Inspection on 28/06/05 for The Gables

This inspection was carried out on 28th June 2005.

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 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 09/02/07

The Gables 20/01/06

The Gables 21/07/04

The Gables 05/03/04

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

CARE HOMES FOR OLDER PEOPLE THE GABLES 18 Broomfield Road Kidderminster Worcestershire DY11 5PB Lead Inspector Nic Andrews Announced 28 June 2005 - 9:10 a.m. The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Gables Address 18 Broomfield Road Kidderminster Worcestershire DY11 5PB 01562 745428 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Tom Gawtam Ramnial and Mrs Helena Maria Ramnial Mr Tom Gawtam Ramnial and Mrs Helena Maria Ramnial CRH 24 Dementia - over 65 Mental Disorder - over 65 Old age Physical disability - over 65 24 24 24 24 Category(ies) of DE(E) registration, with number MD(E) of places OP PD(E) THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The home may accommodate two named people who are over the age of 65 years who are or have been alcohol dependent. The home may also accommodate one named person who is under the age of 65 years and has a physical disability. Date of last inspection 27 January 2005 Brief Description of the Service: The Gables is a large, detached property situated in a pleasant residential area of Kidderminster, close to a bus route and other local amenities. The home is registered to provide residential care for a maximum of 24 older people who may also have a physical disability, dementia illness or other mental health needs. Twenty three service users were accommodated at the time of the inspection. The premises have been extended and adapted for their present use as a care home. The service users are accommodated on the ground and first floor of the building in 20 single bedrooms and 2 double bedrooms. A stair lift is provided to enable the service users to have easier access to the first floor. The current proprietors have been the joint registered providers since 1990. They also manage the home and thus have an active involvement in the day to day operations. Their own accommodation adjoins the care home and they feel that this enables them to maintain close links with both the service users and the staff. THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection that took place over five hours. The premises were inspected in part and some of the records maintained by the home were examined. Time was spent in discussion with the registered providers and discussions were also held with three members of staff, two service users and a relative of one of the service users. What the service does well: 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 GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 and 4 The home’s statement of purpose and service users’ guide contain relevant and detailed information and emphasise the rights of the service users. However, both documents must include additional information in order to ensure that service users and prospective service users are clear about the services the home provides to meet their needs. EVIDENCE: A copy of the home’s statement of purpose was made available for inspection. It was pleasing to note the emphasis that had been placed within the statement of purpose on the service users’ rights and on the principles that underpin good quality residential care. However, the statement of purpose did not include all of the matters listed in Schedule 1 of the Regulations. The registered providers are, therefore, required to review and revise the statement of purpose in order to ensure that the statement of purpose includes an appropriate reference to all of the issues listed in Schedule 1. A copy of the service users’ guide (referred to by the home as ‘An Overview of the Home’s Services’) was also made available for inspection. As with the home’s statement of purpose, it was pleasing to note the emphasis that was placed in the service users’ guide on the service users’ rights. The service users’ guide also contained relevant and detailed information about the home THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 8 and the services and facilities provided. However, the service users’ guide contained very little information about the professional experience of the registered providers or the staff. Additionally, the service users’ guide did not include a statement that a copy of the most recent inspection report was kept in the home available for perusal by service users and their relatives on request. The service users’ guide did not include the service users’ views of the home or information about how to contact the office of the local social services and health care authorities. The reference in the service users’ guide to the National Care Standards Commission (NCSC) was out of date and should be changed to the Commission for Social Care Inspection (CSCI). As with the statement of purpose, the registered providers are required to revise the service users’ guide in order to ensure that it includes all of the issues listed in Standard 1.2 and 1.3 of the National Minimum Standards (NMS) as referred to above. The registered providers confirmed that a copy of the home’s statement of terms and conditions of residence i.e. contract, had been issued to all of the current service users. It was also confirmed that all of the service users or their relatives had signed a copy of the statement of terms and conditions. A copy of the statement of terms and conditions of residence was made available for inspection. The contents of the statement of terms and conditions of residence were satisfactory. However, the document did not include any reference to the rooms to be occupied as indicated in Standard 2.2 of the NMS. The statement of terms and conditions of residence must be amended accordingly for future service users. The home received support from the local psychiatrist, community psychiatric nurse and district nursing service. It was confirmed that all of the service users were registered with a local GP. Six local GP practises were used by the home. The staff were also supported in their care of the service users by professionals from other agencies when necessary including physiotherapists, occupational therapists, the continence adviser and the infection control nurse. However, none of these services were currently involved in the care of the service users. It was confirmed that the care plan in respect of ten of the service users was based on their dementia needs. None of the service users with a dementia illness required support from outside the home apart from two service users who were visited by the community psychiatric nurse. The home provided a training package for all the staff as part of their induction to the home. The registered providers had made arrangements for all the staff to receive training in dementia care in October 2005. THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11 The service users are assured that at the time of their