Inspection on 21/11/05 for The Gables

This inspection was carried out on 21st November 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gables 14/03/08

The Gables 01/09/06

The Gables 03/05/06

The Gables 01/03/05

The Gables 04/10/04

The Gables 16/03/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 The Gables 11 Heathside Road Withington Manchester M20 4XW Lead Inspector Steve O`Connor Unannounced Inspection 21st November 2005 12:30 The Gables DS0000021616.V267566.R01.S.doc Version 5.0 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 DS0000021616.V267566.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000021616.V267566.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Gables Address 11 Heathside Road Withington Manchester M20 4XW 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) Mrs Teresa Williams Ms Christine Davies Care Home 9 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (2) of places The Gables DS0000021616.V267566.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home provides care for a maximum of 9 service users requiring care by reason of learning disability. Two named service users are aged 65 or over. Should these service users leave the home, the places will revert to the service user category LD. The home must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 6th June 2005 Date of last inspection Brief Description of the Service: The Gables is a registered care home providing 24-hour accommodation and support for nine adults with a learning disability. The home is situated close to the centre of Withington and is in keeping with the surrounding area and comprises two semi-detached houses converted into one. The accommodation is arranged on two floors. The furnishings and fittings of the home are domestic in style. The Gables aims to create a supportive environment, which enables service users to maximise their independent living skills. The home has long established links with the local community and good working relationships with the local health and social services. The proprietor employs a full time manager who oversees the day-to-day running of The Gables. The Gables DS0000021616.V267566.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 21st November 2005. During the inspection time was spent talking with staff on duty and the registered manager. In addition people’s files, records and other relevant documentation were examined. As this inspection only looked at a limited number of standards the report should be read together with the previous and any future reports to gain a full picture of how the home is meeting the needs of the people living there. At the last inspection the home needed to work on several areas to make sure it met the National Minimum Standards (NMS). Most of these matters had been completed. However, several areas of work had not been completed to the required standards. A number of these actions have been raised in several previous inspection reports. Further action may have to be taken if the home does not complete the work required within the timescales set by the CSCI. These issues will be taken up with the owner of the home. What the service does well: What has improved since the last inspection? What they could do better: The last inspection report highlighted that the manager needed much more time and resources to be able to concentrate on managing the home rather than the day-to-day support of people. Although the manager has managed to work on a number of the areas identified in the last report, which is an improvement, there are still actions that remain outstanding. In addition, the manager is still carrying out shift work. This problem was also raised in the The Gables DS0000021616.V267566.R01.S.doc Version 5.0 Page 6 March and June 2005 reports but very little seems to have been done to change things. An issue that has been raised since the inspection of March 2005 was the need for an increase in the support hour’s staff provide to support people. Some people’s personal care support needs had increased since the last inspection and all nine people living at the home need a lot of support in different ways. For some, it’s practical and physical support and for others it is emotional and behavioural support. Having two staff on duty during the mornings, evenings, on some midweek days and weekends to support all nine people means that there is very little opportunity for spending quality time with each person. Where possible extra cover had been provided in the mornings but this was mostly by the deputy manager and manager herself. The home has not adequately addressed this ongoing problem and, as highlighted above, has had an impact on the ability of the manager to address some of the work that is required to meet the required standards. The inspection report from October 2004 and again in March and June 2005 identified the need for, and plans of the home to introduce a new care planning process and format based on ‘Person Centred Planning’ (PCP) as put forward by the Government’s White Paper ‘Valuing People’. New care plans had been developed but these were of a poor standard and had no reference to PCP. 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 DS0000021616.V267566.R01.S.doc Version 5.0 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 DS0000021616.V267566.