Inspection on 13/06/07 for The Gables

This inspection was carried out on 13th June 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 07/05/08

The Gables 01/11/06

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Gables Gravesend Road Wrotham Kent TN15 7QD Lead Inspector Justine Williams Key Unannounced Inspection 13th June 2007 09:15 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 DS0000067669.V339985.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 DS0000067669.V339985.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address Gravesend Road Wrotham Kent TN15 7QD 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) 02086609953 01732 822758 thegablesnursinghome@hotmail.com Stargate Partnership Ltd Vacant Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places The Gables DS0000067669.V339985.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2006 Brief Description of the Service: The Gables is a large detached property set in extensive grounds. The home is registered to provide nursing care to 25 older people. There are 6-shared bedrooms and 13 single bedrooms, 10 of which have en-suite toilet facilities. Many of the rooms registered for shared use are being used as singles and the number of double rooms are being reduced, to provide larger single bedrooms for residents. Most of the bedrooms are overlooking the Kent countryside. The home has a small lounge and dining room. The home is situated in a rural location close to the A20 and M20, public transport links are some distance, there is ample off road parking in the grounds of the home. The nearest shops are in Wrotham or Meopham, both are a couple of miles away. The home has recently been taken over by Stargate partnership Ltd, and the responsible individual and the new manager plan to extend, refurbish and redecorate the property in the future. Many of the bedrooms have already been refurbished. The current fees range from £431.59 to £548.02 per week, newspapers hairdressing and chiropody not included in the fees. The Gables DS0000067669.V339985.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on 13th June 2007 between 09.15 am and 2.15pm by regulatory inspector Justine Williams. During that time residents, staff and the deputy manager agreed to speak with the inspector both in public and privately. This report contains assessments made from observations, conversations and records, case tracking and a tour of the premises. Feedback was given during and at the end of the inspection. As part of the inspection process surveys were sent to service users, GP’s, health care professionals, care managers and relatives of residents. Some specific comments made were: “Overall the staff do very well” “better/more qualified nurses are needed on the shop floor” “the refurbishment of the accommodation and change of management has been an improvement” “the majority of staff employed give wonderful emotional support which I consider over and above their job role” What the service does well: The admission processes allow residents to make an informed choice to move to the home and they have their needs assessed prior to moving in. The staff have a good knowledge of the health needs of their residents and conduct assessments regularly and act on their findings. Residents enjoy good relationships with the staff team. Residents benefit from a well planned menu, which is cooked well and presented attractively, and where feedback on food is sought. Residents benefit from the open and inclusive atmosphere of the home where feedback from residents is sought and acted upon. Staff training is being organised and updates arranged so that staff receive the updates they need. Staff are safely recruited and have all the relevant checks carried out prior to commencing shifts at the home. The staff have continued to deliver care to residents despite the environment offering significant challenges and the manager having left. The Gables DS0000067669.V339985.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Gables DS0000067669.V339985.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 DS0000067669.V339985.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from thorough admission procedures and move to the home assured their needs can be met. EVIDENCE: Residents are given an opportunity to visit the Gables prior to moving in though often they are not well enough, but residents said their relatives had been welcomed to the home and shown around, as well as being provided with the homes brochure. The service users guides are not routinely given to prospective residents, but are made available in the home once the resident moves in. the deputy manager is currently updating the guide and a copy will be put in each residents room on completion. The Gables DS0000067669.V339985.R01.S.doc Version 5.2 Page 9 Prospective residents are assessed by the deputy manager prior to moving in, and again shortly after they arrive at the home. Residents said their needs are met by the home. The Gables DS0000067669.V339985.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents would benefit from detailed care plans which they are involved in drawing up. The health needs of residents are managed appropriately. EVIDENCE: The home is converting its documentation to the Standex system, and staff are learning about how best to use the new system. The care plans must contain enough detail to enable staff to carry out the care for the residents in the manner they prefer, residents care plans are very nursing based and do not contain detail about how to meet residents social and religious needs or detail about their preferred daily routines such as times for getting up, washing, bathing, and retiring etc. The Gables DS0000067669.V339985.R01.S.doc Version 5.2 Page 11 Reviews of the care plans had been carried out regularly and residents had not always been involved in the planning of their care, or the reviews. Each resident is risk assessed for development of pressure sores, nutritional vulnerability, continence moving and handling etc. as well as other activities. Residents have a falls risk assessment. Staff are using the nutritional screening tool which comes with the standex package, the manager should review this along with other screening tools to ensure these are the most efficient ones to use and to ensure the home works with good practice guidelines. The staff are recording any visits from and to healthcare professionals, with a brief synopsis of the outcome of the visit. Residents said the staff arrange visits by their GP’s when they ask, and they have access to chiropody, sight tests etc. the home has purchased a number of pressure relieving devices, and these are used for those who need them. The home has recently changed the medication system used to the NOMAD system, staff have received training in the use of NOMAD. The home have a medication policy which the staff work to and the trained nursing staff administer the medication. The storage of medicines is unchanged since the previous inspection where it was found to be appropriate. A sign must be used where oxygen is stored in line with health and safety laws and guidance. Residents enjoy good relationships with the staff and felt they were treated with respect for their privacy and dignity. The Gables DS0000067669.V339985.