Inspection on 19/12/07 for The Gables

This inspection was carried out on 19th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gables 15/12/08

The Gables 09/01/07

The Gables 05/09/05

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

CARE HOME ADULTS 18-65 The Gables 22 Beacon Close Crowborough East Sussex TN6 1DX Lead Inspector Caroline Johnson Key Unannounced Inspection 19th December 2007 10:35 The Gables DS0000063870.V350881.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 DS0000063870.V350881.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 DS0000063870.V350881.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address 22 Beacon Close Crowborough East Sussex TN6 1DX 01892 655260 01892 660154 pete.langley@yahoo.co.uk www.eastsussex.gov.uk/socialcare East Sussex County Council 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) Peter Langley Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5) of places The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The maximum number of service users to be accommodated is five (5). The home provides placement for three service users aged between eighteen (18) and sixty-five (65) years. The home provides placement for two (2) named service users who are over sixty-five (65) years of age. Service users must be aged between thirty (30) and sixty-five (65) years on admission. Service users with a learning disability only to be accommodated. Date of last inspection 9th January 2007 Brief Description of the Service: The Gables was established in 1991 and is registered to provide residential care for up to five younger adults who have a learning disability. Currently all residents are over the age of 45 years. The home provides long term placements with day care provision provided in the main by the home. The building is owned and maintained by Kelsey Housing Association with the services and staffing supplied by East Sussex County Council Social Services Department. East Sussex County Council Social Services also operate nine further services in the local area in this way. There are close links between the Gables and some of the other homes in the group. The home is a large bungalow situated in a small residential cul-de-sac. The home has a large vehicle, and public transport links are available from the town centre, a short walk away. Residents’ accommodation is provided in five single rooms with one providing ensuite facilities. Communal space consists of a large combined lounge dining room overlooking a garden and patio. There are a number of individual aids and adaptations to the building to assist in the mobility of one resident. The homes literature states that it aims to provide residential service and care support for adults with learning disabilities promoting independence and enabling access to community facilities. Residents’ contributions towards the fees are currently £62.35 to £94.45 per week, depending on the services and facilities provided. Extras such as: hairdressing, chiropody, transport, toiletries are at an additional cost. The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 5 The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Home’s Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at the Gables will be referred to as ‘residents’. As part of the inspection process a site visit was carried out on 19 December 2007 and the visit lasted from 10.35am until 5.20pm. During the visit there was an opportunity to meet with the manager and two care staff. In addition time was spent in private with two of the residents and with all the residents in the dining room during the evening meal. A full tour of the building was undertaken. A wide range of paperwork was examined including two care plans. In addition record keeping was seen in relation to staff training, quality assurance, staff meeting minutes, health and safety, maintenance and medication. In advance of the inspection user survey cards and comment cards were sent to the home for distribution to residents, relatives and visiting professionals. Only one relative comment card was returned and the comment expressed was ‘We have every confidence in the gables staff. All members of our family are always welcome any time. We consider them all as friends and can confide in them knowing we will always get sensible and true comments’. The home also completed an AQAA (annual quality assurance assessment) and information from that document is also used as evidence in this report. What the service does well: There is a stable staff team with most of the staff having worked in the home for a number of years. Staff feel well supported and described the manager as ‘very approachable’. The home is well decorated and generally well maintained to a good standard. Bedrooms are homely and they have been personalised by the individual residents and reflect their individual tastes and interests. The majority of the residents attend a variety of activities through the week and make use of their local community. Staff were seen to encourage residents to make food choices and all interactions observed between staff and residents were courteous and respectful. The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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 summary of this inspection report can be made available in other formats on request. The Gables DS0000063870.V350881.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 DS0000063870.V350881.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. 