Inspection on 05/11/08 for The Gables

This inspection was carried out on 5th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Gables 11/08/08

The Gables 11/09/07

The Gables 17/07/06

The Gables 23/01/06

The Gables 18/08/05

The Gables 17/03/05

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Gables, The 29/31 Ashurst Road Walmley Birmingham West Midlands B76 1JE Lead Inspector Brenda O’Neill Unannounced Inspection 5th November 2008 09:50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000062346.V373014.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 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. DS0000062346.V373014.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gables, The Address 29/31 Ashurst Road Walmley Birmingham West Midlands B76 1JE 0121 351 6614 0121 313 2752 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) Karamaa Ltd Miss Kelly Jean Kinsella Care Home 24 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (24) of places DS0000062346.V373014.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That the registration category is 24 older people that may include up to 10 people with Dementia. Registration category 24 (OP) 10 DE(E) In addition to the manager and ancillary staff maintain minimum staffing levels of three care staff throughout the waking day and two care staff on waking night duty one of whom should be designated senior. 11th August 2008 Date of last inspection Brief Description of the Service: The Gables is a number of post war houses that have been extensively converted to provide care and accommodation to 24 older people. The home is located in a quiet road within easy access of shopping facilities, local churches and regular public transport services. The home comprises of nine single bedrooms on the ground floor and fifteen single bedrooms on the first floor. Two of the bedrooms have en-suite facilities of toilet and shower. There is one assisted shower facility and one assisted bathing facility and numerous toilets located throughout the home. The people living in the home are able to gain access to the first floor via stairs or by lift. Communal areas within the home are located on the ground floor and comprise of one very large lounge/dining room which also includes a conservatory and a smaller lounge. The larger lounge overlooks a very well maintained garden. The home also has a kitchen and a large combined laundry and food store which is located in an outbuilding. There is access to the home for people with mobility difficulties by means of a ramped front entrance with handrails. The current range of fees at the home were not available at the time of this inspection. DS0000062346.V373014.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate outcomes. Two inspectors carried out this key inspection over one day in November 2008. This was the second key for the home inspection this year. Following the previous inspection in August the home had been judged as poor. We asked the provider of the home to send us an improvement plan detailing how he was going to ensure the home improved. The improvement plan was received within the timescale given. At the time of this inspection sufficient progress had been made to ensure that the people living in the home received an adequate service. During the inspection a tour of the home was undertaken, two files for the people living in the home were sampled and five staff files as well as other care, health and safety and training documentation. The inspectors spoke with the manager, two staff members, two visitors and six of the people living in the home. There had been no complaints logged at the home since the last inspection. Some concerns had been raised with us by a health care professional when visiting the home about staffing levels and staff working excessive hours. These issues were looked into and explored with the manager. It appeared that on occasions staffing levels fell to two which would not fully meet the needs of the people living in the home particularly in relation to activities. There had been no adult protection issues at the home since the last inspection. What the service does well: The assessments carried out before people were admitted to the home ensured their needs could be met by the staff. People could visit the home before admission to assess the facilities available to them. The systems in place for care planning and assessing the risks people were exposed to were generally good and ensured people received person centred care and that any risks were appropriately managed. Staff were able to identify any health care needs and there was evidence of these being followed up and monitored. Medicine management in the home was generally good and the improvements noted at the last inspection had been sustained ensuring people received their medication as prescribed. DS0000062346.V373014.R01.S.doc Version 5.2 Page 6 There were no rigid rules or routines in the home and the people living there were able to spend their time as they chose. The home had outside entertainers quite regularly and had recently had a Halloween party which everyone seemed to have enjoyed. Several visitors were seen to come and go from the home while we were there and all were made welcome. Two visitors were spoken with and they were very positive in the comments about the home which included: ‘Happy with care and running of the home.’ ‘Staff go out of their way to help.’ ‘The standard of care is good residents are well looked after.’ Staff encouraged the people living in the home to make choices wherever possible, for example, in how to spend their time, when to go to bed and get up, what to eat and what to wear. The people living in the home that were spoken with were satisfied with the food served to them. Comments included: ‘Nice food’ ‘Have what I want’ ‘Plenty to eat.’ Throughout the course of the inspection it was clear there were good relationships between the people living in the home and the staff team. The individuals and visitors spoken with stated: ‘Staff are doing an excellent job’ ‘Staff are very friendly and helpful’. What has improved since the last inspection? What they could do better: DS0000062346.V373014.R01.S.doc Version 5.2 Page 7 To ensure the staff were able to manage any risks and the people living in the home were safeguarded the risk assessments for the people living in the home needed to be accessible to them at all times. All the staff working at the home needed to receive training in adult protection issues. This will ensure they can respond appropriately to any issues and that the people living in the home are safeguarded. The registered provider needed to ensure the home was kept to an acceptable standard and that the people living there were not being put at risk by ensuring all the repairs around the home were addressed in a timely manner. Staffing levels must be maintained at a level that ensures all the needs of the people living in the home can be met and without the ongoing use of the manager’s hours. To ensure staff were able to care for the people living in the home safely they need to have undertaken all the required training including, manual handling, basic food hygiene, health and safety and first aid. The registered provider must inform the Commission of the management arrangements for the home when the existing manager has left and how any shortfalls this creates on the rota will be covered. This will ensure the home is being run in the best interests of the people living there. 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. DS0000062346.V373014.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000062346.V373014.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information available for people wanting to move into the home needed to be updated to ensure it reflected all the correct details so that people could make an informed decision as to whether the home could meet their needs. The pre admission assessment process ensured the needs of prospective users of the service were known prior to admission. People were able to visit the home prior to admission to see if it was suitable and would meet their needs. EVIDENCE: The service user guide for the home needed to be reviewed and updated to ensure it included all the correct information for anyone wanting to move into the home. For example, the range of fees charged at the home that were detailed were not the current fees and the address and telephone for the Commission were incorrect. A recommendation for this was made following the last inspection but it had not been addressed. DS0000062346.V373014.R01.S.doc Version 5.2 Page 10 The file for one person admitted to the home since the last inspection was sampled. This included evidence that the manager of the home had undertaken a pre admission assessment for the individual. All the required areas had been covered during the assessment including, personal care, diet, sight hearing, mobility and interests. The assessment document also included a summary of whether the individual’s needs could be met by the home. The file also included a copy of the care plan that had been drawn up by the social worker prior to admission. However there was no copy of the assessment undertaken by the social worker. It was strongly recommended that this was obtained as it would give the staff at the home more information about the individual’s history. The pre admission assessment sampled was done during the person’s pre admission visit to the home. On the day of the inspection a person who was considering moving into the home was visiting with her relatives. She was shown around, given some information by staff and spent some time in the home discussing what she had seen and the information she had been given. DS0000062346.V373014.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The systems in place at the home for care planning and risk assessments were comprehensive ensuring the staff knew how to meet the needs of the people living in the home and minimise any identified risks. Risk assessments needed to be accessible to staff at all times. Medication management was generally good and ensured that medication was administered as prescribed. EVIDENCE: Two care files were sample during the course of this inspection. One was for a person recently admitted to the home, the other was for a person who had been living in the home for some months. The person recently admitted to the home did not have a care plan in place. This individual had been in the home for a little over a month. The manager stated she had not had time to draw up the care plan. When the individual was admitted the manager had written an overview of his needs for staff and this was quite detailed. It included the tasks that the individual would need help DS0000062346.V373014.R01.S.doc Version 5.2 Page 12 with and what he was able to do. This overview had been removed from the file that staff accessed on a daily basis meaning there was no information available to them. It was strongly recommended that any written overviews remained with daily files until care plans were drawn up. The manager was very aware that a care plan should have been in place after the period of the time the individual had been living in the home. The person who had lived at the home for some months did have a care plan. This was very well detailed and included details of all the individual’s needs and how they were to be met by staff. There were also details of what the individual was able to do without help and of their preferences, likes and dislikes. The file also showed that short term care plans were put in place when the need arose, for example, for a health concern. However the manager needed to remember when short term care plans were finished with to remove them from the working file. No risk assessments were seen for the most recent admission