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is no plan of activities and trips or external entertainment is not offered. Residents receive a balanced and appealing diet, with choices of meal and snacks. EVIDENCE: The activities coordinator post is vacant at present and the deputy is advertising the post in the near future. Any activities arranged are carried out by care staff if they have time, and take place infrequently. The deputy said the owners were hoping to provide use of a minibus for trips in the future. Residents have become unused to outings or participating in organised group or individual activities. Consequently there is an inertia about the home and most of residents days are spent watching television. This lack of stimulation is exacerbated by the current low number of people living at the home, with consequent reduced opportunity for interaction. Rather than spend time in the The Gables DS0000067669.V339985.R01.S.doc Version 5.2 Page 13 lounge with the more mentally frail residents, some people choose to remain in their bedrooms and are therefore more isolated. Comments made on surveys included “ I am not sure there is anything to do other than watch television” Residents said their relatives are welcomed to the home though there is not a private room available other than the resident’s own bedroom. Residents who are able are enabled to exercise some control over their lives and make choices. The home has a new chef employed since the last inspection, and care staff are rostered to cover kitchen duties and cooking in his absence. Residents said the chef was very good, and that meals were beautifully presented and cooked to a high standard. The supply of food has also changed with the home using the local green grocer and butcher. Choices of snack are also more obvious for residents, as they are written on the wipe board in the dining area with the days menus. Care staff are responsible for the drinks trolley, though the deputy hopes to hire a kitchen assistant in future. The Gables DS0000067669.V339985.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Residents have access to people who listen to any concerns and who will take action to ensure they are protected from abuse. EVIDENCE: Residents said they would complain to the deputy or any staff member if they were unhappy, and they believed that any complaint they made would be listened to an acted upon. The home has received 1 complaint since the last inspection, and details of actions taken are recorded. The home has started a comment book, but it is still blank at present. All staff have received adult protection training recently and showed a good awareness of what their responsibilities are. The deputy is aware of her responsibilities in reporting and documenting allegations. The home has an ongoing adult protection investigation still open. The Gables DS0000067669.V339985.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents have a homely environment to live in, which will be vastly improved when the homes planned and much needed refurbishment is completed. EVIDENCE: The Gables is a detached building with residents’ accommodation arranged over two floors. It was registered under previous legislation and consequently there is not the availability of communal space a new registration would require and there is a high ratio of double bedrooms, some rooms would not be registered under the Care Standards Act 2000. Changes in residential and social care mean that people referred to care homes have increased frailties and care needs than previously. Whilst The Gables is able to offer a very The Gables DS0000067669.V339985.R01.S.doc Version 5.2 Page 16 “homely” environment, from observation, it is very difficult for staff to meet all residents’ care needs safely. For example, transporting lifting hoists to different parts of the house and to use them in some of the bedrooms, furniture has to be moved around. The communal areas and several bedrooms are in need of refurbishment and redecoration, although the bedrooms, which have been redecorated, were vastly improved, with new furniture; light matching curtains and bedspreads, and new carpets and paintwork. The flooring in the lounge and dining room has been renewed with carpets taken up and laminate flooring in its place. Other building work is planned for autumn 2007, when a 10-room extension is planned, at this time the rest of the house will undergo a major refit. The wooden handrail on the stairs to the patio is rotten and in need of repair, however this is not in use or a fire exit. The skandia frame in the shower room should be fixed or handrails fitted as this presents a hazard as they can tip. Trailing wires across a bedroom floor should be secured to prevent trip hazards. The walls in the corridors are damaged, and marked. Resident’s bedroom doors are not fitted with locks. Several doors need the closures fixing as they slam and residents said the noise is intrusive, several doors are very squeaky which also is a source of irritation for residents. The deputy has changed one of the lounges into a dining room and whilst residents should be able to choose to use a dining room, the result is that when the home is full there is not enough space for all the resident to use the lounge or the dining room. The lack of communal space means that many residents stay in their rooms, and may become isolated as a result Carpets in some of the bedrooms were stained, though the home was generally clean. The laundry sink should be labelled as the hand-washing sink provided it is not used for soaking clothing and other items, otherwise a hand washing sink should be fitted. Net underwear is now labelled for individual use to protect residence from infection control hazards and to promote their dignity. Chairs use din bathrooms for residents to sit on must be washable, not wooden or fabric. The number of slings is inadequate, to allow for use on several residents and for them to be cleaned between usage. Alcohol hand cleaners are fitted throughout the home in corridors these must be included in the risk assessment. . The Gables DS0000067669.V339985.