Inspection on 30/03/07 for The Gables

This inspection was carried out on 30th March 2007.

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

The inspector 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 26/02/09

The Gables 02/07/07

The Gables 24/08/06

The Gables 13/02/06

The Gables 03/03/05

The Gables 03/09/04

The Gables 03/02/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 The Gables Moreland Drive Gerrards Cross Bucks SL9 8BB Lead Inspector Mike Murphy Unannounced Inspection 30th March 2007 10:00 The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address Moreland Drive Gerrards Cross Bucks SL9 8BB 01753 890399 01753 890399 admin.thegables@fremantletrust.org admin@fremantletrust.org The Fremantle Trust 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) Georgina Crothers Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th August 2006 Brief Description of the Service: The Gables is a home for seven adults with learning disabilities and high care needs. The home is situated within close proximity of Gerrards Cross town centre. There is a main bus route from the town centre to nearby towns. The house is sited on a large cul-de-sac, next to a school. The accommodation is over two floors, however the majority of service users have bedrooms on the ground floor. There are two bedrooms upstairs for the more mobile service users. All bedrooms are individually decorated to personal taste. The home has a large communal lounge, dining room and a separate sensory room. There is a large garden at the back of the home and some parking spaces at the front. The property is not identifiable from the outside as a care home. Fees for the service: £997.22 per week. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector between 10:00 am and 6:00 pm on a weekday in March 2007. The inspection methodology included consideration of information supplied by the registered manager and of questionnaires completed by other stakeholders in advance of the inspection, discussion with the assistant manager, operations manager, staff, interaction with service users, observation of practice, examination of records (including care plans), a walk around the building and grounds, and consideration of information provided by healthcare professionals. The inspection finds that the home provides a comfortable, safe and supportive environment for service users. Arrangements for assessing and meeting individual needs are good but care plan records are not in a form which is readily understandable to service users. Standards of practice in record keeping are uneven in some sections of care plans. The home has a good reputation with local health professionals. Arrangements for providing service users with a varied lifestyle are good and include daily attendance at day services, local trips out and holidays in Cornwall. However, both staff and a family respondent to CSCI have identified a need for additional staff time to provide further support in this respect. The arrangements for dealing with complaints and concerns and for the protection of service users have improved since the last inspection. The home provides a pleasant and safe environment for service users. It is located in a quiet residential area, just over one mile from Gerrards Cross village centre. It provides a range of accommodation in which service users may spend time with others or on their own as they wish. Suitable adaptations have been made to meet the needs of individual service users. Staffing meets current needs but indirect pressure on staffing seemed evident. The home had just under the equivalent of two full time vacancies at the time of this inspection. A wish for one more member of staff in the evenings was expressed and for the manager to have more time in management. Some questionnaire respondents also expressed concerns about the turnover of less experienced staff and the potential adverse impact of that on service users. These are not simple issues to resolve but each has some effect on the quality of life for service users in the home. Overall however, this inspection finds that this home provides good support to service users and a service which is valued by service users, families and health professionals. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Staff training has increased and service users benefit through being cared for by staff with improved skills in risk assessment and management. Health and safety awareness has improved and the home has a nominated representative on the organisation’s health and safety committee structure. It is reported that there is now an improved focus on the needs of service users among the staff team. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. The needs of prospective service users are thoroughly assessed prior to admission. Prospective service users visit the home to meet staff and other service users and to experience its service. The process aims to ensure that the service user is comfortable in accepting the offer of a place and that the home is able to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has not had an admission since the last inspection. The Fremantle Trust referral and admissions process was discussed with the operations manager. This applies to all homes run by the trust. On receiving a referral for a place the manager would request a copy of the care assessment carried out by the referring social worker. If the referral seems appropriate then the manager would carry out an assessment at the prospective service user’s current place of residence. The assessment would be structured using a referral form and would include assessment of risk. Where the referral is considered suitable and the manager is of the view that the home would be able to meet the prospective service user’s needs, the referral moves forward and a series of visits to the home are arranged. These are organised in line with the abilities and needs of the prospective user but The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 10 typically involve a visit for tea, a weekend stay and then if it goes well progressively longer stays. A review is held six weeks after admission. This includes the service user, his or her family, and the care manager. Further information is acquired throughout this period and a care plan is developed in line with the service user’s needs. