Inspection on 13/02/06 for The Gables

This inspection was carried out on 13th February 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gables 26/02/09

The Gables 02/07/07

The Gables 30/03/07

The Gables 24/08/06

The Gables 03/03/05

The Gables 03/09/04

The Gables 03/02/04

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Treloar College

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

CARE HOME ADULTS 18-65 The Gables Moreland Drive Gerrards Cross Bucks SL9 8BB Lead Inspector Gill Gentles Unannounced Inspection 13th February 2006 08:00 The Gables DS0000023055.V268230.R01.S.doc Version 5.0 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 DS0000023055.V268230.R01.S.doc Version 5.0 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 DS0000023055.V268230.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Gables Address Moreland Drive Gerrards Cross Bucks SL9 8BB 01753 890399 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) admin@fremantletrust.org The Fremantle Trust Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Gables DS0000023055.V268230.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th May 2005 Brief Description of the Service: The Gables is a home for seven adults with Learning Difficulties and high care needs. The home is situated within close proximity of Gerrards Cross town centre. There is a main bus route from the town centre to nearby towns. The house is sited on a large cul-de-sac, next to a school. The accommodation is over two floors, however the majority of Service Users live on the ground floor. There are two bedrooms upstairs for the more mobile Service Users, a stair lift has been installed to ensure Service Users can access their own rooms. There are five rooms on the ground floor. All bedrooms are individually decorated to each Service Users personal taste. The home has a large communal lounge dining room and a separate sensory room.The garden is large in size and all Service Users have access. The property is not identifiable from the outside as a care home. The Gables DS0000023055.V268230.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Mrs.Gill Gentles and Mrs. Nicky Cahill carried out this unannounced inspection during a 2.5 hour period on Monday 13th February 06 at 8 am. Both inspectors’ concentrated on perusing separate documentation, talking to residents, the manager and staff members. What the service does well: What has improved since the last inspection? What they could do better: The home has the appropriate policy and procedure in pace in relation to Protection of Vulnerable Adults however there is a shortfall in training potentially putting residents at risk. Inappropriate documentation in relation to health and safety checks and safe working practices were in place failing to protect residents from harm. The Gables DS0000023055.V268230.R01.S.doc Version 5.0 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Gables DS0000023055.V268230.R01.S.doc Version 5.0 Page 7 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 DS0000023055.V268230.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 The home has a Service Users Guide in place to ensure that the current and prospective residents have an understanding of the service available to them. The manager ensures a thorough assessment takes place, taking into account resident compatibility to ensure smooth transitions with minimum disruption. EVIDENCE: A requirement was issued at the previous inspection to produce a Service Users Guide which the manager has successfully completed. The guide is basic and doesn’t necessarily meet the specifics written in the standard. However due to the residents limited abilities this document is adequate for them to comprehend. Since the last inspection the home has admitted a new resident. Documentary evidence confirmed that the home, along with Buckinghamshire Social Services, carried out assessments. The county’s assessment incorporated information relating to:• Healthcare needs • Personal care needs • Mobility • History. The in-house assessment wasn’t as detailed but it did include:• Changing needs The Gables DS0000023055.V268230.R01.S.doc Version 5.0 Page 9 • • • • Staffing levels Personal history Likes/dislikes Managers view One resident was transferred to The Gables from another Fremantle Home and was finding the change difficult. Documentation evidenced reasons for this individual not to move into this home, although he/she was accepted. Fortunately the needs of the individual have changed dramatically for the best and the home is managing to meet all the needs except for providing daytime activities, which the care manager is organising. The Gables DS0000023055.V268230.