in the lounge is required. 30/12/06 30/12/06 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 OP12 OP15 Good Practice Recommendations It is recommended that the variety and time dedicated for staff to run activities is reviewed regularly as the service develops It is recommended that a choice of meal be available every day, including Sundays, and that snacks are made available and are included on the menu, to ensure DS0000067669.V312794.R01.S.doc Version 5.2 Page 24 The Gables 3 4 5 6 OP16 OP18 OP19 OP27 7 8 OP31 OP33 residents understand they may have a snack at any reasonable time. It is recommended that minor complaints be included in the complaints file or log and the actions undertaken to put them right. It is strongly recommended that the manager arrange adult protection training for staff as soon as possible and regular updates thereafter. It is strongly recommended that planned refurbishment and redecoration of the lounges, some corridors and some bedrooms be initiated as soon as possible. It is recommended that the managers planed review of the staffing numbers in particular the nursing staff be undertaken as soon as possible. It is strongly recommended that sustainable arrangements be made to cover the chefs days off, and that guidance from the department of trade and industry regarding working times be adhered to. It is recommended that the manager undertake the Registered Managers Award as soon as possible. It is recommended that the manager undertake effective quality assurance monitoring in due coarse. The Gables DS0000067669.V312794.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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