Inspection on 16/02/06 for The Gables

This inspection was carried out on 16th February 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 22 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gables 11/09/07

The Gables 12/12/06

The Gables 17/05/06

The Gables 01/12/05

The Gables 11/02/05

The Gables 07/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 The Gables 2/4 Blackheath Park Blackheath London SE3 9RR Lead Inspector Mrs Susan Hall Unannounced Inspection 16th February 2006 10.00 The Gables DS0000006760.V283500.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 DS0000006760.V283500.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 DS0000006760.V283500.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Gables Address 2/4 Blackheath Park Blackheath London SE3 9RR 020 8852 8799 020 8297 2782 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) londonroad@tiscali.co.uk Milbury Care Services Limited Mrs Audrey Grehan Care Home 27 Category(ies) of Learning disability (24), Learning disability over registration, with number 65 years of age (3) of places The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 places registered for LD(E) are for named service users only. Date of last inspection 1st December 2005 Brief Description of the Service: The Gables consists of 2 linked houses which were built in the late 19th Century, and are situated in a pleasant residential area of Blackheath. They are located within walking distance of Blackheath village, near to shops and other amenities. A railway station and local bus routes are easily accessible. The Gables is one of several care homes owned and run by Milbury Community Services Ltd., all of which are located in the London Borough of Greenwich. The houses are divided internally into 4 flats - 2 on the ground floor, (flats 3 and 4) and 2 on the first floor (flats 1 and 2). One of the ground floor flats (flat 3) was formerly used for service users receiving respite care, but the respite service has now been transferred to another unit in Greenwich. The other flats have different numbers of bedrooms (4, 5,and 6), and therefore allow space for up to 15 service users. Each flat is entirely self-sufficient, with it’s own lounge, dining-area, kitchen, laundry area and bathrooms. There is a large garden at the rear of the property which is available for all service users. The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place from 10.00 – 13.45, and was carried out to assess the progress made since the last inspection. The Manager was not present in the home as she was attending a Managers’ meeting. The Inspector was assisted by a Home Leader and several support workers, in gathering information. The inspection included a tour of flats 2, 3 and 4; reading care plans and other documentation; and checking medication in flat 4. The Inspector met and chatted with 5 service users during the course of the visit. A large number of requirements and recommendations were given at the previous inspection, and many of these had been met, or were in the process of being met. Some of these had been dated for completion by the end March 2006, so the Inspector was not expecting all of them to have been met at this visit. However, she was pleased to see that much of the internal redecoration had been carried out, and the premises looked generally much improved since the last visit. What the service does well: What has improved since the last inspection? Much of the décor had been repainted, and this included communal areas and corridors, and some of the bedrooms. Carpeting had been replaced in many areas. Repairs had been made to several items noted in the previous report; including a hinge for a bedroom door, window frames in flat 2, room2, and skirting boards in a ground floor shower room. Curtains and old furniture were being replaced, and some new items were seen in service users’ bedrooms. The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 6 Some service users had been moved from small unsuitable bedrooms into larger rooms (with their agreement). These rooms are more suitable for service users who need nursing equipment. All radiators and freestanding heaters had been fitted with safety guards. Medication procedures had been improved. A start had been made on improving care planning, by including an index at the front of each file, and a service user’s profile. The Inspector saw 2 detailed life plans, which are established through individual meetings with a life plan co-ordinator, the service user, their family and friends, and their keyworkers. 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 DS0000006760.V283500.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 DS0000006760.V283500.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): 1 The Statement of Purpose provides sufficient information to enable service users to make an informed choice about staying in the home. EVIDENCE: The Home’s Statement of Purpose has been updated to include information about the Registered Manager and the Providers. Standards 2-5 were assessed at the last inspection, and were being met. The Gables DS0000006760.V283500.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): 6-10 Service users’ care plans remain unsatisfactory, with out of date information and inadequate risk assessments. There is insufficient documentary evidence to show that service users are consulted about their lifestyles and participation in the life of the home, except for 6-12 monthly life plan reviews. A start had been made on upgrading the files by indexing the contents, and including a service user profile. EVIDENCE: The Inspector examined 3 care plans from flat 2 – having previously examined care plans from flats 2 and 4 at the last inspection. The Inspector noted that these service users had lived at the home for a number of years, and were clearly well known to staff. However, the documentation included much information which was out of date, and lacked details about how best to care for the service users. The Inspector was pleased to see that a service user profile had been written for each person, and included at the front of their files. These are well written, and give a clear overview of every aspect of the service users’ lives, and it would be possible to manage basic care by reading these profiles. The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 10 However, ongoing assessments had not been updated – such as health profile, management of behavioural problems, care of mental health