Inspection on 11/08/08 for The Gables

This inspection was carried out on 11th August 2008.

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

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 05/11/08

The Gables 11/09/07

The Gables 17/07/06

The Gables 23/01/06

The Gables 18/08/05

The Gables 17/03/05

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Gables, The 29/31 Ashurst Road Walmley Birmingham West Midlands B76 1JE Lead Inspector Brenda O’Neill Key Unannounced Inspection 09:30 11th August 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gables, The Address 29/31 Ashurst Road Walmley Birmingham West Midlands B76 1JE 0121 351 6614 0121 313 2752 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) Karamaa Ltd Miss Kelly Jean Kinsella Care Home 24 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (24) of places Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That the registration category is 24 older people that may include up to 10 people with Dementia. Registration category 24 (OP) 10 DE(E) In addition to the manager and ancillary staff maintain minimum staffing levels of three care staff throughout the waking day and two care staff on waking night duty one of whom should be designated senior 11th September 2007 Date of last inspection Brief Description of the Service: The Gables is a number of post war houses that have been extensively converted to provide care and accommodation to 24 older people. The home is located in a quiet road within easy access of shopping facilities, local churches and regular public transport services. The home comprises of nine single bedrooms on the ground floor and fifteen single bedrooms on the first floor. Two of the bedrooms have en-suite facilities of toilet and shower. There is one assisted shower facility and one assisted bathing facility and numerous toilets located throughout the home. The people living in the home are able to gain access to the first floor via stairs or by lift. Communal areas within the home are located on the ground floor and comprise of one very large lounge/dining room which also includes a conservatory and a smaller lounge. The larger lounge overlooks a very well maintained garden. The home also has a kitchen and a large combined laundry and food store which is located in an outbuilding. There is access to the home for people with mobility difficulties by means of a ramped front entrance with handrails. The current range of fees at the home were not available at the time of this inspection. Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 stars. This means that the people who use this service experience poor outcomes. Two inspectors undertook this key inspection over one day in August 2008. One of the inspectors was a pharmacist and was there for only part of the day to specifically check the management of the medication in the home. During the inspection a tour of the home was undertaken, three files for the people living in the home were sampled and six staff files as well as other care, health and safety and training documentation. The inspector spoke with the manager, two staff members and six of the people living in the home. Prior to the inspection the manager had returned a completed Annual Quality Assurance Assessment to the Commission which gave some additional information about the home. Satisfaction surveys were sent to ten of the people living in the home. Six of these were returned and they indicated that the people living at the home were satisfied with the service they were receiving. Some concerns had been raised with us since the last inspection. These were in relation to untrained staff administering medication, staffing levels at the home and staff being employed without the appropriate checks being undertaken. No regulations were found to have been breached in relation to medication administration at the time of this inspection. There had been some issues with staffing levels at the home earlier in the year however at the time of the inspection appropriate staffing levels were being maintained. The manager was asked to forward some documents to us when the concerns were raised about recruitment. She did not have these but asked the provider to forward them as he had been recruiting staff at that time. The provider did not respond to the request. Several breaches of regulations were found in relation to staff recruitment at the time of this inspection. Therefore the people living in the home were not safeguarded. There had been one adult protection issue at the home since the last inspection. The manager of the home had reported this appropriately. What the service does well: The home was calm and relaxed and there was a lot of laughter and friendly banter between the staff and people living in the home. It was pleasing to note that no matter how busy the staff were they still had time to stop and talk to the people living in the home and they were never ignored when asking a question or asking for help. Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 6 It was evident throughout the course of the inspection that there were very good relationships between the staff and the people living in the home comments received included ‘they’re great’ and ‘trust me they are marvellous.’ The care plans and risk assessments for the people living in the home were good and ensured people received person centred care and that any risks were minimised. Staff were identifying health care needs and there was evidence of these being followed up and monitored. The manager was clearly following up issues with doctors, for example, ongoing illnesses, results of blood tests and so on. Several visitors were seen to come and go throughout the course of the inspection and all were made very welcome by staff. Daily records showed that visitors were able to go to the home at all times. There were activities on offer for the people living in the home to take part in if they wished. Staff encouraged the people living in the home to make choices wherever possible, for example, in how to spend their time, when to go to bed and get up, what to eat and what to wear. The people living in the home were generally satisfied with the food served