Inspection on 05/09/05 for The Gables

This inspection was carried out on 5th September 2005.

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

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

Other inspections for this house

The Gables 15/12/08

The Gables 19/12/07

The Gables 09/01/07

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

CARE HOME ADULTS 18-65 The Gables 22 Beacon Close Crowborough East Sussex TN6 1DX Lead Inspector Jon Wheeler Announced Inspection 5th September 2005 14:55 The Gables DS0000063870.V249342.R01.S.doc Version 5.0 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 DS0000063870.V249342.R01.S.doc Version 5.0 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 DS0000063870.V249342.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Gables Address 22 Beacon Close Crowborough East Sussex TN6 1DX 01892 655260 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) East Sussex County Council Vacant Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5) of places The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The maximum number of service users to be accommodated is five (5). The home provides placement for three service users aged between eighteen (18) and sixty-five (65) years. The home provides placement for two (2) named service users who are over sixty-five (65) years of age. Service users must be aged between thirty (30) and sixty-five (65) years on admission. Service users with a learning disability only to be accommodated. Date of last inspection 7 April 2005 Brief Description of the Service: The Gables is registered to provide residential care to five adults. Service users have learning disabilities with additional and for some, complex needs. Whilst the home is registered for younger adults, the people accommodated at The Gables are now beginning to fall within the older people category. The home is a large bungalow situated in a small residential cul-de-sac in Crowborough. The home has a large vehicle, and public transport links are available from the town centre, a short walk away. Service user accommodation is provided in five single rooms. There is a large lounge/dining areas overlooking a large garden and patio. There is a large bathroom which has a ceiling hoist from one bedroom; and a smaller bathroom. Staff are employed by East Sussex County Council Social Services Department, and are responsible for the day to day care of the service users. The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place on 5 September 2005, starting at 2.50pm and lasting for three and a half hours. The inspection involved a tour of the premises, talking to the manager and three care staff, reading care plans, records and checking medication and the management of service users money. Due to their learning disabilities, not all the service users were able to clearly express their views, although three service users were spoken with. Staff were observed working with service users. What the service does well: What has improved since the last inspection? The service has worked hard to provide a wider range of activities to service users, to meet their needs and preferences. Care plans and risks assessments had been updated to reflect changes in needs and support required. The service has updated the fire risk assessments to provide accurate information and guidelines. There has been some maintenance work with replacement lino in the kitchen and a sink top in a bathroom. The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 7 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 DS0000063870.V249342.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Whilst there were comprehensive policies and procedures for admission of new service users, there was not up to date information available to provide comprehensive information about the services provided. The home is able to identify and meet the needs of the service users. Each service user has a contract identifying their rights and responsibilities within the home. EVIDENCE: The organisation had reviewed the statement of purpose and service user guides, which included detailed information about the range of services provided in the home. However, at the time of the inspection, the document was not up to date due to the recent change of manager and staff. It was reported that the organisation was in the process of updating the statement of purpose to ensure it included the details of recent staff and management changes. The home has not had any new admissions for a number of years. However, the manager was able to describe the admissions process, including a comprehensive pre-admissions assessments and the opportunity for prospective service users to visit the home prior to choosing if to move in. The home has a clear policy to ensure an effective pre-admissions process. There was a wide range of evidence that the home is able to meet the needs of the service users. Staff were able to demonstrate a clear knowledge and understanding of the needs of each service user and also how those needs are The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 9 consistently met. Two of the service users spoken with said that they were happy in the home and that they were able to do the things they liked doing, including activities in the home and in the community. There was clear documentation of the needs of the service users and how those needs should be met. Each service user has a contract outlining their rights, responsibilities and terms and conditions of living in the home. The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Care plans clearly identify the needs, preferences and support required for each service user. Service users are supported to make decisions, where possible, in all aspects of their lives. Service users are protected by a range of risk assessments. EVIDENCE: Each service user has a comprehensive care plan, which included background information, communication details, daily routines and personal care support. There was evidence that the care plans had been reviewed with clear indication where the needs of the service users had changed and how the staff team should support those changes. However, not all documents and changes of information in the plan had been dated and signed. Staff were observed supporting service users to make decisions in all aspects of their lives, where they are able to do so. Two service users said