CARE HOME ADULTS 18-65
The Gables 262 Ipswich Road Colchester Essex CO4 0ER Lead Inspector
Marion Angold Key Unannounced Inspection 19th April 2007 10:15 The Gables DS0000028587.V337304.R02.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 DS0000028587.V337304.R02.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 DS0000028587.V337304.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Gables Address 262 Ipswich Road Colchester Essex CO4 0ER 01206 841515 01206 841515 manager_gables@careaspirations.com 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) Care Aspirations Limited Raymond Gilbey Care Home 7 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (1) of places The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 7 persons) One person, over the age of 65 years, who requires care by reason of a learning disability, whose name was made known to the Commission in January 2004 The total number of service users accommodated in the home must not exceed 7 persons 31st October 2006 Date of last inspection Brief Description of the Service: The Gables is a detached, two-storey house on the busy Ipswich Road in Colchester. There is parking for three vehicles at the front of the property and a large, enclosed garden to the rear. A keypad entry system is in operation. The home is registered for seven service users with a learning disability, each of whom has a fully en-suite bedroom, with either bath or shower. A conservatory extension, adjoining the lounge, serves as a dining room. The weekly charge for a room at The Gables is between £879.81 and £1435.32. An extra charge is made for hairdressing, toiletries and chiropody. The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection, covering the key National Minimum Standards, took into account all the information CSCI had received about The Gables since the last inspection. It also included two visits to the home on 19/04/07 and 24/04/07, lasting altogether 7.75 hours. The first visit ended when all the people living, and on duty at the home, went on a planned minibus outing. The combined visits involved • • • • • speaking with people living and working at the home speaking with the person in charge looking all round the home observing how people were supported sampling records. What did we find? 27 Standards were inspected 16 Standards were met 11 Standards were nearly met What the service does well: What has improved since the last inspection?
Activity plans and records had been introduced for each person living at The Gables to show how they were spending their time. The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 6 What they could do better:
• • • • Care plans should tell staff all the ways people need to be supported. They should be reviewed at least every six months. More could be done to improve the quality of people’s daily experience and to provide stimulating activity, tailored to individual needs. People need a more balanced diet, including sufficient quantities of fresh fruit, salad and vegetables. People working at the home must have the training and supervision they need to support people in the best and safest ways possible and to protect them from abuse. The person in charge needs to give sufficient time to his own training and being a manager. • 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 summary of this inspection report can be made available in other formats on request. The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been no new service users to demonstrate ongoing compliance with NMS 2. However this Standard was met at previous inspections. The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Individuals are not consulted about all the decisions that affect them and could play a more active role in planning the care and support they receive. EVIDENCE: Three service users’ care plans were inspected in detail. They covered the main needs and risks experienced by each person and guidance to staff as to how these should be managed. However, there was scope for a more personcentred approach to care planning and greater involvement of the individual in planning for their lives. The manager said this was being addressed through micro teaching sessions for staff on person-centred planning. Records showed that reviews were still taking place annually and not at the minimum required interval of six months. The manager said that this shortfall had been identified through internal audit and that all care plans were in process of being reviewed and would then be reviewed again in six months.
The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 10 Formal letters from Care Aspirations, dated 16/01/07, had been sent to people living at the home, advising them of a change of advocacy arrangements. These letters, held on their files, could not have been read or understood by the recipients. They also showed lack of consultation about the changes. The manager said that, under the new arrangements, two people from Tendring Independent Advocacy Service had recently made an introductory visit to The Gables to meet with the people living there. One of the sampled care plans contained appropriate documentation relating to an infringement of the person’s rights, showing clearly why the decision taken was in their best interests. However, there was nothing in people’s activity plans to show that scheduled activities were subject to a number of variables, such as the availability of staff and the needs of others living at the home. When care plans cannot be followed for reasons outside the person’s control, this needs to be identified as an infringement of their rights. Similarly, there should be documentary evidence that people have been consulted about the use of the dining room for staff training, as this affects their movement about the home. The manager confirmed that arrangements for supporting people to obtain, secure and spend their personal money had not changed since the last inspection, when they had been assessed as satisfactory. The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. To some extent, people’s lifestyles suited their individual needs and preferences but their day-to-day experience of group activities and outings, meant some compromise of their rights and choice. Although they enjoyed their meals, they were not having a consistently healthy diet. EVIDENCE: During the morning of the inspection visit, staff interacted intermittently with individuals between domestic activity, making drinks and preparing lunch. One person was at college. The others wandered around the house or sat in the lounge. Shortly before lunch, staff suggested residents did jigsaw puzzles but one of the two puzzles available had a number of pieces missing. One person keenly completed the other puzzle and then returned to being unoccupied.
