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Inspection on 15/04/09 for The Gables

Also see our care home review for The Gables for more information

This inspection was carried out on 15th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

You have food to eat that you like and that keeps you healthyThere are lots of things for you to do.People said the staff were very nice and were good at their job.They make it a homely place for you to live.

What has improved since the last inspection?

All the right checks are done to make sure the right people are chosen to support you and keep you safe.The manager regularly checks with you to see if you are happy with the way you are looked after.

What the care home could do better:

The document that tells staff how you like to be cared for needs more detail. This is so that staff know how to keep you safe and well.Staff need to have special training to help them keep you safe.The kitchen needs some work to make it bright and fresh.

Key inspection report Care homes for adults (18-65 years) Name: Address: The Gables 262 Ipswich Road Colchester Essex CO4 0ER The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Greaves Date: 1 5 0 4 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 35 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: The Gables 262 Ipswich Road Colchester Essex CO4 0ER 01206841515 01206841515 manager_gables@careaspirations.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Care Aspirations Limited care home 7 Number of places (if applicable): Under 65 Over 65 0 1 learning disability Additional conditions: 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 Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 7 persons) The total number of service users accommodated in the home must not exceed 7 persons Date of last inspection 1 6 0 4 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home The Gables is a detached, two-storey house on the busy Ipswich Road in Colchester. There is parking for 3 vehicles at the front of the property. Each person has their own en-suite bedroom, with either bath or shower. Communal areas are a lounge and a conservatory, which is also used as a dining room. There is a large, enclosed garden at the back of the house. Six people live at the home at the moment. The weekly charge for a room and care and support at The Gables is between £932.87 and £1730.40. This was the information given to us at the time of this visit. People considering Care Homes for Adults (18-65 years) Page 5 of 35 moving to this home may wish to ask for more up to date information from the home. Extra charges are made for hairdressing, toiletries and chiropody. Care Homes for Adults (18-65 years) Page 6 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 35 How we did our inspection: This is what the inspector did when they were at the care home We visited The Gables without telling them we were coming. The last time we visited this home was on 16th April 2008. We looked at paperwork the home needs to keep to make sure that you are being properly and safely looked after. Care Homes for Adults (18-65 years) Page 8 of 35 We spoke to some relatives of people living at the home. The manager helped us with our inspection. The manager sent us information called an Annual Quality Assurance Assessment or AQAA. This gave us information about how the home is run. Care Homes for Adults (18-65 years) Page 9 of 35 There is a Service User Guide that the home can let you have. It tells you all about the home and what they can do for you. What the care home does well You have food to eat that you like and that keeps you healthy There are lots of things for you to do. Care Homes for Adults (18-65 years) Page 10 of 35 People said the staff were very nice and were good at their job. They make it a homely place for you to live. What has got better from the last inspection All the right checks are done to make sure the right people are chosen to support you and keep you safe. Care Homes for Adults (18-65 years) Page 11 of 35 The manager regularly checks with you to see if you are happy with the way you are looked after. What the care home could do better The document that tells staff how you like to be cared for needs more detail. This is so that staff know how to keep you safe and well. Staff need to have special training to help them keep you safe. Care Homes for Adults (18-65 years) Page 12 of 35 The kitchen needs some work to make it bright and fresh. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Jane Greaves CPC1 Capital Park Fulbourn Cambridge Cambridgeshire CB21 5XE 01223771300 Care Homes for Adults (18-65 years) Page 13 of 35 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 14 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 15 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to plenty of meaningful information telling them about the home and the services and facilities available enabling them to make a decision about whether the home can meet their needs. Evidence: Since the previous inspection visit to this service no new people have moved into The Gables. The registered manager reported that there was a team within the Care Aspirations organisation that was responsible for undertaking initial assessments of individuals needs. A further assessment was then undertaken by the manager of the unit to ensure the services and facilities provided at the home were appropriate to meet peoples specific care and lifestyle needs and requirements. This further assessment also took into account the established group of people living there and how the new person would affect the dynamics of the household. The service had a Statement of Purpose and Service User Guide to provide prospective residents and their representatives with the information they need about the facilities and services provided at Gable Lodge. This is so they can make an informed decision about whether the home would meet their needs. This