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. The home’s admission procedure was not followed and as a result left a prospective resident and other residents in a potentially vulnerable situation. Clarification is required to ensure that the information provided to prospective residents and/or their representatives is detailed. EVIDENCE: There is a combined statement of purpose and service user guide. In addition a Licence agreement is available to inform residents and their representatives of their rights and responsibilities whilst staying at the home. This contract is made in conjunction with the East Sussex County Council and Kelsey Housing Association and is in a pictorial format for ease of understanding. A requirement was made at the last inspection that the statement of purpose should be updated and that the terms and conditions of residence should be agreed with each resident and/or their representative and a copy maintained in the home. In both the statement of purpose and in the Licence agreement there is reference to a separate terms and conditions of residence but it was not clear if there is a separate document or if the licence agreement serves as a terms The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 10 and conditions of residence. This needs to be clarified. There is no reference in either document to insurance arrangements or to the discharge process. It was reported that staff have discussed the licence agreement with each resident and that this would have been documented in the daily log. However, it would not have been possible to determine when this was done. There is currently no space on the form to provide a signature or date. As required at the last inspection the cost of each resident’s fees are included in the statement of purpose and additional activities are highlighted but the cost of each activity is not specified, as this will vary depending on the activities chosen by residents. There has been one new admission to the home since the last inspection. Records showed that a social care assessment was carried out in August 2007 and that a series of visits were planned to ascertain more information. Staff from the resident’s previous placement visited the home and identified a number of environmental adaptations that needed to be made prior to the move. Arrangements were being made for this to happen. It is recorded that the Resource Officer requested that the move not be rushed as some concerns had been identified and needed to be resolved. However, the following day an instruction was issued from senior management that the resident should move in within a week. It was reported that the manager and his line manager had no say in the matter. The transfer was considered necessary due to increased concerns regarding this resident’s mobility in their former placement. As a result the detailed transition plan written by the previous placement could not be followed. The resident did visit the home and have an overnight stay but this was after the decision for moving had been taken. The home was therefore unable to follow their admission procedures to ensure that the prospective resident was given the best opportunity to succeed in their new placement and that compatibility with other residents was achieved. Information was provided by the previous placement also run by ESCC, however some of the guidance was not accurate and further information had to be obtained. The environmental adaptations recommended have been made. Reviews have been held and further reviews are planned due to uncertainty of the appropriateness of the placement and additional problems encountered now that the resident’s mobility has improved. As there is no information in the licence agreement about discharge or periods of notice it was not clear what the resident’s rights are in this situation or equally what the home’s responsibilities are. The Gables DS0000063870.V350881.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. 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. The quality of care plans is good but further information is required to ensure that all the needs of the residents are met. EVIDENCE: Two care plans were examined in detail. In each file there is a detailed pen portrait advising about the resident’s previous history and information that is important to them. There is information about their routines and the people and places that are important to them and about how they communicate. Each care plan is reviewed annually and there is an interim review after six months. In the files seen risk assessments had been carried out and were up to date for one of the residents. There were some risk assessments in place regarding the resident’s mobility but very little reference to this resident’s visual impairment and how to minimise the risk of accidents/incidents occurring. In relation to the second plan there was information from a previous placement that was being gradually updated. All work carried out to date was The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 12 of a good standard but all areas should now be up to date to avoid any confusion. Residents were seen to make decisions over the course of the day such as choosing the food they ate. In addition one resident who is unable to verbally make his needs known is able to lead staff to where he wants to go. Staff reported that residents also decide what colour scheme they want their room when it is decorated. Individual goals are set at reviews and progress is reviewed periodically. Goals identified are generally what the residents have decided they would like to do, for example for one residents it involves having a boat trip and for another attending the theatre and cycling regularly. In the plans seen there were no goals in place that involved the development of new skills. It was not clear if this is due to the age range of the majority of the residents or if this is down to individual choice. The Gables DS0000063870.V350881.