The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 12 This scenario suggested there was a need for more individually planned activities and resources. During the morning of the site visit, one person called out to staff in the kitchen, ‘Can we go out today, please?’ Outings took place most afternoons but were dependent on the availability of staff and willingness of everyone living at the home to participate. On the afternoon of the inspection visit one person had to be coaxed to get on the minibus in order for the outing to go ahead. The trip included picking up staff and taking people to and from college. Although staff said that the people not attending college would enjoy refreshments somewhere during the afternoon, it was evident that, to some extent, they had to fit in with plans that were not tailored to their particular needs. Records of individual likes and dislikes related only partially to their activity plan and daily activity records. For example, one person’s like of train rides, helping in the garden, swimming and Jacuzzi, were not picked up in their activity plan. One person’s weekly activity schedule contained only 3 entries; consequently, as their daily activity records showed, they spent much of the remaining time without meaningful activity (‘relaxing around unit with peers’ or ‘time around the home’). Although one person’s care plan suggested activities could be used as a way of reducing their agitation, records showed that, on an occasion when they had experienced continued agitation, they had not had any structured activity throughout the day. Since the last inspection, the company had arranged for an occupational therapist to visit every other week and provide an optional activity. This was in addition to music therapy, chair exercise and reflexology sessions taking place in the home. The manager said that in order to provide a full personcentred activity programme and individually tailored outings, service users needed one to one support, for which they were not funded. Arrangements for people to have contact with family and the people who mattered to them had not changed since the last inspection, when this Standard was met. One care plan sampled contained a letter to a relative consulting them about plans to take the person living at the home on holiday and evidence that the relative had been invited to the care review. Observation and records showed that people had freedom of movement around the home and could choose to be alone and whether to help with housekeeping and gardening tasks. The use of the conservatory for staff training should be done in consultation with the people living at the home, especially as the conservatory/dining room adjoins the lounge and constitutes almost half their communal space. Staff said they only had training when people living at the home were watching television or otherwise occupied.
The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 13 Lunch on the initial day of inspection consisted of sandwiches (wholemeal or white, ham or cheese), sausages, crisps or cheddar biscuits and a drink of squash. There was no salad or fruit. Each returned their empty plate to the kitchen, not expecting and not being offered anything else. Menus showed that they seldom had a second course or any kind of pudding. Records also showed that people were getting much fewer than the daily recommended 5 portions of fruit, vegetables or salad. Some days the only portion was the optional orange juice for breakfast. Some records needed to be more specific as, from entries such as ‘fresh veg’ or ‘salad’, it was not possible to know how many portions people had consumed. Staff demonstrated that they were responsive to people’s preferences and dislikes. However, it was evident that people had eaten more packaged and convenience foods, such as pizza, than meals prepared from fresh ingredients. Staff acknowledged that they did not adhere to the menu plan and it seemed that this had led to people having a poorer diet. The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at The Gables were receiving personal and health care support appropriate to their needs and the manager’s plan to arrange suitable training would ensure continued protection of people needing support with medication. EVIDENCE: There had been no change to the way people received personal support. Care plans showed how this was to be given. Weekly checklists showed that care was taken to ensure that all aspects of personal hygiene were covered. The home had no communal toilet or bathing/showering facilities. People were at all times assisted in the privacy of their own fully en suite rooms. Everyone was appropriately and well presented on the day of inspection and, in hearing from one person about their shopping trip, it was evident that they enjoyed choosing their own clothes. Health care records were sampled for 3 people and mostly showed appropriate monitoring of health issues in line with particular care plans and symptoms
The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 15 being followed up with the GP. It was reported that people living at the home received annual health checks, the last one having been carried out in February 2007. An incident record for one person showed that staff knew about their medical condition and the procedures to follow for their protection and recovery. One person’s records showed a gradual loss of weight over the past year and no accompanying comment or action plan. The manager said he would look into this. It has since been reported that the person has started to gain weight. Two sets of medication and Medication Administration Records were inspected. No gaps or errors were identified in this sample. Individual photographs were attached to the records to avoid mistakes with the person’s identity. There was also guidance to staff in respect of PRN (as needed) medication. It was noted that one such protocol appropriately highlighted alternatives to drug intervention. However, the person’s dietary records showed that the preventative plan, of providing plenty of fruit and vegetables, was not being followed. The home was not maintaining a list of each person’s current medication for cross reference with the Medication Administration Records and a means of checking that each person was receiving their due medication. There was also no list with the Medication Administration Records of staff authorised to administer medication and their sample signatures, as they would appear on the Medication Administration Records; so it could not easily be determined, who had administered the medication at any one time. Inspection of the medication cupboards showed good stock control and the person giving people their lunchtime medication followed accepted procedures for administration and recording. By all accounts, only seniors administered