to them. Menus at the home were discussed at meetings with the people living there and adjustments made in response to their comments. The surveys returned to us indicated people would know who to raise any issues with if they were unhappy about anything. What has improved since the last inspection? The manager had further developed the pre admission assessment document and the new document covered some additional areas and also allowed for such things as social worker’s comments and funding arrangements to be included. The medicine management had improved. The manager had installed good systems to ensure that all the medicines were administered as prescribed. Staff were recording a little more about how people were spending their days to evidence their social needs were being met. There had been some improvements made to the environment. The issues raised at the last inspection in relation to safety had been addressed. These included safe storage of COSHH items, the code for a fire door on the first floor being accessible to the people living in the home and the kitchen door being Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 7 wedged open. Many of the bedrooms had had new furniture and several new commodes had been purchased. Staffing levels had improved and were maintained at the appropriate levels to care for the people living in the home. 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. Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information available for people wanting to move into the home needed to be updated to ensure it reflected all the correct details so that people could make an informed decision as to whether the home could meet their needs. The pre admission assessment process ensured the needs of prospective users of the service were known prior to admission. People were able to visit the home prior to admission to assess the suitability of the home. EVIDENCE: The service user guide for the home needed to be reviewed and updated to ensure it included all the correct information for anyone wanting to move into the home. For example, the range of fees charged at the home that were detailed were not the current fees and the address and telephone for the Commission were incorrect. Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 10 The care files for two people admitted to the home since the last inspection were sampled. Both files included copies of the pre admission assessments undertaken by staff at the home. All the required areas were covered in the assessments including, personal care needs, mobility, family involvement, social and religious needs. The assessment also included a brief summary of whether the home could meet the individuals’ needs or not. Both the individuals had social work involvement in their admissions and copies of the care plans drawn up by them were also on file. The manager had further developed the pre admission assessment document and the new document covered some additional areas and also allowed for such things as social worker’s comments and funding arrangements to be included. The pre admission assessments sampled were both undertaken at the home on pre admission visits to the home. Some of the surveys returned to us prior to the inspection indicated people were not being issued with a contract stating their terms and conditions of residence at the home. Both of the files sampled included copies of signed and dated contracts. The manager of the home stated people were issued with contracts at all times. Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems in place at the home for care planning and risk assessments were comprehensive ensuring the staff knew how to meet the needs of the people living in the home and minimise any identified risks. The medicine management was good. All medicines audited had been administered as the doctor prescribed and records reflected practice. EVIDENCE: Three care files were sampled during the course of the inspection. All the files were for people admitted to the home since the last inspection, two of whom had a level of dementia. All the files included comprehensive care plans. All the individuals’ needs that had been identified on their assessments had been included in the care plans. There had also been some changes made to the care plans as the needs of the individuals changed. Care plans included details of how people’s dementia affected them, their likes, dislikes and preferences and to what extent they Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 12 were able to self care. Care plans were in place for personal care, communication, mobility, nutrition and social care needs. The plans included some good detail of how staff were to meet the needs of the people living in the home. For example, one of the care plans detailed that the person often refused personal care and that staff should go away and then keep going back to offer assistance. Other small details, which were important to the individual, were also included, for example, ‘put her comb in her pocket she likes it with her’. One of the people had particular dietary needs in relation to his religion and this was well detailed stating what he was not allowed to drink with the name of the drink he was allowed to have. This was bought in specially for him. There were good care plans in place for the management of ongoing health care needs, for example, dry skin, soreness and arthritis. These included how these illnesses were to be treated, creams to be applied and where and pain relief. One of the individuals had a care plan in place for diabetes this was discussed with the manager as it could have been further developed. The care plan stated the normal blood sugar reading was 7 but records indicated that this was the lowest reading that was really acceptable and it was often higher than this. The care plan needed to detail the safe range and at what point it was unsafe and staff should seek medical help. Staff were clearly aware of when the reading was really high as records detailed when this had been noticed and that the reading had been taken again a little later to ensure it had come down. All the files sampled had nutritional and tissue viability