information was also available in easy Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: read format. We looked at the information held for two people living at The Gables, these confirmed that pre admission assessments were completed before the people moved into the home. Care Homes for Adults (18-65 years) Page 17 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were able to tell us how they maintain peoples care and support however the lack of detailed recording means there is no qualitative way of measuring individuals continual development of their abilities and capabilities. Evidence: The manager reported that person centred care planning training had been delivered to the whole staff team. We looked at care plans for two people living at The Gables. One persons plan indicated that they needed assistance with personal hygiene tasks however with encouragement could carry out and maintain their own personal hygiene. The persons own views documented within the care plan stated that they preferred staff to assist with personal hygiene. Daily records told us personal hygiene care needs met. There was no detail about how much input staff provided to support this person with their personal hygiene or what strategies were employed to encourage the person to be as independent as possible. Another care plan we looked at read: To assist X in attending to their daily personal hygiene needs of showering, shaving and dressing. This did not provide the necessary detail of how these tasks were to be undertaken according to the persons individual needs and wishes. It is acknowledged that the staff team have very Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: good knowledge of how individuals want to be supported as they have worked with this group of people for some time however this information has not been developed into person centred care plans and does not provide evidence of how care and support was provided for people. The care Plans we looked at contained a person profile, a photograph and a pen portrait. There were specific assessments such as for tissue viability. There was detail of the medication each person was prescribed and protocols in place for medications to be taken as required such as Senna and Diazepam. There were separate areas within the care plans addressing such areas as epilepsy, chest infections, anxiety, personal hygiene, constipation and capacity to understand. The manager reported that two people living at the home were actively involved in planning their own care and support. The care plan we looked at for one of these people does not include evidence of this. Since the previous inspection visit the manager had arranged for independent advocates to visit people living at The Gables monthly. Records showed us that general discussion took place regarding activities and daily life. There is no information as to what assistance was provided for the people living at the home therefore it was not possible to assess the outcome of this for people. It was reported that the advocates were invited to peoples reviews and were supporting with information about clubs and activities available in the locality. Daily records detailed peoples demeanour and provided information about what they had done with their day. One file we looked at contained notes of a care plan review. There was some good information around communication with a person that does not have verbal capacity. For example how the person communicates to indicate if staff have understood something the individual was trying to convey, correctly or not. The notes were not signed or dated to indicate who had undertaken the review and who else may have been involved.(ie, resident, advocate, relative, social worker) The information in the review had not been incorporated into the care plan. It was reported that the organisation has developed a service user forum where representatives from each home will attend and share views and ideas on what they would like to do and how they would like to do it. An independent advocate that currently attends each unit will be invited to the forum to provide support for people. The care plans we looked at contained risk assessments for such areas as verbal abuse, physical abuse, inappropriate sexual behaviour, self injurious behaviour, epilepsy and mobility. In the main, the assessments identified the areas of risk however did not provide clear guidance on how to manage the specific areas. For example one Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: assessment relating to physical abuse identified that Staff to be aware of triggers regarding the other clients. Section 4 of this risk assessment entitled management of risk included no detail about what staff should do in the event of physical violence occurring. An assessment relating to potential destruction of property stated that Staff to be aware of trigger, however there was no information about what the triggers may be. The management of risk section about how the behaviours would be de-escalated and managed were blank. The improvement plan submitted to us resulting from the previous inspection visit included the following: Formal training on risk assessment/risk management is ongoing within the organisation. Risk assessments on behaviours which challenge others are being developed more deeply to address the management of these behaviours. The completion date for this element of the improvement plan was 31st July 2008. Care Homes for Adults (18-65 years) Page 20 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to make choices and take part in recreational activities that meet their expectations. Evidence: The two files we looked at as part of this inspection process included a weekly activity schedule for the individual. Examples of activities to be undertaken were a walk, reflexology, music therapy, minibus trip, pub, relaxing and watching television. One person living at the home attends college. Daily records showed us that people go out regularly to the pub, shopping, trips to seaside, bowling, walks in the park, family visits and trips into town. Discussion with staff and one person living at the home confirmed these activities. There was a weekly schedule on the wall in the communal lounge area, this gave the outline of the activities for the week ahead such as a walk to shops, passive exercise, walk to pub, the weekly food shop, Chairobics, bowling, music therapy and arts and crafts. Due to bereavement and annual leave the home was running short of one staff member on this day, the manager reported that this had impacted on activities. Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: Records showed us that various communal events took place such as BBQs in the summer, Christmas parties and birthday parties. The managers AQAA told us that there are plans to involve the residents in improving the garden area for their use. One person was very keen to tell us about a planned holiday they were looking forward to. The organisation provides an allowance for each person to have an annual holiday. One person has planned to go to the Broads and another to Yarmouth and one person has declined to go away for an annual holiday. Observation and records showed us that people were free to move around the home and could chose to be alone or involved with household tasks. Individuals records and discussion with the registered manager confirmed that people are supported to maintain regular family contact. There was a daily menu displayed on a board in the communal hallway. Inspection of the kitchen cupboards, fridges and freezers confirmed that meals are varied and include fresh fruit and frozen and fresh vegetables. We had discussion with manager and staff about how the menu is devised. Those people with verbal capacity clearly state their choices and staff said their considerable knowledge of each persons likes and dislikes were involved in the menu development too. Records showed us that people had occasional take away meals, one person told us that they really enjoyed these. The lunchtime meal was observed and was noted to be a relaxed and unhurried affair. Nutrition records are kept to confirm that people living at the home enjoy a healthy and varied diet, snacks and drinks were included in these records. Family members we spoke with told us their relative always seems happy and content at The Gables. One person told us that the service had supplied their relative with a Stereo for their room because the person enjoyed music so much. Care Homes for Adults (18-65 years) Page 22 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are knowledgeable about peoples individual health and personal care needs however inconsistent and brief records means they cannot be sure if all individuals needs will be fully met. Evidence: The care plans we looked at contained basic information about how people prefer to have their personal and healthcare support provided. There was no detail about what guidance and support each person needed to keep healthy and maintain good hygiene. It was acknowledged that staff have a lot of experience from working with this particular group of people for a length of time however records do not reflect the detail of the support provided. For example one persons care plan states I prefer staff to help me with personal hygiene. There was no detail about how the help should be provided and with what areas of personal hygiene. This means it is not possible for staff to effectively review peoples care plans or assess their continuing development and there is no way of assessing if people are consistently receiving their care as they would wish. In each persons care plan folder there was a Health Plan Booklet. The information in this did not correspond with the information in the care plan. For example weight records were out of date and medication records not completed in one booklet we looked at. This information was included in the relevant sections of the care plan. The registered Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: manager could not tell us what this booklet was used for but acknowledged that if it was going to be kept in the care plan it should be a working document as out of date information could be misleading. Care plans contained records of hospital appointments, the outcomes of these and where any may not have been attended. Care plans contained a tick list to confirm that all aspects of personal care and hygiene have been met. Each person had their own en suite bathroom, there were no communal bathrooms or shower facilities in the home. All people were appropriately dressed at this visit. The managers AQAA states People choose their own clothing on shopping trips with their key worker and also have a choice of clothing on a daily basis. Assistance is given to individuals with regards to the expenditure of their clothing budget allowance. Family members spoken with told us their relative was always clean, fresh and well presented. Medication was securely stored in a locked cabinet within a locked cupboard. Two members of staff are involved in administering medication, one to act as a witness. Staff have received training in the safe administration of medicines. Individual protocols have been developed in relation to PRN medications, a copy was kept in the individuals care plan and in the medication folder. The managers AQAA states Medication/health is reviewed regularly by the persons GP and where appropriate by their consultant psychologist. Medicines are supplied by a pharnmacy in a monitored dosage system Care Homes for Adults (18-65 years) Page 24 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Gables are protected from abuse, neglect and self harm. Evidence: The managers AQAA stated Staff are trained to respond to peoples concerns or complaints in line with the companys abuse policy, which was written in response to the Department