CARE HOME ADULTS 18-65
The Gables 262 Ipswich Road Colchester Essex CO4 0ER Lead Inspector
Marion Angold Unannounced Inspection 13th March 2006 11.10 The Gables DS0000028587.V286304.R01.S.doc Version 5.1 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 DS0000028587.V286304.R01.S.doc Version 5.1 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 DS0000028587.V286304.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Gables Address 262 Ipswich Road Colchester Essex CO4 0ER 01206 841515 01206 841515 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) Care Aspirations Limited Raymond Gilbey Care Home 7 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (1) of places The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 7 persons) One person, over the age of 65 years, who requires care by reason of a learning disability, whose name was made known to the Commission in January 2004 The total number of service users accommodated in the home must not exceed 7 persons 5th December 2005 Date of last inspection Brief Description of the Service: The Gables is a detached, two-storey house on the busy Ipswich Road in Colchester. There is parking for three vehicles at the front of the property and a large, enclosed garden to the rear. A keypad entry system is in operation. The home is registered for seven service users with a learning disability, each of whom has a fully en-suite bedroom, with either bath or shower. Recent alterations to the home include a conservatory extension, for use as a dining room, this adjoins the original lounge. The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 11.10 am and 17.50 pm. The manager, Raymond Gilbey, voluntarily interrupted annual leave to attend the inspection. Staff and residents also assisted. The inspector was pleased to meet briefly with a relative of one of the residents. The inspection also involved observation and looking at records. This inspection mainly covered the core National Minimum Standards, not inspected on 5 December 2005, and the shortfalls, identified in the last report. Therefore, for a more complete picture of the home, the report of the last inspection should also be read. Of the 11 Standards inspected on this occasion, 9 were met, and 2 presented minor shortfalls. It should be noted that 17 out of the 20 Standards assessed at the last inspection, were met. What the service does well: What has improved since the last inspection?
National Minimum Standard 20, relating to arrangements for ensuring that residents received the medication they needed, was not inspected. However, the manager reported that the irregularity with one service user’s medication, highlighted at the previous inspection, had been rectified by returning the surplus tablets to the pharmacy and instructing staff in the correct procedures. This will be followed up at future inspections.
The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 6 The manager also reported that, further to the last inspection, he had contacted the staffing agency used by the home, to stipulate that staff bring with them appropriate identification. (This highlighted a need for a record to be kept of all telephone conversations pertaining to the running of the home.) 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 Gables DS0000028587.V286304.R01.S.doc Version 5.1 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 DS0000028587.V286304.R01.S.doc Version 5.1 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): None of these Standards were inspected. EVIDENCE: Discussion took place with the manager after the inspection about whether the primary needs of one resident were learning disability. This matter is being considered outside of the inspection. The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 9 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 and 7 Residents benefited from staff having clear information about their needs and from the support they received to make decisions and choices. EVIDENCE: The two care plans examined reflected the individuals’ needs and strengths. They had been reviewed at 6 monthly intervals and changes in need had been identified and acted upon. Records showed that relatives had been consulted. One person’s care plan covered issues that had been raised by their relative, detailing how particular needs should be met. Residents continued to be represented by an independent advocate. Suitable arrangements were in place for securing residents’ personal money and making transactions on their behalf. Records, receipts and balances were accurate, as sampled. One care plan showed that, whereas the person concerned did not understand the value of money, they should be supported in their ability to choose what they wanted to buy. The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 10 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 and 17 Care practices reflected a culture of respect for residents’ rights and responsibilities. Residents enjoyed a healthy and varied diet, which they helped to choose. EVIDENCE: Care plans and observation showed that routines were flexible to accommodate individual needs and preferences. Residents had unrestricted access to the communal areas of the home and garden. Staff were seen to promote residents’ dignity, by the manner in which they addressed them and offered assistance unobtrusively. A family atmosphere prevailed in the home, with staff responding to questions, and chatting with, and involving residents as they went about their required duties. The senior returned from their shopping expedition with plentiful supplies of food. The hot meal of the day was postponed until the evening to accommodate individual arrangements and needs. Two of the residents had chosen the menu. A fresh meal was prepared from basic ingredients and included several vegetables. Residents were offered fruit during the afternoon. Residents showed that they enjoyed their meal.
