Inspection on 13/06/06 for The Gables

This inspection was carried out on 13th June 2006.

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

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

Other inspections for this house

The Gables 14/12/09

The Gables 05/07/09

The Gables 07/05/09

The Gables 02/11/07

The Gables 06/06/07

The Gables 19/12/05

The Gables 06/04/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Gables 1 East Park Street Chatteris Cambridgeshire PE16 6LA Lead Inspector Alan Buttery Key Unannounced Inspection 13th June 2006 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address 1 East Park Street Chatteris Cambridgeshire PE16 6LA 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) 01354 693858 01354 696400 Stargate Partnership Ltd Care Home 41 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (23), of places Physical disability over 65 years of age (1) The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th December 2005 Brief Description of the Service: The Gables is an old largely Georgian house in the centre of the small Cambridgeshire town of Chatteris, which has been updated and extended to provide accommodation for up to 41 older people. The accommodation is split over two floors. On the ground floor, there are bedrooms and communal areas, which provide secure accommodation for 17 older people with dementia, and on the first floor facilities for up to 24 older service users without dementia. There are bathroom and toilet facilities on both floors, and a large enclosed rear garden. On the day of the inspection the manager said that the fees ranged from £340 to £465.75. Copies of CSCI inspection reports are in the entrance hall. The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out by two inspectors who made a tour of the building, spoke to service users and staff, inspected documents and spent time with the manager. The manager has been in post since 5 June 2006. This inspection was unannounced and was a key inspection. All of the key standards were assessed. At the time of the inspection there were 5 service user vacancies. What the service does well: What has improved since the last inspection? What they could do better: Not all of the staff had received training in fire safety as often as required. Staff files were inspected and it was noted that not all of the information required to be received before a person started employment at the home was available for inspection. Complaints must be investigated within the timescales stated in the complaints procedure. According to the complaints log not all complainants had received a response to the complaint that they had made. The Gables DS0000063700.V292954.R01.S.doc Version 5.2 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 DS0000063700.V292954.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Assessments are carried out so that the service users know that the home can meet their needs. EVIDENCE: Records of information about four service users were checked. All four files contained assessment information that had been completed before each person was admitted. The home has a Service User Guide which contains all of the required information. Service users spoken to stated that they had received a copy of this Guide and a copy is also kept in the entrance hall. The home also has documentation confirming that all service users or their representatives have received a copy of the Service User Guide. A copy of the Statement of Purpose is also in the entrance hall. The manager is aware that this needs to be amended as the current document details the name of the previous Registered Manager. The home does not offer intermediate care. The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 9 The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome are is adequate. This judgement has been made using available evidence including a visit to the service. Care plan reviews must be more comprehensive and care plans must be amended when service users needs change. Not all medications are securely stored and this puts service users at risk. EVIDENCE: The care plans of four service users were seen during this inspection. Care plans give clear guidance to staff on how to meet the needs of the service users and there was evidence that reviews were being held monthly. Three of the four service users had been living at the home for more than a year and each time the care plan had been received the review stated ‘no change’. It is unusual for service users needs not to change at all within twelve months and the manager agreed to ensure that thorough reviews took place to ensure that where there were any changes these were recorded and another care plan is written. Service users have access to a wide range of health care professional and GP’s and District Nurses regularly visit the home. Training in the administration of insulin has been provided by District Nurse and appropriate delegation forms are in use. The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 11 The home uses a monitored dosage system of drug administration and records confirmed that all staff who administer staff have received appropriate training. None of the service users currently accommodated in the home handle their own medication. The records of medication received into the home, administered and disposed of were seen and were satisfactory. The room storing medication on the first floor of the home was inspected and was satisfactory. There was no overstocking of medication and the room was maintained at a satisfactory temperature. It was noted that a bottle of liquid medication was held in an unlocked cupboard in the managers office and also that the medication due to be returned to the pharmacist was also held in this office. The inspectors were informed that this room is usually locked. Service users stated that they have good relationships with staff, that staff are courteous and polite and that they always call them by their preferred name. Service users confirmed that staff always knock and wait before entering their bedroom. This was witnessed during the inspection. The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are able to make choices in all aspects of their