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for and supported by properly recruited and trained staff. EVIDENCE: The home currently has only 13 residents living at the home and as such the staffing levels are more than adequate. Should the home fill up a review of the staffing numbers will need to be conducted as historically the home has been understaffed. The residents confirmed that they do not have to wait for very long for assistance when they ring their call bells, and most said they receive help washing and dressing at a reasonable time. Comments made included “they need more staff, they always seem so busy”. The home has more than 50 of care staff having attained NVQ at level 2 or above. The homes induction is compliant with skills for care, and new staff receive an induction to the home, which includes shadowing senior staff until they feel comfortable and skilled enough to be included in the numbers. The Gables DS0000067669.V339985.R01.S.doc Version 5.2 Page 18 The home operates a thorough recruitment procedure with staff being required to complete an application form, provide 2 references, and all staff are CRB and POVA checked prior to commencing employment. Staff are receiving updates in fire training, moving and handling etc, when they are due, and the deputy is using a matrix to ensure staff receive the training updates they require, with the exception of first aid training, there are not sufficient number of staff with first aid qualifications for a first aider to be on every shift, this must be addressed. The Gables DS0000067669.V339985.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of residents will be improved by refurbishment of the home, provision of equipment and training. EVIDENCE: The manager post is vacant at the Gables at present and the deputy manager is running the home with the support from a manager of another home owned by the Stargate Company. The deputy is enrolled on the registered managers award training. The deputy undertakes training periodically to update her skills. The Gables DS0000067669.V339985.R01.S.doc Version 5.2 Page 20 The homes quality assurance systems require development, although there are some systems in place for feedback such as residents meeting and staff meetings. Visits by the responsible individual under regulation 26 are not being submitted to the Commission. The home does not manage the finances of the residents, and they are encouraged to manager their own finances for as long as they are able. The home does not employ a maintenance man, maintenance staff are accessed through the company that own the home and the deputy manager said there needs to be a sufficient number of jobs that need to be done before the maintenance staff will visit the home, as such one resident waited for 2 weeks for a bulb to be changed. The health and safety of residents is promoted through the induction and training programme, although first aid training must be prioritised. The provision of lifting slings in a variety of sizes and other moving and handling equipment such as slide sheets will help to ensure safer working practices. Staff said that a standing hoist on each floor would reduce wait times for service users. One residents commented on the survey form that they often have to wait at no fault of the staff as the hoist is already in use. Trailing wires must be secured to reduce the risks of trips and falls. The home ensures maintenance and servicing of equipment is carried out. Risk assessments are carried out on the environment. The Gables DS0000067669.V339985.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 The Gables DS0000067669.V339985.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15 (1) Requirement The registered person shall after consultation with the service user, prepare a care plan as to how the residents needs are to be met, in that The level of detail recorded is sufficient, and residents are consulted and involved in the care plans. The registered person shall consult service users about their social interests, and make arrangements to enable them to engage in local social and community activities. The registered person shall ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally, in that the major refurbishment planned be commenced as soon as possible and that in the interim a review be conducted of those areas requiring attention, and maintenance be carried out. And that door closures not working and allowing them to slam, be repaired. DS0000067669.V339985.R01.S.doc Timescale for action 30/08/07 2 OP12 16 (2)(m) 30/08/07 3 OP19 23 (2) 30/08/07 The Gables Version 5.2 Page 23 4 OP26 13 (3) 5 OP30 13 (4) The registered person shall make 30/08/07 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home, in thatA dedicated hand washing sink be provided in the laundry. Repeated from the last inspection. Chairs used in bathrooms must be washable. Hoist slings must be supplied in sufficient number that they are used for single residents and can be washed between residents when there is a risk of cross infection. The registered person shall make 30/09/07 suitable arrangements for the training of staff in first aid. The registered person shall make 30/08/07 suitable arrangements to provide a safe system for moving and handling service users in thathoist slings be provided in sufficient numbers and sizes to meet the needs of the service users. 6 OP38 13(5) 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 OP27 Good Practice Recommendations It is recommended that the managers planed review of the staffing numbers in particular the nursing staff be undertaken as soon as numbers of residents increase. It is recommended that the home undertake effective DS0000067669.V339985.R01.S.doc Version 5.2 Page 24 2 OP33 The Gables quality assurance monitoring in due coarse. 3 OP38 It is strongly recommended that a review into the provision of moving and handling equipment be conducted The Gables DS0000067669.V339985.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 The Gables DS0000067669.V339985.R01.S.doc Version 5.2 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!