of Health No secrets policy. This outlines the procedure and timescale to be followed when dealing with complaints. Discussion with staff members confirmed they were aware of the complaints policy and knew the appropriate actions to be taken should they, or anyone using the service have any concerns. The Service User Guide included an easy read and pictorial document entitled How to complain. There have been no complaints received by the service or the Care Quality Commission since the previous inspection of this service. The manager was able to report that all staff members had attended training in safeguarding vulnerable adults. The computer training records were not available to confirm this at this time as the organisation was in the process of transferring the records. Staff on duty on the day of this visit were able to confirm they had received this training and were clear about what they would do if they had concerns about the welfare of people living at The Gables. Care Homes for Adults (18-65 years) Page 25 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe home that is appropriate to their needs. Evidence: The managers AQAA stated We provide a well maintained and equipped home that is suitable for its stated purpose and provides a homely, comfortable and safe environment for all service users. We looked around the home including all the communal areas. The lounge and dining areas were spacious and maintained to a good standard. Previous inspections of this service highlighted that cushion covers on the lounge suite had shrunk with frequent laundering. This continued to be a problem, the manager reported that a new set of covers had been provided eight months previously however these were now shrunken and ill fitting. The manager reported that the organisation had a small central maintenance team to look after all units and there is currently no formal programme of refurbishment of the home. One en suite bathroom had unsightly black marks on the mastic surrounding the bath. The manager was not aware of this but reported it would be dealt with when the maintenance team next visited the home. It was reported that people living at the home were not involved with selecting the Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: colours of the decor in the communal areas, however were able to influence the colours of their personal bedrooms. People were shown swatches of material to choose the colours for their bedding and curtains. There was a staff clocking in machine in the entrance hall that was not in keeping with provided a homely atmosphere. The entrance hall was untidy with cleaning equipment and laundry etc. The noticeboard in the upstairs hallway outside the office had information relating purely to staff, for example pay dates. The manager agreed that this information was not relevant to the people living at the home and therefore should not be on display in a communal area. There was a grey metal filing cabinet in the communal dining area, the top two drawers were virtually empty and the bottom drawer contained various blank forms that staff needed to have access to. This did not contribute to a domestic and homely environment. The kitchen was very small and compact and in need of refurbishment. The units were tired and some door fronts were ill fitting. The downstairs communal toilet radiator was corroded. The house was clean and fresh, free from any unpleasant odours. People living at The Gables have access to a good sized rear garden with patio seating. One person invited us to see their bedroom, it was evident that people were encouraged to make this space their own with personal effects reflecting their personalities and interests. Appropriate hand washing facilities of soap and paper towels were available where staff may need to provide assistance with personal care. A stock of four boxes of disposable gloves were stored in the kitchen. The registered manager acknowledged that this was inappropriate as the gloves were supplied for the use of staff when providing personal care. Infection control training was delivered in house, the registered manager was not able to confirm when the previous training had taken place however did confirm that this was part of the annual basic core training. Care Homes for Adults (18-65 years) Page 27 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive care and support from experienced and safely recruited staff members, however more training specifically targetted to meet the needs of this group of people would help to keep people safer. Evidence: There had been no new recruits to the staff team working at the home since the previous inspection visit, so it was not possible to assess if the recruitment process had improved to ensure the people living at the home were supported by safely recruited staff. A complete audit of staff recruitment records had taken place in October 2008 to ensure that all the information necessary to reassure people that the right staff were employed to work with this vulnerable service user group. There were records to show that enhanced Criminal Bureau Disclosures and references had been obtained for the present staff team. The manager was able to demonstrate his awareness of the correct procedures to be followed before a new member of staff could start to work at the unit. There were 12 people employed to work at the home and all were trained to a minimum of NVQ level 2 in care. 4 people had achieved the NVQ 3 qualification and 3 people were working towards it. 1 person was working towards the NVQ 4 at the time of this visit. Staff rotas indicated that 1 senior and 2 support workers were on duty for each day shift with 2 waking night staff on duty. Staff work 3 long days per week from 0800 to 2130 Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: hours. The home was short staffed on the day of this visit due to bereavement and annual leave. There were 6 residents living at the home at this