assessments in place and where people were at risk there was a corresponding management plan. These plans also indicated if there was further information on any of the other care plans. Manual handling and falls risk assessments were also in place. These detailed quite clearly what staff should do should someone fall. There was evidence in the daily records that the personal care needs of the people living in the home were being met. Staff were also recording when people refused help with personal care. Staff were identifying health care needs and there was evidence of these being followed up and monitored. The manager was clearly following up issues with doctors, for example, ongoing illnesses, results of blood tests and so on. Evidence of this was seen on all files as she had kept copies of the faxes sent to doctor’s surgeries. The people living in the home had access to G.P.s, district nurses, chiropodists, opticians and so on. People were being weighed regularly where they agreed to this. One of the people living in the home refused to be weighed on an ongoing basis and did refuse meals on occasions. There was a care plan in place for this stating care staff must record refusals and offer supplements. It was recommended that in circumstances such as these the person should have a detailed food record so that it could be identified exactly what was being eaten to ensure their nutritional needs were being met. These records were in place Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 13 for other people living in the home where there were concerns about their dietary intake. The pharmacist inspection took place at the same time as the main inspection. The manager had installed a good quality assurance system and this had ensured that the medicines are administered as prescribed. All the requirements left at the last inspection regarding medication had been fully met. The medicines were stored in the medication trolley, which was taken to the people living in the home or a separate locked cabinet in a locked room. All controlled drugs were stored correctly. Medicines requiring refrigeration were kept in a separate section in the main food refrigerator. Audits indicated that the medicines were administered as the doctor prescribed. The home had installed a system to check the prescription prior to dispensing and to check the medicines received into the home. Hand written medicine charts recording the prescribed medicines were well written and contained all the information needed to enable correct administration. The care assistant showed respect to all the people living in the home whilst administering their medication. She followed good practice and read the medicine charts before administration and signed them directly afterwards. All controlled drug balances were correct and the register matched the entries on the medicine chart indicating good practice. The care assistant had a good understanding for the safe handling of medicines and had a reasonable understanding of what the medicines were for. Medicines prescribed for occasional use all had supporting protocols so staff were aware when and why a medicine should be administered in accordance with the doctors instructions. The home stocked a small quantity of homely remedies use to treat minor ailments. They had a good system to record their use and supporting protocols for staff to follow to ensure correct administration. The doctors who look after the people who live in the home had endorsed these. The care plan for one highly dependant person was looked at. Staff would be able to support the person by reading it. No issues were raised by the people living in the home during the course of the inspection in relation to their privacy and dignity. The interactions between staff and the people living in the home were very friendly and respectful. Staff assisted individuals with personal care needs sensitively. Consultation with health care professionals took place in the privacy of individuals’ bedrooms. People were able to lock their bedroom doors if they wished and if they wanted Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 14 private time during the day in their bedrooms this was not seen as an issue. The manager stated some staff had been unhappy about people locking their bedroom doors at night as they may be at risk. She had assured them that this was their right and it was based on a risk assessment and that the doors could be accessed in the case of an emergency. At the time of the inspection it was noted that there was not a lock on two of the toilet doors this needed to be addressed to ensure privacy could be maintained. One of these had been missing for a considerable amount of time. Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 15 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were no rigid rules or routines in the home and the people living there were able to spend their time as they chose. There were activities on offer and the people living in the home were able to maintain contact with families and friends. The meals in the home were good and choices or alternatives were available at all meals. EVIDENCE: As at the last inspection it was a very busy time of day when the inspector arrived at the home. Some of the people living in the home were having breakfast, others had finished and others were still getting up. The home was calm and relaxed and there was a lot of laughter and friendly banter between the staff and people living in the home. It was pleasing to note that no matter how busy the staff were they still had time to stop and talk to the people living in the home and they were never ignored when asking a question or asking for help. No rigid rules or routines were observed during the course of the inspection. People were seen to wander freely around the home, spend time in their Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 16 bedrooms, sitting chatting to each other or visitors, reading, watching television and listening to music. Some of the people living in the home were showing a lot interest in the Olympic games. One of the people living in the home spoke to us about how he liked to spend time in his room