death, the staff will treat them and their family with care, sensitivity and respect. EVIDENCE: The registered providers described the care provided for a former service user with a terminal illness who died in the home. It was clear from the details provided that the home upheld all of the principles of care and good practice guidelines referred to in Standard 11 of the NMS. A copy of the home’s policy and procedure for handling dying and death was made available for inspection. The contents of the policy and procedure were clear and comprehensive. However, the policy and procedure should include the offer of the provision of bereavement counselling by trained professionals/specialist agency if required. In addition, the reference in the policy to the now former National Care Standards Commission (NCSC) should be changed to the Commission for Social Care Inspection (CSCI). THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 Service users are helped to exercise choice and control over their lives. EVIDENCE: The registered providers supported the principle that service users should handle their own financial affairs for as long as possible. However, the home did handle the personal allowances on behalf of twelve service users. The money was used for paying for hairdressing and for buying newspapers etc. The money was kept in individual packets in a safe. No advocates were currently involved in supporting any of the service users. However, the home’s policy on service users’ rights stated that the home would ensure that service users were enabled to have ‘access to people and services that help them to express and exercise whatever choices they can make’. The service users’ guide should include details i.e. the address and telephone number, of the local, independent advocacy service and Citizens’ Advice Bureau. The registered providers stated that prospective service users were encouraged to bring personal possessions with them when they were admitted to the home. It was also confirmed that access to the service users’ personal records was facilitated by the home. The service users’ guide stated that service users ‘may have access to their notes at any time to see what is actually being recorded’. The home’s policy on service users’ rights included a reference to the all of the above issues as stated in Standard 14.2, 14.3, 14.4 and 14.5 of the National Minimum Standards. THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Complaints are handled appropriately and service users are confident that their concerns will be listened to, taken seriously and acted upon. EVIDENCE: The home had a satisfactory complaints procedure. However, the complaints procedure still referred to the now former NCSC. The reference to the NCSC must be deleted and replaced with an appropriate reference to the CSCI. The home had a complaints book in which complaints made against the home could be recorded. Two complaints had been made against the home within the past year. The one complaint was of a minor nature and was dealt with by the home. The other complaint, made by the relative of a service user regarding the standard of care provided, was referred to the CSCI for investigation. The complaint was not upheld. The service users and the relative of one service user with whom discussions were held during the inspection expressed their confidence in the willingness and ability of the registered providers to resolve any concerns that might arise quickly and appropriately. THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 and 21 The indoor and outdoor communal facilities were both comfortable and accessible. However, minor improvements need to be made to the environment in order to ensure the safety of the service users. EVIDENCE: The home provided a dining room, a large lounge and a smaller lounge. None of the current service users smoked, therefore, all of the communal i.e. shared, space was ‘smoke-free’. Any new service users who smoked would be asked to smoke outside. The members of staff who smoked, were allowed to smoke outside. The shared space was clean and tidy. The furnishings were comfortable and appropriate. There was a large, fluorescent strip light on the ceiling in the main lounge that detracted from the homely character of the room. The registered providers said that, unfortunately, a strip light was the only way in which a satisfactory level of lighting in that part of the lounge could be provided. There was a very pleasant, well-maintained, enclosed rear garden with seating. Several service users were sitting outside under a gazebo enjoying the warm weather. However, the path outside the rear of the building at the perimeter of the garden did not have a handrail and this posed a possible risk to the safety of the service users. THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 13 The bathing and toilet facilities were adequate. On the ground floor there was a bathroom with a toilet and wash hand basin. The bath included a showerhead. There were also two other bathrooms both of which had a bath that contained a seat, a toilet and a wash hand basin. In addition, there were also three separate toilets and a walk-in shower. On the first floor there was a bathroom with a bath that contained a seat, a toilet and a wash hand basin. There were also three separate toilets with a wash hand basin. None of the bathrooms or toilets contained liquid soap and paper towel dispensers. There were no handrails in the corridors on the first floor and grab rails were not provided in all of the toilets. THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 28 The number and deployment of staff is sufficient to meet the needs of the service users. However, the standard of NVQ level 2 training should be improved. EVIDENCE: The home had a satisfactory level of staffing. A copy of the staff rota for one week was made available for inspection. The staff rota did not include the hours worked by the registered providers or show the position/designated role of each member of staff. The registered providers shared the responsibility for the day-to-day management of the home. In addition, an assistant manager was employed for 40 hours per week, one senior carer and one trainee senior were employed for 28 hours and 20 hours (minimum) per week respectively and eleven care assistants were employed for a total of 171 hours per week. Two domestic assistants were employed for a total of 32 hours per week and a clerical assistant was employed for 16 hours a week. The home also employed a gardener/maintenance man. Care assistants were employed to be on waking and sleeping-in duty at night. The registered providers confirmed that there was always two staff on duty at night, one on waking duty and one asleep and ‘on call’. No person was employed specifically to be responsible for the cooking or catering arrangements. The care staff were responsible for carrying out the cooking and catering duties as well as their caring tasks. The registered providers confirmed that the current arrangements for the preparation, cooking and serving