needs, day centre care and medication details. Examples of unsatisfactory documentation include items such as a health profile written in 1998, updated in 2000 – but not updated since; a detailed nursing assessment written in June 2004 – but not updated since; management of incontinence last written in June 2004; medication regime written in 2002; a health profile not updated since 1998; and a nutrition assessment written in 2004. The Inspector read a care plan for agitation and aggression – but the plan did not give any guidelines or information on how to manage or reduce this on a day to day basis. Another care plan had been written for “earache” in August 2005 – but had not been evaluated at all. Individual risk assessments were also inadequate. A risk assessment for a service user who may go missing had not been updated since June 2004, and did not state clearly what action should be taken if this occurred. There was a general lack of other risk assessments, such as going out in the garden, going out unattended, and use of various equipment – although a kitchen safety risk assessment was seen, and this one was up to date (written in November 2005). The Home Leader discussed the process of “life planning” with the Inspector, and one life plan action sheet was viewed. Life planning is carried out with a Social Services Life Plan Co-ordinator, the service user and their friends/relatives (as applicable), the home’s keyworker, and the day centre’s keyworker. The life plan itemised the service user’s choices about going out socially; development of skills; holiday choice; and preferred activities. This included such details as liking to work in the garden, carrying out a “skills for working life” course at the day centre, and joining in with activities such as bingo, disco, snooker and table tennis. Life plan meetings are carried out every 6-12 months, (depending on the service user’s needs/agreement), and would provide a good basis for updating some of the care plans and risk assessments. The Inspector was unable to confirm that all service users have up to date life plans, and so cannot establish that standards 7 and 8 are being met. Documentation was stored satisfactorily, and did not compromise service users’ confidentiality. Previously given requirements for these standards have been repeated, but with a new timescale for completion. The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 11 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): 11 – 16 There is insufficient evidence to show that service users are enabled to develop practical living skills, and social and emotional development. Day centres provide the opportunity for educational opportunities, and service users are able to participate in the local community. There is access to different activities, but a greater range of pursuits and entertainment could be made available. EVIDENCE: Service users have been allocated to different day centres, and the Inspector found it encouraging to note that each service user has a keyworker at their day centre, who liaise with the home’s staff regarding their health and welfare. It would be helpful if this information was clearly documented in care plans, and there were clear guidelines included about managing different behavioural problems, and development of independent life skills. One service user’s life plan included a basic weekly timetable, but this was not seen in other plans, and timetables were not seen to be easily available to service users (e.g. displayed in their own rooms), or produced in a format which service users could understand. The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 12 The Home Leader informed the Inspector that a psychologist was in the process of assisting the home with developing behavioural guidelines for service users, and communication strategies. Service users are able to access the local community, either using the home’s minibus or car, or public transport. Sometimes there are insufficient staff to take service users out - especially at weekends – but the Inspector agreed that good management can ensure that any service users who want to go out should be able to go at different times of the day, and in small groups. So this is dependent upon good management rather than a lack of transport. Activities are made available, but more choice could be arranged. The Deputy Manager is assessing the possibility of additional activities such as swimming, bowling and the cinema, and there are still plans for “pampering” days for service users who are having a day off from their day centres. There was no evidence seen in care plans for enabling service users to take part in the general household duties of the home, except that some service users help with food shopping. This is another subject to be included in future care planning. The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 13 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): 18,19,20 There is insufficient information included in care plans to show how service users are given personal support and nursing care. Health care plans need to be revised and updated. Medication practices had been improved since the last inspection, but still needed some attention. EVIDENCE: Daily report books included information about personal care given, and if a shower or bath was taken. The care plans viewed did not include plans for management of personal hygiene, or specify preferences re items such as shaving, hairdressing, baths or showers. Health care needs were unsatisfactorily documented. Health profiles were out of date, and there were insufficient guidelines for health needs such as the management of incontinence or constipation, or the management of epilepsy. Some plans had been well written but had not been evaluated, so it was unclear if they were still relevant. The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 14 Nutritional assessments were out of date, and moving and handling assessments and skin integrity assessments were not viewed. These would be of particular relevance to the older service users. GP visits and out-patient appointments had good records, and prescriptions are not renewed if a medication review is due. Evidence was seen for dental care, optician appointments, chiropody, smear tests and breast screening. The medication cupboards were checked in flat 4. The stock cupboards were in good order, and Medication Administration Records (MAR charts) had been completed well. The Inspector noted that