Inspection on 30/08/05 for The Gables

This inspection was carried out on 30th August 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 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 23/08/06

The Gables 08/02/06

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 Jackie Herring Unannounced 30 August 2005 13:00 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 B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Gables Address Highfield Road Middlesbrough TS4 2PE 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) 01642 515345 01642 515343 T L Care Ltd Mrs Carol Marie Singleton Care Home 64 Category(ies) of Old age (OP) 32 registration, with number Dementia (DE) 32 of places The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17/11/04 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. The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection and took place over two days, seven inspection hours in total. Staff files were examined, as was a random sample of service and maintenance records. Residents, relatives, visitors and staff were interviewed and there was also informal discussion. Some resident’s records were also examined and a tour of the home took place and detailed discussion took place with the manager, who presented as being very professional and committed to making improvements at The Gables. What the service does well: What has improved since the last inspection? What they could do better: The programme for recreational activities would benefit from further development. Whilst the staffing numbers are appropriate, there has been quite substantial use of agency staff, which has an effect on continuity of care, staff morale and skill mix, as the senior staff is having to cover more than one unit. The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 Page 6 Environmentally, improvements are required particularly in relation to the bathrooms on the EMI units; the smoking staff room, for a number of reasons as detailed in the report; confidentiality of information around the “nurses station” and the use of extension cable, which were observed to be potential tripping hazards. The review and updating of records such as policies and procedures needs to be completed and the Health and Safety records must always be available within the home. 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 B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 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 standard(s) 2 Residents are provided with terms and conditions that contain the required information. EVIDENCE: This standard was an outstanding requirement from the previous inspection. A copy of the terms and conditions of residency was made available for examination during the inspection. It contained all of the required information. The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 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) 7, 10 The individual plans did not contain all of the information needed. Residents are treated with privacy and dignity. EVIDENCE: This standard was an outstanding requirement from the previous inspection in which it had been identified that all of the individual records did not contain a photograph of the residents or evidence of resident and/or their representative’s involvement with their individual plan of care. The manager produced a ready prepared list of outstanding photographs that needed to be taken and confirmed that there were systems in place for recording involvement and satisfaction with individual plans of care. It was agreed that this was in need of review and updating particularly when the needs of residents changed. Residents said, “The staff are polite, they speak to us respectfully”, “Definitely treated with dignity and definitely treated as an individual”. The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 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) 12, 13, 14 Resident’s lives would be enhanced further by developments to the occupation, socialisation and activities programme. Open visiting is encouraged and residents are able to maintain contact with family and friends. EVIDENCE: During discussion with residents the recent summer fair was positively discussed. One resident said, “Really enjoyable day, we had Hawaiian outfits on. One resident said that they sometimes play games, another residents said, “There isn’t much in the way of recreation or activities, there is the odd treat, like the recent visit to the farm”. One visitor also said that there did not appear too much to keep people occupied. During discussion with the manager, it was confirmed that the social activity programme was currently under review and would be developed further and that residents were being consulted. Residents did describe being able to go to the local shops and also described visits from the local church and having been involved in voting earlier in the year. During the inspection, relatives and friends were observed to be visiting and residents and staff confirmed that visitors were welcome at any time. The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 Page 11 Staff described a fairly flexible life with The Gables and gave examples of choice and lifestyle preferences. One staff member said, “The routine is flexible, it is the residents choice and their individual routines, for example, one gentleman likes his breakfast in his room and he does not get up until 11.30am”. The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 Page 12 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, 18 The systems are in place at The Gables to protect residents from abuse and to enable residents to make complaints should the need arise. EVIDENCE: During discussion with staff, they confirmed that they were aware of the complaints procedure and would be able to assist resident/relatives to make a complaint should the need arise. The complaint procedure was on display within the home. Staff also confirmed they had received information and training on the topic of abuse and the Department of Health’s guidance regarding No Secrets. Housekeeping staff also confirmed they had been involved in this training. One resident said, “If I was worried, I would speak to my family, I have never had to raise any concerns. The complaints records were examined and contained detailed information. The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 Page 13 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) 19, 20, 21, 22, 26 Several areas at The Gables did not provide a safe, well-maintained environment for residents and there were insufficient useable bathing facilities for residents within the EMI units. EVIDENCE: A tour of the home took place, with each of the four units visited and a random number of bedrooms visited. It was observed that the shower rooms in Elm unit did not have a lock fitted to the door; there was also the need to install a shower curtain. The smoking staff facility was also visited, which is located on Elm unit. It was observed that the smoke from the staff room permeated onto the corridor. The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 Page 14 The staff room was in need of redecoration; it was nicotine stained and also black soot like marks were close