Inspection on 12/09/08 for The Gables

This inspection was carried out on 12th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gables 12/09/07

The Gables 10/08/06

The Gables 28/02/06

The Gables 18/08/05

The Gables 21/02/05

The Gables 04/10/04

Similar services:

Ashlea Mews Residential Home

Eastwood

West Lodge

Arran House

Avenue Community Nursing Home

Cosin Lodge

Farmborough Court

Cragston Court

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

CARE HOME ADULTS 18-65 The Gables 7 Park Terrace Bedlington Station Northumberland NE22 7JY Lead Inspector Allan Helmrich Key Unannounced Inspection 12th and 15th September 2008 10:00 The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables DS0000000533.V371467.R02.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address 7 Park Terrace Bedlington Station Northumberland NE22 7JY 01670-826639 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) no email Mrs Dianne Joan Brown Mrs Dianne Joan Brown Care Home 11 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (4) The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two named service users have a Learning Disability. No further admissions should take place for category LD without prior consultation with CSCI. 12th September 2007 Date of last inspection Brief Description of the Service: The Gables is a converted domestic detached house. Care may be provided for 7 adults and 4 older people with a mental disorder. The home is in Bedlington Station near to shops and other community facilities. Accommodation is provided over two floors, 7 bedrooms are single and 2 are doubles. None of the bedrooms have ensuite facilities. A bathroom and toilet are available on each floor. On the ground floor there is a kitchen, dining room and a lounge. There are 2 yards, one has access from the kitchen that is used for bin storage and the other with seating is used by residents and for domestic purposes. There is no lift in the home making it unsuitable for anyone with a physical disability. The home has a Service User Guide and a copy of the inspection report is available in the home. The home’s weekly fees are £395. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. “We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken.” The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Visit: The inspection was unannounced and was undertaken by the link inspector for the service. The inspection was carried out over 2 days and lasted 7 hrs. During the visit we: • • • • • • • Talked with people who use the service. Talked with the home manager and staff on duty. Looked at information about the people who use the service and how well their needs are met, Looked at case records for three residents and other records that must be kept, including medication. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to assess if it was clean, safe and comfortable. Checked what improvements had been made since the last visit. Also surveys were sent to residents and staff. Responses were received from eight residents and four staff members. Information from these sources is used in this report. What the service does well: The Gables provides a service that all residents are comfortable with. The manager clearly knows each of the residents very well and is a good advocate for them. Each resident is supported and encouraged to be active and use community facilities and services. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 6 A high proportion of the staff team has achieved National Vocational Qualifications in care to assist them in providing good care to the residents. Eight residents completed a questionnaire. All of the responses were positive about the care provided, however none of the residents included individual comments. Four responses were received from members of the staff team. Again the responses were generally positive. Positive comments included; ‘The home provides a safe and supportive environment while taking into consideration peoples personal needs and choices.’ ‘Residents’ well being and needs always come first.’ ‘Residents are well looked after and live in homely comfortable surroundings.’ ‘The manager puts a lot of time and effort into providing home cooked meals, outings and decoration’. What has improved since the last inspection? What they could do better: Residents enjoy living in the home and are complimentary about the staff team and as mentioned previously some work has been done to improve the environment. However further work is required to provide a modern home. Administration and recording systems have been improved and evaluations are carried out but further work in ‘goal planning’ is required to promote fulfilment, privacy, dignity and wellbeing within the resident group. Further use of the quality monitoring tool should identify areas for improvement that will enhance the life of people who live in the home. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 7 Areas that staff felt could be improved are; ‘More equipment could be provided, for example gloves and aprons.’ ‘More social activities that could be enjoyed by all residents.’ ‘More training related to mental health issues and how staff can be more supportive to residents.’ ‘Promote more independence and encourage activities.’ Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. A system is in place to enable the proprietor to be confidant the needs and expectations of people admitted to the service can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The most recent admission to the home was only accepted after information was collected from appropriate professional people, a pre admission assessment was completed and the manager was satisfied the balance in the home would not be upset. A visit to the home was encouraged and the views of other residents in the home were taken account of before a place was offered. The records show that admission was closely followed by a full assessment of needs and was done with the involvement of the resident. Information to staff is provided in care plans and risk assessments were produced to ensure there was a level of support for the resident to live a supported life of their choice. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. People are involved in planning their care, making choices and decisions about what they want to do. They are encouraged to be independent but records do not always support this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has a case record that includes care plans to provide the support they need. There are monthly reviews signed by the resident and key worker and reviews have been conducted that involve appropriate professional supporters. In some of the files there was a record of discussion identifying specific goals such as; going to the shops, alcohol intake and visiting relatives, but these have not been converted into plans for achievement. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 11 Residents spoken to stated that care and support is provided in a way that suits them and staff talked about how they ensure that peoples needs and desires are met in a safe way. However the records were not always written in a way that respected the choices of people living in the home. If there are house rules these should be agreed with people and signed up to. Residents are supported to manage their finances and a system of recording is in place that monitors this so that an audit can be done. Should a risk be identified, details of that risk are recorded with any actions appropriate to ensure levels of harm are measured against any loss of independence. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is good. Each person is able to choose what to do and where to go and they are part of the local community. Everyone is supported in their preferred relationships and rights and responsibilities are actively promoted. A healthy diet is offered to all. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People are encouraged to be active. One resident has recently done a basic food hygiene course. Some residents assist with routine domestic chores and one resident works each weekday in a market garden. Residents support each other and are proud of their home. They use many local facilities and are part of the local community. Records show that some The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 13 residents visit churches they are registered with the local health centre and can be seen out regularly in local shops and pubs. Holidays are planned with staff support and previously this year some residents have been to Filey. Other trips are planned. The majority of residents have some family contact and this is encouraged and supported by the staff team. Staff promote healthy eating with fresh fruit and vegetables included in the daily menus but residents choice is respected. Nutritional assessments are conducted and professional guidance is obtained when necessary. Residents assessed as able have access to the kitchen to prepare snacks and drinks. Support is provided whenever necessary by staff. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. Staff do not promote good personal care but rather respect each residents independence and personal choice. Appropriate professional support is obtained to maintain residents emotional and physical healthcare needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most people are independent with personal care and the staff team encourages independence in this area. The care plans related to this sensitive area of care should be reviewed as on occasion residents can leave the home with their dignity compromised. Each care plan should contain agreed standards to promote dignity and ensure that residents’ individuality is maintained without loss of respect. The manager is effective at ensuring people get access to a range of general and specialist healthcare services. Care plans identified that appropriate The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 15 professional assistance is requested to support individuals when they require it and daily recordings demonstrated that staff regularly monitor the physical and mental health of everyone in the home. Records showed that people had been to the dentist, optician, GP and had received specialist monitoring when necessary for things such as catheterisation. Personal care tasks are not always done in private with staff applying creams to a resident’s leg in a communal area. Personal care should always be done privately to ensure dignity is maintained. Each resident who commented was content with the standards of care provided. Staff would like more training associated with mental health and also better access to disposable gloves and aprons to assist them in their work. The home’s policies and procedures for recording and dispensing medicines are well written and have been signed by staff as read. Residents who self medicate have been assessed as competent and these details are recorded in care plans. Medicines are held securely in the home for the safety of all. The following elements should be addressed for the safety and wellbeing of the residents. A record of signatures of staff who dispense medicines should be available. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. Residents’ opinions are valued and staff are trained to protect them from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents confirmed they are aware of how to complain and that staff listen to them. The home has a complaints process and a log to record any complaints made. No complaints have been received since the last inspection. Staff have received training in abuse awareness and the proprietor is fully aware of the system for protecting vulnerable people. Department of health guidance for staff regarding abuse awareness is available to staff in the home. