Inspection on 11/09/07 for The Gables

This inspection was carried out on 11th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Gables 05/11/08

The Gables 11/08/08

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 08/07/2008.

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 11th September 2007 09:10 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.V344444.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.V344444.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.V344444.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. 17th July 2006 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 fees at the home were not available at the time of this inspection. Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this key inspection over one day in September 2007. During the inspection a tour of the home was undertaken, three files for the people living in the home were sampled and two staff files as well as other care, health and safety and training documentation. The inspector spoke with the manager, two staff members and seven 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. The inspector also received three completed comment cards from the people living in the home and two from relatives. All the comments received about the service were positive. One minor concern had been raised with the Commission since the last inspection in relation to the telephone for the use of the people living in the home being out of order for some time. The proprietor quickly resolved this after a telephone call from the inspector. One minor complaint had been raised at the home about some fruit in a bowl which had gone mouldy again this was quickly resolved. Three adult protection issues have been raised by the home with Social Care and Health. All the issues have been resolved satisfactorily. 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. There were no rigid rules or routines in the home and the people living there were able to spend their time as they chose. The people living in the home were very positive about the staff group at the home and comments made included ‘they are lovely’, ‘they’re great’ and one individual stated that her great age was attributed to ‘the way they look after me.’ Relatives commented, ‘always smiling even when under pressure’ and ‘the new staff are wonderful.’ There were activities available both in the home and out in the community for those people wishing to take part. Visitors were welcome at the home at any reasonable times. There was evidence in daily records of the home contacting relatives when necessary and of people visiting the home. One relative commented ‘there is absolutely full liaison between the staff and myself in the care of my mother.’ Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 6 Care plans and risk assessments that were in place were comprehensive and ensured people living in the home received individualised care. All the people living in the home that were spoken with were satisfied with the catering arrangements at the home. Meal times were observed to be very pleasant and unhurried. Individuals could eat in the dining room, lounge or their bedrooms if they wished. The home continued to be well maintained, comfortable, nicely furnished and decorated with ongoing improvements being made. What has improved since the last inspection? What they could do better: To ensure the needs of the people being admitted to the home were known prior to them moving in there needed to be evidence on site that a pre admission assessment has been undertaken. Risk assessments needed to be undertaken on all individuals as soon as possible after admission to ensure that any identified risks were managed appropriately. Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 7 Improvements were needed in the management of medication in the home to ensure the people living there received their prescribed medication at the correct times. Adequate staffing levels needed to be maintained at all times without using the care manager as part of the care rota. This will ensure there are adequate numbers of staff to care for the people living in the home. To ensure all staff have the necessary skills and knowledge to care for the people living in the home there must be evidence on site that they have undertaken appropriate induction training. To ensure the people living in the home were safeguarded the manager needed to ensure COSHH substances were stored securely at all times, fire doors were not wedged open and that there was evidence on site that all the equipment in the home had been serviced. 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.V344444.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.V344444.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): 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 pre admission assessment process ensured the needs of prospective users of the service were known prior to admission however evidence of this was not always available. People were able to visit the home prior to admission to assess the suitability of the home. EVIDENCE: The manager had developed a new form to be used by the staff when assessing the needs of any people wanting to move into the home. The form covered all the areas detailed in the National Minimum Standards. The files for two people admitted to the home since the last inspection were sampled. There was evidence of the manager at the home undertaking an assessment for one of the individuals and this covered all the required areas including, personal care, dietary needs, oral health and social care needs. The assessment documentation could not be found for the other individual. The Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 10 manager stated it was definitely done and the deputy manager had completed the documentation and that it had been used to inform the individual’s care plan. This information was to be faxed to the inspector but it had not been received prior to writing this report. People wanting to move into the home were able to visit the home prior to admission to assess the facilities available. Gables, The DS0000062346.V344444.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 adequate. 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. Improvements were needed to the medication system to ensure the people living in the home were not placed at risk and received their medication as prescribed. EVIDENCE: Three care files were sampled during this inspection. Two were for people recently admitted to the home, one of whom had dementia, and the other for a person who had lived at the home for a considerable amount of time and was quite physically frail. One of the individuals who had lived at the home for a month did not have a care plan or any risk assessments in place. This was discussed with the manager who was well aware of this but stated she had not had time to write up the documents. A brief overview of the individual had been written up on Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 12 the day of admission which detailed some of their needs. It is important that an initial care plan is written within one or two weeks of admission to the home that includes details of how staff are to meet any needs identified through the assessment process. Clearly from the daily records this individual