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were assessed during the previous inspection. The Gables DS0000021616.V267566.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 The home’s systems and practices for care planning, risk assessment and recording did not fully reflect people’s changing needs and goals. EVIDENCE: The care plans still only provide basic details of people’s personal care and health needs and do not accurately reflect people’s holistic goals or the full range of support provided. There was some evidence of in-house reviews that looked at issues even though some goals were not identified in people’s care plans. This requirement was reiterated for the third report running. The previous inspection report identified that the home needed to make sure that it had undertaken risk assessments and support guidance that cover issues such as restrictions of choice and decision making, hazards associated with managing people’s finances and medication and relating to risks from people’s behaviour that may be challenging. Whilst the home had undertaken a range of risk assessments in connection with certain known risks and behaviours there was no overall link between a person’s assessed needs, fully identifying those needs, undertaking risk assessments and developing a person centred care plan. The Gables DS0000021616.V267566.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 The home provides people with balanced meals and was aware of people’s nutritional needs. EVIDENCE: The home had a good supply of fresh food and other food stores. People were involved in the choice of menus and were offered a range of meals. Mealtimes were usually part of the normal home routine but could be flexible depending on what activities people were involved with. A previous requirement was for the home to clearly record the opportunities for activities that people are offered and participate in. A record was being maintained. However, some activities that people took part in had stopped and the home was trying to find new opportunities. The Gables DS0000021616.V267566.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 The home’s medication administration policies, procedures and systems do not sufficiently protect people. EVIDENCE: The medication administration system was assessed. MAR sheets were found to have signatures missing for the administering of medication. This was also found at the previous inspection and the requirement was reiterated. There was some medication prescribed ‘as required’ (PRN). This medication did not have any written administering guidance. The home were currently undertaking a medication distance learning course on the safe handling of medication. The Gables DS0000021616.V267566.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were assessed at the previous inspection. The Gables DS0000021616.V267566.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were assessed at the previous inspection. The Gables DS0000021616.V267566.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 and 34 The staff are generally competent to support people’s needs. However, the home’s recruitment procedures have not reflected changes in adult protection policy and the staff team is insufficient to fully meet people’s needs. EVIDENCE: The deputy manager has achieved the NVQ level 4 and the support workers are all currently undertaking the NVQ level 2. The support staff are all parttime workers and many are in full/part time education. The manager stated that this makes undertaking training and qualifications within the part-time hours very difficult to achieve. Staff have undertaken a variety of care training such as food hygiene, first aid, epilepsy and learning disability awareness. The deputy manager is also now qualified to carry out moving and handling of people assessments and care plans. It is recommended that 50 of care staff should achieve a minimum of NVQ level 2 in care by the end of 2005. The previous inspection report required the home to review the job description. This has been actioned. The Gables DS0000021616.V267566.R01.S.doc Version 5.0 Page 15 The previous report also required that the home ensure that there is sufficient staff to meet people’s needs. The personal care of some people had increased due to either health or behavioural reasons. This meant that the manager had to try to rota extra staff on during the mornings to cope with the additional demands. However, due to all the support workers being on part-time hours this had resulted in either the manager or deputy manager having to cover these shifts. The home’s support hours were from 9am to 9pm with a waking and sleep-in staff on duty between those hours. This meant that the home only provided 176 of support. The minimum staffing levels set by the previous inspection authority was for a minimum of 210 hours of support. The staff rota seen also showed that there was no additional staff for those busy mornings or the days when all nine people were in the house. This is an issue that has been raised with the home in the inspection report of March 2005 and has still not been adequately addressed. The last inspection report required the home to look at certain areas of the recruitment process. Staff files now contained the documentation and information required and a new umbrella body had been found to process Criminal Record Bureau applications. The need to update the Disciplinary and Grievance Policy and procedure had not been addressed and was reiterated. Staff were now receiving more regular supervision as required from the previous inspection report. The Gables DS0000021616.V267566.