to the ventilation fan. The door of the staff room was unlocked and there was a kettle in the room, which could be a potential scalding risk to residents. The male changing room was observed to be used as a storage area preventing it from being used as needed. The toilet within the female changing area was blocked, extremely smelly and had been like this for some time. The current bathrooms and shower facilities should be reviewed as two of the units did not have assisted bathing facilities and the current provision was not suitable for the residents. Residents with dementia who were frail or had mobility problems or who were not able to step in and out of the bath either had to have a shower or leave their own unit to have a bath on another unit. Elderly frail units had the choice and option of both facilities. In one of the units a sideboard in the dining room was damaged and needed to be replaced. The use of extension cables also needed to be reviewed as they were observed to be a potential trip hazard, as they were not attached to the skirting boards. It was identified that an Occupational Assessment was needed in respect of one residents and their current seating arrangements, as a stool was being placed under the recliner chair. The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 Page 15 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, 29, Residents are protected by the robust recruitment procedures. Whilst the numbers of staff are sufficient to meet the needs of the residents, the skill mix and amount of agency staff usage potentially has an effect of their needs being fully met at all times. EVIDENCE: Over the two inspection days, there was discussion with staff, residents and manager about the staffing levels and skill mix. It was acknowledged that there had been some staffing difficulties, which had increased the use of agency staff within the home. Although there had been some staff turnover, this was not high and some of the current vacancy factor is accounted for from company promotions and some vacant positions not being filled for some time. There was some concern from the staff about the current situation and they were aware that all of the posts were being advertised and that the manager was doing what she could to recruit the appropriate staff. One of the concerns expressed by the staff related to skill mix, in which senior carers/supervisors/team leaders had to cover two units instead of one. A further concern was the use of agency staff and whilst it was acknowledged that this was necessary to ensure correct numbers of staff, there were times when this was thought to be difficult, particularly on night duty when on some occasions there were two or three agency staff on duty. The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 Page 16 The manager was fully aware of the staffing situation and was being proactive in addressing the matter. It was confirmed that interviews had taken place and further permanent staff were to commence employment. A sample of staff files was examined and they contained all of the required information. Residents said, “the workers are grand, they will do anything for you, they are caring”. Residents also said, “On the whole sufficient staff, sometimes they are a little pushed”, another resident said, “sometimes I have to wait, believe this to be an acceptable amount of time”. The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 Page 17 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) 34, 38 Health and safety is not robust enough to ensure that residents are fully protected. Effective systems are in place to safeguard residents personal allowanced. There is the potential for breaches of confidentiality around the nurse’s station. EVIDENCE: The manager continues to complete the registered managers award. It was also confirmed that a number of resident surveys have been issued, there continues to be the need to collate this information and present it in a brief report, which is accessible to residents, relatives and staff. A random sample of residents personal allowance records were examined and they contained detail information that was supported by receipts. The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 Page 18 A small number of service and maintenance records were looked at, such as fire equipment, hoists and the lift and in the main found to be in order. On both days of the inspection however, the records of water temperatures were not available within the home. Immediate action was taken during the inspection to test the bath and shower water temperatures and the manager informed the inspector that the records would be put into place immediately. The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 Page 19 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 x 3 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x COMPLAINTS AND PROTECTION 2 3 2 2 x x x 2 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x 2 3 x x x 2 The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 Page 20 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 OP19 Regulation 13 Timescale for action The use of extension cables must Immediate be reviewed as they presented as a potential trip hazard. The smoking staff room must be kept locked at all times. The bathing facilities on the EMI units must be reviewed as there is currently no choice in terms of showering or bathing as the current baths are not suitable for the majority of residents. Requirement 2. OP21/OP22 23 1 December 2005 3. OP26 23 A lock must be installed on the shower room door on Elm unit and a shower curtain installed. The ventilation of the staff 1 smoking room must be increased November as the smell of cigarette smoke 2005 on Ash unit was extremely noticeable. The smoking staff room must be redeorated and the male changing area must be suitable for purpose. The quality assurance systems must continue to be fully implemented. Action must be taken to increase the confidentiality of information B51 B01 S122 The Gables V246916 300805 Stage 4.doc 4. 5. OP33 OP37 24 17 1 December 2005 The Gables Version 1.40 Page 21 around the nurses station. 6. 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 OP7 Good Practice Recommendations The update of the residents records should be completed ensuring there is an up to date photograph and evidence of residens/relatives involvment in regard to assessment of need and care plans. The activities programme should be reviewed and further developed. One resident should have an OT assessment to ensure suitability of her seating arrangements. The current recruitment procedure should continue to enable the number of permanent staff to be increased and also an increase in the skill mix of staff. The manager must complete the Registered Managers Award and undertake NVQ Level 4 in Care. Health and safety records, such as the water temperatures should be available for examination. The review and update of the policies and procedures should be completed. 2. 3. 4. 5. 6. OP12 OP22 OP27 OP31 OP38 The Gables B51 B01 S122 The Gables V246916 300805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Unit B, 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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