Inspection on 23/08/06 for The Gables

This inspection was carried out on 23rd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Gables 22/08/07

The Gables 08/02/06

The Gables 30/08/05

The Gables 17/11/04

The Gables 14/07/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE The Gables Highfield Road Middlesbrough TS4 2PE Lead Inspector Derek Stow Key Unannounced Inspection 23rd August 2006 3:00 X10015.doc Version 1.40 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 DS0000000122.V308803.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address Highfield Road Middlesbrough TS4 2PE 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) 01642 515345 01642 515346 T L Care Ltd Mrs Carol Marie Singleton Care Home 64 Category(ies) of Dementia (32), Old age, not falling within any registration, with number other category (32) of places The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2006 Brief Description of the Service: The Gables is a 64-bedded care home, which is a two-storey purpose built property. The Gables provides personal care for older people and also for older people with dementia. The care is provided within four dedicated units on both floors within the home. All 64 bedrooms are single rooms with ensuite facilities. It has an enclosed garden to the rear of the home. The home has been operating since September 1999 and is operated by TL Care Ltd who operate a further four care homes within the Tees Valley area. The Gables is situated near to Middlesbrough Town Centre with close access to public transport, shops and a public house/hotel. Cost of service at The Gables On the date of this inspection the standard fee for care at The Gables was £338 per week. The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection at The Gables was unannounced and took sixteen and a half hours spread over three visits with the inspector examining a number of records; speaking to six residents, three relatives, the manager, four members of the Care staff and the cook. A tour of the building was carried out with the manager and requirements identified at the last inspection were re-visited. This inspection looked at only those standards, which the Commission for Social Care Inspection regard as Key standards. The details of any issues identified as requiring action together with recommendations for improvement are to be found at the back of this report. What the service does well: What has improved since the last inspection? The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 6 The majority of issues identified at the last inspection have been addressed including improvements to care planning, ventilation in the smoking room and re-placing some of the carpets. In addition the new Manager continues to build a strong staff team with over 70 of staff having NVQ Level 2 or above. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome group of standards is “good”. This judgment has been made from evidence gathered both during and before the visit to this service. Service users have their needs assessed before moving in to “The Gables”. Intermediate Care is not provided at The Gables. EVIDENCE: Four residents files were examined during the inspection. The information gathered during pre-admission assessment had improved in quality following a requirement from the previous inspection and good personal history information had been collected. The manager said that this improvement has been achieved by ensuring that both she and the relevant unit manager visit any prospective residents prior to admission. The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 9 This information provides the important basis for care planning not only in helping to ensure health and personal care needs are met but also social needs such as hobbies, leisure, and religious needs. Strengthening the personal profile to include more focus on these aspects will go towards building a useful Social Care plan. The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is “adequate”. This judgment has been made from evidence gathered both during and before the visit to this service. All residents have a plan of care, which sets out their personal and health needs, however care plans should be strengthened to include clear statements covering social, leisure and religious needs. Appropriate policies and procedures are in place for dealing with medication. Residents at “The Gables” enjoy the privacy of their own rooms whenever they wish and feel treated with dignity and respect. EVIDENCE: The four files examined all had photographs of residents in place together with a named key worker and the resident had signed Care Plans. There was clear evidence of residents’ weight being taken as part of a nutritional assessment and where bedrails were used risk assessments were in place supported by an Occupational Therapist. The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 11 The development of a clear social care Plan would strengthen this area of service and help to ensure that residents were encouraged to take up or maintain relevant hobbies, interests and social/religious outings etc. Not all records of weights and monthly reviews were up to date. In discussion with the manager it was noted that a few residents need particular encouragement in maintaining their hygiene needs and in this regard clear records should be kept together with close monitoring and review. Appropriate policies and procedures were in place regarding the giving of medicines and various medicines were checked and found to be satisfactory during the inspection. 10 survey forms had been sent to the Commission for Social Care Inspection prior to this inspection and all 10 expressed overall satisfaction with the care service provided at The Gables. One resident wrote, “ The staff are very caring and listen to everything I have to say”. All the residents spoken with during the inspection said that they had freedom, privacy and felt that they were treated with dignity and respect. The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome group of standards is ”good”. This judgment has been made from evidence gathered both during and before the visit to this service. Residents on the whole find life at The Gables satisfactory. There are activities organised 5 days a week and there is open visiting for friends and relatives. A wholesome and balanced diet is provided. EVIDENCE: Opportunities for engaging in activities within and outside of the home has recently been given a boost at The Gables with the appointment of a full-time Activity Organiser in June 2006 and residents spoke positively about his contribution to their lives. This will be further strengthened by developing an individual Social Care Plan building on the information gathered at initial assessment and subject to key worker, six monthly and annual review. A clearly written programme of activities was posted around the units. The six residents spoken with during the inspection spoke of enjoying the freedom and privacy of their own en-suite rooms with one lady saying that she enjoys painting in her room and another saying how she enjoys feeding the birds in the garden. The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 13 Relatives and friends were seen to be visiting freely throughout the day. Residents and staff spoke positively about the quality of food and choices available although in discussion with the Manager it was felt that the Sunday buffet should be reviewed as well as sandwiches at teatime. One resident said, “there is always someone to talk to, I could not wish for a better place to live”. The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome group of standards is “good”. This judgment has been made from evidence gathered both during and before the visit to this service. Residents and relatives are confident that their views and concerns are listened to and acted upon by staff and managers at The Gables and residents are protected. EVIDENCE: A satisfactory complaints procedure is in operation at The Gables and the 4 formal complaints received within the past year were dealt with appropriately by the manager. The policy and procedure should now be updated to make it clear to residents and relatives that the responsibility to receive, resolve and