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The home has the health and safety practices in place to maintain people’s safety. The home’s management policy means that people do not fully benefit from a well run home and have no formal systems for monitoring the quality of the service based on people’s views. EVIDENCE: At the last inspection in June 2005 it was recognised that due to the level of day-to-day work and recent staffing difficulties the manager did not have sufficient time and resources to be able to address the majority of the requirements. Since then the manager has worked on addressing a number of requirements. However, a number of important areas have not yet been addressed which the manager explained was due to the need to meet increases in some people’s personal care needs and challenging behaviour. This issue links with the home failing to address the requirement that the home must ensure that there was sufficient staff to meet people’s needs. The requirement was reiterated for the second time. The Gables DS0000021616.V267566.R01.S.doc Version 5.0 Page 17 The manager explained that they were not able to carry out any quality assurance work due to the day-to-day demands of supporting people’s needs. Usually the manager would seek the views of people, family and other relevant people through a questionnaire. People still have house meetings every few months to talk about issues that affect the home. The home must develop a quality assurance system based on standard 39 of the national Minimum Standards and provide the CSCI with details of the proposed system. The manager has not enrolled to undertake the required registered Managers Award. The manager must clarify with the CSCI the timescales for them to complete the required qualification. The home had developed the systems needed under the COSHH and RIDDOR regulations. Fire checks were being undertaken and a fire risk assessment had been completed. All gas, electric and fire equipment had an up-to-date service. The Gables DS0000021616.V267566.R01.S.doc Version 5.0 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 1 2 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Gables Score X X 2 X Standard No 37 38 39 40 41 42 43 Score 2 X 1 X X 3 X DS0000021616.V267566.R01.S.doc Version 5.0 Page 19 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement Timescale for action 31/12/05 2 YA9 13 3 YA7 13 4 YA20 13 Peoples care plans must contain all the information required by Regulation 15 and Schedule 3 of the Care Homes Regulations 2001 and be reviewed at least every six months. (The timescale of 04.01.05, 04.06.05 and 01.09.05 was not met). A plan of action must be submitted to the CSCI within the timescales stated. All restrictions of choice, decision 31/12/05 making, risk assessments and support must be reflected in each person’s care plan. A plan of action must be submitted to the CSCI within the timescales stated. All restrictions of choice, decision 31/12/05 making, risk assessments and support must be reflected in each person’s care plan. A plan of action must be submitted to the CSCI within the timescales stated. All medication administered must 31/12/05 be signed as a record on the MAR sheets. A plan of action must be submitted to the CSCI within the timescales stated. DS0000021616.V267566.R01.S.doc Version 5.0 The Gables Page 20 5 YA20 13 6 YA33 18 7 YA34 19 8 YA37 12 9 YA37 9 10 YA39 24 Medication prescribed ‘as required’ (PRN) must have written administering guidance. A plan of action must be submitted to the CSCI within the timescales stated. Sufficient staff must be provided to fully meet all service users needs at all times. (The timescale of 04.06.05 and 01.07.05 was not met). A plan of action must be submitted to the CSCI within the timescales stated. The recruitment and disciplinary policies and procedures must be updated to include the implementation of the POVA scheme. The timescale of 04.06.05 and 01.09.05 was not met). A plan of action must be submitted to the CSCI within the timescales stated. The manager must be provided with sufficient time and resources to be able to undertake the work required for the operational management of the service. (The timescale of 04.06.05 and 01.07.05 was not met). A plan of action must be submitted to the CSCI within the timescales stated. The manager must clarify with the CSCI the timescales for them to complete the required qualification. A plan of action must be submitted to the CSCI within the timescales stated. The home must develop a quality assurance system based on standard 39 of the national Minimum Standards and provide the CSCI with details of the proposed system. A plan of action must be submitted to the CSCI within the timescales stated. DS0000021616.V267566.R01.S.doc 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 The Gables Version 5.0 Page 21 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 YA32 Good Practice Recommendations It is recommended that 50 of care staff should achieve a minimum of NVQ level 2 in care by the end of 2005. The Gables DS0000021616.V267566.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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