Inspection on 17/05/06 for The Gables

This inspection was carried out on 17th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 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 16/02/06

The Gables 01/12/05

The Gables 11/02/05

The Gables 07/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

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 Keith Izzard Unannounced Inspection 17th May 2006 10:20 The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 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.V298088.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 places registered for LD(E) are for named service users only. Date of last inspection 16th February 2006 Brief Description of the Service: The Gables consists of 2 linked houses that 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 that is available for all service users. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days between 10.20 – 16.30 on 17th and 10.00 – 16.30 on 18th May 2006. The Manager was present in the home for most of the time, and assisted the Inspector with locating documentation, showing him around the home, and introducing him to other staff and service users. The Inspector also attended a hand over meeting between shifts attended by all staff members on duty including the manager. The Inspector interviewed 6 Service Users but some had limited communication due to their learning disabilities. Other service users were attending day centres. The Inspector also talked with the deputy manager and 6 care support workers, and met other staff briefly during the inspection. The service has received a large number of requirements in previous inspections, many of them to do with the condition of the building and these are now beginning to be addressed. This improvement must be maintained as timescales have again been extended to complete the work required. Equally, restated requirements have been made in relation to care records and planning, evidence was available that these areas are now receiving attention and again this momentum must be maintained as extended timescales have been granted. What the service does well: The Inspector received positive comments from 6 service users during the inspection, and from CSCI generated questionnaires that were returned by seven relatives, on the whole, they included positive comments. Four questionnaires were received from professionals that were broadly positive and included a very positive comment in respect of the improvements taking place in care planning and recording. Overall, comment cards were positive about the caring attitude of staff members. Service users interviewed and observed by the Inspector appeared happy and content within their home. The manager, her deputy and all care staff interviewed were positive about the inspection process and actively assisted the inspection in a constructive manner. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are still many outstanding requirements regarding the environment – especially replacing old kitchen units and equipment, and refurbishment of some other rooms. These are itemised further in the report and the momentum to address these areas must be maintained in order that compliance with the National Minimum Standards is achieved. Three service user bedroom doors must be fitted with magnetic closure devices in order to improve fire safety. Various areas of the building must have lagging provided for exposed hot pipes as soon as possible in order to prevent accidental burning of service users. Some medication procedures were improved, but hand written entries on MAR sheets must be countersigned and record two signatures and the contract for the disposal of unused medication must be reviewed in the light of appropriate containers not being provided by the contractor. In view of the comment made by a GP, all staff members should ensure that they are adequately prepared with information prior to any medical appointment for service users in order to best assist with any information that may be required to assist the GP. Care plans still need much work to update nursing assessments, risk assessments, and health care needs; and to include behavioural guidelines and evidence that service users are able to develop independent living skills. A requirement has been made for the remaining care plans not yet updated to be completed by August 2006. Care plans and assessments must be reviewed every 6 months. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 7 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.V298088.R01.S.doc Version 5.2 Page 8 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.V298088.R01.S.doc Version 5.2 Page 9 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): 1-5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides sufficient detail to enable service users and relatives to make an informed choice prior to admission. Service users are provided with terms and conditions of residency. EVIDENCE: The home’s Statement of Purpose is set out in line with standard 1.1, and Schedule 1 of the Regulations. It is well presented, and has been recently been updated and now includes the required information including staffing of the home and the details regarding the Registered and Responsible individual. The service users’ guide contains all relevant information, and is produced in larger print and with several small pictures. The complaints procedure is produced in a simple picture format, and a copy of this is provided in each flat, as well as in the service users’ guide. The home has not had any new admissions during the last year, but may be in a position to admit new service users in the next few months, after redecorating is completed. There was an outstanding recommendation to produce a simplified format for a service users’ guide, (e.g. a series of laminated photographs), so that prospective service users might be given some idea of the home prior to visiting. This was produced and a copy sent to the CSCI prior to writing this report. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 10 The Inspector viewed several pre-admission assessments in service users’ care plans, and these were very detailed, and showed that sufficient information was recorded before a decision was made to offer a placement to the service user. The assessments indicated that information was taken in regards to different aspects of daily living, communication needs, and social preferences, and included health needs and evidence of assessing compatibility with other service users. The Manager stated that the admission procedure would be carried out slowly, according to the needs of the service user and their understanding. Relatives and the Care Manager would probably visit first, and then a visit would be arranged with the service user to enable them to meet staff and other service users, and possibly stay for a meal. After this, an overnight stay or a weekend visit, prior to arranging placement for a trial period. All service users had their accommodation and personal/nursing care provided by the local authority, and in line with Regulation 5.3, a copy of the agreement had been added to each care plan. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some service users’ care plans were still unsatisfactory, and about half did not contain up to date and relevant information about service users. There was no indication of service user and family involvement with these plans. However, a number had been updated in response to a previous requirement and a further extension of the timescale was granted to facilitate the completion of the outstanding care plans. It was noted that reviews via Life Planning meetings are held approximately yearly although some were delayed, but Standard 6 states that reviews must be held six monthly, involving significant professionals, family, friends and advocates and a requirement was made accordingly. Risk assessments for service users had been updated in accordance with a previous requirement and the Inspector found evidence that this had taken place in four service user care files that were examined. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 12 EVIDENCE: Some service users’ care plans were still unsatisfactory, and did not contain up to date and relevant information about service users. There was no indication of service user and family involvement with these plans. However, approximately half had been updated in response to a previous requirement and a extension of the timescale was granted to facilitate the completion of the outstanding care plans. See Restated Requirement 1. As noted at the previous inspection service user profiles 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. It was noted that reviews via Life Planning meetings are held approximately yearly although some were delayed, but Standard 6 states that reviews be held six monthly, involving significant professionals, family, friends and advocates and a requirement was made accordingly. This is particularly important for service users who have communication difficulties and in some instances have little or no family support. See Restated Requirement 1. Risk assessments for service users had been updated in accordance with a previous requirement and the Inspector found evidence that this had taken place in four service user care files that were examined. However, it was noted that one risk assessment in respect of travel outside of the building was contradictory in terms of whether an escort was needed other than the driver of the vehicle. Risk assessments should always be clear to assist care staff, particularly for those who are new or non- permanent staff. Documentation was stored satisfactorily, and did not compromise service users’ confidentiality. Previous requirements for these standards have been repeated, but with a new timescale for completion and the Inspector agreed a timescale that the manager agreed was realistic. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is still insufficient evidence to show that service users are enabled to develop practical living skills, and social and emotional development. However, in those care files that have been updated already, it was evident that good efforts had been made to record these areas and to provide behavioural guidelines for staff where appropriate. 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 social activities should be made available. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 14 EVIDENCE: Service users have been allocated to different day centres, and, as noted before, each service user has a key worker at their day centre, who, liaise with the home’s staff regarding their health and welfare. This information is now being documented in those care plans that have already been updated, and also guidelines included about managing different behavioural problems, and development of independent life skills. The visiting Psychologist has provided behavioural guidelines for appropriate service users and further appointments are being scheduled to complete such work for one service user who still requires this input. See Restated Requirement 2. The manager quoted an example where a service user had benefited from this input and had minimised the presenting behavioural problems by moving her to another bedroom. In response to a previous requirement the staff team are about to implement weekly activity planners that will be constructed using the “widget system” thus facilitating understanding by those service users with communication difficulties. This will be provided for all service users and will also facilitate monitoring of whether participation has taken place thus enabling staff and others to be aware of any possible shortfalls in provision of activities and outings for individual service users. Efforts must be made to implement this as soon as possible and be linked to outcomes in individuals care plans. See Restated Requirement 3. Service users are able to access the local community, either using the home’s minibus or car, or public transport. Sometimes, staff members felt that there are insufficient staff to take service users out - especially at weekends – but the manager stated that 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. See Recommendation1. Activities are made available, but more choice could be arranged. The manager is still developing further initiatives in this respect and this area should remain high on the agenda for further development. See Restated Requirement 3. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 15 Each flat has its own kitchen and own budget for food. Menus are planned together in the different flats according to the preferences of those service users. Alternative meals or snacks are available for those who may change their minds. Kitchens were appropriately stocked with a variety of food. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: GP visits and outpatient 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. As in the previous inspection, it was noted that a number of re evaluations had not been recorded as having taken place. This would have been picked up if regular six monthly reviews had taken place. See Requirement 5. Daily report books included information about personal care given, and if a shower or bath was taken. Those care plans had not been updated did not include plans for management of personal hygiene, or specify preferences in relation to the following; shaving, hairdressing, baths or showers. Evidence was available that updated care plans had addressed these issues. See Restated Requirement 4. It was noted that that the responsible person had recently audited the medication system in April 2006, the manager had requested this in view of the previous number of medication errors and reported that subsequently practice had improved. The manager also stated that all staff dealing with The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 17 medication are all booked for a training course to be provided by Boots in June 2006. The main medicine cupboard was checked and also the individual MAR sheets for service users in Flat 1. The stock cupboard was in good order, and Medication Administration Records (MAR charts) had been completed well except, that one handwritten entry had not been countersigned as required. There was a large amount of medicine for disposal, and a contract has now been signed for the disposal of unused medication. The manager stated that the contractor had not supplied secure containers for the safe and secure disposal of medication. Therefore, medication not been disposed of as required. There are, therefore, 2 requirements regarding medication. See Requirements 6 & 7. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 - 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system in place. Adult protection procedures and prevention of abuse are included in staff training programmes. EVIDENCE: The complaints procedure is included in the service users’ guide, and is also on display in the main entrance hall to the flats. It has been complied in a picture format, to enable service users to have some understanding of how to initiate a complaint, and who to go to if they are concerned about any issues. No formal complaints had been received since September 2004. A complaints log included some details of the action taken in response to complaints, and confirmed that the complaints had been upheld. This log did not contain comprehensive details of interviews held, conversations with complainants, or how the matters were resolved, - although it did specify that complainants were satisfied with the outcome. There was a previous recommendation made in the December 2005 report that the management of future complaints to be recorded in greater detail. The manager confirmed that all future complaints received would conform to the Standard. Staff training records showed that some staff had attended training courses for POVA (protection of vulnerable adults), and non-violent crisis intervention training. The Inspector was informed that all staff members except three, including one new staff member, had received training on adult protection in the past year, the three who have not will receive this training in June 2006. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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 viewed at this visit and it had been redecorated. The Inspector was informed that the lounge and dining room carpets had been replaced and the kitchen units were scheduled for replacement, the week after the inspection. The fridge had already been replaced. It is recommended that bedroom should be redecorated, attention given to the wash- basin and the carpet replaced. See Recommendation 2. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 20 Flat 2 The repairs subject to a previous requirement have been restated as bedroom 4 still needs the ceiling repaired and general redecoration. The lounge carpet and old furniture need to be replaced and the date for completion of this work has still to be confirmed. Similarly, the kitchen units in flat 2 are still scheduled for replacement once flat 1 has been completed. Restated Requirements 8 & 9. In Flat 3, the Inspector was pleased to note that both the clutter in the bathroom had been removed and the old furniture from the lounge/diner. New furniture has been provided in this room and the carpet is scheduled for shampooing whist the service users are away on holiday. The kitchen is still awaiting refurbishment and is also scheduled for completion after flats 1 and 2. Restated Requirement 10. In Flat 4, the kitchen units still need to be replaced and the room refurbished. The manager stated that the previous