Inspection on 18/08/05 for The Gables

This inspection was carried out on 18th August 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

The Gables 05/11/08

The Gables 11/08/08

The Gables 11/09/07

The Gables 17/07/06

The Gables 23/01/06

The Gables 17/03/05

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE The Gables 29/31 Ashurst Road Walmley BWest Midlands B76 8JE Lead Inspector Brenda ONeill Announced 18 August 2005 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 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 E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Gables Address 29-31 Ashurst Road Walmley West Midlands B76 8JE 0121 351 6614 0121 313 2752 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Karamaa Ltd Kelly Kinsella (Acting) Care Home 24 Category(ies) of Old Age (24) registration, with number of places The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the registration category is 24 older people not falling within any other category. 24 (OP) 2. Hot water restrictor valves are fitted to all hot water outlets accessible to service users within 6 months of registration. 3. All radiators are risk assessed and guarded or replaced with LST radiators with radiators in bathrooms and toilets and those near to beds or inrestricted places be addressed as a matter of priority. Those that are high risk within 3 months of registration and the remainder within 6 months. 4. The nurse call system must be extended to the two en-suite facilities and into the toilet next to bedroom number 10. Within 3 months of registration. 5. A commode pot washer/disinfector to be fitted in a separate room from the bathrooms or toilets within 6 months of registration. 6. Bedroom doors to be fitted with suited locks which can be used by service users but enable access by staff in the event of an emergency within 12months of registration. 7. All bedrooms to have a lockable item of furniture within 6months of registration. 8. Bedrooms to be audited for furniture against the National Minimum Standards and arrangements made to provide items that are currently not in place within 12 months of registration. 9. Electrical extraction to be fitted into the internal toilets and en-suite facilities within 6 months of registration. 10. Pipe work that is exposed in the ground floor toilet near to bedroom 9 and in the main ground floor bathroom must be boxed in within 3 months of registration. 11.The outstanding requirements as identified by West Midlands Fire Service must be addressed at a time scale agreed with them. 12. Office space that affords some degree of privacy for staff when on the telephone, completing records or dealing with private matters must be created within 12 months of registration. 13. Extend bedroom nine within 12 months of registration or cease to use it as a bedroom subject to it becoming vacant at such a time. 14. In addition to the manager and ancillary staff maintain minimum staffing levels of three care staff throughout the waking day and two care staff on waking night duty one of whom should be designated senior. Date of last inspection 17 March 2005 The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 5 Brief Description of the Service: The Gables is a number of post war houses that have been extensively converted to provide care and accommodation to 24 older people. The home is located in a quiet road within easy access of shopping facilities, local churches and regular public transport services. The home comprises of nine single bedrooms on the ground floor and fifteen single bedrooms on the first floor. Two of the bedrooms have en-suite facilities of toilet and shower. There are two assisted bathing facilities and numerous toilets located throughout the home. Service users are able to gain access to the first floor via stairs or by lift. Communal areas within the home are located on the ground floor and comprise of one very large lounge/dining room which also includes a conservatory and a smaller lounge. The larger lounge overlooks a very well maintained garden. The home also has a kitchen and a large combined laundry and food store which is located in an outbuilding. There is access to the home for people with people mobility difficulties by means of a ramped front entrance with handrails. The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection and was carried out by two inspectors over one day in August 2005. This was the first of the statutory visits to the home for 2005/2006. During the visit a tour of the premises was carried out, three resident and three staff files were sampled as well as other policies, procedures, care records and health and safety records. The inspectors spoke with the acting manager, deputy manager, proprietors, six residents, one visitor, two care staff, the cook and the domestic assistant. What the service does well: What has improved since the last inspection? There had been several improvements to the environment making it safer and more comfortable for the residents including, radiators being guarded, hot piping boxed in, new furniture for some bedrooms, some general redecoration, alarm and lighting fitted to the fire exit and electrical extraction fitted to the The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 7 internal toilets. Fire drills were up to date and there was evidence on site of the servicing of all the equipment. The care planning process was being improved and this would ensure that staff knew all the residents’ needs and they would know what help the residents needed. The acting manager had developed a system of staff supervision and an induction pack and several training courses had taken place. This will ensure staff are receiving the appropriate support and training and equipped with the necessary knowledge and skills to do their jobs. The complaints procedure had been changed so that it ensured anyone wishing to complain would know they could go directly to the CSCI if they wished. 