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The majority of the residents have a varied and interesting programme of activities throughout the week that reflect their individual choices and wishes. Arrangements must be made to ensure that all residents have equal opportunities in this area. EVIDENCE: Some of the residents have structured activities each week such as bowling and sensory. One resident goes to a day centre one day a week and staff support him to attend line dancing via this day centre. Residents also enjoy regular trips to cafes and shops. Some of the residents also enjoy theatre outings. At the time of inspection two of the residents were taken out for the morning. Staff advised that where possible at least two residents have an outing each morning. A record is made if activities have to be cancelled or if they are declined. Annual holidays are no longer provided but the residents have one-to-one days out instead. One resident advised that he likes to go to The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 14 Church every Sunday. A second resident used to go but has recently chosen to opt out. Staff spoken with stated that they felt that they were not meeting the needs of one resident who used to go out regularly but since moving into the home, due to improvements in his mobility and an increase in the the level of support required, they are not able to take him out as regularly as he was used to and the number of activities he is involved in has significantly reduced. They have however, set up a weekly walk to one of their sister homes where this resident has tea and visits with the residents there. All visits from family members and friends are recorded. Staff advised that where appropriate they assist residents to maintain contact with their families by writing cards and making phone calls. A resident spoken with stated that he loves listening to music in his room. It was noted that at mealtime one resident ate his meal at the hatch by the kitchen, three residents ate at the dining table and the fifth resident ate when everyone else was finished. Staff served the residents but did not sit with them. This seemed a missed opportunity in encouraging social interaction. One of the residents was very clear in making a choice about what he wanted for his dessert and another resident choose to have a sherry with his dinner. The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is thorough in ensuring that the healthcare needs of the residents are met. EVIDENCE: Staff were seen to treat residents with respect and dignity, they were courteous and there was a very relaxed atmosphere in the house. Two good practice recommendations were made at the time of the last inspection. They included that hand written medication administration records be checked and countersigned for accuracy by a second member of staff and that a policy be in place on the use of homely remedies or over the counter medication and an approved list of such medication be available. Records showed that medication is checked in but not countersigned. It was reported that the home chooses not to use homely remedies or over the counter medication so therefore there is no need to have a list of approved medicines. It was noted that medication that had been prescribed had then been bought over the counter rather than obtained with other medications. Although the home does not use homely remedies there is a policy in place covering this subject. The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 16 The arrangements in place for the storage of medication were satisfactory. There were some creams in the cupboard that needed to be returned to the local pharmacy. Record keeping was in order. One member of staff completed a refresher course on the management of medications this year. All other staff last had training on the subject on 2005. In relation to the two care plans examined records showed that one resident’s weight was monitored regularly the second resident’s weight was last recorded in July 2007. Appointments are made for residents to receive chiropody and to attend opticians and dental appointments as necessary. A referral has been made to Speech and Language in respect of one resident and a dietician has provided advice and support for another resident. The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are good procedures in place to ensure that any complaints made are dealt with appropriately. Further measures need to be taken to safeguard the risk of harm or abuse by ensuring that staff receive training on the subject. EVIDENCE: There is a detailed complaints procedure in place. In addition there is a simplified version of the complaints procedure in the statement of purpose. It was reported that there have been no complaints since the last inspection. No complaints have been made to the Commission about this service. A requirement was made that the last inspection that staff receive training on adult protection and prevention of abuse. The manager advised that he had received updated training in the past year but the staff team have yet to receive training. Two adult protection alerts have been made since the last inspection of the home. A strategy meeting was held and the minutes were available. It was noted in the minutes of the meeting that the Community Nurse had not been informed of the transfer of a resident from one service to another and had she known she would have visited to provide information regarding their healthcare needs. The Gables DS0000063870.V350881.R01.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well maintained, clean and decorated to a good standard. Residents have specialist equipment and where necessary adaptations have been made to the environment to assist in promoting each resident’s independence. EVIDENCE: Communal areas consist of a large lounge/dining room. There is a garden area that surrounds the premises, which has a patio area and a flowerbed. Staff advised that the residents make use of this area in the summer months. Bedrooms are well decorated, homely, and have been individually personalised by the residents with the support of their keyworkers. Since the last inspection of the home the exterior of the property has been repainted. In addition a new sofa has been purchased. It was reported that The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 19 one of the residents had had problems getting in/out of the previous sofa so this resident was taken out to assist in purchasing the new sofa and to make sure it was right for him. There is a lack of storage space in the home and the manager advised that since the last inspection attempts have been made to improve in this area. One of the areas highlighted at the last inspection was the entrance porch. This area is now used to store two freezers. This is not in keeping with creating a homely environment. Along one of the corridors between bedrooms and the lounge/dining room there is space to hang coats and it was noted that area was also used to store the hoover and a wheelchair. As