an opened tube of daktacort was stored in a medication cupboard, and this should be stored in a fridge. Three boxes of rehydration sachets (for homely remedies) were out of date. There was a large amount of medicine for disposal, as no contract had been made for the disposal of unused medication. There are 2 requirements regarding medication. The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 15 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): 23 Staff are trained in the recognition and prevention of adult abuse, and would report any concerns or suspicions of abuse. EVIDENCE: The complaints procedure was viewed at the last inspection and was satisfactory. There had been no new complaints since the previous inspection. Staff have been trained to recognise signs of abuse, and the Home Leader stated that this is “at the forefront of training for this home”. Staff are aware of the importance of whistle-blowing if necessary, and report any incidents or accidents. The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 16 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 - 30 A programme of redecoration and refurbishment had continued since the last inspection, and the premises looked generally improved. There is still much outstanding work to be completed, and when this is done, the environment will provide much better surroundings for the service users. EVIDENCE: Redecorating and re-carpeting of the ground floor corridors has made a significant difference to the first impressions of the home. It appears brighter and cleaner, and is a much pleasanter environment for service users and staff. Flat 1 was not viewed at this visit, as it had already been decorated and was viewed at the last inspection. The Inspector was informed that the lounge and dining room carpets had been replaced, but the kitchen units had not yet been done. The laundry facilities remain unsuitable. Flat 2 had had repairs made to an identified bedroom door, and room 2 window frames had been repaired and repainted. The kitchen units had not yet been replaced. Bedroom 4 was in a generally poor condition, and has cracks in the ceiling. This room needs repairs and redecorating. The bathroom was in The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 17 reasonable condition, except that the bath panel is damaged and should be replaced. Flat 3. Redecoration for flat 3 had been completed, and service users had been moved into the three bedrooms in flat 3 from smaller unsuitable rooms in flat 4. The service users had settled well into their new bedrooms, and one told the Inspector that she liked her room. These were well decorated, and had new furniture and soft furnishings. There is a large bathroom in flat 3 which has an assisted bath. This is nicely decorated, and has overhead tracking. The room was not in use though, as it was cluttered with other items (wheelchairs etc.). Some of these have been left in the home since flat 3 was used for respite care, and these items need to be moved so that the bathroom is available. Flat 3 also has a large shower room, which is available for use. Another large room has been designated as a lounge/diner, but this was out of use as it was cluttered with old furniture. Flat 4 had been redecorated in the corridors and bathrooms. The shower room had had skirting boards repaired, but the room now needed further attention to the shower chair and shower surround. Both of these were in poor condition. The shower room floor is non-slip, but appeared to be old and stained, and may need replacing if it cannot be improved. Two unused rooms had not yet been decorated, as there are plans to alter one of these into a sensory room, which would be an excellent addition for caring for service users. The other room may be used as an office or storage space. Flat 4 has a large lounge/dining room, but this had not been redecorated, and was in poor condition. The kitchen still needs the units replacing, and general refurbishment. The home has a full time maintenance man who was busy with some repairs, and hanging new curtains. The home is suitably equipped with nursing beds and hoists. However, there is no sluice for emptying and cleaning commodes, and a sluice should be fitted for the effective management of nursing care and infection control. The Inspector was pleased to see that the home was already looking much better, and that there is a continued programme for the rest of the work to be completed. She also noted that radiators and free standing heaters had been fitted with guards. There were no offensive smells in the home. There is a large rear garden which was in a reasonable state for the winter months. The maintenance man has plans for improving this, and the Inspector was informed that money has been allocated for the improvement of the garden. The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 18 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): 31,33,34. Staffing levels continue to need further appraisal, as some service users have high dependency levels and need more input. It is difficult to establish if staffing numbers are sufficient while the home is going through a time of upheaval with major refurbishment work. EVIDENCE: Staff were interacting well with each other and with service users. There are clearly defined roles for Home Leaders, and support staff were responding well to situations where they are needed. It has been a difficult time for the staff and service users with so much work going on. There has been constant redecoration, repairs, re-carpeting, replacing furniture and changing of bedrooms for several months, and there is still much work to be done. This has caused an unsettled environment. Staff have also been stretched by the need to update and improve documentation and care planning, so there is a high amount of additional work for all staff at present. It will be more straightforward to assess staffing levels when the environmental work is completed, and care plans are up to date. The perception of staff was that there are barely sufficient staff for each shift during this unsettled time. The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 19 Staffing deployment has also been altered due to service users moving into flat 3, which had been unused for some time. This has brought about a change of keyworkers, and some staff having to move to work in different flats. The home continues to have one nurse on duty for each shift, and sometimes there are 2. This enables the nursing staff