Inspection on 06/06/07 for The Gables

This inspection was carried out on 6th June 2007.

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

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

Other inspections for this house

The Gables 14/12/09

The Gables 05/07/09

The Gables 07/05/09

The Gables 02/11/07

The Gables 13/06/06

The Gables 19/12/05

The Gables 06/04/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Gables 1 East Park Street Chatteris Cambridgeshire PE16 6LA Lead Inspector Alan Buttery Key Unannounced Inspection 6th June 2007 10:00 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 The Gables DS0000063700.V343382.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. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address 1 East Park Street Chatteris Cambridgeshire PE16 6LA 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) 01354 693858 01354 696400 Stargate Partnership Ltd Mrs Elizabeth Salter Care Home 41 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (23), of places Physical disability over 65 years of age (1) The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th June 2006 Brief Description of the Service: The Gables is an old largely Georgian house in the centre of the small Cambridgeshire town of Chatteris, which has been updated and extended to provide accommodation for up to 41 older people. The accommodation is split over two floors. On the ground floor, there are bedrooms and communal areas, which provide secure accommodation for 17 older people with dementia, and on the first floor facilities for up to 24 older service users without dementia. There are bathroom and toilet facilities on both floors, and a large enclosed rear garden. On the day of the inspection the manager said that the fees ranged from £340 to £465.75. Copies of CSCI inspection reports are in the entrance hall. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, and looked at the key standards for older people. The manager of the service was available to assist the inspector with information and documentation required, and both during the inspection and subsequently, the views of staff members were gathered. During the inspection itself, a number of people who live at the Gables were spoken with, and their views are reflected within the report. What the service does well: What has improved since the last inspection? What they could do better: A number of areas requiring improvement were noted during the inspection, and these are reflected ion the requirements left at the end of this report. These include more attention on care planning, staff training and recruitment, management issues and health and safety concerns. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 6 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 DS0000063700.V343382.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. New documentation is being introduced which should ensure better information is available on people wishing to move into the home, and ensure their needs are identified and can be met. EVIDENCE: At the time of the inspection, and pending some planned changes to the categories of people living in the home, there were 6 vacancies. However a number of potential new admissions have been identified. The records for someone who had recently moved into the home were examined, and although a new form of assessment and care plan document has been introduced, some concerns were apparent which were discussed with the manager. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 9 The new documentation provides the facility to gather all the required information on any prospective new admission, but clearly has to be used appropriately by who ever is carrying out the assessment, to ensure that a full picture of the person considering a move to the home is available, and that the home are confident that their individual needs can be met. The assessments are generally completed by the manager or deputy manager. The homes Statement of Purpose and Service User guide are currently accurate, but the planned changes will require these to be revised to reflect the intended new arrangements. The service does not offer intermediate care. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 10 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): Standards 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. Although people living in the home are treated with dignity and respect, more detailed information and planning is needed to ensure all health and social care needs can be met. EVIDENCE: Previous inspection have identified shortcomings in Care planning in the home, and it was therefore encouraging to see the new documentation that has been introduced, and that the existing care plans are being reviewed more regularly. However, these care plans need to be completed for all people in the home, and used for the benefit of the people living there. An example of one of the new style of care plans was seen for someone who had moved into the home five days previously, and although assessment detail had been obtained, no care plans were in place, and staff helping support the person involved did not have the necessary information to carry out their tasks safely or appropriately. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 11 It was also felt that the care plans followed a very medical model, and although giving some scope to social and recreational aspects were not focussing on the outcomes sought for people living in the home, and there was little evidence of the involvement of the people receiving care and support. No one living in the home is able to manage medication for himself or herself, and therefore, senior staff working at the service assist in administering medication. With recent staff changes, the service should ensure that there is always an adequately trained staff member available to administer medication to the people living there. Staff were seen interacting well with people in the home, but the layout of the home can make staffing difficult, for example concerns have been raised with the CSCI regarding people with dementia sometimes left alone in the lounge area, and potentially at risk of assault from another person living there, which has been an issue in recent weeks. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 12 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): Standards 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. Activities and social events are arranged, but people living in the home do not have enough opportunity to choose what to do, especially those with dementia. EVIDENCE: The service continues to offer a range of activities to people living in the home, although many of these are more suited to people living upstairs, who are not suffering from dementia. However, a training course is underway for staff dealing with people suffering from dementia, which will hopefully highlight more areas, and activities that can be arranged. Within the individual plans, there is no evidence of the involvement of the people living in the home, or detail on how they choose to spend their time. The service has good links within the local community, and are planning various summer events, which include local people as well as families of people living in the home. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 13 Current redecoration work is affecting the people living upstairs, as their lounge and dining room are out of action, but the people spoken to were happy with the arrangements made, spending time with friends in each other’s rooms. People living in the home who were spoken with on the day of the inspection felt that the standard of food was good, with variety and choice available, although less favourable comments have also been received, and the service must therefore ensure that choice and variety is available at all mealtimes. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 14 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. Although complaints and concerns are listened to and acted on, insufficient training has been provided in Adult protection issues, leaving staff unsure how to deal with potential abuse EVIDENCE: Policies and procedures are in place to ensure that concerns are listened to and acted on, and the service has an adult protection policy in place in line with the local authority procedures. However, training for staff working in the home in adult protection matters is not up to standard, and the service must ensure that all staff receive training as part of their initial induction and on a regular basis thereafter. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 15 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): Standards 19 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Work currently underway will improve facilities for people living in the home. EVIDENCE: On the day of the inspection, builders were working in the home, making changes upstairs, in readiness of planned changes in the home. This made an assessment of the environment quite difficult, and will therefore be considered further at a later visit. However, discussions with the manager indicated that the change swill improve the environment. Recommended changes to the doors leading into and out of the lounge downstairs have not been made. At present the doors open into the room, and it was suggested windows would ensure that people were not behind the doors when opened and at risk of injury, and these changes should now be actioned. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 16 On the day of the inspection, the premises were clean and free from offensive smells, although the impact of building and decorating was noted. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 17 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): Standards 27, 28, 29 and 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Poor recruitment and training practices mean people living in the home may not be adequately or safely supported. EVIDENCE: At the present time, the manager confirmed that the home has a full complement of staff, and work with 6 carers on the morning shift, 4 in the afternoons, with an additional carer working during the evening. 3 staff work at night in the home. These levels are being reviewed in the light of possible changes. However, issues remain with the recruitment policies within the service, and training. Files were examined for three members of staff chosen at random, and it was again noted that the required procedures had not been followed, although two of the three files were for staff who commenced prior to the last random visit. Records must show that all staff undertake a rigorous selection process, and this must include an application form, two written and verified references, CRB and Pova first checks, details of the interview process including any gaps in employment. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 18 The documentation used in the home must also be re-considered, as for example, the application form doesn’t ask for a potential employees date of birth! The service is also failing to provide satisfactory training to staff. There is no standard induction training, and the required mandatory training is not being provided on a regular basis. There was some evidence that courses were arranged, but staff failed to attend, and their terms and conditions should make it clear that attendance of mandatory training is required of them. A course for staff working with people with dementia has been arranged, and is run by the Alzheimer’s society over a ten week period. However, this is being provided at one of the provider’s homes in Lincolnshire, which makes it more difficult for local staff to access. A number of senior members of staff have left the service recently, and the service must ensure that sufficient experienced staff are available at all times. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 19 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, 36 and 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Poor management and training deficiencies potentially leave people living and working in the home at risk of injury. EVIDENCE: Issues indicated earlier around recruitment and training question the management within this service, both in the service itself and in relation to the support given to the registered manager. While the level of care given is not in question, a number of deficiencies in record keeping have been identified at this and previous inspection, and requirements made are not being attended to in the timescales given The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 20 For example, care planning issues were identified in October 2006, but new Care plans were only introduced last month, and recruitment procedures are still not meeting the requirements of standards. At the present time, the staff working in the service, and the registered manager are not adequately supervised, and this must be addressed. For example a new member of staff who commenced work in November 2006 has received no formal supervision. Although Health and safety polices are in place, the mandatory training required is not in place, a number of staff have received no fire safety training for over a year, no moving and handling training has been provided or attended by staff who have worked in the home for six months or more (this was arranged while the inspection was in progress and two dates in June provided) In all other areas, training was patchy, and a detailed plan for the next three months must be produced. The manager conformed that there are no budgetary issues preventing training being provided. Money belonging to people living in the home is appropriately managed. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 21 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 X 1 The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1)(a) Requirement Detailed assessment information must form the basis any admission to ensure that people potentially moving to the home can be sure all their needs will be met. The individual care plans must show how people moving into or living in the home have been involved, and include all aspects of their care. A range activities and social events must be available to everyone living in the home People living in the home must be involved in decisions affecting their everyday lives. Regular training must be given to all staff to ensure people living in the home are protected from abuse, and staff are familiar with actions required if abuse is suspected. A review of staffing levels must be undertaken to ensure people living in the home are safely supported at all times. Recruitment procedures must follow the requirements of this DS0000063700.V343382.R01.S.doc Timescale for action 31/07/07 2. OP7 15(1) 31/07/07 3. 4. 5. OP12 OP14 OP18 16(2)(n) 16(2)(m) 13(6) 31/08/07 30/09/07 30/07/07 6. OP27 18(1)(a) 31/07/07 7. OP29 19(1)(b)(i ) 31/07/07 The Gables Version 5.2 Page 23 8. OP30 18C(i) 9. OP36 18(2) 10. OP38 13(6) regulation, and all necessary information be available to ensure the safety pf people living in the home. Staff must undertake training 31/07/07 appropriate to their role to ensure the people they support can be confident in their abilities. Appropriate supervision must be 31/08/07 provided to all staff to ensure they are able to undertake duties in a suitable manner Mandatory training must be 31/08/07 provided to all staff to ensure the health and safety of people living and working in the home 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 OP19 Good Practice Recommendations The doors into the lounge used by people with dementia should have windows to ensure staff and visitors are able to see service users behind the door when entering the lounge. The Gables DS0000063700.V343382.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 DS0000063700.V343382.R01.S.doc Version 5.2 Page 25 - 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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