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 E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 9 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 standard(s) 2, 3, 4 and 5. Prospective residents had the opportunity to visit the home prior to admission to assess the quality, facilities and suitability of the home. The assessment procedures ensured the needs of the residents were known by staff prior to admission. The manager must demonstrate to the CSCI that the home is able to meet the needs of any prospective resident assessed as being outside the registration category prior to admission. EVIDENCE: The files sampled evidenced that where applicable social workers and other health care professionals had undertaken assessments on the needs of the residents prior to admission to the home. Where residents were privately funded the staff at the home carried out their own assessments and these covered all the necessary areas. It was noted that the outcome of one of the assessments was clearly outside the registration category of the home. The previous manager arranged this admission however the current proprietors had taken over the home at this point and should have been aware of this. The acting manager and the proprietors must ensure that any future admissions are within the registration category or submit an application for variation to the CSCI detailing how the needs of individual will be met. The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 10 People thinking of going to live at the home were given the opportunity to visit prior to admission. The files sampled included copies of the contracts/statements of terms and conditions of residence and these detailed all the necessary information including information about the trial period at the home. The overall evidence indicated that the needs of the residents were being met by staff in the home. There was documentation in relation to personal, health and social care needs being met and all those residents spoken with were satisfied their needs were being met. There were some aids and adaptations throughout the home to assist those residents with mobility difficulties. The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 11 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 standard(s) 7,8, 9 and 10. The new care planning system in the home was good and needed to be put in place for all residents detailing how their individual needs would be met. Risk assessments needed to be improved to ensure all identified risks and strategies for managing them were clearly identified. The health and personal care needs of the residents were being met. The medication system had improved, further improvements were needed to ensure residents were not placed at risk. EVIDENCE: The acting manager was in the process of changing the care planning system in the home. One of the new care plans was completed and this included evidence that the resident had been consulted and there was some social and medical history. It included very good detail of the needs of the resident, what she could do for herself and what she needed help with and how the help was to be given. There were very good details of mobility needs and how staff were to help overcome the individual’s anxieties, likes, dislikes and preferences were also detailed. The other care plans sampled detailed resident’s needs but not how these were to be met by staff. There were manual handling risk assessments included on the files however these did not detail the actions to be taken by staff in the event of a fall. There also needed to be personal risk The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 12 assessments for all residents detailing how any identified risks were to be minimised. There was ongoing documented evidence of the personal care needs of the residents being met. Staff were identifying health care needs, following them up and then monitoring them. The acting manager was able to demonstrate how the staff recognised and followed up such things as ongoing urine infections. There was evidence of visits from health care professionals such as doctors, one of whom visited during the course of the inspection, chiropodists, dentists and opticians. It was recommended that visits from health care professionals are documented separately from the daily records to enable them to be tracked easily by staff. Residents did have tissue viability assessments and where a risk had been identified it was documented on the care plan how this was to be addressed. Residents also needed to have nutritional screenings to identify any issues that may need to be followed up or monitored. Improvements had been made to the management of medicines in the home. All the medicines audited were found to be correct, the acting manager had been carrying out regular staff drug audits to ensure the competence of staff, the policies and procedures for medicine management had been improved, but still needed further development, balances of medication held in the home were being carried forward to the next MAR (medication administration record) chart and there was a specimen signature sheet available. Issues to be addressed at this visit were: - The medication policy must include details of risk assessments and