medication. The manager acknowledged that the last medications training had taken place in 2004 and that staff were due for refresher courses. As the corporate training programme did not include training in this area, the manager said he would approach Care Aspirations for funding to enable staff to attend refresher training provided by their pharmacy. The manager should ensure that training provided is to Skills for Care standards, involving an assessment of competence not only in the use of the Monitored Dosage System but also in some of the wider aspects of handling medicines. The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The views of people living at the Gables were being taken more into account but they could be better safeguarded from abuse if staff had training in this area. EVIDENCE: The last independent annual survey of customer satisfaction showed that 85 of the responses were positive. It is anticipated that the next annual survey will include service users as well as their families and representatives. In the interim, Care Aspirations have developed user-friendly questionnaires with different faces to denote levels of satisfaction. These had been put on display in The Gables’ entrance lobby for people to take and use although no completed ones were seen. New advocacy arrangements had been made, although, as indicated under NMS 7, the people concerned had not been consulted about changing the provider. The manager said that micro teaching sessions on person-centredplanning encouraged staff to listen and act on the views and wishes of the people they were supporting. CSCI looks forward to more developments in this area. The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 17 The manager said they had not received any complaints since the last inspection. Monthly reports to the Commission from the provider had also not identified any complaints. The home’s response to the last known complaint it received, which pre-dated the last inspection, was open and constructive. Following the last inspection, the registered persons were required to ensure that all persons working at the care home were aware of their duty to protect residents from harm and abuse. Minutes of a staff meeting held in December 06 showed that staff had been reminded of their duty to report abuse. Records sampled for 3 staff showed that none of them had attended protection of vulnerable adults training and the company’s training programme did not offer courses specifically on safeguarding adults. Knowledge of how to protect people from abuse is fundamental to good care practice and should be provided as part of the core-training programme. The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 and 30 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were benefiting from a comfortable, clean and safe environment with fully en suite bedrooms, suited to their needs. EVIDENCE: All inside areas were inspected and found to be well maintained, clean, fresh, safe and suitable for their purpose. Maintenance records showed that the maintenance person continued to complete a weekly house check. Since the last tour of premises, carpets had been replaced in 3 upstairs rooms. Without carpet, communal areas were not as homely as the bedrooms. Cushion covers on the lounge suite, new last year, had shrunk with frequent laundering and needed to be replaced. The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 19 All bedrooms were suitable for the needs of their occupants with spotlights, safe radiators, full en suite facilities, individual bedding and colour scheme and personal effects. One room had an air conditioner, which the manager stated was for the particular needs of the occupant but also benefited others in very hot weather by cooling down the atmosphere generally upstairs. The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing levels met the basic needs of people using the service but did not give much scope for individualised person-centred support. Gaps in training and supervision have a potentially negative impact on the quality of care and support provided. EVIDENCE: Three members of staff were on duty on the first day of inspection. The roster for the week beginning 16/04/07 showed the same, with the manager also present from 8.00 until 16.00 hours on his days of duty. On 24/4/07 only 2 staff were on duty (plus the manager, although he was at management meeting during morning) because one person had reported in sick and was not replaced. The manager said that Care Aspirations decided the staffing ratios. He indicated that the present ratio of 3 staff to 6 service users was adequate to meet people’s needs and provide some person-centred care but that the oneThe Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 21 to-one support people needed for individually tailored activities was not funded by the commissioning authorities. . The manager said they had no new recruits since the last inspection to demonstrate compliance with the Care Homes Regulations 2001; the most recent people to come to work at The Gables had transferred from other Care Aspirations units. This applied to 2 of the people on duty on the day of the site visit, whose records were inspected. Recruitment continued to be managed at the Head Office of Care Aspirations. All three of the staff records inspected contained some kind of photographic identity, although the quality of some photocopied photographs from a passport or driving licence, makes them barely adequate for this purpose. Care Aspirations continued to provide all staff with the opportunity for completing the National Vocational Qualification (NVQ) in care, Level 2, and The Gables continued to have more than 50 of staff, who had achieved this (Care Aspirations gave the figure of 85 ). Records sampled for 3 members of staff, continued to show gaps in health and safety training and limited training specifically tailored to working with people with learning disability. One person could not recall any recent training apart from watching a DVD about fire safety and moving and handling. The manager advised that all day staff had attended in house training on person centred planning at end of 06 but this had not been recorded on their files. There was also nothing to show the course content or how skills and competencies had been assessed. People working at the home indicated that they did not find that use of DVDs for health and safety training as helpful or effective as having the interactive training from experts in the field, previously provided by Care Aspirations. The manager was advised about the need to introduce Skills for Care portable induction portfolios. He was aware of organisational changes in this area but explained that all staff, who were recently new to The Gables, had previously worked elsewhere in the organisation and not