watching his videos and DVDs. One of the people living in the home had celebrated their 101st birthday two days before the inspection. There had been a party with an outside entertainer, an Elvis impersonator, the people living in the home said how much they had enjoyed this. The individual who had been celebrating her birthday spoke of how much she had enjoyed the day also. There was an activity programme in the home that was facilitated by the staff. This was displayed on the wall in the dining area and included such things as bingo, board games, cards, skittles, video and pop corn afternoons and sing songs. The manager stated these were changed quite regularly. The people living in the home that were spoken with stated they were quite happy and no one appeared to get bored. There was also evidence that trips out to the theatre had taken place and that entertainers were going into the home quite regularly. The staff had set up a tuck shop and this was taken around on Saturdays. A dartboard had just been purchased for the home and this was to be added to the activities programme. Staff were recording a little more about how people were spending their days as recommended at the last inspection. Several visitors were seen to come and go throughout the course of the inspection and all were made very welcome by staff. Daily records showed that visitors were able to go to the home at all times. Staff encouraged the people living in the home to make choices wherever possible, for example, in how to spend their time, when to go to bed and get up, what to eat and what to wear. The care plans for the people living in the home detailed where they were able to make choices for themselves. All the bedrooms were personalised to the occupants choosing and some individuals continued to handle some of their own finances. The AQAA stated the home was offering two advocacy services to enable people to make more choices. Details of these organisations were on display in the entrance hall of the home. The people living in the home were generally satisfied with the food served to them. One person did comment ‘meat can sometimes be a bit tough.’ Other people were very satisfied one stated ‘I enjoy the meals with potatoes and veg.’ Menus at the home were discussed at meetings with the people living there and adjustments made in response to their comments. Individuals’ likes, dislikes and preferences were detailed on their care plans. Lunchtime was a very social occasion and people were offered a glass of wine to accompany their meal. Copies of the menus were on the wall in the dining area and there was a list of alternative meals on the tables. It was also noted that there were dishes of sweets around the dining area for people to help themselves to throughout the day. Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 17 Records of the food being served to the people living in the home were being kept and these had some indication of the amounts eaten. The records for breakfast were pre printed sheets which detailed the known preferences of the people living in the home however it also showed that where people wanted something different this was given. The manager needed to ensure that there was evidence at all meals that medical diets were being catered for, for example, diabetics. Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 18 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 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was an appropriate complaints procedure and all the people living in the home or their representatives received a copy. The people living in the home were not being fully safeguarded due to poor staff recruitment procedures. EVIDENCE: The complaints and adult protection procedures were not viewed at this inspection as they have been seen at previous inspections. It was known that the people living in the home received a copy of the complaints procedure in the service user guide. There was also a copy of the procedure on the wall in the entrance hall of the home. The people living in the home had very good relationships with the staff which would give them the confidence to raise any issues they may have. The surveys returned to us indicated people would know who to raise any issues with if they were unhappy about anything. The AQAA stated the home had a general complaints book where they record complaints and see what improvements they needed to make. There was nothing recorded in the book at the time of the inspection. It was recommended that any minor ‘grumbles’ and how they were resolved were recorded in the book to further show that staff listened to the people living in the home and acted on what they said. Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 19 Some concerns had been raised with us since the last inspection. These were in relation to untrained staff administering medication, staffing levels at the home and staff being employed without the appropriate checks being undertaken. No regulations were found to have been breached in relation to medication administration at the time of this inspection. There had been some issues with staffing levels at the home earlier in the year however at the time of the inspection appropriate staffing levels were being maintained. The manager was asked to forward some documents to us when the concerns were raised about recruitment. She did not have these but asked the provider to forward them as he had been recruiting staff at that time. The provider did not respond to the request. Several breaches of regulations were found in relation to staff recruitment at the time of this inspection. Therefore the people living in the home were not safeguarded. More details of the breaches are included in this report understaffing. There had been one adult protection issue at the home since the last inspection. The manager of the home had reported this appropriately. The AQAA returned to us before the inspection stated that one of the improvements in the home was that staff were more aware of what to look for in relation to potential abuse and staff had received more training in this. However as there was no training matrix for the home it was not possible to establish how many staff had received this training. Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 20 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, 20, 21, 22, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provided the people living there with a generally well maintained, safe and comfortable environment in which to live. EVIDENCE: The home was generally well maintained, safe and comfortable. The issues raised at the last inspection in relation to safety had been addressed. These included safe storage of COSHH items, the code for a fire door on the first floor being accessible to the people living in the home and the kitchen door being wedged open. The manager and one staff member spoke about some issues with night staff wedging bedroom doors open at night as this was what some of the individuals living in the home wanted. The manager had addressed this with the staff and was undertaking spot checks to ensure they complied. It was recommended that where individuals want their bedroom doors open at night door stops that release when the fire alarm is activated are installed. It Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 21 was also noted that there were several items of furniture being stored very close to the fire exit on the first floor. Although these did not block the exit it limited the space in the area. This was discussed with the manager and she was advised the items must be relocated. There had been no changes to the communal areas of the home which were generally well furnished and decorated. It was noted that some of the corridors on the ground floor were in need of repainting and the carpet was quite dirty in parts. Also the carpet in the corridor outside the kitchen was very worn. The garden was very well maintained and there was a ramped exit from the home however the lawned area would be difficult for anyone with mobility difficulties to access and as at the last inspection it was strongly recommended that the possibility of a ramp be explored. There had been no changes to bathing and toilet facilities at the home which met the needs of the people living there. They had a choice of having either a bath or a shower and both facilities allowed for staff assistance. The bath was in need of repair as the control to fill the bath had broken and staff had to fill it with the shower attachment which was taking a considerable amount of time. There were some aids and adaptations throughout the home and these appeared to meet the needs of the people resident at the time and included, shaft lift, hand and grab rails, assisted bathing facilities and an emergency call system. Stair gates had been installed to further safe guard the people living in the home. The manager had raised some issues with us earlier in the year about the home not having a freestanding hoist. At that time there was a person living in the home who had some handling needs that the staff could not meet. The provider should consider purchasing a mobile hoist or he must ensure that people who need this equipment are not accommodated at the home. The bedrooms seen were generally well decorated and many had had new furniture and beds. The rooms were personalised to the occupants’ choosing. The home was clean and generally odour free, with the exception of one or two bedrooms which the manager was endeavouring to address, with appropriate systems in place for the disposal of clinical waste. Liquid soap and disposable towels were available in all communal facilities and staff had access to protective clothing when necessary. The home had a mechanical commode pot washer for effective cleaning of commode pots and several new commodes had been purchased. The kitchen was clean and tidy. The environmental health officer had visited the home since the last inspection. The requirements made as a result of the visit were generally quite minor and had been addressed. Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 22 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 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels had improved and were maintained at the appropriate levels to care for the people living in the home. It could not be evidenced that staff had received all the appropriate training to enable them to care for the people living in the home. The recruitment procedures for new staff were poor and did not safe guard the people living in the home. EVIDENCE: At the time of the last inspection there were serious concerns raised about the staffing levels in the home. This had improved at the time of this inspection and minimum staffing levels were being maintained. However the rotas indicated that the manager was still being put on the rota to undertake care shifts and cooking when the cook was not on duty. We had been informed earlier in the year that the owners were doing the rotas at the home. They should ensure the manager is not rostered to cover care and cooking duties on an ongoing basis and that this only happens in the case of any emergencies. It was evident throughout the course of the inspection that there were very good relationships between the staff and the people living in the home comments received included ‘they’re great’ and ‘trust me they are marvellous.’ Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 23 At the time of the last inspection the manager was recruiting new staff and the recruitment procedures in the home were robust and ensured the people living in the home were safeguarded. The manager had notified us that one of the owners of the home had taken over staff recruitment and at the time of this inspection it was found to be very poor and did not safeguard the people living in the home. Six staff files were sampled and only one of these had all the required documentation in place. However the references, POVA first check and CRB had all been obtained after the person had started their employment at the home. None of the other files were complete. Applications were not always fully completed, there was no evidence of POVA first checks or CRBs on some of the files, references were dated after employment started or were not available. There was no evidence that declared convictions had been explored