compliance checks for residents who wish to self administer medication, the homely remedies policy must include a list of permitted medication and then that the G.P.’s agreement is to be obtained for administration. All policies must be signed and dated. - There must be no gaps on the medication administration records. - The date the medication is received into the home must be recorded. - There must be written protocols for the administration of PRN (as and when necessary medication) to ensure staff are clear when to administer. - Any creams or ointments must be dated when opened. Residents appeared satisfied that their privacy and dignity were respected. They received treatment from health care professionals in the privacy of their bedrooms and were able to see visitors either in their bedrooms or one of the quieter areas of the home. Staff were observed to be mindful of resident’s privacy, for example, knocking on doors and waiting for a reply before entering. The privacy of residents had been further enhanced since the last inspection with the fitting of locks to the bedroom doors which residents were able to have a key to if they wished. Some rooms also had a lockable facility for the residents use however all residents needed to have this facility made available to them. The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 13 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 standard(s) 12, 13, 14 and 15. There were no rigid rules or routines in the home and residents were able to spend their time as they chose. There were activities on offer and residents were able to maintain contact with families and friends. The meals in the home were good and choices or alternatives were available at all meals. EVIDENCE: There did not appear to be any rigid rules or routines in the home. Residents were observed to spend time in their rooms, wander freely around the home, chatting in small groups and watching television. Staff commented that activities include such things as bingo, outings, board games, nail care, old films and sing songs. One resident commented that ring and ride take her to see her friend, others spoke of going to a luncheon club and another said staff had taken her to the shops. It appeared that the residents chose how to spend their time and staff encouraged them to make choices wherever possible, for example, in how to spend their time, when to go to bed and get up, what to eat and what to wear. All the bedrooms were personalised to the occupants choosing and some residents continued to handle some of their own finances. The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 14 There were no restrictions on visiting the home within reasonable hours and several visitors were seen coming and going from the home during the course of the inspection. All the residents spoken with were happy with the catering arrangements at the home and comments from them included: ‘ I have breakfast in my room, lunch and tea in the dining room.’ ‘ The food is acceptable we have a choice of food for breakfast and tea, set meal at lunch time.’ ‘ Food is nice.’ The inspectors joined the residents for lunch and the meal was well cooked and presented. It was evident that staff knew the residents likes and dislikes from what was served, for example, one resident had a small portion, another no carrots, another lots of gravy. One of the residents did not want what was on the menu and an alternative was served. The menus seen were quite varied and had been discussed with the residents at a meeting. The residents also confirmed that the cook did ask them if they liked the food. The dining area was well decorated and furnished however the conservatory area being used was very warm even though their was a cooler in there. It was strongly recommended that the temperature was monitored and steps taken to ensure it was kept at an ambient temperature. The acting manager needed to ensure that records of food served to the residents were being kept that evidenced such things as choices, alternatives and any special diets. The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 15 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 standard(s) 16 and 18. There was an appropriate complaints procedure and all residents or their representatives received a copy. To ensure the protection of the residents staff must receive training in the prevention and reporting of abuse and the policies and procedures in the home must be in line with the multi agency guidelines. EVIDENCE: The complaints procedure had been amended since the last inspection to ensure that complainants were aware they could refer a complaint to the CSCI at any point. No complaints had been lodged at the home or with the CSCI. The home had policies and procedures for adult protection, whistle blowing and physical intervention. There was also a copy of the multi agency guidelines regarding the protection of vulnerable adults on site. The acting manager needed to ensure that the home’s procedures were in line with the multi agency guidelines and that all staff were aware of the reporting procedures. When spoken with staff were unsure of the correct procedures in the reporting of any suspicion or event of abuse and must receive training in this subject. The policy and procedure for physical intervention/restraint also needed to be further developed to ensure staff were clear about what could be seen as restraint and that any used must be agreed by all professionals concerned, written into a care plan and regularly reviewed. The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 16 