to spend more time working alongside support staff, and assisting them with promoting personal hygiene and general care. The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 20 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): 38,42 The Registered Manager gives a clear sense of leadership and direction to other staff. Matters of health and safety are taken seriously, for the protection of service users and staff. EVIDENCE: The Registered Manager takes part in handovers on most days, so that she is involved in overseeing every aspect of the life of the home. These handovers are a good forum for communication, and are held in the afternoons when shifts overlap. There has been an increase in staff meetings (now held approximately every 46 weeks), so that staff are encouraged to share their views, and work together to improve the home. The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 21 Separate meetings are held for nursing staff to discuss how to manage nursing care, bring about improvements in documentation, and to give a lead to support staff. Staff have been given training in mandatory subjects such as moving and handling and fire prevention. The Inspector was pleased to see that radiators had been fitted with guards. Hot water temperatures are checked weekly for each flat. Accident records had been satisfactorily completed. The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 22 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 3 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 X 23 3 ENVIRONMENT Standard No Score 24 1 25 3 26 2 27 2 28 2 29 2 30 1 STAFFING Standard No Score 31 3 32 X 33 2 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 2 1 3 LIFESTYLES Standard No Score 11 1 12 3 13 2 14 2 15 3 16 2 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 1 X X 3 X X X 3 X The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? 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 Requirement Care plans must be updated to reflect changing needs. All care plans should be reviewed to ensure they have been appropriately updated. They should then be reviewed every 6 months. Previous requirement with new timescale. Risk assessments must be completed for all aspects of risk for each individual service user, and appropriately reviewed and updated. Previous requirement with new timescale. Timescale for action 30/04/06 2 YA9 13 (4) 30/04/06 3 YA11 12 (1)(2) To ensure that service users are being offered appropriate opportunities for developing practical living skills. Previous requirement with new timescale. 30/04/06 The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 24 4 YA11 12 (1) To put behavioural guidelines in place in order for staff to assist service users to understand how to modify unacceptable behaviour. Previous requirement with new timescale. To reassess the level of activities available for service users, increasing these as applicable. To include evidence in care planning regarding service users’ agreed involvement in household duties, and promotion of their independence. To ensure that care plans specify in detail the personal and nursing care that needs to be given. Previous requirement with new timescale. To ensure that healthcare needs are properly monitored, and ongoing care is given as advised. All healthcare needs and nursing assessments to be properly documented, and kept up to date. 1.To ensure that all medication items are properly stored (i.e. in drugs fridge if specified on the prescription information leaflet). 2. To ensure that homely remedies do not go out of date. (Both of these were with immediate effect.) 30/04/06 5 YA14 12 (1) 31/05/06 6 YA16 12 (1) 30/04/06 7 YA18 12 (1-3) 30/04/06 8 YA19 12 (1) 30/04/06 9 YA20 13 (2) 16/03/06 10 YA20 13 (2) A contract must be arranged for the disposal of unused medication, and a copy of the contract sent to the Inspector. 31/03/06 The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 25 11 12 YA24 YA24 16 (2) 23 (2) (b) Flat 1 - replace kitchen units and fridge. Flat 2 Bedroom 4 to have ceiling repairs and redecoration. Bath panel to be replaced. Lounge carpet and old furniture to be replaced. 31/03/06 30/04/06 13 14 YA24 YA24 16 (2) 23 (2) Flat 2 - replace kitchen units Flat 3 Unnecessary equipment and clutter to be removed from the bathroom so that it can be used. Old furniture to be removed from lounge/diner. New carpet and furniture to be put in lounge/diner and room made available for use. 30/06/06 30/04/06 15 16 17 YA24 YA24 YA24 23 (2) 16 (2) 23 (2) Flat 3 – kitchen to be refurbished. Flat 4 - replace kitchen units, and refurbish kitchen. Flat 4 Lounge/diner to be redecorated and refurbished. Shower chair and surround to be repaired/replaced; Shower room floor to be thoroughly cleaned or replaced. 30/06/06 31/03/06 30/04/06 18 YA24 23 (2) Arrange for the disposal of old discarded furniture items stored outside, and in the home. Previous requirement with new timescale. 30/04/06 The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 26 19 YA24 23 (2) To ensure completion of decorating for all internal areas. To ensure re-carpeting is completed for all assessed areas. Review bedroom furniture and replace as needed. Flat 1 – laundry facilities are unsuitable. To produce an action plan for a more suitable laundry area which meets infection control criteria. To provide a sluicing facility for the emptying and cleaning of commodes. 31/03/06 20 21 YA26 YA30 16 (2) (c) 16 & 23 (2) 31/03/06 30/04/06 22 YA30 23 (2) (k) 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard YA1 YA12 Good Practice Recommendations To prepare a service users’ guide in a simplified format which is relevant to prospective service users. To provide each service user with a weekly planner, in a relevant format, so that they can see where they are going each day To ensure that full details are recorded of any future complaints, showing how the complaint has been resolved. Flat 2, room 2 - en-suite facility - to replace either the shower or bath with a toilet. To alter one of the unused rooms in flat 4 into a sensory room. To keep staffing levels under review, and be able to show that these are sufficient to meet the needs of service users. DS0000006760.V283500.R01.S.doc Version 5.1 Page 27 3 4 5 6 YA22 YA27 YA29 YA33 The Gables Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Gables DS0000006760.V283500.R01.S.doc Version 5.1 Page 28 - 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. 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