or that where workers were from overseas they were able to work in this country. We tried to contact the provider during the course of the inspection but he was not available. He contacted us the next day and was told of our concerns in relation to staff recruitment. He stated he had additional documentation in relation to this and that he would get this to us in two days. This did not arrive. We spoke to the manager of the home the day after this and she said the provider had left some additional information in the home and this would be copied and brought to us. This did arrive. This included some information about one of the overseas workers, one POVA first check dated a long time after the person had started work at the home and a risk assessment for an offence. This additional information did not complete the staff recruitment records. There was some evidence that some of the new staff had undertaken some training since being employed but this was not evident for all of them. We had conversations with the owner earlier in the year about the requirements for training. The manager had raised some concerns with us about shortfalls in the training for some staff and she had sent the owner a breakdown of what training was required by staff in the home. This highlighted issues over certificates not being received by staff as training invoices had not been paid for and training being cancelled due to costs. The manager stated there had been some training in equal opportunities, manual handling, medication and diabetes awareness. Fire training was done in house as one of the staff had been trained as a trainer. It was difficult to assess what shortfalls there were exactly as the home did not have a training matrix. There was only evidence of induction training for one of the new staff at the home. This had all been covered in one day. The AQAA stated the home had a new induction training pack however there was no evidence of this being completed. The manager had developed an extensive assessment pack for care staff being trained as senior care assistants and this included observations, questions and policies and procedures. One of these had been completed for a member of staff over two months and was very comprehensive. The AQAA stated that six of the Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 24 fifteen staff employed at the home had NVQ level 2 or the equivalent. This is a little below the required 50 . Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The day to day management of the home was good but this was not supported by some of the actions undertaken by the provider which left the people living in the home at risk. The home needed a yearly development plan based on seeking the views of the people living there with a view to continuously improving the service. EVIDENCE: The manager of the home had a good knowledge of the needs of the people living in the home and was very committed to ensuring they had the best quality of life possible. There had been further improvements in the home in relation to such things as the management of medication, pre admission assessments and the staffing levels in the home. The day to day management of the home was good. Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 26 Some of the tasks the manager had previously been responsible for had been taken over by the providers, for example, staff recruitment and rotas. There had been a marked a deterioration in the recruitment procedures in the home since this time. This has had a profound affect on the overall outcome of this inspection as it could not be shown that the people living in the home were being safeguarded. The owner of the home must ensure he is fully aware of the procedures and regulations when taking responsibility for any of the tasks in the home that were previously delegated to the manager and had been carried out well. It was evident when speaking to the manager and the provider there had been some disagreements between them in relation to training, staffing rotas and recruitment. These issues needed to be addressed as they were affecting the overall moral in the home. The home still had no formal quality monitoring system in place but there were several ways of consulting with the people living in the home and their relatives. These included meetings with the people living in the home where such things as concerns, ideas, fundraising, key working and trips out were discussed. Relatives were also welcome to attend the meetings if they wished. The outcomes of the meetings were displayed on the notice board in the home. Satisfaction surveys were regularly given to the people living in the home and their relatives. Those seen included some very positive comments about the service offered at the home. Feedback was also sought from the staff and visiting professionals in the form of surveys. The manager had also started to produce a newsletter for the home keeping all those concerned up to date with what was happening in the home. There were also regular staff meetings and in house health and safety checks which all contribute to monitoring the quality of the service offered. The manager needed to collate all the information from surveys, meetings, audits and so on to produce a yearly development plan for the home to show how they intended to improve the service offered. The home was managing some small amounts of money on behalf of the people living in the home. The records for this were sampled and all found to be appropriate. Income and expenditure were clearly detailed and receipts were available for any money spent on behalf of the people living in the home. All the balances of money held in the home that were checked were correct. Staff were receiving some training in safe working practices and the issues raised at the last inspection in relation to health and safety had been addressed. There was evidence on site that the in house checks on the fire system were carried out as required and that fire drills were undertaken every six months. It was noted that on the fire checks it was indicated that one of the fire doors was not closing properly and this had been outstanding for a considerable amount of time. There was evidence on site that some of the Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 27 equipment in the home had been serviced but not all. We needed evidence sent to us that the fire alarm, gas equipment, emergency call system and the bath hoist had been serviced. The recording and reporting of accidents and incidents in the home were appropriate. Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 28 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 2 2 2 X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13(4)(c) Requirement Care plans for diabetes must include the safe range of readings for blood sugar levels and what staff should do if readings are outside this range. Timescale for action 12/09/08 2. OP18 13(6) This will ensure the people living in the home are safeguarded. The registered provider must 12/09/08 ensure that the recruitment procedures in the home are robust and that they are followed consistently. This will ensure that the people living in the home are safeguarded. The area around the fire exit on the first floor must be cleared of all items of furniture. This will ensure the people living in the home are not put at risk. The registered provider must ensure: That all the required checks have been undertaken on all staff working at the home and 3. OP19 13(4)(c) 12/09/08 4. OP29 19(1) schedule 2. 30/09/08 Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 30 evidence of this is available on site. All the required checks are undertaken prior to any new staff being employed at the home and evidence of this is available onsite. This will ensure the people living in the home are fully safeguarded. There must be evidence on site that staff have undertaken appropriate induction training in the home. This will ensure staff have all the required skills and knowledge to care for the people living in the home. The registered provider must ensure all staff have received all the necessary training to ensure that they are suitably qualified and competent to care for the people living in the home. Evidence that the fire alarm and gas equipment have been serviced must be forwarded to the CSCI. This will show the people living in the home are not being exposed to any unnecessary risks. The fire door highlighted as not closing properly on the home’s fire system checks must be addressed. This will ensure the people living in the home are safeguarded. 5. OP30 18(1)(a) 30/09/08 6. OP30 18(1)(a) 31/10/08 7. OP38 23(2)(c) 12/09/08 8. OP38 23(4)(c) (i) 30/09/08 Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 31 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 OP1 OP8 Good Practice Recommendations The service user guide for the home should be reviewed and updated to ensure it includes all the correct information for people wanting to move into the home It is recommended that where any of the people living in the home will not be weighed and do refuse meals on occasions detailed records of their dietary intake are kept. This will ensure the nutritional needs of the people living in the home are met. To ensure the privacy of the people living in the home it is strongly recommended that locks are fitted to the toilets in the home. Food records should detail where medical diets are being catered for. This will ensure the home is meeting the dietary needs of the people living there. It was recommended that any minor ‘grumbles’ raised by the people living in the home and how they were resolved were recorded to further show the staff listened to the people living in the home and acted on what they said. It is recommended that where the people living in the home want their bedroom doors left open at night door stops that release when the fire alarm is activated are installed. This will ensure people can be cared for as they wish without them being put at risk. All areas of the home must be kept reasonably decorated. Carpets must be cleaned as required and replaced if necessary. This will ensure the home is kept to an acceptable standard for the people living there. It is strongly recommended that the possibility of having a ramp installed to give easy access to the lawned area of the garden be explored. This would enable those with mobility difficulties to access the entire garden. The bath should be repaired to ensure it can be filled in a reasonable amount of time. This will ensure water can be kept to an acceptable temperature for the people living in the home. The provider should consider purchasing a mobile hoist or he must ensure that people who need this equipment are not accommodated at the home. This will ensure the handling needs of the people living in the home can be DS0000062346.V368233.R01.S.doc Version 5.2 Page 32 3. 4. 5. OP10 OP15 OP16 6. OP19 7. OP20 8. OP20 9. OP21 10. OP22 Gables, The 11. OP27 12. OP28 13. 14. 15. OP30 OP31 OP33 16. OP38 met at all times. The registered provider should ensure the manager is not rostered to cover care and cooking duties on an ongoing basis and that this only happens in the case of any emergencies. This will ensure the manager is able to fulfil her role effectively. 50 of care staff should be qualified to NVQ level 2 or the equivalent. This will ensure staff have all the required knowledge and skills to care for the people living in the home. It is recommended that a staff training matrix is developed that details all the training staff have taken part in including the dates and when it is due to be updated. The registered provider should address the issues identified during the inspection between themselves and the manager. This will ensure the home is run effectively. The manager should collate all the information from surveys, meetings, audits and so on to produce a yearly development plan for the home to show how they intended to improve the service offered. Evidence that the bath hoist and emergency call system have been serviced should be forwarded to the Commission. This will evidence that equipment is being serviced as required. Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gables, The DS0000062346.V368233.R01.S.doc Version 5.2 Page 34 - 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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