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 Clear and concise care plans are in place that enable staff to appropriately support residents in line with individual assessed needs and personal goals. Residents (to the best of their ability) are encouraged by the staff to participate in the running of the home, enabling them to make decisions about their lives. EVIDENCE: At the previous inspection a requirement was issued to develop the remaining five Care Plans. It was evident during this inspection that the manager has produced, with the staff team, a very informative Care Plan for a new resident. The care plan was found to be written in the first person and signed and dated by the resident. The plan incorporated the following information:• Essential information • Pen picture • Healthcare • Preferred daily routine • Specific likes • Dislikes etc. The Gables DS0000023055.V268230.R01.S.doc Version 5.0 Page 11 The care plan was clear, concise, easy to read with good information relating to residents choices and decision-making. Residents were clearly offered the opportunities to participate in the basic dayto-day running of their lives during the inspection e.g. choices of breakfast and personal appearance. The Gables DS0000023055.V268230.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 Residents are supported and encouraged to be involved in the daily routines of the home, promoting personal independence and growth. The home provides a supply of nutritious and balanced foods ensuring residents are supported and encouraged to maintain a healthy diet. EVIDENCE: Due to the limited abilities of the residents it is not always possible to involve them in the routines of the home. Independence to the best of individual’s abilities is promoted but the majority of residents are wheelchair bound so restriction of freedom of movement around the home is unavoidable. Two residents are mobile and have, in line with risk assessments, freedom to move around the home. Staff were seen knocking on bedroom doors prior to entering. Again due to the nature of the resident’s disabilities, it is not possible to give out bedroom door keys. The home has developed a menu book to assist residents to select the meals they like. Information was found to be very good and informative with bright The Gables DS0000023055.V268230.R01.S.doc Version 5.0 Page 13 pictures cut out of magazines. There were individual summaries of resident’s likes and dislikes, recipes and information about how to cook specific meals. In general home offers residents a balanced nutritious diet. The Gables DS0000023055.V268230.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Residents receive personal support in the way they prefer ensuring sensitivity and flexibility to maximise privacy dignity and independence. The staff team support residents with their healthcare ensuring that the physical and emotional needs are being met. In general the medication procedures in the home are adequate to ensure residents are safe from harm, however there are some short falls in the recording on the Medication Administration Records. EVIDENCE: The staff working in this home were observed providing personal support to the residents in privacy ensuring dignity is maintained at all times. As far as possible residents independence is promoted, to the best of individual’s abilities. There are no fixed times for going to bed and getting up, except within the time constraints of the transport arriving to take residents to day time activities. The early morning routine was observed during the visit and it was noted that there was no evidence of residents being rushed or short cuts being taken. In fact the atmosphere was relaxed, comfortable and unrushed. Residents were personally supported by the same member of staff from getting up till they left for the day. Personal appearance was selected by the staff with The Gables DS0000023055.V268230.R01.S.doc Version 5.0 Page 15 in-put from individuals ensuring individuality and personal choice was adhered too. The home has the essential technical aids required to promote maximum independence. Additional support from external services such as physiotherapists etc are available as and when required. The home ensures consistency of approach to residents by identifying a designated key-worker. The manager ensures that the health care needs of each individual resident are met. The residents living in the home have access and support from their GP and any other medical professional as and when required. The GP also arranges annually to visit the home and review each resident’s health and medication. The home receives medication on a monthly basis from Boots the chemist in blister packs. The storage was found to be adequate, in a locked cupboard on the kitchen wall. The keys are stored inappropriately and alternative ways to ensure security is maximised were discussed with the manager. The Medication Administration Records showed that explanations for missed medication were lacking. The home has also been administering PRN medication without the appropriate guidance and explanations. The manager is required to ensure that the correct protocols and procedures are adhered to in relation to administering and recording medication. The district nurses drawer in the kitchen was found to be locked which is an improvement on the previous visits. The home had 13 permanent members of staff at the time of the inspection, there was evidence of a shortfall in the staff who have received medication training with records showing only 7 have completed the training. It is a requirement that the manager ensures all staff who administer medication receive current up to date medication training. The Gables DS0000023055.V268230.