lives. EVIDENCE: Service users confirmed that they can go to bed and rise when they wish and that they have lots of choices. These include a choice of meals and a choice of what activities to undertake during the day. The home employs two activities coordinators and on the day of inspection service users were enjoying hand massages. A game of bingo was planned for the afternoon. A hairdresser was also in the home on the day of the inspection. The hairdresser visits the home weekly. One service user stated that she attend prayer meetings in Chatteris each week. Religious services are also conducted in the home. A coffee morning and a jumble sale were recently held. A strawberry tea was being panned at the time of the inspection. The home has many photograph albums showing service users enjoying various activities. A newsletter was on display in the home. This lists forthcoming events and is given to all service users. Residents meetings are held monthly and minutes of these are circulated to service users. The most recent meeting was on 7 June and during this meeting the new manager was introduced to all of the service users. Service users hobbies and interests are recorded when they are admitted to the home and where possible staff ensure that service users and helped to continue to pursue any hobbies and interests that they have. The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 13 Service users spoken to during this inspection praised the quality and variety of food available in the home. They stated that each morning they are told what is on the menu and make their choice. If they do not like what is on the menu they are offered an alternative. On the day of the inspection service users had a choice of either chicken casserole or sausages with onions and gravy. There is also a choice of deserts and on the day of inspection deserts available were either apple pie or cherry and almond sponge. A cooked breakfast is available every day and in the evening a light meal is served such as sandwiches, yoghurts and cake. Many of the meals are prepared using fresh ingredients. A four weekly rolling menu is in operation. The meal at the time of the inspection looked very appetising and nutritious and the dining areas were very pleasant. Service users confirmed that drinks and snacks are available throughout the day and night. Special diets are also prepared if required and a dietician is available on request. Service users stated that their visitors are able to visit whenever they want and they can be entertained either in the communal areas of the home or the residents bedroom. The visiting policy of the home is also contained in the Statement of Purpose and the Service User Guide. The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users know that their concerns will be listened to but there was not evidence that all complaints had been thoroughly investigated. EVIDENCE: The home has a satisfactory complaints procedure which in is on display in the home, is contained in the Service User Guide and the Statement of Purpose. Service users spoken to stated that they would speak to a member of staff if they had any concerns. The complaints log was seen during this inspection. It was noted that seven complaints had been received by the home since the previous inspection which was undertaken on 19 December 2005. Six of the seven complains related to complaints about staffing levels. According to the information contained in the complaints log investigations into three of the complaints had not been completed. These complaints were received on 8 March, 22 March and 8 April. The complaints procedure states that all complaints will be investigated within 28 days. This timescale for investigating complaints is also required by the Care Homes Regulations 2001. Staff members spoken to stated that they felt confident that they know about abuse and would have no hesitation in reporting any concerns. All staff have received training in the Protection of Vulnerable Adults and the home has satisfactory policies detailing the procedure to be followed when there are allegations of abuse. The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Generally the home is clean and well maintained so that service users have a comfortable, homely place to live. EVIDENCE: Generally the standard of maintenance and decoration at this home is very good. The only issue is respect of the building was that the laundry room door was faulty. Various items had been placed behind the door so that it could not be opened and staff were having to enter the laundry room through another door which could only be accessed by going into the garden. Staff spoken to stated that the laundry door had been faulty for at least three months. The home has a programme of refurbishment which is ongoing. The majority of bedrooms have been redecorated and it was clear from the occupied bedrooms seen that service users are encouraged to personalise their rooms, bringing in their own furniture and belonging if they want to. The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 16 The home can accommodate 41 service users (24 on the first floor and 17 on the ground floor). Apart from one double bedroom on the ground floor all of the rooms are single rooms. None of the bedrooms have en-suite facilities but the home has an adequate number of bathrooms are toilets to meet the needs of the service users. Bedroom doors are lockable and toilets and bathrooms have appropriate locks. The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The procedures for employing staff are poor and do not ensure the safety of service users. EVIDENCE: At the time of the inspection there were 6 members of care staff on duty plus the manager. Five of the care staff commenced their shift at 8am and the remaining member of staff commenced their shift at 9am. Those staff who commenced work at 8am finished at 3pm and the person who started at 9am finished their shift at 1pm. Staff and relatives had raised concerns about a decrease in staffing levels. As a result of these concerns an additional person is now working from 9am until 1pm. Staff spoken to during the inspection stated that it would be better if the additional person