CARE HOMES FOR OLDER PEOPLE
The Gables 22 Post Office Road Dersingham Kings Lynn Norfolk PE31 6HS Lead Inspector
Mrs Jacky Vugler Unannounced Inspection 17th January 2006 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Gables Address 22 Post Office Road Dersingham Kings Lynn Norfolk PE31 6HS 01485 540528 01485 540528 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) Ms Lynda McInerney Ms Lynda McInerney Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th May 2005 Brief Description of the Service: The Gables is a care home providing personal care and accommodation for sixteen older people. It is privately owned by Miss Linda McInerney.The home is a large detached house located in the village of Dersingham and is in close proximity to the shops, library and other facilities of the village.The home was opened in 1987. It consists of accommodation on the ground and first floors, with the majority of bedrooms being on the ground floor.Fourteen of the homes bedrooms are single and there is one shared room. The home does not have a passenger lift, but there is a stair lift providing access to the four bedrooms, which are on the first floor. The home has grassed areas to the front and rear of the property, which several of the bedrooms look onto. The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection taking place on a weekday over four and quarter hours. The Proprietor Miss Lynda McInerney and the new manager Mrs Mandy Sadler were present throughout the inspection. Fifteen residents were accommodated on the day. Comment cards were received from seven residents and five relatives. These were all positive and separate comments were made speaking highly of the home, one saying, “The Gables could not be praised more if it were a persons own home”. Three residents were spoken to privately as well as six in a group. Three members of staff and the hairdresser were spoken to privately. What the service does well: What has improved since the last inspection? What they could do better:
The newly appointed manager should apply to the CSCI for registration. The maintenance book was seen and these issues must continue to be dealt with in order of priority.
The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 6 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 DS0000027426.V270698.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed on this occasion. The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 There is a safe system of storing, administering and recording medicines in place. EVIDENCE: The home uses the Boots monitored dosage system. The medicine trolley was chained to the wall in the locked medical room. The medicine fridge was also in this room and a daily record was kept of the fridge temperatures. The MAR sheets were appropriately signed, dated and there was a returns book in use, signed by the pharmacist. No residents wished to self-medicate and no controlled drugs were in use. The home struggled to keep all the necessary medications in the trolley and a larger trolley was discussed during the inspection. At the close of inspection a larger medicine trolley had been ordered. All staff have received training in administering medicines. The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 The residents receive a wholesome, balanced diet in pleasant surroundings. EVIDENCE: The residents spoken to said the food is good and evidence was seen of alternative meals being provided. The menus and records of meals served show a range of food on offer. In comment cards six say they like the food, and one says they like it sometimes. None of the residents completing comment cards say they do not like the food. Records are kept of the fridge, freezer and meat probing temperatures. Food cupboards are well stocked and fresh seasonal vegetables are used. The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The home has a satisfactory complaints system and residents and their representatives can be confident that their concerns will be taken seriously and acted upon. EVIDENCE: The complaints procedure is displayed around the home and a copy is given to residents and their representative. The complaints book is kept in the lounge, but there were no entries. There is a policy and information available on vulnerable adults at risk for care workers. Miss McInerney and Mrs Sadler were both knowledgeable on these procedures. All staff had received training in Adult Abuse and those spoken to were aware of abuse and the action to be taken. The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The residents live in a safe, well-maintained environment. The home is clean, hygienic and pleasant. EVIDENCE: An en-suite bathroom has been fitted in a bedroom on the first floor and there are plans to convert the toilet, with no washbasin, and shower room on the first floor into an assisted bathroom or a shower room. The home has a maintenance book in use and some bedrooms have been redecorated. The Proprietor said that the home has a policy to refurbish bedrooms when the resident leaves. The back of the house has been covered with ‘Hi-clad’ and re-painted. Bird tables have been placed in the garden and plants have been planted along the fence, with plans for more in the Spring. This should improve the outlook for the residents over the coming months. The laundry area was clean and tidy and all staff have completed training in infection control. The home was clean, tidy and odour free on the day of inspection.
The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 & 30 The residents are in safe hands at all times. The staff are trained and competent to do their job. EVIDENCE: One member of staff has completed the NVQ level 3 and two are undertaking this. Three members of staff have achieved the NVQ level 2 and a further four are undertaking it. There are many training opportunities offered to staff. There is an individual training record for each member of staff these are clear and signed. All staff have completed training in the safe handling of medicines, adult abuse and nine hold a current first aid certificate. Other training provided includes risk assessments, diabetes, infection control and basic nursing skills. This list is not exhaustive. The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 32 The home well managed and run efficiently. The Proprietor is well supported by senior staff. The residents’ benefit from an open and inclusive management style. EVIDENCE: The Proprietor has employed a Manager who is applying to the CSCI for registration. Mrs Sadler (Manager) is a qualified nurse and is currently undertaking the Registered Managers Award. She has previous experience of managing a care home and has attended a Managers Skill workshop and training on employment law. Miss McInerney and Mrs Sadler said that they both intend to complete training in recruitment and selection in the near future. Miss McInerney also has a Head of Care and a Senior Care Assistant in post. Residents spoken to felt involved in the home and the colourful, pictorial monthly newsletter provided by the Proprietor is displayed in the lounge and is available for residents and their visitors to read. This contains information
The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 15 regarding residents, staff and inspections. In comment cards, 100 said they could access the inspection report. This is good practice. The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 x 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x x x x x The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 17 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Gables DS0000027426.V270698.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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