of food worked well. The registered providers confirmed that the assistant manager had completed NVQ level 2 and level 3 training and that both the senior carer and trainee THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 15 senior had completed NVQ level 2 training and intended to commence the NVQ level 3 training in September 2005. However, the home did not meet the standard of NVQ level 2 training for care staff as specified in the National Minimum Standards. Therefore, the recommendation that was made in regard to NVQ level 2 training as a result of the previous inspection had not been fully implemented. The recommendation now becomes a requirement. Standard 29 was not fully assessed during this inspection. However, the registered providers were advised that a disclosure application must be made to the Criminal Records Bureau in respect of all staff employed at the home including staff who were not employed in a caring capacity. The home’s response to the requirement that was made as a result of the previous inspection in regard to foundation training was assessed. The registered providers confirmed that since the previous inspection one new member of staff had been appointed. It was confirmed that the member of staff was on a TOPSS training course and that she would go on to complete the foundation training. The requirement was, therefore, regarded as having been implemented. THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 and 36 The arrangements for the handling and safekeeping of the service users’ individual money were satisfactory. However, the frequency of staff supervision meetings needed to be increased. EVIDENCE: The registered providers confirmed that neither they nor any of their staff acted in the capacity of an agent or an appointee on behalf of any of the service users. However, the registered providers did handle the personal allowances on behalf of twelve service users. (See Standard 14 above). Appropriate records were maintained and secure facilities were provided. The registered providers stated that no valuable personal possessions belonging to the service users were held in safekeeping by the home apart from a Building Society account book that was kept in a secure facility. The registered providers confirmed that individual staff supervision meetings were being held. A copy of the form that was used for recording supervision meetings was made available for inspection. The form was satisfactory and THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 17 included a reference to the issues listed in Standard 36.2. However, the registered providers recognised that the staff supervision meetings were not being held at the required frequency of six times a year i.e. an average of once every two months. It was pleasing to note that meetings with the senior staff were being held every two weeks. Standard 37 was not fully assessed. However, it was noted that the home’s Certificate of Registration was prominently displayed. It was also noted that a new service user that did not fall within the categories for which the home was registered had recently been admitted to the home. Consequently, the Certificate of Registration did not accurately reflect the circumstances that prevailed within the home at the time of the inspection. Therefore, the registered providers must make an application to the CSCI for a variation in the conditions of registration in order to ensure that the home can appropriately continue to provide care and accommodation for the new service user. THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION x 2 2 x x x x x STAFFING Standard No Score 27 3 28 1 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x 3 2 x x THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 19 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4 Requirement The statement of purpose must be amended so that it includes all of the information detailed in Regulation 4 and Schedule 1. The service users guide must be amended so that it includes all of the information detailed in Regulation 5 and Standard 1 and copies must be given to all current, and any prospective, service users and their families. The statement of terms and conditions must be amended so that it includes all of the information detailed in Standard 2.2. The homes complaints procedure must be amended to include the name of the CSCI. A handrail must be provided around the edge of the path at the rear of the premises in order to ensure the safety of the service users and to minimise the risk of falling. Liquid soap and paper towel dispensers must be provided in all of the communal washing, i.e. bathroom and toilet, facilities. Handrails must be provided in the corridors on the first floor Timescale for action 31 August 2005 31 August 2005 2. 1 5 3. 2 5 31 August 2005 4. 5. 16 20 22 13,23 31 August 2005 31 August 2005 6. 21 13 30 September 2005 30 September Page 20 7. 21 13 THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 8. 27 17 9. 29 19 10. 11. 36 37 18 12. 28 18 and grab rails must be provided in all of the communal toilet facilities within the home. The duty roster must show which staff are on duty at any time of the day and night, including the registered providers, and in what capacity. Disclosure checks from the Criminal Records Bureau must be obtained in respect of all staff employed at the home, including two current members of staff not employed in a caring capacity, and for all new staff before their appointments are confirmed. All care staff must receive formal supervision at least six times a year. An application must be made to the CSCI for a variation in conditions of registration to ensure that the home can appropriately continue to care for a new service user. Arrangements must be made for staff to receive training, which will enable a minimum of 50 of the care staff to attain a qualification at NVQ level 2 or equivalent. 2005 31 August 2005 With immediate effect 31 October 2005 31 August 2005 31 December 2005 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 11 Good Practice Recommendations The homes policy and procedure on dying and death should be amended to include the offer of bereavement counselling by trained professionals/specialist agencies if required and an appropriate reference to the CSCI instead of the now former NCSC. The service users guide should include details of the local independent advocacy service and Citizens Advice Bureau. E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 21 2. 14 THE GABLES 3. 20 The possibility of replacing the fluorescent strip light in the large lounge with suitable, alternative lighting that is more domestic in character should be explored and implemented. 4. 5. THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 22 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7W National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI THE GABLES E52 S18522 The Gables V232404 2806051.doc Version 1.30 Page 23 - 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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