investigate complaints is with the management of the Home and those agencies such as Social Services and Primary Care who contract or commission services on behalf of individual residents. The Commission for Social Care Inspection is not a complaints investigation body and will no longer be involved in the complaints process. However residents, relatives and members of the public can still report any concerns about the running of a particular service to the Commission who will consider the issues and whether the service is meeting the required regulations. The protection of vulnerable adults policy and procedure is in place and Staff spoken with during the inspection all knew what to do if they suspected abuse of residents. The Manager said that staff training in the protection of vulnerable adults is on going for all new staff. The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is “adequate”. This judgment has been made from evidence gathered both during and before the visit to this service. The Gables is generally well maintained, comfortable and in good decorative condition, however various issues identified below should be addressed. The home is generally clean, pleasant, and hygienic. EVIDENCE: The Gables is split in to four units which provides for smaller group living and each has their own small Kitchenette which allows for resident/relatives to independently prepare beverages and smacks. A tour of the home took place, which confirmed that all the bedrooms examined were, well furnished, decorated and personalised with residents’ own possessions. The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 16 However one bedroom had been fitted with curtains which needed cleaning, (the manager explained that this was a mistake by staff); one bathroom needed some remedial work carried out on the tile grouting; one shower needed some remedial work and another shower had unsightly white stains on the blue shower floor. The above issues detracted from the rest of the Home, which is very pleasant and well maintained. All of the residents spoken with were very happy with their own bedrooms with en-suite facilities and no unpleasant odours were apparent. The main kitchen is completely enclosed with no external windows and without air-conditioning. Although currently there is no maximum temperature for staff working conditions the manager will want to consider future legislation and guidance and the reasonable comfort of working staff. The Health and Safety Audit of June 2006 identified various issues which had already been addressed together with requiring that the unsuitable window restrictors must be replaced. The Manager advised that replacements are planned to be fitted in September 06. The report of the Fire officer in March 2006 identified that residents whose bedroom doors are open at night pose a risk to the spread of smoke in the event of fire and be detrimental to safe evacuation. The advice of the fire officer must be followed: however issues should also be considered at individual reviews of residents to determine if an individual resident has an assessed need which should be met in discussion with Commissioning Authorities and the Service Provider. The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome group of standards is “good”. This judgment has been made from evidence gathered both during and before the visit to this service. Residents’ are supported by sufficient numbers of trained staff and they are protected by safe recruitment polices and practice. EVIDENCE: Three staff files were examined during the inspection and all held evidence of identity, Criminal Record Bureau checks as well as 2 references. The Manager stated that no staff start employment without full clearance from the Criminal Record Bureau. The manager said that a full training matrix has been developed and this informs the home when statutory training for individual members of staff needs to be up-dated. A training and supervision record was seen to be in place on staff files and the manager is working hard to increase the frequency of supervision to the recommended 6 times per year for each staff. The manager has worked hard to achieve over 70 NVQ trained staff and a stable staff team with the use of few agency staff. The Manager said that she plans to prioritise training in Dementia Care for those staff working with people with dementia together with ensuring that Induction training for new staff complies with “Skills for Care “ requirements by the end of September 2006. Four Care Staff spoken with during the inspection and all confirmed that they received regular training opportunities and that formal supervision was taking place. The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is “adequate”. This judgment has been made from evidence gathered both during and before the visit to this service. A competent experienced Manager runs The Gables in the best interests of the residents and several quality assurance systems are in place although the results of resident surveys are not yet published. Appropriate procedures are in place to safeguard money held on behalf of residents. Care staff receive formal supervision but not yet 6 x per year. The health, safety and welfare of residents and staff is promoted and protected. The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 19 EVIDENCE: The manager of the Gables has many years experience in the care of older people and is due to complete the Registered managers award in 2007. There are a number of quality assurance systems in place based on seeking the views of residents including reviews, resident meetings, surveys and regulation 26 visits by another manager. However, residents meetings should be held more regularly and the results of quality surveys should be published to meet the standard set out in National Minimum Standard 33.4. The manager is working to achieve formal supervision for staff at least six times a year. A number of health and safety documents and records were examined at the inspection including the accident book, the gas safety certificate, hot water temperatures and various other records. These were all found to be up to date. A check of residents’ finances and records showed the any monies kept on behalf of residents is in safe hands. The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 2 x 3 The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Work must continue in developing a Social care plan and must include lifestyle and preferences including focus on social, leisure and religious needs. Records relating to residents weight, hygiene, reviews and risk assessments must be accurate and up to date. The issues identified regarding the bathroom and shower rooms must be addressed. The registered manager must complete the registered managers course . The Quality Assurance systems must be strengthened including regular resident meetings and resident /relative surveys should be carried out at least twice a year with the results being published The health and safety issues required by the Fire officer must be addressed Timescale for action 31/12/06 1. OP7 14 2. OP7 17(1) schedule 3. 13 9 30/09/06 3 4 OP19 OP31 31/12/06 31/07/07 5. OP33 24 31/12/06 6 OP38 13 30/09/06 The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. OP16 Refer to Standard OP7 OP15 Good Practice Recommendations It is good practice to involve relatives in agreeing risk assessment and to gain their signature. The manager should review the issues identified around the Sunday buffet and sandwiches at teatime with residents and staff. The complaints procedure should be up dated to exclude the Commission for social care Inspection but inform residents/relatives of the role and contact details of the relevant Social Services and Primary Care Trusts who commission/contract for services. It may also be helpful to include this information on individual resident contracts. The manager should review the working comfort of the kitchen staff. A matrix of all maintenance and health and safety requirements would support and ensure compliance. 4. 5 OP19 OP38 The Gables DS0000000122.V308803.R02.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX 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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