The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 11 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): 19 Residents received appropriate support to look after their health. EVIDENCE: Records, and discussion with the manager, showed that service users received routine medical, dental and eye checks. Examples were given of appropriate screening, and involvement of district nursing and occupational therapy teams. Chiropody and weekly reflexology had also been arranged for residents. Staff tried to encourage healthy eating and exercise and residents’ weight was monitored on a monthly basis. It was anticipated that chair-aerobics would resume when the organiser returned from maternity leave. The manager reported that the irregularity with one service user’s medication, highlighted at the previous inspection, had been rectified; this had involved returning the surplus tablets to the pharmacy and instructing staff in the correct procedures. The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 12 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 Staff were attuned to residents’ wishes and feelings and took account of the views of their relatives and representatives. EVIDENCE: Residents made their needs and wishes known throughout the inspection and staff were responsive to verbal and non-verbal cues. Records showed that the home had followed up a suggestion made by the residents’ independent advocate. One person, who had complained about aspects of their relative’s care, indicated that they were satisfied with the outcome. The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 13 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): 24 Residents were benefiting from a clean and comfortable environment, but action was needed in respect of recently notified fire safety requirements. EVIDENCE: Only communal areas were inspected on this occasion. These were found to be in a satisfactory to good state of decoration, and both clean and comfortable. Records showed that fire equipment and emergency lighting were routinely tested. This exercise had been scheduled for the day of inspection and was duly carried out. Fire drills had also taken place regularly. However, certain shortfalls, notified to the home on the 17/2/06, following an inspection by the fire safety officer, had still to be addressed. These included a break glass call point in the conservatory, which, because of its positioning, had been impossible to test since its installation in 2004. The home should have taken steps to address this without prompting from the Fire and Rescue Officer. The manager subsequently reported that arrangements had been made for completion of all the necessary work on 5 April 2006. The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 14 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): 33 Residents would benefit from staff having more time to give them. Minimum staffing ratios compromised residents’ lifestyles and were impacting negatively on the frequency of staff supervision. EVIDENCE: On the day of inspection, one member of staff had reported sick and there were only 2 staff on duty. When the inspector arrived, the senior person was out shopping for the home’s provisions, leaving a residential support worker in charge of 5 service users. Examination of the duty rosters for a number of weeks showed that the staffing ratio varied. At best, there were 3 staff on duty, sometimes two plus the manager, sometimes only 2. Information supplied to CSCI by The Gables showed that staffing ratios had been calculated on the basis of 2 residents having medium dependency and 5 having low dependency needs. The inspector questioned the accuracy of these assessments. The pre-inspection questionnaire had also indicated that the staffing allocation allowed for the equivalent of 3 staff being on duty throughout a 24 hour period, but this was not supported by the evidence available.
The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 15 As there were only two members of staff on duty during the inspection, residents had to take taxis to their activities. Again, this left only one person in charge of remaining residents. Staff indicated that they normally took all the residents out, providing one of the people on duty could drive the mini bus. However, this was not possible without a third staff member or the manager being available to remain with a resident who would not go out. The relative’s concerns, referred to earlier in the report, was that the resident in question, did not go out often enough for rides, when this was the activity they most enjoyed. The person’s care plan also identified that their sole interest appeared to be riding in the mini-bus. Support workers were required to complete all the practical tasks involved in running a home. During the inspection, as part of their duties, they undertook cleaning, shopping, laundry, cooking, escort duties, health and safety checks, and transactions with residents’ money. Although they spent time talking to, and involving residents as they did these things, and responded to residents’ needs and requests as readily as they could, clearly the attention they could give to supporting residents to spend their time enjoyably or constructively was limited. One resident assisted with laying the tables, another listened to music and a third occupied themselves with paper and pens. The others stood, sat or wandered about unoccupied. Staff on duty said that, when a third person was available, they were able to take residents out and support them with activities. The home had last used agency staff on 16/2/06. The manager reported that, following the last inspection, he had contacted the agency they use to stipulate that staff arriving for duty bring appropriate identification. The manager was advised to keep a record of all such transactions. Criminal Record Bureau disclosures were found on all four files sampled, including that of a new recruit to the staff team. Staff supervision records showed that discussions were appropriate to the individual’s role in the home. In one case, 7 supervision meetings had taken place in 14 months; in two others, supervision had lapsed from mid 2005. The manager explained that residents’ needs were always given priority. He also advised that a new system of monthly meetings was being introduced, for the purpose of performance assessment, linked to a bonus scheme. He anticipated that this would increase the frequency of staff supervision. The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 16 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): 39 There was scope for greater consultation with residents about the way their home was run and for making residents’ views known. Care Aspirations’ monthly monitoring reports do not reflect the quality of their internal audits. EVIDENCE: Care Aspirations had employed an independent company to conduct an annual ‘customer’ survey. This year they had taken on board the Commission’s recommendations and published the findings separately for each home. Although residents could use their regular meetings with an advocate to influence the way their home was run, only relatives and representatives had been questioned for the Brambles’ customer satisfaction survey, and not residents themselves. There was also nothing to show how the home planned to improve the quality of service provision, based on the independent survey or their internal monitoring processes. It was reported that Care Aspirations continued to undertake a rigorous monthly audit of care at each of their units. However, the summary reports of
The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 17 the Responsible Individual’s monthly monitoring visits, sent to the Commission, in compliance with Regulation 26 of the Care Homes Regulations 2001, did not reflect this. The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 18 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 X 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 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 2 34 X 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 X X X X 2 X X X X The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 19 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 YA24 Regulation 23(4) Timescale for action The registered persons must 05/04/06 take all necessary action to ensure that residents and staff are protected from the risk of fire. The registered persons must 13/04/06 ensure that, at all times, staff are working in numbers sufficient for the health and welfare of residents and to support residents’ needs and lifestyles. The registered provider must 30/09/06 ensure the results of quality assurance monitoring, review and audit are available for service users or representatives to view. This aspect of the Standard was not inspected on this occasion. The registered persons must ensure that reviews of ‘customer satisfaction’, for the purpose of quality monitoring, are based, where possible, on consultation with residents. They must also demonstrate how their surveys and monitoring are linked to future planning and action. Requirement 2 YA33 18 3. YA39 24(2) The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 20 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 YA41YA34 YA36 YA39 Good Practice Recommendations The registered persons should keep a record of all telephone transactions pertaining to the running of the home. It is recommended that staff are supervised at least every two months. Care Aspirations should review the quality of their monthly reports to the Commission, submitted in accordance with the Care Homes Regulations 2001, Regulation 26. The Gables DS0000028587.V286304.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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