required a full induction. Staff said that the manager called them to the office from time to time for supervision. Records for the people on duty on the initial day of inspection showed that supervision had not been regular. One person had not had supervision since August 2006 and the other two had intervals of 4 and 5 months between their most recent supervisions. Records indicated, however, that the content of these meetings was relevant to people’s roles at The Gables although closer inspection of people’s training records during supervision was indicated. As demonstrated during the site visit, the manager was required to complete periodic assessments of individual performance in a number of prescribed areas. The outcome ratings were linked to pay. The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 22 Periodic staff meetings (1 to 3 monthly intervals) were relevant to the needs of service users. Minutes of the meeting held on 12/12/06 showed that staff were to receive training in person-centred care from the company’s psychologist and reminded staff of their duty to report abuse. The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at The Gables were benefiting from an efficiently run home but their individual views and aspirations were not fully explored or catered for. The manager was aware of the need to progress various matters in the interests of the health and safety of everyone living and working at the home. EVIDENCE: Ray Gilbey said there had been no change to the ratio of care to management hours, only 50 of his time being allocated to management responsibilities. From what he said, it was evident that, in some respects, he did not have all the authority invested in a registered manager and that decisions with respect The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 24 to admissions, staffing and training were very much in the hands of Care Aspirations. Care Aspirations continued to have suitable processes in place for monitoring the quality of care at The Gables, including a monthly audit of the service, a separate, monthly monitoring visit from the Responsible Individual and an annual, independent survey of relatives’ views of the service. (It is anticipated that this year’s survey will also take into account the views of people living at the home.) However, this report has identified a need for closer monitoring in respect of staff training, care reviews and environmental risk assessments, and for consultation with people living at the home about matters which significantly affect their lives. The home’s maintenance folder contained appropriate procedures and provided evidence of routine, internal monitoring of systems to ensure compliance with health and safety requirements (such as checking the temperature of hot water in individual bedrooms) and certified evidence that installations and equipment were regularly checked and serviced. At the last inspection the manager said that the requirement to implement the new Food Safety Management System, arising from a Food Hygiene and Health and Safety inspection in June 2006, was being progressed by Care Aspirations and that the system would be up and running in November 2006. The manager said the system was being tried in one of the other units but was still under consideration by Care Aspirations and had not been implemented at The Gables. The inspector pointed to the fact that implementation had been a ‘requirement’ and as such needed to be addressed as a matter of urgency. The manager agreed to liaise with the environmental health officer, who had just completed another inspection. Environmental risk assessments, linked to the Health and Safety at work Regulations 1992, had been completed on 27/7/05 and 3/8/05. These should be reviewed annually to take account of changing circumstances and needs. Assessments of potentially hazardous products should also be reviewed to show that the products are still in use and the information current. As highlighted under Standard 30, some staff had also still not covered all the necessary health and safety training. The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 25 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 2 X The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 YA17 Regulation 16 Requirement People living at the home must have a balanced diet to maintain good health. Before employing staff the home must obtain all the documents and records that are required to protect residents from people who should not be working with them. This requirement has been brought forward because there have been no new staff at The Gables to demonstrate compliance. Timescale for action 31/05/07 2. YA34 17 Sch 4 19 Sch 2 31/05/07 3. YA35 YA42 13, 18 Staff must have the training they 30/06/07 need to protect people living at the home, and for their own protection. This requirement has exceeded agreed timescales for action since the inspection on 31/10/06. The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 27 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 YA6 YA7 Good Practice Recommendations Care plans should be reviewed at least every six months to identify people’s changing needs. Any infringement of individual rights should be documented to show that the decision has been carefully considered in the interests of the person concerned. People living at The Gables should have a say about matters that significantly affect their lives. People living at the home should have activity plans that address their diversity and lead to their personal development and fulfilment. Professional advice should be sought about the menus to ensure that people are receiving a balanced diet. A record of staff authorised to administer medication and their sample signatures should be kept with the medication administration records for reference so that it is easy to identify those responsible, if there is a query. The home should also maintain a list of each person’s current medication so that medication being ordered / received into the home can be checked against it and mistakes avoided. People providing care and support should have periodic, safeguarding adults training to protect people living at the home from abuse. People living at The Gables should have a say about matters that significantly affect their lives. Records of training should provide some evidence of the skills and competencies achieved so that everyone can be sure that staff are suitably prepared and qualified to support people living at The Gables. Risk assessments should be reviewed and updated at least annually to protect residents and staff. 2. 3. 4. 5. YA7YA16 YA39 YA14 YA17 YA20 6. 7. YA23 YA28 YA16 YA7 YA39 YA35 8. 9. YA42 The Gables DS0000028587.V337304.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000028587.V337304.R02.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!