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. Care plans are based on comprehensive assessment of needs, are generally well written and support the provision of good care to service users Liaison with health and social care agencies is good and aims to ensure that service users needs are met. However, weaknesses with regard to the appropriateness of the current format to this type of service, and uneven practice in relation to daily reports and reviews in the home could compromise the quality of care to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A comprehensive care plan is in place for each service user. Care plans comprise two documents: a large document containing extensive information including correspondence, risk assessments, assessments of need, a care plan for each need, and other information, and, a smaller document which is used for day to day purposes and which includes a summary of essential information on the service user and daily reports. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 12 Three care plans were examined. While care plans are comprehensive and informative they are also bulky and complex. The home is planning to develop its care plans in ‘PCP’ (Person Centred Plan) format in future but has not made significant progress to date. Care plans were examined during the course of the organisation’s audit in the autumn of 2006 and the results of that audit were on the staff notice board in the home. Sections in all care plans included a pen picture of the service user, preferred daily routine, likes and dislikes, risk assessments, a summary assessment of needs, a care plan for each identified need, and ‘personal lifestyle summary’. Risk assessments included moving and handling, medication, travelling, Waterlow (pressure sore) risk assessment, nutritional risk assessment, and risk assessments covering house activities such as using stairs, having a bath or shower, and being in the garden. Some care plans included an ‘ABC’ (antecedents, behaviour and consequences) chart for recording problem behaviours or a ‘body chart’ for recording bruising. Care plans included correspondence with health and social care agencies such as the community learning disability team (CLDT), social services care managers, physiotherapists, speech and language therapists and families. Care plans included records of reviews, including an annual review of care carried out by social services care managers. While care plans are comprehensive some weaknesses in application were noted. The consistency of reviews in the home appeared variable, planned reviews of some risk assessments did not appear to have taken place, and the quality of daily reports varied – in some cases such reports were made on plain paper when there was a form designed for that purpose. The present format of care plans is unlikely to be accessible to all service users and action to address current weaknesses and towards developing the PCP approach would improve the overall quality of care planning in the home. Despite these weaknesses however, the care plans did support the delivery of care and were relevant to the current needs of service users. Staff were observed to support service users in making decisions. Service users were treated with care and sensitivity. Service users are assessed as having a moderate level of dependency and knowledge of individuals is important in accurately responding to expressed needs. Staff and service users appeared to have a good relationship. The weekly menu is planned with service users and each service user makes the main choice for one day of the week (there are seven service users in the home). It was reported that one service user occasionally helps with the washing up while another likes to help in the garden. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. Service users lead a varied lifestyle according to their individual interests, abilities and wishes. This aims to ensure that service users experience a range of social and leisure activities and can feel part of the local community. Service users are encouraged to be involved in planning menus therefore meals provided are likely to reflect the wishes of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Six service users regularly go to a day centre – four to a centre in Beaconsfield and two to a centre in Burnham. One service user generally spends the day at home with staff but goes out on Fridays with a community worker and to a ‘Wednesday Group’ once a month. This inspection took place on a Friday and two service users were at home at its start. One went out for lunch and for the afternoon with a key worker and five returned from their day centres at around 3:30 pm. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 14 The home has its own minibus which was purchased by families of service users. This is used for shopping trips and outings (such as a recent outing to Legoland in Windsor). Staff report that they occasionally walk to Gerrards Cross village with service users and visit shops, a café, and in good weather, a local pub. There is a cinema in Gerrards Cross but service users have not visited it recently. Six service users (two groups of three each time) have had holidays in Cornwall over the past year and there are plans to go there again in 2007. The Fremantle Trust contributes £450 towards the cost and the rest is paid by the service user or their family. All seven service users are currently in touch with their families. It was reported that the families have formed an association named FOG (‘Friends of Gables’) which provides support to the home. The Fremantle Trust has a policy which provides guidance to staff in relation to personal relationships involving service users. Individual daily routines are reported to be very important to each service user. Three regularly like to get up early (before 8:00 am). Breakfast is served around 8:30 and on Monday to Friday service users go to their day centre just after 9:00 am. Service users at home with staff plan activity for the day. Service users return from their day centres at around 4:00 pm and then relax pursuing until dinner. Dinner is served at 5:30 pm. After dinner service users pursue their own interests, which may include watching TV, listening to music or drawing. Service users were reported to usually go to be bed from 10:00 pm. Personal care and support is provide as required over the course of the day. The routine at weekends is said to be more relaxed. Many service users have visitors while others may go home to their families or go on outings with staff. Some service users may also work with staff in light domestic tasks such as sweeping up or cooking. Service users participate in menu planning. Each service user selects the main course for dinner one day a week. The home uses a rotating four week menu which is presented in picture and widget form. It was reported that it is considering developing an eight-week menu in the near future. Choices on the menus supplied for this inspection included ‘Sausage Meatballs, Tomato Sauce and Spaghetti’, ‘Chicken Nuggets, Chips and Beans’, and, ‘Salmon Fishcakes and Salad’. Advice has been provided on managing dysphagia (difficulty in swallowing which may be accompanied by acute discomfort). Breakfast usually consists of cereal and beverages and is served before service users go to their day centres. On the morning of this inspection two service users were at home and were supported by staff in eating their breakfast. Lunch is taken either at the day centre or in the home. Dinner is served at around 5:30 – 6:00 pm. The dining table seats five and service users are supported as required – some requiring a high level of support. A well stocked fruit bowl and drinks are available at all times. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. Staff provide guidance and support to service users as required. Arrangements for liaising with healthcare services in the community and for the control and administration of medicines appear satisfactory. This ensures that service users receive appropriate support in meeting their healthcare needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was observed that personal support is provided with care and sensitivity. Service users preferences with regard to their personal care is recorded in their individual care plan. Service users choose their own clothes, hairstyle etc. Two service users have electrically operated overhead hoists and the home has a mobile hydraulically operated hoist. Grab rails are provided around the home. There is a chair lift linking the ground and first floors. Additional support is provided by the CLDT and local health and social services. Evidence of liaison with a range of services was noted in care plans. Such services included speech and language therapists, physiotherapists, psychiatrists, and community medical and nursing staff. Two professional healthcare respondents who returned CSCI questionnaires were positive in their views of the home. Staff are trained in moving and handling and a range of risk assessments aim to ensure that risk to service users is minimised. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 16 Medicines are prescribed by the service user’s GP and are dispensed by Boots Chemists. The storage and administration of medicines in the home is governed by the policy of the Fremantle Trust. A revised and updated policy is to be issued in the near future. A record of the signatures of staff authorised to administer medication is maintained. All staff attend training provided by Boots Chemists. The manager assesses competence before individual staff are permitted to administer medicines. Medicines are recorded on receipt in the home and a record is kept of medicines returned to the pharmacy. The arrangements for the storage of medicines appeared satisfactory. A cupboard containing currently prescribed medicines (most in the Boots monitored dosage system) and a refrigerator for storing medicines requiring cool storage are in the kitchen on the ground floor. A cupboard for the storage of additional stock is provided in the manager’s office on the first floor. Both cupboards and the refrigerator had appropriate locks. A medicines administration record (‘MAR’ chart) is provided for each service user. This is printed by the dispensing pharmacy and includes details of medicines currently prescribed. Care staff said that handwritten entries by home staff are countersigned by two members of staff. Records include a photograph of each service user and details of the effects and side effects of medicines prescribed. The administration of ‘Homely Remedies’ is authorised by the service user’s GP. This inspection finds that the home’s arrangements for the storage, control and administration of medicines appear to be in good order. No gaps in MAR charts were noted. Arrangements for the storage of medicines were satisfactory. Insulin and some creams were stored in the refrigerator. The insulin is administered by district nurses each morning. Creams had been labelled when opened. Additional arrangements had been put in place for one medicine which required the administration of a higher dose in the evening to that prescribed in the morning. The home’s arrangements are periodically audited by a pharmacist and the report of the most recent visit of 23 January 2007 was examined. This informative report supports good practice in the home. The home did not appear to have a copy of the current edition of the guidelines for the storage and administration of medicines in care homes by the Royal Pharmaceutical Society of Great Britain. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. The home has a good system for recording and investigating complaints. It has a robust framework of policy, procedure, reporting arrangements and recent staff training with regard to the protection of vulnerable adults. Together, these aim to protect service users from abuse and to ensure that complaints are properly investigated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The recording of complaints and compliments is carried out in the context of the organisation’s ‘Fremantle Feedback’ procedure. The complaints procedure is available in picture and widget form for service users. The majority of respondents who returned questionnaires to CSCI in advance of this inspection knew to whom they would address a complaint. Family respondents who had raised concerns with managers reported always receiving an appropriate response. Two complaints and three compliments had been recorded since the last inspection and appear to have been dealt with appropriately by the home. CSCI has not received any complaints about this home since the last inspection. Weaknesses in the application of procedures for the protection of vulnerable adults (POVA) mentioned in the report of the last inspection carried out in August 2006 have been addressed by managers. A staff training session has been held and all but two staff have attended training since that inspection. The manager is now a trainer on the subject having attended training run by The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 18 Buckinghamshire County Council and the Fremantle Trust. The threshold for reporting to statutory authorities in line with joint agency POVA arrangements appears to be at a level which protects the interests of service users. The organisation has a policy governing staff practice in respect of the protection of vulnerable adults and a copy of the joint agency arrangements for Buckinghamshire was available in the home. Managers said that the families of service users are actively involved with the home and would not tolerate what might be perceived as abuse of any kind. The home is also in touch with the ‘Talkback’ advocacy organisation. The organisation has offices in High Wycombe. Staff seen on this inspection were aware of the vulnerability of the service users and were aware of reporting arrangements both within the Fremantle Trust and to statutory bodies. The Fremantle Trust has a policy and procedure governing the management of service users’ monies and the home is required to conform to this. Arrangements are in place in the home in respect of this. One service user is reported to ‘partly’ manage his or her financial affairs. Staff are trained in understanding and responding to physical and verbal aggression (in-house course titled ‘Non Aggressive Physical and Psychological Intervention in Aggression’). The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. The home is well located for the amenities of the local area and it provides a safe, comfortable and pleasant environment for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is located in a quiet residential area, just over one mile from the centre of Gerrards Cross village. Gerrards Cross is served by trains run by Chiltern Railways and buses from towns such as Slough, Uxbridge, High Wycombe and Berkhamsted. Car parking is available in the drive or in the street. The home is a detached two storey house set in its own grounds. There is limited parking in the front drive. The property is owned by a housing association, Housing Solutions. The Fremantle Trust is responsible for the service. The ground floor accommodation is comprised of an entrance hall, dining area, lounge, kitchen, store room, laundry, five single bed rooms, bathroom and wc. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 20 All of the accommodation on the ground floor is accessible by wheelchair. Stairs and a chairlift connect the ground and first floors. The operations manager said that there are plans to install a passenger lift in the future. The first floor accommodation comprises two single bedrooms, staff office and sleep-in room, bathroom, shower, and store room. The medium sized garden to the rear is enclosed with mature shrubs and has areas of lawn, flowerbeds, space for a barbeque, and recreational equipment. It is sufficient in size for the current number of users and is accessible from the lounge. None of the bedroom accommodation is en-suite. Electrically controlled hoists have been installed in two bedrooms. Grab rails are located around the house. There is a portable manual hoist for use when required. A chair lift connects the first and ground floors. The home is comfortably furnished. Bedrooms have been decorated in accordance with the wishes of service users. The laundry on the ground floor has two washing machines, one tumble dryer and a small work area. Staff report that it is sufficient for current use. The kitchen is a reasonable size and includes wall and floor mounted storage units, refrigerator, freezer, cooker, microwave and small electrical items such as a kettle and toaster. Both the laundry and the kitchen were in good order on the day of this inspection. All areas of the home were clean and tidy. The Fremantle Trust has included some improvements to the home’s environment in its development plan for 2007/08. A recommendation made at the August 2006 inspection relating to the use of a jug instead of a shower in an upstairs bathroom had not been actioned. Overall the home provides a comfortable environment for service users and space for service users to choose whether to be with others or on their own. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is adequate. Staffing levels are generally satisfactory and the organisation maintains a good programme of staff training across a range of subjects. These aim to ensure that there are sufficient numbers of appropriately trained and supported staff to meet service user’ needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The present staff establishment provides for three staff in the morning, three in the afternoon and evening, and one waking and one sleep-in at night. The manager has two days a week in which she is supernumerary to staff numbers and can devote her time to managerial work. Lines of accountability are clear both within the home and to senior managers. The manager reports to an operations manager who is responsible for a number of services, and within the home the staffing structure is comprised of the manager, one assistant manager and a number of care workers. The home receives five hours of administrative support per week. Maintenance contracts are arranged by staff at Fremantle Trust head office in Aylesbury. The home is supported in recruiting, inducting, training and developing staff by personnel staff based at the head office. Mixed reports were given on staff The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 22 being issued with the GSCC codes of practice. This was a recommendation of the inspection carried out in August 2006 but does not appear to have been fully acted on. On the day of this inspection the home had 64 hours of staff time vacant – just under two full time equivalent staff. It was felt that increasing the staff numbers to four in the evening would enable staff to spend more one to one time in activities with service users. Feedback from family respondents to CSCI in advance of this inspection indicates that this would be welcomed by some families. One member of staff had been recruited since the last inspection but the relevant personnel file was not examined because the keys to the filing cabinet were not available on the day. The reasons for this were given and accepted as reasonable. It was noted that in the August 2006 inspection report the inspector wrote ‘Recruitment process(es) are robust enough to protect service users from risk of harm’. Three staff currently have NVQ qualifications but the home has not yet reached the 50 standard set in standard 32.6. The staff group comprise a mix of female and male staff and a mix of age and ethnic background. The Fremantle Trust maintains an ongoing training programme throughout the year. It was reported that the training agenda for staff in the home since the last inspection has included medicines administration, food hygiene, POVA, first aid and fire safety. Over the course of the second (calendar) quarter of 2007 training is planned in infection control, diazepam in the treatment of epilepsy, medicines administration, and non-aggressive physical and psychological intervention in aggression. The assistant manager said that an assessment of training needs was carried out in March 2007 and that training needs are also included in staff appraisals and supervision. The operations manager said that the manager had undertaken training in new fire safety regulations, which came in to force in October 2006. The home has designated one member of staff to have a lead role in health and safety and that person has received training in ‘health & safety awareness’. A programme of staff supervision is in place in line with the policy of the Fremantle Trust. A schedule of meetings was on display in the office and staff confirmed that they do have supervision. The home is making progress towards achieving six meetings a year for each member of staff. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This is a well managed home and feedback from service users, families and healthcare professionals indicate that it is generally providing good care outcomes for service users. The registered manager is pursuing an appropriate qualification and has a management agenda for the coming year based on feedback from audit and the views of stakeholders. Completion of these should support improvements in the overall quality of this service which is valued by its stakeholders. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has been in post for one year and was registered with CSCI in March 2007. The registered manager has a number of years experience in caring for service users with a learning disability and is currently pursuing the Registered Managers Award (RMA) and the NVQ assessor’s qualification. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 24 A major quality assurance activity carried out by the Fremantle Trust is the annual service audit. This was carried in the home in the autumn of 2006 and a summary of the results and an action plan are on display in the home. The action plan arising from the audit together with the development plan for the home agreed with senior managers form a core part of the registered manager’s work for the coming year. Managers have acted on all of the requirements of the CSCI inspection carried out in August 2006. Feedback from service users is obtained verbally and non-verbally and the assistant manager said that the families take a keen interest in the home and in the welfare of service users and do not hesitate to comment where necessary. CSCI received 10 responses from stakeholders in advance of this inspection. Two were from or on behalf of service users. Both were positive in their view of the home. Both said that carers listen and act on what they say although one qualified the response with the comment “with a bit of organisation”. Both responded “Always” to the question ‘Do the staff treat you well?’. If dissatisfied they said that they would complain either to a member of staff or the manager. Comments included “I think this is a good home” and “I’m settled here”. The six family respondents were also generally positive in their views of the home. Four of six respondents thought that the home ‘Always’ ‘….meets the needs of your friend/relative?’. Four of six ticked ‘Always’ in answer to the question ‘Do the care staff have the right skills and experience to look after people properly?’. Five of six respondents said that they knew how to make a complaint. Four of six reported that the home ‘always’ responds appropriately when concerns have been raised. Comments on what the service does well included “Diagnosing the residents troubles. Feeding them well – at least [name]”, “Provides a happy, family atmosphere with all round care”, “Take very good care of our child and always very friendly and helpful” and “The home is always kept very clean, they all have a very good balanced diet, and always well dressed”. One commented, “Generally sufficient but could do better”. Family responses to the question ‘How do you think the care home or agency can improve?’ included “To give all the clients more activities to stimulate them, and more one to one communication. It is very boring to be sat in a chair all day”, “If staff remain as now, there is little room for improvement”, “Manager to carry out ‘Management’ at least 5 days per week and not just part of the ‘shift’ system”, “Communication about new staff and staff movements” and “I don’t know – as long as [name] is happy, then I am happy”. Professional respondents both ticked ‘Always’ to the three questions ‘Are individuals’ health care needs met by the care service’, ‘Does the care service respect individuals’ privacy and dignity’ and ‘Does the care service support The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 25 individuals to live the life they choose’. Both were satisfied that the home responds appropriately to concerns raised by professionals. Responses to the question ‘What do you feel the home does well?’ included “Good communication with all staff. Accessible management – interested and committed”, and “Homely environment. Physical care good. Individual support for emotional needs good”. What could it do better? “Very reliant on a few long term experienced staff to foster good communications and understanding. Rapid turnover of young, inexperienced staff quickly threatens high standards”, and “By retention of carers, and less use of agency staff”. Final comments included “A good home – high level of care given. Good working relationship with medical team”, and “Long term staff members should be highly valued. Many ‘regulations’ seem too restrictive to staff e.g. medicines administration and caring for minor illness. Staff allowed to do less than a parent (or) next of kin. This leads to extra work for NHS staff especially district nursing service and GPs…….”. The arrangements for health and safety within the home appear satisfactory. The Fremantle Trust has a health and safety policy and an organisational structure for monitoring health and safety matters. The home has a health and safety lead member of staff who has undertaken additional training in health and safety matters. Procedures are in place for recording accidents and incidents. It is noted that these have recently included needle stick injuries to staff which have prompted managers to remind staff of the importance of following policy and procedures in handling such equipment. The service manager said that managers carrying out Regulation 26 visits each month monitor the nature and incidence of accident and incidents in homes . Arrangements for fire safety appear satisfactory. The service manager reported that new fire risk assessments are being carried out. Contracts are in place for the maintenance of fire safety equipment. A fire drill was last carried out in December 2006. Fire points are tested weekly and the emergency lighting is tested monthly. New staff undertake induction training which includes health and safety awareness. Basic and update training in health and safety subjects is included in the organisation’s annual training programme. The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 27 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 Timescale for action 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 YA23 Good Practice Recommendations All staff are to have a copy of the General Social Care Council code of practice, which can be obtained free from the General Social Care Council. A shower hose is needed to replace the plastic jug in the upstairs bathroom. It is recommended that the home obtain a copy of the Royal Pharmaceutical Society of Great Britain Guidelines on the administration, storage and control of medicines in care homes. 2 3 YA24 YA20 The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Gables DS0000023055.V328076.R01.S.doc Version 5.2 Page 29 - 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. 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