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is adequate. Residents enjoy living in the home that is clean but some work is still required to provide a modern home for the benefit of all This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents all enjoy living at The Gables and are proud of their home. Bedrooms are decorated and personalised to the individuals taste. The manager has produced an improvement plan for the home and some improvements have been made. The bathroom floor has been relayed and some tiling work is in progress. New carpet has been laid in communal areas and an empty bedroom is being refurbished with new furniture and upgraded decoration. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 18 Generally the cleanliness in the home was of a suitable standard and no odours were noted. The laundry is not modern but does contain equipment suitable for ensuring clothes are appropriately washed. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35. Quality in this outcome area is good. A system is in place to ensure a well-trained staff team supports residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four staff returned questionnaires. Each stated they were given up to date information, were given a good induction into the home and generally receive the right level of support from management and other staff team members. Staff would prefer more mental health training to assist them in providing good care and as stated previously better access to gloves and aprons. Each resident who responded to a questionnaire stated staff ‘always’ treat them well. The files of two recent recruits were reviewed. Each contained appropriate information obtained before working in the home to ensure residents are safe from harm. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 20 During the inspection sufficient staff were on duty to ensure residents needs were met. The rota showed that at least two staff are on duty at all times with other staff being made available for social occasions and holidays. Currently the home are seeking a senior care to support the team at weekends. Most of the staff team have a National Vocational Qualification (NVQ) in care and the manager monitors the training to ensure it meets the needs of the resident group. The manager is aware of issues of equality and diversity and two staff in the home have recently completed this training. This helps to ensure residents’ rights are maintained. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is good. The standard of management has improved as the owner/manager has realised the importance of maintaining good systems of communication and care management that improves the lifestyle for individual residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The proprietor has managed the home since 1987 and she has obtained the Registered Managers Award. This demonstrates her competence to manage a care home for vulnerable people. She is very knowledgeable about the individual needs of the residents and is respected by the staff team. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 22 Administration processes have been improved recently. Staff 1-1 supervision sessions take place and some auditing of systems is taking place. Senior staff are being made more aware of the home’s systems but further work is required to ensure these do not fail when the manager is not on duty. For consistency senior staff must be involved in the maintenance of all systems used to support residents. The proprietor is developing a system for assessing the quality of care provided. Also some improvement plans have been produced for the home environment. Training plans are in place for staff, improvements have been made to care records and residents confirmed they are asked to comment about the care provided. Residents told me they are very happy in the home and if they have concerns the manager is informed. Meetings involving residents take place and all issues are recorded. Certificates are in place to show the electrical and gas systems are safe. Fire records are in place for periodic checks of equipment but staff training is not done regularly and the fire risk assessment record should be improved to ensure residents’ safety is maintained. The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 X 3 X X 2 X The Gables DS0000000533.V371467.R02.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA42 Regulation 23(4) Requirement The manager must ensure; A comprehensive fire risk assessment of the building is in place and is reviewed periodically. All staff receive regular fire instruction and that this is recorded and a staff signature obtained. Timescale for action 31/10/08 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. 3. Refer to Standard YA6 YA6 YA18 Good Practice Recommendations Ensure goal plans are produced to back up actions agreed between residents and their key workers. Use goal plans to encourage independence and promote dignity. The manager should review care records and identify areas to staff where recordings could be written more appropriately. The manager should ensure that personal care is promoted to respect the dignity of the individual while ensuring individuality is maintained. DS0000000533.V371467.R02.S.doc Version 5.2 Page 25 The Gables 4. 5. 6. YA20 YA24 YA35 Personal care tasks should always be conducted in private for the dignity of the person. Record the signatures of all staff dispensing medicines to ensure they can be identified should it be required. Continue improving the environment for the benefit of residents and staff. Consider staff requests for training that directly benefit people who live in the home. 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