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 standard(s) 19, 20, 21, 22, 24, 25 and 26. The home provided residents with a comfortable and homely environment. There were some areas that needed to be addressed to ensure the safety of the residents and staff. EVIDENCE: The location and layout of the home was suitable for its stated purpose. It was generally safe and well maintained. The home is accessible to the residents via ramps. Furnishings, fittings and décor were homely in style and of an acceptable standard with the exception of some of the armchairs that were worn and needed replacing. The proprietors of the home had been concentrating on making sure the building was safe for the residents and staff and had addressed several issues since the last inspection including covering radiators, putting a light and alarm on the first floor fire escape and boxing in pipe work. There had also been The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 17 some general redecoration, new furniture and new commodes in four bedrooms and locks fitted to all bedroom doors. The home had a recent visit from the fire officer and numerous requirements were made some had been addressed in relation to clearing combustible materials from under the external fire escape, the fire risk assessment and evacuation procedures. On the day of the inspection the proprietor was obtaining a quote for the outstanding requirements to ensure these were met within the twelve week time scale. It was noted on the day of the inspection that several fire doors were wedged open and an immediate requirement was left at the home in relation to this. The only office space at the home is on the first floor landing and does not allow for any degree of privacy at all. It is a condition of registration for the proprietors to address this by the end of November this year. The inspector was informed that the proprietors were to consult with surveyors as to how to overcome this. Communal space was ample and the décor, furnishings and fittings were generally domestic in character and of an acceptable standard with the exception of some worn armchairs. The garden was very well maintained and there was a ramped exit from the home however the lawned area would be difficult for anyone with anyone with mobility difficulties to access ad it is strongly recommended that the possibility of a ramp be explored. There were appropriate numbers of toilet and bathing facilities in the home with two assisted bathing facilities, two bedrooms with en-suite showers and numerous toilets. Some of the facilities had been repainted others still needed to be addressed, electrical extraction had been fitted to the internal toilets since the last inspection however one of these was not working. One of the ensuite showers had no showerhead and could not be used by the resident and bathroom 1 had some damaged tiles by the door. It was also noted that there was an uncovered fuse box located in one of the toilets it was strongly recommended that this be covered. The aids and adaptations throughout the home appeared to meet the needs of the residents and included, shaft lift, hand and grab rails, assisted bathing facilities and an emergency call system. The emergency call system had been extended to all facilities however in some bedrooms it could not be accessed from the bed as there were no extension leads. The bedrooms varied in size and were all generally well furnished and equipped and all were personalised to the occupants choosing. Appropriate locks had been fitted since the last inspection and some had a lockable facility. The bedrooms had been audited against the National Minimum Standards to highlight items not available. The condition of registration in relation to providing any missing items had not expired. The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 18 Since the last inspection all but three of the radiators in the home had been guarded. The three remaining were not a hazard to the residents but were to be guarded prior to the winter. Exposed hot pipe work had also been guarded. All hot water outlets accessible to the residents had thermostatic mixer valves fitted however the temperature of the hot water in the first floor bathroom was running excessively high and needed to be addressed to prevent the residents burning themselves. The home was clean and odour free with appropriate systems in place for the disposal of clinical waste. Liquid soap and disposable towels were available in all communal facilities and staff had access to protective clothing when necessary. Due to the number of commodes in use a condition of registration was that a commode pot washer/disinfector be installed in the home. The time scale for this had lapsed however the appliance was on site and an appropriate location for it was discussed during the inspection. There were infection control procedures on site. To further enhance the infection control procedures in the home the following issues needed to e addressed: - Items in the fridge in bedroom 15 must be regularly checked, as some were out of date. - Staff needed to ensure the underside of the bath hoist seat was cleaned thoroughly cleaned. - The laundry must have a wash hand basin installed. - The temperature of the food store in the same location as the laundry needed to be monitored to ensure food is not going to spoil. - Core food temperatures must be monitored to ensure they are thoroughly cooked. - Insect screens or an insect-o-cute must be fitted in the kitchen to ensure flies and insects are kept out as much as possible. - The untiled wall in the kitchen must have a finish that