to the home. The manager stated she had done these but they were on the computer. It was pointed out that risk assessments must be accessible to staff to ensure they have all the required information to manage any identified risks. However it was evident from the records that staff were aware of some of the risks for the individual and these had been followed up appropriately. For example, when an ongoing injection was to be administered and for the person being under weight. The G.P. had visited about this and spoken to the dietician. The G.P. had informed the manager of the home that the individual had not lost weight recently. The staff were keeping quite well detailed food records for this person. There were risk assessments in place for the other individual. These were comprehensive and covered all the necessary areas including, nutrition, tissue viability, manual handling and general risks. Where necessary the care plan referred to the corresponding risk assessment. For example, this individual had a specific food allergy, this was detailed in the care plan with a corresponding risk assessment in place. There was a very good falls risk assessment in place and as the home did not have a hoist at the time it detailed how to assist the individual should they fall and not be injured. At the time of the last inspection an issue was raised about developing the care plans in place for diabetes. The individual this concerned was in hospital at the time. However the manager had explored this issue. She had spoken to all the G.P.s involved with the people living in the home who had diabetes and had found out what their normal blood sugar levels should be. She had also found out that as they were all diet or tablet controlled she did not have to check their blood sugar levels as they had been. There was evidence in the daily records that the personal care needs of the people living in the home were being met. Staff were identifying health care DS0000062346.V373014.R01.S.doc Version 5.2 Page 13 needs and there was evidence of these being followed up and monitored. The manager was clearly following up issues with doctors, for example, the frequency of ongoing injections. The people living in the home had access to G.P.s, district nurses, chiropodists, opticians, dentists and so on. People were being weighed where they agreed to this although the frequency varied. The weight charts in place stated to weigh weekly. The manager stated they should be weighed weekly but staff did forget or if someone refused a bath or shower, which is when they would normally be weighed, this was not always being done. Medicine management in the home was generally good and the improvements noted at the last inspection had been sustained. One relatively minor issue was raised where the amount of painkillers remaining in the home did not correspond with the amount that had been received by the home and what had been administered. All medication was acknowledged when it was received by the home, risk assessments were in pace where necessary and copies of prescriptions were available. The manager was completing audits on the medication system but stated this had not been done as frequently recently due to staff shortages. No issues were raised by the people living in the home during the course of the inspection in relation to their privacy and dignity. The interactions between staff and the people living in the home were very friendly and generally respectful. Staff assisted individuals with personal care needs sensitively. Consultation with health care professionals generally took place in the privacy of individuals’ bedrooms. However when we were there flu injections were being given by a visiting doctor in the lounge not in peoples’ bedrooms or another private area. People were able to lock their bedroom doors if they wished and if they wanted private time during the day in their bedrooms this was not seen as an issue. At the time of the last inspection it was noted that there was not a lock on two of the toilet doors and this needed to be addressed to ensure privacy could be maintained. One of these had been missing for a considerable amount of time. At the time of this inspection only one of these had been addressed. DS0000062346.V373014.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were no rigid rules or routines in the home and the people living there were able to spend their time as they chose. There were activities on offer however the staffing levels sometimes impacted on these being carried out. The people living in the home were able to maintain contact with families and friends. The meals in the home were good and choices or alternatives were available at all meals. EVIDENCE: No rigid rules or routines were observed during the course of the inspection. Despite being busy the home had a relaxed atmosphere and all the people living there that were seen were quite content. People were seen to wander freely around the home, spend time in their bedrooms, sitting chatting to each other or visitors, reading, watching television and listening to music. No organised activities were seen during the course of the inspection. There was an activity programme in the home that was facilitated by the staff. This was displayed on the wall in the dining area and had not changed since the last inspection in August. It included such things as bingo, board games, DS0000062346.V373014.R01.S.doc Version 5.2 Page 15 cards, skittles, video and pop corn afternoons and sing songs. The people living in the home that were spoken with stated they were quite happy and no one appeared to get bored. The home had outside entertainers quite regularly and had recently had a Halloween party which everyone seemed to have enjoyed. Trips outside the home were occasionally arranged however the most recent one to the theatre had to be cancelled due to staff shortages. Staff were recording in daily records what the people living in the home were doing with their time and whether they were taking part in activities or not. Several visitors were seen to come and go from the home during the inspection and all were made welcome. Daily records showed that visitors were able to go to the home at all times. Two visitors were spoken with and they were very positive in the comments about the home which included: ‘Happy with care and running of the home.’ ‘Staff go out of their way to help.’ ‘The standard of care is good residents are well looked after.’ As at the last inspection staff encouraged the people living in the home to make choices wherever possible, for example, in how to spend their time, when to go to bed and get up, what to eat and what to wear. The care plans for the people living in the home detailed where they were able to make choices for themselves. All the bedrooms were personalised to the occupants choosing and some individuals continued to handle some of their own finances. The home had a four weekly rotating menu which was on display in the dining area. There was also a list of alternatives to the main menu on the dining tables. The people living in the home that were spoken with were satisfied with the food served to them. Comments included ‘nice food’, ‘have what I want’ and ‘plenty to eat.’ The likes, dislikes, preferences and special diets were detailed on individuals care plans. Menus were discussed with the people living in the home at meetings with them and they were also part of the satisfaction surveys that were issued to the people living in the home. Records of the food being served to the people living in the home were the same as at the last inspection. These had some indication of the amounts eaten. The records for breakfast were pre printed sheets which detailed the known preferences of the people living in the home however it also showed that where people wanted something different this was given. It was recommended at the last inspection that food records included evidence at all meals that medical diets were being catered for, for example, diabetics. This had not been addressed. DS0000062346.V373014.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was an appropriate complaints procedure and all the people living in the home or their representatives received a copy. The staff recruitment procedures had improved and ensured the people living in the home were safeguarded. All staff needed to have training in adult protection issues to ensure they responded appropriately should they witness or suspect any form of abuse. EVIDENCE: The complaints and adult protection procedures were not viewed at this inspection as they have been seen at previous inspections. It was known that the people living in the home received a copy of the complaints procedure in the service user guide. However as stated previously the details for the Commission in the service user guide had not been updated. There had been no complaints logged at the home since the last inspection. Some concerns had been raised with us by a health care professional when visiting the home about staffing levels and staff working excessive hours. These issues were looked into and explored with the manager of the home. It appeared that on occasions staffing levels fell to only two care staff being on duty which would not fully meet the needs of the people living in the home particularly in relation to activities. Staffing is explored further in the staffing section of this report. DS0000062346.V373014.R01.S.doc Version 5.2 Page 17 There had been no adult protection issues at the home since the last inspection. The manager of the home has shown in the past that she is fully aware of her obligations to report any issues that may arise in the home. The training matrix for the home indicated that several of the staff had not received any training in adult protection issues. This must be addressed to ensure staff are aware of how to respond to any suspicion or event of abuse. DS0000062346.V373014.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in the home were comfortable and stated they were satisfied with the environment. The home owners needed to be more proactive in addressing the repairs needed around the home to ensure they were completed in a timely manner. EVIDENCE: There had been no changes to the layout of the home since the last inspection. The people living in the home that were spoken with were comfortable and stated they satisfied with the environment. An issue was raised at the last inspection that some of the people living in the home wanted their bedroom doors open at night. It was recommended that where this was the case door stops that release when the fire alarm is activated were installed. The door stops had been purchased at the time of this DS0000062346.V373014.R01.S.doc Version 5.2 Page 19 inspection but had not been installed. One had been fitted on the kitchen door so that the door could be left open. Also at the time of the last inspection it was noted that there were several items of furniture being stored very close to the fire exit on the first floor. Although these did not block the exit it limited the space in the area. At the time of this inspection this had been addressed. During the tour of the building at this inspection it was noted that several doors were not fitting into their rebates properly and some intumescent strips were coming loose. These issues mean the doors will not stop smoke entering the rooms should there be a fire. On the day of the inspection the owner of the home was spoken to about these issues and advised they must be addressed. He later informed us he had arranged for the problems to be rectified the week after the inspection. He was advised we would follow this up and if not addressed we would inform the local fire officer of the breach. Prior to the publication of this report we were informed that the issues with the fire doors had been addressed. There