two of the residents have visual impairments this is not considered an ideal situation. The hoist is stored in the entrance hallway. The housing association has responsibility for the upkeep of the property. When work is identified as needing to be done this is recorded in the communication book and the Housing Association are contacted regarding the problem. The housing association then issue a worksheet advising of the projected timescale for completion of works. It was reported that generally the response time is quick but that if it involves sub contracting this can cause a delay. The home does not have a system to track easily the progress of work reported. The housing association carries out an annual inspection of the premises and provides a report to the Resource Officer. Verbal feedback is given to the manager. As required at the last inspection the home has yet to carry out a written plan of re-decoration and repair. There are sufficient numbers of toilets and bathing facilities located around the building. There is a range of specialist adaptations in the home, included an adapted bath, ceiling and mobile hoists and adapted beds where necessary to meet the needs of the individual residents. The doors in the kitchen have been adapted as stable doors and staff advised that this has assisted greatly in monitoring residents’ safety. Leading on from the laundry area there is a ‘lean to’ that is currently used occasionally as an office. All areas of the home were observed to be clean with a high standard of hygiene maintained. The Gables DS0000063870.V350881.R01.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff feel well supported but emphasis needs to be placed on ensuring that all staff receive regular supervision and have regular opportunities to keep up to date with their mandatory training. EVIDENCE: Staff recruitment files are held at a separate address. A record is kept at the home of all the checks that have been carried out. The record for the newest member of staff was examined and this confirmed that all necessary checks had been carried out. There was a record that identification had been checked but no record of what type of identification was checked. The residents’ licence agreement advises that residents can be involved in the recruitment and induction process for new staff. However, it was reported that residents are currently not able to take part in the process. Three of the eight staff currently possess NVQ level two or above. In addition one staff member is currently working towards this qualification and another two staff are on a waiting list to commence studying. The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 21 In relation to mandatory training four staff need to attend a refresher course in food hygiene. It is over two years since staff received training on moving and handling and first aid is due to be renewed in 2008. It was reported that all staff received training on fire safety a year ago and that one staff member is going on a fire officer training course in the near future and training will then be cascaded to all staff. Training had been arranged on infection control but was cancelled so needs to be rebooked. The manager confirmed that he has up to date training on the subject. In addition to mandatory training two staff attended training on bereavement and loss, one did a course on emergency evacuation from vehicles, two staff did a course on mental health awareness and two did a course on understanding mental health and learning disabilities. One member of staff completed a course on epilepsy and the manager confirmed that all other staff have completed a course on this subject. In addition a Speech and Language therapist has held workshops on communication for staff. None of the staff team have completed a course on working with people who have a visual impairment although most of the staff team have worked at the home a long time and know the residents well. In relation to staff supervisions, records showed that half of the staff team received regular supervision throughout the year and that half had not received formal supervision as regular. It was reported that some of the oneto-one sessions were not recorded as supervisions but that they occurred regularly. The manager’s last two supervisions were in July and December 2007. The home has recently introduced a new induction package, which complies with the Common Induction Standards. However, as they have not recruited anyone new for some time they have yet to use the document. The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements should be made to how the home seeks information from residents and other interested parties so that the home can continually review and improve upon the service it offers. Visits from the Responsible Individual or a representative on his behalf must be unannounced in order to get a clear picture of the running of the home. Arrangements must be made to improve storage and to consider safety and potential risk of accidents/incidents in the hallway and corridors. EVIDENCE: The manager has completed the Registered Manager’s Award. It is his intention to complete NVQ level four in the future. Staff meetings are held on The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 23 a monthly basis and staff spoken with stated that they find them useful. Staff spoken with stated that they feel supported, one staff member stated that all the staff get on well and all the senior staff are approachable. The manager confirmed that monthly visits are carried out whereby a person designated on behalf of the provider visits the home and writes a report of their findings. The last record available was dated March 2007. However, reports of the last two visits in September and October were e-mailed to the Commission on the afternoon of the inspection. It was also noted in the communication book that the monthly visits were announced rather than unannounced. As part of the home’s quality assurance system satisfaction questionnaires are distributed to the residents. It was reported that a pictorial questionnaire is sent to the home. Staff assist the residents to complete and they are