Inspection on 14/03/08 for The Gables

This inspection was carried out on 14th March 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gables 01/09/06

The Gables 03/05/06

The Gables 21/11/05

The Gables 01/03/05

The Gables 04/10/04

The Gables 16/03/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 The Gables 11 Heathside Road Withington Manchester M20 4XW Lead Inspector Joe Kenny Unannounced Inspection 14 March 2008 10:00 The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables DS0000021616.V360046.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 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 DS0000021616.V360046.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address 11 Heathside Road Withington Manchester M20 4XW 0161 445 7757 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) Mrs Teresa Williams Ms Christine Davies Care Home 9 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (2) of places The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home provides care for a maximum of 9 service users requiring care by reason of learning disability. Two named service users are aged 65 or over. Should these service users leave the home, the places will revert to the service user category LD. The home must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 26th January 2007 Date of last inspection Brief Description of the Service: The Gables is a registered care home providing 24-hour accommodation and support for nine adults with a learning disability. The home is situated close to the centre of Withington and is in keeping with the surrounding area and comprises of two semi-detached houses converted into one. The accommodation is arranged on two floors. The furnishings and fittings of the home are domestic in style. The Gables aims to create a supportive environment, which enables service users to maximise their independent living skills. The home has long established links with the local community and good working relationships with the local health and social services. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out unannounced on the 14 March 2008 and was conducted over a seven hour period. The inspection looked at the National Minimum Standards for care homes supporting adults to determine how the home was meeting required standards. Information provided by the home in the form of a completed Annual Quality Assurance Assessment, a self-assessment by the home of how it feels it is meeting minimum standards, and comment cards returned by people who live in the home provide the basis for the findings of this inspection. During the course of the visit time was spent in discussions with staff and people who use the service, inspecting records relating to the management of the home and care plans. A tour of the premises was undertaken. The Commission for Social Care Inspection (CSCI) has not received any complaints or concerns regarding the home since the last inspection report. What the service does well: People are supported to remain independent in all aspects of daily living where possible. People are therefore encouraged to be responsible for some domestic routines in the home and their own rooms. The home was found to be comfortable, clean, and well maintained. The home provides people with a number of lounges and a large, bright conservatory area. People have unrestricted access to their bedrooms. Participation in daily routines and domestic tasks is based on people’s ability. People are supported to attend a range of day services, local colleges and other specialist services for people with learning disabilities. A range of activities is available to people within the home such as arts, crafts and music. Other social activities such as day trips and social evenings are also held. The home continues to encourage and support people to maintain relationships with their families and welcomes visitors to the home. The Gables DS0000021616.V360046.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 DS0000021616.V360046.R01.S.doc Version 5.2 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 DS0000021616.V360046.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home must ensure that people’s needs are assessed before coming to live at the home. EVIDENCE: There had been no new admissions to the home since the last inspection. However information received at this visit indicated that a number of admissions predating the last inspection were emergency admissions. As a result the manager stated it was some time following the person’s admission, before a clear picture of their needs was determined. The home is advised to ensure the placing authority provides sufficient information, immediately following emergency admission, in on order to assist the home in determining if it can meet the person’s needs. The procedures for admissions were clearly understood by the manager in terms of assessment and trial visits being offered. Emergency admissions do not enable the home to follow its agreed admission procedures and such arrangements should be monitored and reviewed in discussion with placing authorities. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 9 The home’s Statement of Purpose and Service User Guide required reviewing following recent changes in staff working at the home and the statement must accurately reflect the service and staffing arrangements at the home. All revised versions of the above documents should be dated as evidence of the review. Records and comments by people living in the home on the day and through comment cards received prior to the visit indicated that they had been consulted about their move. People confired they “were sometimes consulted about decisions. All indicated they could choose how they spent their day and week ends. All persons confirmed the home was clean, staff treated them with respect and “listened to them”. One person said they were “very happy”. One person said in response to their move to the home “not able to make decision at the time but happy now”. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported in a way which reflects their choices, preferences and wishes. EVIDENCE: Information in care plans continues to be developed in way which reflects peoples preferences, their choices and wishes. This was achieved by listening to what people wanted and involving relatives where necessary to support people to realise their individual preferences in relation to personal and social care issues. The information is recorded in their care plan and staff maintain a daily record of how people have been supported. Care plans were examined on the day and evidenced a more person centred approach, reflecting involvement of the person being cared for and/or involvement of relatives in this process. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 11 The process had not been completed for all persons and the manager stated she was striving to complete the development of person centred care planning. People required varying degrees of support. One person using the service did require staff to support them where another service user’s behaviour and actions had an adverse effect on their care. Their actions are perceived to be supportive and for the good of the other person however, they required regular monitoring and intervention by staff in the best interest of both parties. All care plans and especially risk assessments must evidence they are regularly reviewed and where possible involve the person or their representative in this process. On examination of a sample of files it was noted that some forms had been developed to monitor issues around behaviour, however, these were not always being maintanied by staff to assist in planning and review. Comments by staff and observations on the day, evidenced that the manager and staff had a good understanding of the needs of people they support. On the day of the inspection people were observed to be involved in activities of interest to them and would then be spending the remainder of the evening watching television programmes in the lounge. All relatives responded positively to the questions asked. Some comments were, “no compliants made and “never had a problem”. One relative said “ I think they do a very good job” and another said “ I am very pleased for what the staff at Gables do for (Named relative)”. Onother said “I am satisfied with the level of care my ……….. receives”. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are encouraged to take responsibility for how they spend their day and are involved and participate in all aspects of daily living. EVIDENCE: From information received in comment cards completed by relatives and people living in the home, it was evident that people are supported to access a range of social and leisure activities, in the home and local community, which reflected their choices and interests. People were supported to maintain relationships with their family and friends and staff were available to support them on personal and health care appointments. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 13 A number of people continue to attend resources in the community such as day centres and local colleges. These provide specialist learning disability and mental health support to users of the service, however access to such resources has reduced due to external issues outside of the home’s control. People are encouraged and supported to maintain and develop their independence skills through allocated domestic tasks within the home and through maintaining their own bedrooms. People are also supported and encouraged to become involved in appropriate work placements. The issue of the home having sufficient staffing levels required to support people to take part in social, leisure and educational activities was again raised. This issue will be addressed in the Staffing section of the report. Meal and menu arrangements involve people living in the home and people are consulted on preferences at each meal. The light snack prepared at midday was well presented. Staff prepared the main meal and all staff on duty confirmed they had received training in basic food hygiene. The main meal offered a choice, it was stated that the meal being prepared was a preferred choice of people. There were ample provisions available in the kitchen and additional food supplies stored in a secure, dry outbuilding. There was evidence of fresh fruit and provisions being purchased on a weekly basis. Mealtimes were flexible and served in the dining area. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home supports people to maintain their personal and healthcare needs. Medication procedures required review to fully protect people. EVIDENCE: Personal and health care needs are set out in each person’s care plan. People are registered with a general practitioner and one GP practice is currently used to support people. Records are also maintained where other health professionals, such as continence advisers, support a person and specialist health care relating to people’s identified needs. Plans set out the level of support and assistance to be provided by staff on personal care issues. Staff maintained detailed records to evidence the support they offered. People are encouraged and prompted to maintain their own personal care. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 15 Daily records were well maintained, however, the content of written reports needs to be reviewed as the language used by staff was sometimes subjective and relevant details were not always included. An example was an entry in one person’s notes of the person being ‘violent towards….’ , with no futher information about the behaviour, outcomes or action taken. The home had developed and reviewed its medication policy and looked at specific issues relating to homely remedies, self-medication and prescribing instructions as these areas had been identified for attention at previous inspections. The homely remedies policy should, however, detail a comprehensive list of all homely medications. Medication is located in a locked unit in one of the lounge areas. A recommendation was made that the key to the medication unit is held by the person responsible for administering medication on each shift, as it was being kept in an open key safe box mounted on the wall in the kitchen. Any balances of medication brought forward from the previous month need to be recorded on the Medication Administration Records (MAR) sheets as a total running balance to ensure audit and monitoring procedures for all medication is clear and easily measured. A further recording issue needed to be brought to the attention of the pharmacist as the MAR sheet issued and being signed by staff for one person was for the incorrect period dates. The medication for a further person required reviewing through consultation with the person’s GP as it was being given in the morning instead of at night as detailed on the prescribing instructions. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Policies and procedures were in place to enable people to raise any concerns and to express their views about the service they receive. Procedures relating to safeguarding should be reviewed and refresher training provided to ensure people are fully protected. EVIDENCE: One person said they knew who to speak to if they had any complaints, indicating they would speak to the manager, staff, their advocate or relatives. The complaint procedure was available to people and their representatives and they had been made aware of their right to make complaints. A register is maintained of any issues raised by people or their representative in relation to their care. There had been no complaints received by the home since the last inspection. The Commission in the same period had received no complaints. Policies and procedures for the protection of vulnerable adults from abuse were in place. The information available at the time of this visit indicated that staff had all received training in the awareness of abuse. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 17 However, following discussions with staff in relation to challenging behaviours and specific issues relating to the actions of one person which affected another resident, it was evident that additional refresher training on abuse awareness was required as staff were unaware safeguarding procedures also applied to interactions between people who use the service. The home is also advised to ensure all staff have a knowledge of the Authority’s Adult Safeguarding procedures. Local The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe, clean and homely environment. EVIDENCE: Internally the home was found to be clean, comfortable and well maintained. Bedrooms reflected people’s interests and communal areas are spacious, bright and enable people to access quiet areas to sit and lounges with television and music systems. The conservatory areas is used for activities and dining. Secure external grounds are available to people living there, weather permitting. The grounds to the side of the building required attention in relation to the boundary fence. This needed replacing as it had come down with the high winds and did not offer a defining boundary between the home and the neighbouring house. A sunken drain should have a metal grid placed over to prevent risk to persons accessing the side of the building. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 19 On touring the building some areas required attention and related to the following: To ensure effective infection control procedures are adhered to the manager was advised to have a paper towel dispenser in the staff toilet. The privacy lock on the toilet, opposite the office, first floor requires attention, as it did not engage in a receiver. The manger was advised to carry out a risk assessment of the wardrobes in bedrooms. They are free standing and some present a risk of falling forward due to loads and uneven floors. Where arisk is identified, the wardrobes should be secured to the wall to reduce the risk to residents and staff. A medic bath is located in one bedroom and no longer used by that person. The manager stated it has on occasion been used to support another person. This arrangement requires reviewing as use of the facility by another person is intrusive on the person who resides in the room and because the person no longer uses the facility, it takes up a considerable area of the room. In a double bedroom there is an access point to the roof space. This should be held shut with a lockable device. Additional single controlled lighting should be provided to the two people who reside in the double bedroom. The laundry and food storage area is located in an outside building /converted garage. The area is secure, dry and clean. Laundry facilities and procedures appeared clear and well managed. There is a sluicing area and a sluicing wash programme on the washing machine. A dryer is also located in this area. Any soiled on wet linen/personal clothing is transferred to this area using red liners to denote it requires sluicing programme. There was also ample stock of disposable gloves and aprons located for storage purposes in the garage area. This area is locked at night. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing arrangements must be regularly reviewed to ensure people have the necessary support to meet their assessed needs. EVIDENCE: Staffing arrangements at night required reviewing to ensure staff were aware of their responsibilities. It was unclear whether the night time arrangements were one person sleeping and one awake or 2 people sleeping. Staff also commented that arrangements in the morning meant staff who had been on night duties remained on site assisting with getting people up, preparing breakfast and administering medication up to 1.5 hours after their shift and are, it is stated, not paid for this time. Appropriate staffing levels must be maintained to meet the needs of people being supported. During the day hours there are three staff working between the hours of 09:00 and 17:00 hours and two start working between 17:00 and 21:0 hours. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 21 There is a vacancy for 40 hours as the deputy manager left two week prior to this visit, existing staff covers the 40 hours. The rotas for the period covering the inspection indicated that 190 hours and the additional 40 hour vacancy cover was provided to people living in the home. The manager is rostered to spend most of her hours providing support to residents. It is recommended that the manager is provided with time to carry out her managerial responsibilities. Staff files were examined and contained supervision and training records a staff contract, application forms and two references. Records of interviews are also held on the file. The manager holds copies of Criminal Record Bureau checks in a secure and confidential area of her office. The manager is to complete NVQ 4 and Registered Managers Award this year. Seven staff have done NVQ level II and are completing NVQ level III. An external training company provides programmes of training and some staff have attended the Local Authority training section. New staff appraisal forms were seen and are used to address a previous recommendation from the last inspection. The manager does hold regular one to one with staff and records of supervision were seen. Staff meetings are held at a minimum of one every month and records were also seen to confirm Staff commented the there were good internal communication procedure to ensure information was passed between shifts and included communication book and daily records. One staff member commented they felt the home “provide a well run and stabel staff environment for service users in our care”. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Administration and management procedures require reviewing to ensure the home is run in the best interest of people living there. EVIDENCE: The manager has the necessary skills and experience to manager the service and is in the process of completing NVQ level IV and the registered manangers award. However the demands on the manager and absence of a designated deputy require addressing to ensure the manager has the time and resources for the daily opertational procedures of the home. This is necessary to monitor and address shortfalls identified in this report and to address requirements made. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 23 Staffing arrangments require monitoring to ensure people’s needs, choices and preferences are met and respected at all times. Training programmes require monitoring and refresher courses are needed in identified areas such as adult safeguarding procedures. Some areas of the house and its grounds require attention to ensure people and staff are safe. Records were availabe to evidence required monitoring and tests and checks are carried out in relation to fire safety and the maintenance of equipment. Appropriate insurance cover was in place It is recommended that an annual action plan is developed from the information gathered through the quality assurance process. Personal allowances were examined and sample records and cash amounts checked. Receipts were obtained for all transactions. Records of discussion on spending on behalf of sercice users are held on file. The manager was advised to ensure that an additional counter signature by staff is entered as second witness to the transaction. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 25 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 YA6 Regulation 15 Timescale for action Peoples care plans relating to 09/05/08 risk assessments must be reviewed regularly and where possible involve the person or their representative. The balances of medication 09/05/08 brought forward from the previous month must be recorded on the Medication Administration Records (MAR) sheets as a total running balance to ensure audit and monitoring procedures for all medication is clear and easily measured. The medication for a named 09/05/08 person required reviewing and consultation with the person GP as it was being given in the morning instead of night as detailed on the prescribing instructions. Additional training is required in 09/05/08 relation to adult safeguarding procedures. Requirement 2 YA20 13 3 YA20 13 4 YA23 13 The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 26 5 YA24 23 Issues relating to the exterior 09/05/08 and interior of the building require attention to ensure the home is maintained in a safe condition for people living there and staff supporting them. 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 YA4 Good Practice Recommendations The homes Statement of Purpose and service user guide required reviewing following recent changes in staff working at the home. The statement should accurately reflect the service and staffing arrangements at the home. All revised versions of the above documents should be dated as evidence of the review. The home is advised to ensure the placing authority provides sufficient information, immediately following emergency admission, in on order to assist the home in determining if it can meet the persons needs It is recommended that the manager is provided with time to undertake her managerial duties The home is advised to ensure all staff have read the Local Authority Adult Safeguarding guidelines . It is recommended that the home develop an annual action plan from the information gathered through the quality assurance process. The person responsible for administration should hold the key to the medication on their person when on duty. The pharmacist should be requested to supply MAR sheets dated for the correct period. It is recommednded that staff maintain the record format developed to monitor issues around behaviour which challenges to assist in planning and review. 2 YA14 3 4 5 6 YA37 YA12 YA39 YA18 7 YA15 The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 27 8 YA32 7 YA17 Staffing levels should be reviewed to ensure that sufficient staff are available to meet the needs of residents at all times and that staff have a clear understanding of their roles and responsibilities. The manager was advised to ensure that an additional counter signature by staff is entered as second witness to the financial transactions. The Gables DS0000021616.V360046.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 DS0000021616.V360046.R01.S.doc Version 5.2 Page 29 - 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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