could start at 8am or finish later than 1pm. This is because the busiest part of the day is between 8am and 9am and by the time that the member of staff comes on duty the majority of service users have eaten their breakfast. They also stated that the main meal of the day is served from 12.30 and that it is not helpful when a member of staff finishes their shift at 1pm as the service users are requiring assistance. The manager was informed of these concerns. Staff training records were inspected and it was noted that a wide variety of courses are available to staff. Several staff have started a dementia course and all staff who administer medication have received appropriate training. Other training available includes diabetes, first aid, the prevention and treatment of pressure sores, moving and handling, nutrition and adult protection. Fire safety training is provided but not all staff have received this The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 18 as often as required. Further information about this is in the next section of the report. Four staff files were seen. Only two of these contained all of the required information. The manager was unable to find the CRB disclosures for two of the members of staff but Pova First documentation was available in the home. A photograph of one member of staff was not available and one member of staff only had one written reference on their file. Proof of identification was not available for one of the staff. A recommendation made following the previous inspection that ‘references not written on headed paper should be verified’ has not been addressed. The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Accurate records of money must be maintained to ensure that service users are not at risk of financial abuse. Service users views are sought regularly so that they have the opportunity to be involved in the running of the home. EVIDENCE: At the time of this inspection the manager had only been in post for a week. She has previously been registered as the manager of a care home in Norfolk and stated that she is in the process of applying to be registered as the manager of the Gables. The manager holds NVQ awards at level 2 and 3 and is currently working towards gaining the Registered Managers Award. During discussion with the manager it was evident that she was aware of her responsibilities as required by the Care Standards Act 2000. The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 20 Residents views about the home are sought during the resident meetings and service users stated that they would also speak to the manager or a senior member of staff if they had any concerns. The home also operates a quality assurance system: questionnaires are sent to service users and their relatives or representatives. The previous two inspection reports stated that ‘a monthly report must be provided by the registered person’. Regulation 26 of the Care Homes Regulations requires the provider to visit the home at least one a month unannounced and to leave a written report at the home. The reports were read and it was noted that the most recent report available in the home was dated 18 January 2006. Staff spoken to stated that they receive formal supervision at least every two months. One staff member who is responsible for supervising staff stated that she has received supervision training. Staff supervision records are maintained and were available for inspection. The home will hold money on behalf of service users. The financial records and money held on behalf of three service users were seen during this inspection. It was noted that the amount of money recorded for one service user did not tally with the amount of money actually held. A discussion was held with the manager about the financial records as not all of them were clear. Policies and procedures are in place to manage the health and safety of service users in the home and regular checks of equipment are made. Risk assessments are carried out and staff receive training in matters of health and safety. Fire alarm tests are undertaken weekly and emergency lighting tests are undertaken monthly. Staff training records showed that some staff had not received fire safety training since 4 November 2005. Arrangements must be made to ensure that all staff receive training in fire safety at least twice a year. The accident book was inspected and was satisfactory. The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 17 X 18 3 2 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 3 x 1 The Gables DS0000063700.V292954.R01.S.doc Version 5.2 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. 2. 3. Standard OP7 OP9 OP16 Regulation 15(2)(b) 13(2) 22 Timescale for action Care plans must be revised when 31/07/06 the needs of the service user change. All medication must be securely 14/06/06 stored. All complaints must be fully 30/06/06 investigated and there must be a record of the outcome of the complaint and action taken(if applicable). The laundry room door must be 13/07/06 repaired or replaced. Staffing levels must be reviewed 31/07/06 The information required by this regulation must be obtained before staff work at the home. An application by the person proposing to be registered as the Manager of the home must be submitted to the CSCI. Accurate records of monies held by the home on behalf of service users must be maintained. Reports required by this regulation must be available in the home for inspection. 14/06/06 31/08/06 Requirement 4. 5. 6. 7. OP19 OP27 OP29 OP31 23(2)(b) 18(1)(a) 19 8(1) 8. OP35 17(2) 14/06/06 9. OP36 26 30/06/06 The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 23 10. OP38 24(4)(d) Arrangements must be made for all staff to receive fire training at least twice in a twelve month period 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP29 Good Practice Recommendations References not written on headed paper should be verified. This recommendation is carried forward from the previous inspection. The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI The Gables DS0000063700.V292954.R01.S.doc Version 5.2 Page 25 - 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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