requirement to redecorate the lounge/ diner be redecorated and refurbished will be done in June 2006 whilst service users are on holiday. The shower chair and surround have yet to be replaced. Restated Requirements 11 & 12. Disposal of old and discarded furniture was the subject of a previous requirement and was complied with. The previous requirement to ensure completion of decorating for all internal areas has been done with the exception of flat 4 and there are still some outstanding areas for completion of re carpeting, as already mentioned. See Restated Requirement 13. A review of bedroom furniture was complied with. Flat 1, laundry facilities remain unsuitable, the manager has discussed this with the Responsible Person but an action plan still needs to be submitted to CSCI as to how this will be addressed. Restated Requirement 14. The previous requirement to provide a sluicing facility for the emptying and cleaning of commodes is also repeated. Restated Requirement 15. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 21 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): 31-36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff members were observed to be interacting well with each other and with service users. There are clearly defined roles for Home Leaders, and support staff members were responding well to situations where they are needed. As noted in the previous inspection It has been a difficult time for the staff and service users with so much work going on within the building, some service users moving into new bedrooms and the reopening of flat 3. 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 members 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 numbers of staff for each shift during this unsettled time. Staffing deployment has also been altered due to service users moving into flat 3, which had been unused for The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 22 some time. This has brought about a change of key- workers, 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. Support workers are allocated to a flat for 5-6 months at a time. The plan is that they will change to different flats every so often, after staff discussion meetings, so that they can develop more ability by caring for other service users. The Inspector was concerned that as some service users have high dependency levels, staff members sometimes need to work in pairs to give care; this leaves only 1 or 0 staff to oversee other service users during that time. The staffing numbers also appear insufficient for enabling service users to go out with the appropriate support, although the manager stated that this could be better achieved through good communication and management of the rota. There is a repeated recommendation to review staffing levels, and be able to demonstrate that they adequately meet the needs of the home. See Restated Recommendation 1. The Inspector was able to talk with one nurse and 5 support workers. The Staff members who were spoken to, confirmed that mandatory training needs are well supplied by the company, and they are able to attend training according to the updates that they need to complete. The Inspector saw a training matrix at this inspection, and was able to confirm that all staff are provided with the necessary training. One more support worker had completed NVQ 2 training, and is waiting for their certification. This provided 8 staff with NVQ 2 training. The manager agreed that the number of staff with the required NVQ level 2 will need to be carefully monitored as currently this is marginally below the 50 requirement, however one is currently undertaking this training. Certificates in staff files showed evidence of mandatory training for basic food hygiene, health and safety, moving and handling, fire awareness, and communication skills. Moving and handling training included use of hoist facilities. Other training courses included epilepsy awareness, non-violent crisis intervention and report writing. Training is carried out within the Company, and also by accessing external training for some subjects. The Inspector did not examine staff recruitment files as only one new staff member had been recruited and this Standard was comprehensively examined at the previous inspection. The new member of staff was, however, interviewed and confirmed that the correct procedures had been complied with prior to her commencing work and that induction had been provided for her. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 23 Some staff did not appear to have had supervision for the recommended 6 times per year, but records were well maintained, and showed that staff have opportunity to raise concerns and ideas in an individual environment. The Inspector could see that processes had been set up to manage supervision, and considering that, and the change of management, has not given a requirement or recommendation in this respect, as in the previous inspection. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 24 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): 37-42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. Minutes of these meetings were seen by the Inspector The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 25 were examined and found to be comprehensive in their coverage and several staff members interviewed stated that they felt able and were encouraged to participate in these meetings. 