were some minor repairs around the home that needed to be addressed, for example, broken fridge door handle, knobs missing off furniture, curtains hanging down, the carpet on the stairs was loose and a leaking toilet. We were informed that all these had been reported to the owners of the home. The owners needed to be more proactive when staff reported repairs and ensure they were addressed in a timely manner. The communal areas of the home were generally well furnished and decorated. As at the time of the last inspection some of the corridors on the ground floor were in need of repainting and the carpet was quite dirty in parts. Also the carpet in the corridor outside the kitchen was very worn. The garden was very well maintained and there was a ramped exit from the home however the lawned area would be difficult for anyone with mobility difficulties to access and as at the last inspection it was strongly recommended that the possibility of a ramp be explored. There had been no changes to bathing and toilet facilities at the home. The people living in the home usually had a choice of having either a bath or a shower and both facilities allowed for staff assistance. However at the time of this inspection the bath hoist was broken and in need of repair as did the control to fill the bath. Due to this all the people living in the home were having to use the shower. There were some aids and adaptations throughout the home and these appeared to meet the needs of the people resident at the time and included, shaft lift, hand and grab rails, assisted bathing facilities and an emergency call system. Stair gates had been installed to further safe guard the people living in the home. At the time of the last inspection it was recommended that the owner of the home purchased a free standing hoist. We were told this was on order at the time of the inspection and due to be delivered the following week. DS0000062346.V373014.R01.S.doc Version 5.2 Page 20 Several bedrooms were seen during the inspection. The majority were adequately furnished and decorated however there were at least two that were in need of decoration. It was also noted that one of the empty bedrooms had very dirty carpet and this needed to be replaced before the room was occupied. The home was clean and generally odour free with appropriate systems in place for the disposal of clinical waste. Liquid soap and disposable towels were available in all communal facilities and staff had access to protective clothing when necessary. The home had a mechanical commode pot washer for effective cleaning of commode pots and several new commodes had been purchased. The kitchen was clean and tidy. DS0000062346.V373014.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. At times the staffing levels were not adequate enough to ensure all the needs of the people living in the home could be met. It could not be evidenced that staff had received all the appropriate training to enable them to care for the people living in the home. Staff recruitment procedures had improved and ensured the people living in the home were safeguarded. EVIDENCE: The staffing rotas for three consecutive weeks were sampled during the inspection. These indicated that generally there were three care staff throughout the waking day and two night staff. Over the three week period there were four shifts when there only two care staff on duty. Even though the home had five empty beds at the time two care staff would only have been able to meet the basic needs of the people living in the home. Staffing levels need to be maintained at a level that ensures all the needs of the people living in the home can be met including their social needs. As at the last inspection it was noted that that the manager was still being put on the rota to undertake care shifts and cooking when the cook was not on duty. This was happening on an ongoing basis and involved the manager working very long hours and not having any days off. They owners of the home must ensure the manager is not rostered to cover care and cooking DS0000062346.V373014.R01.S.doc Version 5.2 Page 22 duties on an ongoing basis and that this only happens in the case of any emergencies. Throughout the course of the inspection it was clear there were good relationships between the people living in the home and the staff team. The individuals and visitors spoken with stated ‘staff are doing an excellent job’ and ‘staff are very friendly and helpful’. At the time of the last inspection one of the owners had taken over the staff recruitment in the home and it was found to be very poor and did not safeguard the people living in the home. Following the last inspection we received an improvement plan from the owner. On this he acknowledged that he had not followed recruitment procedures as he was trying to recruit staff quickly. He is now very aware of his obligations to ensure staff recruited are appropriately checked to ensure the people living in the home are not put at risk. The shortfalls in the staff recruitment documentation noted at the last inspection had been addressed for the staff that were still employed at the home. The home were in the process of recruiting further staff, one was due to start the week of the inspection. The recruitment documentation for this individual was checked. There was a completed application form and two written references on site and although the POVA first check was not on site a copy was seen on the computer. It was noted that one of the references was not dated. It was strongly recommended that all references were checked to ensure they were dated. No new staff had commenced working at the home since the last inspection therefore it was not possible to check the induction training. The requirement for this made following the last inspection has been brought forward to this report. The manager had drawn up a training matrix since the last inspection. However she had not had time to enter the dates when training had been undertaken by the staff. During the course of the inspection she was able to indicate on the matrix what training she thought staff had had without having to go through all the records. The matrix did indicate some shortfalls in the training staff needed to ensure they could work safely with the people living in the home including, manual handling, food hygiene, health and safety, first aid and adult protection. These shortfalls needed to be addressed. The matrix indicated the home employed fifteen staff and six of these had NVQ level 2 which is a little below the required 50 . DS0000062346.V373014.