is easy to clean. The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30. Appropriate staffing levels were being maintained to enable the resident’s needs to be met. There were robust recruitment procedures but these needed to be applied consistently to ensure the protection of the residents. Staff training records needed to be kept to evidence staff were equipped with the required skills and knowledge to care for the residents. EVIDENCE: Minimum staffing levels of three care assistants throughout the waking day and two at night were being maintained. There had been several staff vacancies but these had been recruited to and only one night care and a cook vacancy remained. The home had a core group of staff who had worked there for some time which was very good for the continuity of care of the residents. All the residents and one visitor who were spoken with were very positive in their comments about the staff including; - ‘Staff are nice and kind.’ - ‘Staff call and check on me every night it’s good to know you’re not alone.’ - ‘ Ladies (meaning staff) are lovely.’ The files of the three most recent employees were sampled. The recruitment procedures for staff had vastly improved and with the exception of one reference all the required documentation had been obtained prior to the employment of the staff. The acting manager was reminded that she also needed to have a photograph of all staff and to keep a record of when they The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 20 commenced their employment, their role and the number of hours they are employed for. Six of the seventeen care staff were qualified to NVQ level 2 or the equivalent and another three were undertaking the qualification. The acting manager was aware of the requirement that 50 of care staff must be qualified to this level. New staff received induction training however the records for this were not adequate. The acting manager had compiled a new induction pack and was ‘testing’ this out at the time of the inspection. There were some very good detailed records of on the job training where staff had been supervised by the manager in basic tasks such as bathing, assisting with eating, making beds and writing reports. Training that had taken place was food hygiene, manual handling, fire procedures, catheter care and Parkinson’s awareness. Planned training included dementia care, handling of medicines and diabetes awareness. The acting manager needed to ensure that both the induction and foundation training for staff was in line with the specifications laid down by the Learning Skills Council and that there was documentary evidence of any training undertaken. The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 36, 37 and 38. The manager and the proprietors were aware and had an understanding of the areas the home needed to improve. Some of the issues needed prompt attention and a clear development plan needed to be followed to ensure the home was run in the best interests of the residents with their involvement. EVIDENCE: The acting manager of the home had just successfully completed her registration interview with the CSCI and when all the required references were received the process would be completed. She had worked at the home for a number of years and demonstrated her knowledge of the needs of the residents in her care and the running of a residential home. She was well aware of the need to meet the requirements made following the inspection and was very committed to this. She was receiving a lot of support from the proprietors of the home and the deputy manager and they all appeared to The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 22 work very well together. The acting manager was undertaking her Registered managers Award and was aware of the requirement to complete this. Staff and residents spoken with were very positive in their comments about both the manager and the proprietors of the home stating they work hard and when necessary take part in the caring and cleaning tasks. Staff and residents were consulted on a regular basis about issues in the home, meals, leisure activities and so on. The forthcoming residents meetings were posted on the notice board with the agenda and relatives were invited when appropriate. There were no formal ways of monitoring the quality in the home with a view to improvements but the manager and the responsible individual were aware of the requirement to formalise this. The systems in place for the management of monies on behalf of the residents were not satisfactory. The records could not be audited, there were not always receipts available for expenditure and only the acting manager was signing the records. It was also necessary for the residents to have ongoing individual records rather than any transactions being entered in a book as these were not possible to track. An immediate requirement was left at the home to address the issues. The issue of the residents paying for their own meals at luncheon and stroke clubs was also discussed with the responsible individual and the acting manager. As the residents pay for their meals in their fees then they should be reimbursed at the appropriate rate for any meals they pay for. Both were to explore this issue and address and had not really thought about this as it had been an ongoing arrangement. The manager had set up a system for staff supervision and this appeared to meet the requirement of six per year. The policies and procedures in the home were in the process of being reviewed and the majority of those seen were appropriate. Those requiring amendment were the adult