returned to the local office. The answers were collated and the findings are sent to the home. However, the report of the findings showed pictures of smiling or sad faces with no indication of what the questions were or how much assistance the residents required to complete the questionnaire. It was confirmed that currently there are no relatives’ satisfaction questionnaires. The manager advised that a consultation process is currently underway with the relatives of the residents about future plans for the service and that relatives are fully involved in this process. The manager also confirmed that annual audits are carried out on health and safety, care plans and medication. In addition issues are picked up during the monthly visits to the home. As part of the inspection process user surveys were sent to the home for distribution to the residents and comment cards sent to the home for distribution to relatives. At the time of completion of this report one relative comment card was received. This was positive and a comment made included ‘ We have every confidence in the gables staff. All members of our family are always welcome any time. We consider them all as friends and can confide in them knowing we will always get sensible and true comments’. As part of health and safety the Council carried out an unannounced assessment of the premises in August 2007. It was reported that all recommendations made have been addressed. In addition the manager carries out a quarterly workplace report and any issues highlighted are reported to the housing association. Records were in place to show that portable appliances are tested annually, the boiler is serviced regularly and water temperatures are monitored. The manager confirmed that the hoist was serviced the day prior to the inspection and the paperwork relevant to this has gone to the housing association. A copy will be obtained and kept for the home file. The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 24 A requirement was made at the previous inspection that the entrance hall and corridors, currently used as storage areas, be risk assessed to ensure that these areas are safe for use. This has been partly met in that the porch area is now clear although as referred to previously in this report it is now used to house two freezers. The corridors are still used as a storage area and a written risk assessment must be carried out to determine the safety of this practice with particular reference to those residents who have sight impairments. The Gables DS0000063870.V350881.R01.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 3 2 2 3 3 4 3 5 2 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 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 X X 2 X The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 26 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 YA5 Regulation 5(1)(bb) & (bc) Requirement The Terms and Conditions of residence/licence agreement must be expanded to include additional information about insurance and about the discharge process including rights of both individual residents and the home’s responsibilities. All care plans must be up to date, showing detailed information about how needs are to be met. Service users individual risk assessments must be updated as soon as possible to reflect the current risks. An assessment must be carried out to determine the needs of one resident in relation to how they should spend their day and arrangements made for this to happen. Staff must undergo training in adult protection and a record of attendance must be maintained. [This was a requirement of the previous inspection timescale given was 30/04/07]. Timescale for action 29/02/08 2. YA6 15(1) 29/02/08 3. YA9 13(4)(c) 31/01/08 4. YA14 16(2n) 15/02/08 5. YA23 13(6) 29/02/08 The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 27 6. YA24 23(2)(d) That a plan of re-decoration and repair must be developed, which addresses the all areas redecoration and includes timescales for their completion. [This was a requirement of the previous inspection timescale given was 30/04/07]. At least one member of staff must receive training on working with people with a visual impairment and this training must then be cascaded to all staff. That staff are appropriately trained to undertake their roles. [This was a requirement of the previous inspection timescale given was 30/05/07 this includes training on the administration of medication, first aid, moving and handling, infection control and fire safety]. All staff must receive regular formal supervision. The monthly visits carried out by the Registered Individual or a designated person on his behalf must be unannounced. As part of the home’s quality assurance system the views of relatives and other stakeholders must be sought about the quality of the service provided. In relation to residents’ satisfaction questionnaires, a revised system must be found that will the seek views of the residents in such a way as to inform practice. That the entrance hall and corridors are risk assessed to ensure that these areas are safe for use. [This was a requirement of the previous inspection timescale 28/2/07 and has been partly met but a written assessment must be carried DS0000063870.V350881.R01.S.doc 15/02/08 7. YA35 18(1) 31/03/08 8. YA35 18(1) 31/03/08 9. 10. YA36 YA39 18(2) 26 31/01/08 31/01/08 11. YA39 24(1) 29/02/08 12. YA42 13(4)(c) 31/01/08 The Gables Version 5.2 Page 28 out]. 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 YA2 Good Practice Recommendations That the home provides a service users guide in a format that service users who are admitted to the home will be able to use. [This was a recommendation of the previous inspection]. Where appropriate care plans should include clearly identifiable goals that encouragement personal development. A system for tracking progress made with issues referred to the housing association should be in place. 2. 3. YA6 YA24 The Gables DS0000063870.V350881.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 DS0000063870.V350881.R01.S.doc Version 5.2 Page 30 - 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. 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