also had some risks which had no management plans in place. The other two files both included care plans which were generally comprehensive and included details of what the individuals were able to do for themselves, where they required assistance from staff and what type of assistance. The plans also included the likes, dislikes and preferences of the individuals in areas such as diet and social activity. Areas covered by the plans included, health, personal care, mobility, diet, social and cultural needs. Communication was being included in the care plans as recommended at the last inspection. Care plans had been put in place for short term needs, for example, pressure sores, however it was not always clear if these were still in use and it was strongly recommended that when they were no longer needed they were removed from the files. The care plans were easy to follow and staff had been asked to read them and sign to say they agreed to follow. There was evidence that the people living in the home had been consulted about their care plans and they were being reviewed on a monthly basis. All relevant risk assessments were in place on two of the files sampled including, manual handling, personal, tissue viability and nutrition and where a risk had been identified there was a corresponding care plan. The manual handling assessments had been improved since the last inspection and detailed the handling methods to be used, for example, there was good detail of how someone was to be turned whilst in bed and actions to be taken when someone fell and was uninjured. Care plans for pressure relief had been improved and detailed the equipment to be used and how it was to be used. There were also risk assessments in place when bedsides were being used. One of the files sampled also included a very good management plan for staff to follow in the event of any challenging behaviour. Some minor amendments to the risk assessments were discussed with the manager. For example, one of the risk assessments about the possibility of an individual going missing could have been further improved. It gave details of how staff were to deter the person from leaving the home but not what they should do if the person did go missing. Again staff had signed to say that they understood and would follow the risk assessments. There was evidence in the daily records that the personal care needs of the people living in the home were being met. Staff were identifying health care needs and there was evidence of these being followed up and monitored. The people living in the home clearly had access to G.P.s, district nurses, chiropodists, opticians and so on. There was also evidence that when needed referrals to other specialist health care professionals were made, for example, dieticians. Wherever possible individuals were being weighed on a regular basis but due to the type of scales in the home this was not practical for all of the Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 13 people living in the home. To try and address this staff were measuring the upper arms of those individuals concerned to monitor if there had been any weight loss. Medication in the home continued to be administered via a 28 day monitored dosage system. A random audit of the system was undertaken. All medication was being acknowledged as received into the home on the MAR (medication administration record) charts and copies of prescriptions were being kept. The home had numerous boxes of medication in use as well as blister packs. Medication from the blister packs was being administered appropriately. However several discrepancies were noted in the boxed medication where the numbers of tablets remaining in the boxes did not correspond with what had been received and administered. One of the people living in the home was having a course of antibiotics and should have had two tablets twice a day, from the records it was evident that only one tablet was being administered on some occasions. Another person had two different strengths of the same tablet both to be administered at the same time. The amounts of tablets left in the boxes indicated that the person had received two tablets of the same dose at some point. The manager was undertaking audits on the medication system but these errors had not been identified. It was also noted there were some gaps on the MAR charts this is an ongoing issue in the home. Controlled medication was being recorded and administered appropriately. The information received prior to the inspection stated the home had policies and procedures in place for medication as required at the last inspection. 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 private time during the day in their bedrooms this was not seen as an issue. At the time of the inspection it was noted that there was not a lock on one of the toilet doors this needed to be addressed to ensure privacy could be maintained. Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 14 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: 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. There were no rigid rules or routines in the home and the people living there were able to spend their time as they chose. People were seen sat together chatting, spending time quietly in their rooms, reading, watching television, listening to music and wandering freely around the home. Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 15 The activities folder in the entrance hall of the home evidenced that there were organised activities both in the home and out in the community these included, 100th birthday party, music shows, singers coming into the home, buffet and karaoke, exercise, summer fete, pub meal, theatre trips, coffee mornings and strawberry tea. One relative commented ‘ they’re always trying to entertain.’ The activities folder also included a lot of thank you cards one of these described staff as ‘very special people.’ A member of staff also did some organised activities one day a week. The manager also stated that on a regular basis staff spent time with individuals living in the home, particularly those that spent a lot of time in their rooms, talking to them, playing them music and showing them photographs and such like. There was little evidence of this in the daily records. Staff needed to record how people were spending their days to evidence their social needs were being met. Visitors were welcome at the home at any reasonable times. There was evidence in daily records of the home contacting relatives when necessary and of people visiting the home. One relative commented ‘there is absolutely full liaison between the staff and myself in the care of my mother.’ 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. All the bedrooms were personalised to the occupants choosing and some individuals continued to handle some of their own finances. Menus in the home were varied and nutritious. As recommended at the last inspection a list of alternatives to the main menu was on the dining tables. The people living in the home were seen to enjoy their breakfast and their lunch on the day of the inspection. Everyone was asked if they wanted anymore at lunchtime and one individual was seen to have a glass of beer with his lunch which he clearly enjoyed. Staff were at hand to offer assistance if needed. The people living in the home were consulted about the menus at meetings and their likes, dislikes and special dietary needs were detailed on their care plans. Records of the food being served to the people living in the home were being kept. Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 16 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 good. 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. To ensure that people living in the home were protected from abuse staff had undertaken adult protection training. EVIDENCE: The complaints and adult protection procedures 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. One minor concern had been raised with the Commission in relation to the telephone for the use of the people living in the home being out of order for some time. The proprietor quickly resolved this after a telephone call from the inspector. One minor complaint had been raised at the home about some fruit in a bowl that had gone mouldy again this was quickly resolved. Three adult protection issues have been raised by the home with Social Care and Health. One of these issues was not appropriately acted on by the home in relation to the suspension of staff. However clearly they had learned from this Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 17 experience and the other issues were acted on quickly and appropriately. All the issues have been resolved satisfactorily. The majority of the staff had received training in adult protection. At the time of this inspection the policies and procedures in relation to adult protection were accessible to staff as was required at the last inspection. Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 18 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. Further improvements had been made to the environment which provided the people living in the home with a comfortable and well maintained home to live in. EVIDENCE: There had been no changes to the layout of the home since the last inspection. Further improvements had been made to the environment, for example, new furniture in the lounges and the home was well maintained. It was noted that the kitchen door was wedged open all the time and this should have been kept locked as it is a fire door. There were COSHH substances left out in the kitchen when there were no staff in there and the key was left in the cleaning cupboard on the first floor which also contained COSHH substances. The manager must ensure that COSHH substances are stored securely at all times. Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 19 It was also noted that the code to the alarmed fire exit door on the first floor of the home was on the wall. This should be kept elsewhere. It should not be assumed that the people living in the home would not read this and leave the home without staff knowing. Communal space was ample and the décor, furnishings and fittings were domestic in character and of a good standard. All the communal areas had been redecorated, new chairs and occasional tables had been purchased for the lounges and dining room and new curtains had been fitted in the lounges. 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. New flooring had been fitted in the bathroom, shower room and toilets. The aids and adaptations throughout the home 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. Some bedrooms were seen they varied in size and were all generally well furnished and equipped and all were personalised to the occupants choosing. Appropriate locks had been fitted and the majority had a lockable facility. Bedrooms were redecorated on an ongoing basis. The home was clean and odour free 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. The kitchen was clean and tidy however it was noted that there were some opened foods in the fridge and on the shelves in the kitchen which had not been dated on opening. Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. At times the staffing levels were not adequate enough to ensure the needs of the people living in the home could be met. Staff were receiving training to enable them to care for the people living in the home. The recruitment procedures for new staff were robust and safeguarded the people living in the home. EVIDENCE: The rotas for the home evidenced that on several occasions the home were dropping below the required minimum levels particularly in the afternoon. The inspector had some concerns over the staffing levels and the excessive hours being worked by the manager. The majority of the time the manager was being included in the care rota to make up the numbers. Some agency staff were being used at the time of the inspection but this was not covering all the shortfalls. The issues of staffing levels and hours being worked by the manager were discussed with both the manager and the proprietor after the inspection. The home were in the process of recruiting staff and the proprietor stated that they would use more agency staff in the mean time. The Commission will need to be kept informed of the staffing levels at the home so that they can be ensured they are appropriate for the needs of the people living in the home. The people living in the home were very positive about the staff group at the home and comments made included ‘they are lovely’, ‘they’re great’ and one Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 21 individual stated that her great age was attributed to ‘the way they look after me.’ Relatives commented, ‘always smiling even when under pressure’ and ‘the new staff are wonderful.’ The recruitment records for two staff appointed since the last inspection were sampled. The records were complete and included completed application forms, medical questionnaires, 2 references, POVA first and CRB checks. It was noted that one of the references was dated after the person had started work at the home. The manager was reminded that both references should be obtained prior to staff commencing their employment. There was evidence that staff undertook in house induction training over the first two days of employment. There was no evidence that they had completed induction training in line with the specifications laid down by Skills for Care. The manager stated they had undertaken this but as there had been some wrangle over payment the certificates had not been issued. Staff all had individual training records and these were sampled. They showed that staff had undertaken training in all the required topics including, fire, first aid, manual handling, adult protection, food hygiene and first aid as well as other topics such as dementia care. It was recommended that the manager developed a training matrix for the home that detailed all staff and the training they had undertaken including the date of completion and when this was due to be updated. This would make training much easier to keep track of. Only three of the sixteen staff had completed their NVQ level 2. Another three staff were undertaking the training but this would still not give the home the required fifty percent. Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 22 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 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Low staffing levels impinged on the smooth running of the home at times. The home needed to have a quality assurance system in place based on seeking the views of the people living there with a view to continuously improving the service. The health and safety of the people living in the home and staff were generally well managed. EVIDENCE: The manager has worked at the home for a number of years but not always as the manager. She had grown in confidence in her role as manager and had made several improvements in the home since her appointment. She was clearly committed to ensuring the people living in the home received a good service and is always very receptive to comments made by inspectors. She Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 23 had completed her Registered Managers Award since the last inspection. Clearly at this inspection she was very tired and was working excessive hours due to the shortage of care staff. This was also having consequences for her keeping up with her management tasks, For example, medication management and drawing up care plans. These issues were fully discussed with her at the time of the inspection. The manager was very knowledgeable about the needs of the people living in the home. They were very comfortable in her presence and clearly confident to raise any issues with her. No progress had been made on the home having a formal quality monitoring system in place. However the people living in the home were consulted on a regular basis via meetings when topics such as food, activities and the availability of advocacy services were discussed. 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 home occasionally send out questionnaires to the people living in the home and their relatives for their comments and this year visiting professionals had also been sent questionnaires for their comments. The manager was satisfied that all the people living in the home had access to some money when needed. Some of the people living in the home continued to manage their own finances to some degree. There was an advocacy service available for any individuals to help them manage their finances if they wished to use it. The home was managing some small amounts of money for some of the people living there. The records for this were sampled. These were auditable, there were receipts available for expenditure and two signatures were being obtained for any transactions made on behalf of individuals. All the balances checked at the time of the inspection were correct. Health and safety in the home were generally well managed. Issues raised at this inspection were the kitchen being wedged open and COSHH substances being accessible to the people living in the home. Staff received training in safe working practices, protective clothing was available when required and there was a system in place for the disposal of clinical waste. The in house checks on the fire alarm and emergency lighting were up to date and fire drills were being undertaken at the required frequency. There was evidence on site of the servicing of the majority of the equipment including, fire alarm, lift, portable electrical appliances and gas equipment. No evidence could be found that the emergency call system or the bath hoist had been serviced. Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 24 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 X X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 3 3 X 3 X 2 STAFFING Standard No Score 27 1 28 1 29 3 30 3 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.V344444.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes. 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 14(1)(a) Requirement There must be evidence on site that a pre admission assessment has been undertaken on any people moving into the home. Timescale for action 31/10/07 2. OP7 13(4)(c) 13(5) This will ensure that the needs of the individual are known before admission. Risk assessments must be 31/10/07 undertaken for any identified risks individuals may have on their admission to the home. This will ensure the people living in the home are safeguarded. The registered manager must ensure: The people living in the home receive the prescribed doses of medication at the correct times. There are no gaps on medication administration records unless it is for PRN medication. (Previous time scale of 14/08/06 not met.) More regular staff drug audits take place to assess staff competence in medicine management. Appropriate 3. OP9 13(2) 31/10/07 Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 26 action must be taken when discrepancies are found. This will ensure the people living in the home receive their medication as prescribed. COSHH substances must be stored securely at all times. The code for opening the fire exit on the first floor must not be sited by the door. The kitchen door must not be wedged open. This will ensure the people living in the home are not put at risk. Any opened foods that are stored in the fridge or on shelves in the kitchen must be dated when opened. Adequate numbers of staff must be employed to ensure the manager does not have to cover care shifts on an ongoing basis. (Previous time scale of 01/10/06 not met.) Adequate staffing levels must be maintained on an ongoing basis. CSCI must be notified when staffing levels fall below the required minimum. This will ensure there are adequate numbers of staff on duty to care for the people living in the home. The induction training for staff 31/10/07 must be in line with the specifications laid down by Skills for Care and completed within 12 weeks of commencing employment. (Previous time scale of 01/09/06 not met.) 4. OP19 13(4)(c) 23(4)(a) 31/10/07 5. OP26 13(3) 31/10/07 6. OP27 18(1)(a) 14/10/07 7. OP30 18(1)(a) Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 27 Records of this must be retained on site. This will ensure staff have all the required skills and knowledge to care for the people living in the home. Evidence that the emergency call 14/10/07 system and the bath hoist have been serviced must be forwarded to the CSCI. This will ensure the people living in the home are safeguarded. 8. OP38 23(2)(c) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is strongly recommended that care plans are drawn up within two weeks of people being admitted to the home to ensure they receive person centred care. It was recommended that short term care plans that were no longer in use were removed from care plan files so as to avoid any confusion. To ensure the privacy of the people living in the home it is strongly recommended that a lock is fitted to the ground floor toilet. Staff should record how the people living in the home are spending their days to evidence their social needs are met. 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. 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 DS0000062346.V344444.R01.S.doc Version 5.2 Page 28 2. 3. 4. OP10 OP12 OP20 5. OP28 6. OP30 Gables, The 7. OP33 including the dates and when it is due to be updated. The home should have an effective quality assurance and quality monitoring system in place that is based on seeking the views of the people living in the home with a view to continually improving the service. Gables, The DS0000062346.V344444.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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.V344444.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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