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, the minutes of these meetings were also seen by the Inspector. Six, staff members were interviewed by the Inspector and all commented that they felt the home was well managed and that they would have no hesitation in approaching either the manager or the deputy manager with any concerns either about the running of the home or in relation to individual service users. Both the manager and her deputy are well qualified, experienced and competent to run the home. Service user and relative surveys had been conducted regularly and another is planned for June 2006, the manager agreed to provide the results of the next survey to the CSCI. Six service users were interviewed for their views on the home and four of them were also case tracked in respect of their care records and the awareness demonstrated by their key workers in terms of their knowledge of the service users. The Inspector was please to note that all service users spoke favourably about the home and four key- workers and other staff members appeared well versed in respect of the individual needs presented by service users. CSCI generated questionnaires were returned by seven relatives on the whole they included positive comments, two relatively minor negative comments about the service were shared with the manager. Four questionnaires were received from professionals were broadly positive, two negative comments regarding communication with a day centre, and from the GP about inexperienced staff members attending surgery were again shared with the manager. The manager undertook to address the issues raised. Staff training courses showed that mandatory training is being carried out, and that staff members are aware of safe working practices. General maintenance repairs are itemised in a separate notebook each day in individual flats. A new maintenance man recently recruited, and was working hard to deal with the issues raised. General risk assessments for the home were very detailed, and had been reviewed in September 2005. Fire drills were being carried out 4 times per year for night duty staff, and more frequently in the day times. A fire inspection was carried out in October 2005 and it was noted that the home had already complied with the requirements arising from the subsequent report excepting the provision of magnetic closures on three service users’ bedroom doors, this must be addressed as soon as possible. See Requirement 16. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 26 It was noted that a number of areas of exposed hot water piping in the building was not appropriately lagged in order to prevent accidental burns, this must be attended to as soon as possible for the safety of service users. See Requirement 17. Additionally, other routine checks in respect of health and safety matters was conducted by the Inspector and it was noted that all had been completed appropriately and within the necessary timescales. The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 27 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 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 3 26 3 27 2 28 2 29 2 30 1 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 2 3 3 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 3 3 3 3 3 2 3 x The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 28 Yes 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 continue to 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. Timescale for action 31/08/06 2 YA11 12 (1) To put behavioural guidelines in place in order for staff to assist a service user in Flat 4, to understand how to modify unacceptable behaviour. 31/08/06 3. YA14 12 (1) To reassess the level of activities available for service users, increasing these as applicable. Restated requirement, previous timescale of 30/05/06 not met. Weekly Planners to be introduced using the widget system to aid understanding by service users. DS0000006760.V298088.R01.S.doc 31/08/06 The Gables Version 5.2 Page 29 4. YA18 12 (1-3) 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. Previous requirement with new timescale. 31/08/06 5. YA19 12 (1) 31/08/06 6 7 YA20 YA20 13 13 Handwritten entries on the MAR sheet must have two signatures A contract must be arranged for the disposal of unused medication, and a copy of the contract sent to the Inspector. Suitable containers must be provided by the existing contractor, or the contractor must be changed. Restated requirement, previous timescale of 30/03/06 not met. Flat 2 Bedroom 4 to have ceiling repairs and redecoration. Bath panel to be replaced. Lounge carpet and old furniture to be replaced. Restated requirement, previous timescale of 30/04/06 not met. Flat 2 – kitchen to be refurbished. Restated requirement, previous timescale of 30/04/06 not met. Flat 3 - replace kitchen units 01/08/06 31/08/06 8 YA24 23 (2) (b) 31/08/06 9 YA24 23 (2) 31/08/06 10 YA24 16 (2) 31/08/06 The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 30 11 YA24 16 (2) Restated requirement, previous timescale of 30/04/06 not met. Flat 4 - replace kitchen units, and refurbish kitchen. Restated requirement, previous timescale of 30/03/06 not met. 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. Restated requirement, previous timescale of 30/03/06 not met. 31/08/06 12 YA24 23 (2) 31/08/06 13 YA24 23 (2) To ensure completion of 31/08/06 decorating for all internal areas. To ensure re-carpeting is completed for all assessed areas. Restated requirement, previous timescale of 30/03/06 not met. 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. Three service user bedroom doors must be fitted with magnetic closure mechanisms as soon as possible. Any exposed areas of hot water piping in the building must be effectively lagged to prevent injury to service users. 31/08/06 14. YA30 16 & 23 (2) 15. YA30 23 (2) (k) 31/08/06 16 YA42 23 (4) 31/08/06 17 YA42 13 (4) c 01/07/06 The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA33 Good Practice Recommendations To keep staffing levels under review, and be able to show that these are sufficient to meet the needs of service users. It is recommended that bedroom 1 in flat 1 should be redecorated, attention given to the wash- basin and the carpet replaced. 2 YA25 The Gables DS0000006760.V298088.R01.S.doc Version 5.2 Page 32 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. 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