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager was ensuring the smooth running of the home in a competent manner at the time of the inspection. To ensure the home continues to be run in the best interests of the people living there the future management arrangements need to be notified to the Commission. The home needed a yearly development plan based on seeking the views of the people living there with a view to continuously improving the service. EVIDENCE: The manager of the home had worked there for a considerable amount of time and had a very good knowledge of the needs of the people living in the home. DS0000062346.V373014.R01.S.doc Version 5.2 Page 24 At the time of this inspection the manager was clearly extremely tired and had not had a day off for a considerable amount of time. There were still some unresolved issues between the manager and the owners of the home including staff training and rotas. We had been notified that the manager was leaving the home a short time after the inspection. The owner had told us he was advertising for a new manager and in the interim one of the existing staff would be covering the post. This will mean that there will be a shortfall on the care rota that will need to be covered. The owner must inform us of the management arrangements for the home and how any shortfalls this creates on the rota will be covered. There were some quality monitoring systems in the home, for example, satisfaction surveys for the people living in the home, staff, relatives and health care professionals. The satisfaction surveys for the people living in the home covered areas such as daily living, food, personal care and the premises. The results from the last lot of these had been drawn together by the manager. The outcomes were mainly positive but did raise some issues that had been discussed at a meeting with the people living in the home, for example, people asking for additional snacks and some issues raised about the seating arrangements at meal times. Staff surveys had raised issues about the lack of training, the need for moving and handling equipment and the repairs around the home. The manager had raised all these with the owner. The manager also had fairly regular meetings with the people living in the home where a variety of topics were discussed, for example, changes to the activities programme, any concerns and forthcoming events. At the time of the last inspection the manager had started to produce a newsletter for the home keeping all those concerned up to date with what was happening in the home. Staff meetings were also held and in house health and safety checks which all contribute to monitoring the quality of the service offered. As at the last inspection all the information from surveys, meetings, audits and so on needed to be collated to produce a yearly development plan for the home to show how they intended to improve the service offered. The home was managing some small amounts of money on behalf of the people living in the home. The records for this were sampled at the inspection in August 2008 and all found to be appropriate. Income and expenditure were clearly detailed and receipts were available for any money spent on behalf of the people living in the home. All the balances of money held in the home that were checked were correct. Records were not sampled during this inspection but the manager has consistently demonstrated the system in place is robust and safeguards the people living in the home. It was noted during the course of the inspection that a cupboard where records were stored that included personal information did not have a lock on it. Also the cupboard used to store staff records was left open for prolonged periods of time when there was no one in the office. All records that are stored in the DS0000062346.V373014.R01.S.doc Version 5.2 Page 25 home should be stored in accordance with data protection legislation to ensure the privacy of the people concerned. Staff at the home had received some training in safe working practices however the dates for this could not be verified and some shortfalls had been noted on the training matrix. The in house checks on the fire system had not been done for three weeks which is very unusual for this home. This appears to have happened as the person who would normally do this had been on leave. Fire drills were undertaken every six months as required. Some issues were raised about poorly fitting fire doors during this inspection. The owner told us this was to be addressed and this will be monitored by us. After the last inspection the owner of the home notified us of the contract and certificate numbers for the servicing of the fire alarm and the gas equipment. Evidence of these should be kept at the home so that we are able to check when doing inspections. The recording and reporting of accidents and incidents in the home were appropriate. DS0000062346.V373014.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 2 3 X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 DS0000062346.V373014.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes. 