they were able to choose their activities. Service users were observed being asked what they wanted to eat and drink. Staff were able to describe a variety of ways they use observation of body language and reactions of service users who are not able to clearly express their opinions and choices. There were risk assessments where service user’s rights or freedom were limited to ensure The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 11 their health and safety. The risk assessments viewed had been recently reviewed and in some cases updated to reflect the support needed to meet any changing needs. The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Service users are generally supported to access a range of activities, in the home and in the community. Service users are supported to maintain relationships with their families and friends and are given respect and dignity in their daily lives. The service provides a varied menu, which meets the individual preferences and dietary needs of the service users. EVIDENCE: Service users are supported to undertake a range of activities, which generally reflect their needs, preferences and age. Whilst there was documentary evidence of service users attending some activities, the service had not recorded where service users had been offered an activity, but declined. One service user generally chooses not to go out from the home, but whilst staff confirmed he was regularly offered the opportunity to go out, it was not recorded when he refused or chose to stay in. Two of the service users said they were able to choose what activities they did. At the time of the inspection, one service user returned from a trip out to Eastbourne, where he had had a drink and watched a band playing. Service users do a range of therapeutic, vocational and leisure activities include music The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 13 sessions, going to cafes, the theatre, bowling, sensory room sessions, going to church and shopping. Activities occur in the home and using facilities in the local community and other towns. Service users are supported to maintain relationships with their families and friends. Feedback from families stated that they are very happy with the care provided to their relatives in the home. Families said that the staff are approachable and supportive. Staff were observed providing dignified and sensitive support in a relaxed and friendly manner. Staff were aware of the rights and choices of service users and were observed offering choices and support in a variety of ways, to meet the individual needs of the service users. Service users are able to choose when to spend time on their own, and can do so in their own bedrooms. One service user said he often chooses to spend time in his bedroom watching TV or listening to music, rather than go out and do other activities. There is a varied menu, offering appetising and nutritious meals. Staff were able to describe the dietary requirements of each of the service users and how those needs are met. Two of the service users said that the food is nice and they are able to choose what to eat. The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21. Service users receive dignified and sensitive support to meet their personal, emotional and health needs. There are robust systems for the storage, administration and recording of medication, to protect the service users. Staff are sensitive to, and are able to meet, the changing needs of the service users. EVIDENCE: Staff were observed providing sensitive care to meet the personal needs of the service users. They were observed asking service users, in a sensitive and dignified way, their opinions on all aspects of their care including their personal support needs, their food and drinks and activities. One staff member clearly described the food on a plate, given to a service user who is visually impaired, so he knew what he was about to eat. There was documentary evidence that service users are supported to access a range of health services, to meet their individual needs. They are all registered with a local GP, and are able to access specialist support from the local community health team. There was documentary evidence of service users having regular dental and optician check-ups. The home has a clear medication administration policy and all staff who dispense medication have received training. All medication was stored securely The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 15 and had been dispensed and recorded accurately, in line with the home’s policy and procedure. Staff were aware of the changing needs of the service users, and were able to describe how those needs are met. There was documentary evidence of service users accessing generally more sedate or leisurely activities as they age. Two of the service users spoken with said they now preferred to do more leisurely activities and one said he liked to spend more time in his bedroom watching television or listening to his music. The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. An effective complaints procedure and appropriate adult protection policies and training for staff protect the rights and interests of the service users. EVIDENCE: There is a complaints policy and procedure for the home. Families were aware of the procedure and felt able to complain, but were happy with the service. No complaints had been received in the home recently. Two of the service users said they felt able to complain, or raise anything concerning them. All staff had completed adult protection training. Staff spoken with were able to describe how they would raise any concerns about the protection and wellbeing of service users. Service users’ money is kept securely in separate tins, with all income and expenditure accurately recorded. The money is checked every day to ensure its accuracy. The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. The home offers a comfortable and homely environment, which is reasonably well maintained. Service user bedrooms and communal areas are comfortable and meet their individual needs. The home was clean, tidy and hygienic. EVIDENCE: There was evidence of a clean, hygienic and tidy environment, which was generally in good decorative order. There was evidence of some on-going maintenance work, with the lino on the kitchen floor and a sink top in a bathroom having been replaced. Service users bedrooms