protection policies and procedures, there needed to be an accident procedure for staff to follow and the missing persons procedure needed to include notification to the CSCI via regulation 37. The acting manager also needed to ensure that the CSCI was notified any event affecting the well being of the residents as detailed under Regulation 37 of the Care Homes Regulations 2001. Although the responsible individual is one of the proprietors and regularly attended the home it was still necessary for her to visit the home unannounced and complete reports on the conduct of the home. These reports needed to be available for inspection. Health and safety were generally well maintained and staff had received training in safe working practices and more was planned. There was evidence on site of the required checks on the fire system, fire drills and fire training The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 23 being carried out. There was evidence on site of all equipment having been serviced, the hard wiring inspection and portable appliance checks were up to date. There were premises risk assessments however these needed to be further developed to detail how all risks were being minimised rather than just highlighting where any action was required. Other issues that arose were in relation to the fire officer’s report, the hot water temperature to one bath and infection control procedures. Accident and incident recording were appropriate however the CSCI was not always notified appropriately in relation to accidents and incidents. The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 24 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 2 2 2 x 2 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 2 3 2 x 1 2 2 2 The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 25 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 1 Regulation 4(1) schedule 1 Requirement Timescale for action 01/10/05 2. 1 5(1) 3. 4 12(1)(a) (b) 4. 7 15(1) The statement of purpose must contain all the details specified in Schedule 1 of the Care Homes Regulations 2001. (Previous time scale given 01/05/05. Not assessed for compliance at this visit.) The service user guide must 01/10/05 contain all the details specified under Regulation 5 of the Care Homes Regulations and be available in a format suitable for the residents. (Previous time scale given 01/05/05. Not assessed for compliance at this visit.) An application for variation must 01/09/05 be forwarded to the CSCI for any prospective residents that have been assessed as outside the registration category of the home. All residents must have care 01/11/05 plans that detail how all their needs in relation to health and welfare are to be met by care staff. There must also be evidence that wherever possible residents have been consulted in relation to the care plans. (Previous time scales of Version 1.40 The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Page 26 5. 7 13(4)(b) (c) 6. 7 13(5) 7. 8 12(1)(a) 8. 9 13(2) 9. 9 13(2) 10. 11. 9 9 13(2) 13(2) 01/03/05 and 01/05/05 not met.) All service users must have personal risk assessments that detail how any identified risks are to be minimised. Where no risks are identified this must also be documented. (Previous time scales of 01/03/05 and 01/05/05 not met.) All service users must have manual handling risk assessments these must be dated, signed and reviewed regularly. They must include details of the actions to be taken by staff in the event of a fall. (Previous time scales of 01/03/05 and 01/05/05 partially met.) All residents must have nutritional screenings. (Previous time scales of 01/03/05 and 01/05/05 not met.) The medication policy must include details of: - Risk assessments and compliance checks for residents who wish to self administer medication. - The homely remedies policy must include a list of permitted medication and then that the G.P.’s agreement is to be obtained for administration. - All policies must be signed and dated. There must be no gaps on medication administration records unless it is for PRN medication. (Previous time scale of 19/03/05 not met.) The date medication is received into the home must be recorded on the MAR chart. There must be written protocols for the administration of PRN medication. 01/10/05 01/10/05 01/10/05 01/10/05 01/09/05 01/09/05 01/09/05 The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 27 12. 13. 9 15 13(2) 17(2) schedule 4(13) 14. 15. 18 18 13(6) 13(6) 16. 18 13(7)(8) Any creams or ointments must be dated when opened. Records of food served to service users must be kept in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory in relation to nutrition and otherwise, and of any special diets prepared for individual service users. (Previous time scales of 01/03/05 and 01/06/05 not met.) All staff must receive adult protection training. The homes adult protection procedure must be amended to ensure it is in line with the multi agency guidelines. The home must have a written policy and procedure on physical intervention - which should be in line with codes of professional practice recognised by relevant professionals. Physical Intervention must be written in the care plan with a description and the reason for use and on whose authority. It must be subject to frequent review. Any worn armchairs must be replaced. (Previous time of 01/04/05 not met.) Wedges being used to hold open fire doors must e removed and not used again. All the requirements made by the fire officer must be met by the timescale given unless otherwise agreed with the fire officer. An office that affords some degree of privacy to staff when on the telephone, completing records or dealing with private 01/09/05 01/10/05 01/12/05 01/10/05 01/11/05 17. 