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 OP7 Regulation 13(4)(c) Requirement The risk assessments for the people living in the home must be accessible to staff at all times. This will ensure the staff are able to manage any risks and the people living in the home are safeguarded. All the staff working at the home must receive training in adult protection issues. Timescale for action 01/12/08 2. OP18 13(6) 01/02/09 3. OP19 23(2)(b) This will ensure staff can respond appropriately to any issues and that the people living in the home are safeguarded. 01/12/08 The registered provider must ensure that any repairs needed around the home are addressed in a timely manner. This will ensure the people living in the home are not put at risk and that the home is kept to an acceptable standard. The registered provider must ensure that: Staffing levels are maintained at DS0000062346.V373014.R01.S.doc 4. OP27 18(1)(a) 01/12/08 Version 5.2 Page 28 a level that ensures all the needs of the people living in the home can be met. The manager is not included on the rota to cover care and cooking on an ongoing basis. This will ensure the needs of the people living in the home can be fully met. There must be evidence on site that staff have undertaken appropriate induction training in the home. This will ensure staff have all the required skills and knowledge to care for the people living in the home. Not assessed at this inspection. The registered provider must ensure all staff have received training in: Manual handling. Basic food hygiene. Health and safety. First aid. and that the training is up to date. This will ensure that staff are suitably qualified and competent to care for the people living in the home. must inform us of the management arrangements for the home and how any shortfalls this creates on the rota will be covered. The registered provider must inform the Commission of the management arrangements for the home when the existing manager has left and how any shortfalls this creates on the rota will be covered. 5. OP30 18(1)(a) 01/02/09 6. OP30 18(1)(a) 28/02/09 7. OP31 9(1)(2) 01/12/08 DS0000062346.V373014.R01.S.doc Version 5.2 Page 29 This will ensure the home is being run in the best interests of the people living there. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP3 Good Practice Recommendations The service user guide for the home should be reviewed and updated to ensure it includes all the correct information for people wanting to move into the home. It is strongly recommended that a copy of the social workers assessment this is obtained as it would give the staff at the home more information about the individual’s history. Care plans should be drawn up within the first month of individuals moving into the home and in the interim any written overviews should remain with daily records. This will ensure staff have sufficient information to provide people with person centred care. Short term care plans should be removed from working files when they are no longer in use to ensure staff have only current information. It is recommended that the people living in the home are weighed weekly as detailed on the weight charts and any refusals are noted. This will ensure staff are able to identify any issues at an early stage. To ensure the privacy of the people living in the home it is strongly recommended that a lock is fitted to the toilet identified during the inspection. The social needs of the people living in the home should be considered when staffing rotas are drawn up. Food records should detail where medical diets are being catered for. This will ensure the home is meeting the dietary needs of the people living there. It is recommended that where the people living in the home want their bedroom doors left open at night door stops that release when the fire alarm is activated are installed. This will ensure people can be cared for as they wish without them being put at risk. All areas of the home must be kept reasonably decorated. DS0000062346.V373014.R01.S.doc Version 5.2 Page 30 3. OP7 4. 5. OP7 OP8 6. 7. 8. 9. OP10 OP12 OP15 OP19 10. OP20 11. OP20 12. OP21 13. OP22 14. OP28 15. 16. OP30 OP33 17. 18. OP37 OP38 Carpets must be cleaned as required and replaced if necessary. This will ensure the home is kept to an acceptable standard for the people living there. It is strongly recommended that the possibility of having a ramp installed to give easy access to the lawned area of the garden be explored. This would enable those with mobility difficulties to access the entire garden. The bath hoist and the control to fill the bath should be repaired. This will ensure the people living in the home have a choice of having either a bath or a shower and that there are adequate facilities available. The provider should consider purchasing a mobile hoist or he must ensure that people who need this equipment are not accommodated at the home. This will ensure the handling needs of the people living in the home can be met at all times. 50 of care staff should be qualified to NVQ level 2 or the equivalent. This will ensure staff have all the required knowledge and skills to care for the people living in the home. It is recommended that the staff training matrix includes details of all the training staff have taken part in and the dates and when it is due to be updated. The manager should collate all the information from surveys, meetings, audits and so on to produce a yearly development plan for the home to show how they intended to improve the service offered. All records in the home that include personal information should be kept securely. This will ensure the home complies with data protection legislation. Evidence that the equipment in the home has been serviced should be kept on site. This will ensure the documentation can be checked on inspections and evidence that equipment is being serviced as required. DS0000062346.V373014.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 DS0000062346.V373014.R01.S.doc Version 5.2 Page 32 - 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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