are individually decorated and personalised to reflect individual tastes, needs and preferences. One service user said he was happy with his bedroom and liked to spend time in it watching television or listening to his music. One service user has a ceiling hoist in his bedroom, which runs on tracking to the bathroom, whilst still providing privacy to him and to other users of the bathroom. There is a large bathroom with an adapted bath and shower facility. There is also a smaller bathroom used by some of the service users who do not require adaptations or specialist support. There is sufficient communal space with a large lounge/dining area, which looks out on to a secluded and tidy garden. There is a large kitchen, where The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 18 some service users are supported, where possible, to make their own drinks and snacks. There is a range of specialist adaptations in the home, included an adapted bath, ceiling and mobile hoists and adapted beds to meet the needs of the individual service users. Whilst the garden was generally well-maintained, there was a large hole to the side of the building. There was evidence that the service had made attempts to arrange for the hole to be repaired. In addition, the down pipe to the drain was broken and was causing damp to the outside wall of a service user’s bedroom. It is required that repairs are made as a matter of urgency to ensure the health, safety and welfare of service users and staff. The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 36. An enthusiastic, knowledgeable and skilled staff team provide good quality care to understand and meet the needs of the service users. Good supervision and support enable staff to provide consistent and caring support. EVIDENCE: Staff were able to describe in detail their roles and responsibilities and those of their colleagues. The staff confirmed that they had all been issued with a contract of employment. There have been several new staff in the team. All staff spoken with said that there was a positive atmosphere in the team and new members said they had been well-supported to fit in and work well with their colleagues. The service users spoken with said that the staff were all caring and worked hard to help them meet their needs. Staff were enthusiastic and positive about their roles and the care provided to the service users. Staff rotas indicated that there are generally three or four staff on weekday shifts. However, at weekends, there may be only two staff on duty, which limits the opportunities for service users to access activities outside the home. There was documentary evidence that on some weekend shifts there were no permanent staff on duty, although it is recognised that the relief staff are skilled and experienced. The issues of sufficient staff on each shift were discussed with the manager and the organisation’s resource officer, and it was required that staffing levels be reviewed to enable service users to access activities at the weekends and ensure their needs are met. The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 20 The organisation has worked hard to ensure that all employment records are up to date and accurate, and ensure references and criminal records bureau checks are taken prior to the worker commencing employment. The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42. The manager ensures a clear ethos and values of the home enable staff to provide good quality care to the service users. Service users rights and choices are promoted by monitoring systems, policies and records within the home. A range of regular health and safety checks ensure the health and welfare of the service users and staff. EVIDENCE: The home has a new manager, who previously managed another service in the group. He is in the process of submitting an application to register with the Commission. Staff and service users described the manager as approachable and supportive. He was able to describe his induction period and demonstrated a sound knowledge of the needs of the service users. Staff reported that there was now a relaxed and friendly atmosphere in the home and were able to describe a clear ethos and values of the service, based on promoting the rights, choices and independence of the service users. Staff were positive The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 22 about their roles and the about the way they could effectively support the service users. Service users and carers reported that they felt their views were listened to. Two service users said they were encouraged by staff to raise issues and concerns and to say how they wanted their care and service provided. There was evidence of regular review of the needs and preferences of the service users. Where service users were not able to clearly express their views or choices, there was evidence of staff using their knowledge and experience to try to provide care and support in the way they think the individual service users would prefer. There was documentary evidence of a range of policies, procedures and records held by the home, being up to date and accurate. Staff were able to describe how a sample of policies worked in practice and demonstrated a sound knowledge of their application and effectiveness. There was documentary evidence of a range of regular health and safety checks, including recent checks of the fire safety equipment, an update of the fire evacuation plans and checks to the environment and equipment in the home. The Gables DS0000063870.V249342.R01.S.doc Version 5.0 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 2 3 X 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Gables Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 3 X DS0000063870.V249342.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard YA 1 YA 33 YA 24 Regulation 4. Sch 1. 18 (1) (a) 13 (4) Requirement The home provides an up to date and accurate statement of purpose. The home reviews the number of staff on each shift. Repairs are made to the down pipe and hole in the drain area. Timescale for action 10/10/05 05/09/05 10/10/05 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 YA 6 YA 11 Good Practice Recommendations All documents and changes in the care plans are signed and dated. The home records where activities are offered to service users, but are declined. 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