time and two staff to cater for their needs with the manager on duty 8am to 4pm. The organisation had introduced a system of micro teaching. One person from the organisation was responsible for all units of the basic core training other than fire awareness and moving and handling. They visited the units individually and delivered short refresher training sessions. At the time of this visit there were no training courses available for this year (Year started on April 01) other than Control and Restraint. The company hadnt provided staff with the training specifically to deal with challenging behaviours. The managers AQAA identified the need for specific training to meet peoples needs. Further discussion with the manager and staff identified that this related to challenging behaviours. Care plans identified the risk of people having challenging behaviours and gave detail of how to talk to people one to one in a gentle and calming manner to avert the chances of a challenging episode, however there was no information about how to de-escalate a situation if it did arise. The computer training records were not available to view at the time of this visit as the organisation was in the process of transferring the records. The registered manager was responsible for delivering Fire Awareness training and moving and handling training, he was able to confirm that the whole staff team had attended these units. The training schedule for 2009/10 had not been released at the time of this visit. Relatives we spoke with told us they felt the staff were all very nice and they were always made welcome with a cup of tea and a smile when they visited. Care Homes for Adults (18-65 years) Page 29 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Gables benefit from living in a well managed home that is safe and meets their needs. Evidence: There were clear lines of accountability from manager through senior support workers to support staff. The registered manager had been in post for 6 1/2 years and had achieved the Registered Managers Award and NVQ level 4. The manager had attended train the trainer courses in moving and handling and fire awareness so that he could provide this training in house for his team. The manager reported that the company held away days for the managers that covered various issues relating to management of care services. The manager was on call constantly should an emergency arise and worked Monday to Friday 8am to 4pm. The organisation had an external quality assurance process undertaken by an external consultant involving the views of all people involved with the home including the residents, their families and representatives. A report was produced identifying any shortfalls. In addition to this there was a monthly audit of the service undertaken by another manager from within the organisation as well as the separate monthly visit from Care Homes for Adults (18-65 years) Page 30 of 35 Evidence: the Responsible Individual. We looked at safety certificates for Gas, Electrical systems, Portable Appliance Testing and fire alarms, this showed us that all equipment was regularly checked and serviced. Records maintained at the home told us that fire alarms were tested weekly in the house, fridge temperatures were checked daily as were bath and shower room water temperatures. The managers AQAA told us The home and service users finances are the responsibility of the manager, with the overall budget for the home being set and controlled by the Care Aspirations Head Office. There was a petty cash fund available for staff to access in the absence of the manager, it was reported that this facilitated access to peoples personal monies, daycare payment and provisions etc. Peoples pocket monies were safely stored on behalf of the people living at the home. they were in a locked drawer in the managers office, senior staff had access to the monies in the managers absence. Two peoples balances were checked and agreed with the records. Receipts were cross referenced with the records to provide an audit trail of where the money had been spent. The manager checked that the balances agreed with the records weekly. Care Homes for Adults (18-65 years) Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 9 13 (6) Where some people living in 29/05/2008 the home have been identified through risk assessment of presenting behaviour that can be challenging to others, training and risk management strategies need to be agreed for staff to appropriately support the individual. This will ensure that staff have the skills and knowledge to manage and understand behaviours that can present as challenging to others. Care Homes for Adults (18-65 years) Page 32 of 35 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 6 15 Care plans need to include 31/05/2009 specific information about how individuals want and need their personal care and support provided and daily records needs to include detail of how the care and support was delivered Detailed daily records will enable an audit of the care provided to ensure people are receiving the care and support in the way they want and need. 2 9 13 Where some people living in 31/05/2009 the home have been identified through risk assessment of presenting behaviour that can be challenging to others, training and risk management strategies need to be agreed for staff to appropriately support the Care Homes for Adults (18-65 years) Page 33 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action individual. This will ensure that staff have the skills and knowledge to manage and understand behaviours that can present as challenging to others. 3 35 18 Staff need to receive training 30/06/2009 in managing challenging behaviours in order to meet the specific needs of the people they support. This will help to keep people safe and reduce the risks to other people living at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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