18. 19. 19 19 19 16(2)(c) 23(4)(c) 23(4)(a) 01/11/05 19/08/05 04/10/05 20. 19 23(1)(a) (2)(a) 29/11/05 The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 28 21. 21 23(2)(d) 22. 23. 24. 25. 21 21 21 22 23(2)(c) 23(2)(c) 23(2)(b) 23(2)(n) 26. 23 23(2)(f) matters must be provided. (Previous time scale had not lapsed.) Any bathrooms and toilets in need of decoration must be addressed. (Previous time scale of 01/04/05 partially met.) The extractor fan in toilet 2 must be in working order. The shower fitment in bedroom 15 must be repaired. The damaged tiles by the bathroom door must be addressed. Extension leads must be available for the emergency call system to ensure residents are able to summon help when necessary. Bedroom 9 to be extended or cease to be used as a bedroom. (Previous time scale had not lapsed.) All bedrooms must be audited against the Ntional Minimum Standards and arrangements made to provide items currently not in use. (Partially met but previous time scale given had not lapsed.) The water to the bath in the first floor bathroom is running at a excessively high temperature and must be addressed. A commode pot washer/disinfector must be installed in the home. (Previous time scale given 29/05/05 not met.) Items in the fridge in bedroom 15 must be checked regularly to ensure they are not out of date. The laundry must have a wash hand basin installed. Staff must ensure that the underside of the bath hoist seat 01/11/05 01/10/05 01/10/05 01/10/05 01/09/05 27. 24 16(2)(c) 29/11/05 subject to it being vacant at the time. 29/11/05 28. 25 13(4)(c) 22/08/05 29. 26 13(3) 14/10/05 30. 31. 32. 26 26 26 13(3) 13(3) 13(3) 01/09/05 01/11/05 01/09/05 The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 29 is thoroughly cleaned. 33. 26 13(3) The temeperture of the food store in the same location as the laundry must be montored to ensure food is not going to spoil. The core temperatures of cooked foods must be monitored to ensure they are thoroughly cooked. 01/09/05 01/09/05 01/10/05 Insect screens or an insect-ocute must be fitted in the kitchen The untiles wall in the kitchen must have a finish that is easily cleaned. 50 of care staff must be qualified to NVQ level 2 or the equivalent. Two written references must be obtained for all staff prior to their commencing their employment. There must be a recent photograph of all staff. There must be a record of when staff commenced their employment, the position they hold and the number of hours they work. 36. 30 18(1)(a) The induction and foundation training for staff must be cross referenced to the specifications laid down by the Learning Skills Council to ensure it meets the requirements. 01/11/05 01/12/05 31/12/05 01/10/05 34. 35. 28 29 18(1)(a) 19(4)(b) (i) 17(2) schedule 4 (6)(d)(e) 37. 38. 31 33 9(2)(b)(i) 24(1)(a) All staff must have individual training records. The manager of the home must 31/12/05 be qualified to NVQ level 4 in management and care. The home must have an effective 01/11/05 Version 1.40 Page 30 The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc (b) 39. 35 17(2) schedule 4(9)(a)(b) 40. 35 13(6) 41. 42. 37 37 37 17(2) schedule 4(16) quality assurance and quality monitoring system in place that is based on seeking the views of the residents. (Previous time scale given of 01/04/05 not met.) The records of monies handled on behalf of the residents must include: - Total; balance - Monies deposited - Monies spent - Receipts available to verify expenditure - Service users sign financial records where able - Bank /Building society account details - Two staff must sign the records wherever possible. - The records must be audited on a regular basis. the responsible individual must make arrangements for the residents to be reimbursed for any meals that they purchase that have already been paid for in their fees. The CSCI muts be notified of any event that affects the well being of the residents. The home must have a suitable procedure for staff to follow in the event of an accident. 25/08/05. 01/10/05 19/08/05 01/10/05 43. 37 26 44. 38 13(4)(c) The missing persons procedure must include notification to the CSCI. The responsible individual must 01/10/05 visit the home unannounced on a monthly basis and complete a report on the conduct of the home. The reports must be available for inspection. The premises risk assessments 01/11/05 must be further dveloped to include details of how all risks are minimised. Version 1.40 Page 31 The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc 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. 3. 4. Refer to Standard 8 15 20 21 Good Practice Recommendations It is recommended that visits from health care professionals are recorded separately from daily records to enable easy tracking. It is strongly recommended that steps are taken to ensure the conservatory area is not too warm and kept at an ambient temperature. It is strongly recommended that the possibility of having a ramp installed to give easy access to the lawned area of the garden be explored. It is strongly recommended that the fuse box in the toilet is covered. The Gables E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 32 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor , Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ 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 E54 S62346 TheGables V237837 180805 AI Stage 4.doc Version 1.40 Page 33 - 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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