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 There is clear written guidance in place to ensure that residents know how to make a comment about the service they receive. The home has the appropriate policy and procedure in place in relation to Protection of Vulnerable Adults however there is a shortfall in training potentially putting residents at risk. EVIDENCE: Several years ago Fremantle instigated a feedback system for all complaints, compliments, concerns and questions to be addressed. The same system applies to all who wish to make a comment about the service it provides, such as residents, staff and visitors to the home. The resident version is written and in pictorial form. The information clearly explains whom they can talk to and includes Fremantle’s head office address and the Commission for Social Care Inspection’s contact details. The manager confirmed that the home has not received any complaints about the service they provide. The home has the appropriate policy and procedure in place in relation to the Protection of Vulnerable Adults. A requirement was issued at the previous inspection to ensure that all staff receive training in Protection of Vulnerable Adults. Records viewed showed that the manager has made some headway by ensuring 7 out of 13 staff are trained. The manager must ensure that all staff are trained. The Gables DS0000023055.V268230.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed during this inspection apart from inspecting the bathroom that was in need of refurbishment. A requirement was issued in May 05 with a deadline of September 05. Unfortunately Fremantle Trust has not carried out this requirement. The Commission has not received any communication from the property department requesting an extension to the timescale; therefore the manager and organisation must ensure that the bathroom is completely refurbished by the given date in this report, failing which the Commission may consider enforcement action. The Gables DS0000023055.V268230.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 The staff team have undergone some rigorous training since the last inspection; ensuring residents receive care from competent staff. EVIDENCE: At the previous inspection a requirement was issued in relation to staff being trained in Fire Awareness, Infection Control, First Aid, Food Hygiene and Manual Handling to ensure the appropriate support is given to the residents safely and without any risk to individual’s health. During this visit records showed that the manager has worked hard to ensure that all 13 members of staff have been trained in the identified subjects. The manager has an identified training budget ensuring that all staff are offered the same opportunities to attend training courses to develop their individual and team skills. Staff are working towards NVQ’s however, percentages were not assessed during this inspection. The Gables DS0000023055.V268230.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 Inappropriate documentation in relation to health and safety checks and safe working practices was in place, potentially putting residents at risk. EVIDENCE: Health and safety records were examined in relation to ensuring that the residents are safe in their home. However, shortfalls were noted which resulted in immediate requirements being issued on the day of the inspection. The home was unable to provide the appropriate certification in relation to: • A gas safety inspection • Servicing of the hoists It was also noted that erratic fire alarm checks had been completed with gaps of weeks observed in the records book. Emergency lights had been serviced but with no regular checks or charge of the batteries having taken place. This was not the first time the home has been issued with requirements regarding the safety of residents, in particular the fire safety checks, therefore the manager is reminded to ensure that the appropriate checks are carried out and recorded appropriately. The Gables DS0000023055.V268230.R01.S.doc Version 5.0 Page 20 Since the unannounced inspection the manager has forwarded to the Commission copies of the gas and hoist safety certificates. The Gables DS0000023055.V268230.R01.S.doc Version 5.0 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Gables Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 X DS0000023055.V268230.R01.S.doc Version 5.0 Page 22 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 YA20 Regulation 18(1) Requirement The manager is required to ensure that the correct protocols and procedures are adhered too in relation to administering and recording medication. It is a requirement that the manager ensures all staff who administer medication receive current up to date medication training. The manager must ensure that all staff are trained in Protection of Vulnerable Adults. PREVIOUS TIMESCALE OF 15/09/05 NOT MET. The manager and organisation must ensure that the bathroom is completely refurbished by the given date. PREVIOUS TIMESCALE OF 30/09/05 NOT MET. The manager is reminded to ensure that the appropriate health and safety checks are carried out and recorded appropriately. DS0000023055.V268230.R01.S.doc Timescale for action 01/04/06 2 YA20 18(1) 31/03/06 3 YA23 18(1) 31/03/06 4 YA27 23 30/04/06 5 YA42 13(4) 14/02/06 The Gables Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Gables DS0000023055.V268230.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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