Inspection on 08/02/06 for The Gables

This inspection was carried out on 8th February 2006.

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 22/08/07

The Gables 23/08/06

The Gables 30/08/05

The Gables 17/11/04

The Gables 14/07/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE The Gables Highfield Road Middlesbrough TS4 2PE Lead Inspector Jackie Herring Unannounced Inspection 8th February 2006 09:30 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 DS0000000122.V266327.R01.S.doc Version 5.1 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 DS0000000122.V266327.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Gables Address Highfield Road Middlesbrough TS4 2PE 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) 01642 515345 01642 515346 T L Care Ltd Mrs Carol Marie Singleton Care Home 64 Category(ies) of Dementia (32), Old age, not falling within any registration, with number other category (32) of places The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th August 2005 Brief Description of the Service: The Gables is a 64-bedded care home, which is a two-storey purpose built property. The Gables provides personal care for older people and also for older people with dementia. The care is provided within four dedicated units on both floors within the home. All 64 bedrooms are single rooms with ensuite facilities. It has an enclosed garden to the rear of the home. The home has been operating since September 1999 and is operated by TL Care Ltd who operate a further four care homes within the Tees Valley area. The Gables is situated near to Middlesbrough Town Centre with close access to public transport, shops and a public house/hotel. The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over two inspection days, inspection hours in total. The manager was on annual leave on both of the inspection days, however the operations manager was available for feedback at the end of the process. Resident’s records were examined along with the medication procedures and resident’s personal allowance records. Residents were involved in discussions about life at The Gables and there was informal discussion with staff. Feedback was given to the Operations Manager in the absence of the manager and there was some very constructive discussion in which a continued commitment to improvement at The Gables was very evident. What the service does well: What has improved since the last inspection? There have been a number of improvements since the last inspection with the bathroom facilities on the EMI units now being much more accessible due to the installation of more specialist equipment. Improvements have been made to the environment including ongoing decoration of the home, access to the staff smoking, which has now been made safe, and ventilation to this area. The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 6 The manager has implemented some quality assurance measures and good progress has been made and any areas identified for improvement have been addressed. 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 DS0000000122.V266327.R01.S.doc Version 5.1 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 DS0000000122.V266327.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Whilst individual assessments are completed prior to any new resident being admitted into The Gables, the documentation did not contain the sufficient detail to demonstrate that individual resident’s needs could be met by the home. EVIDENCE: Six sets of resident’s records were examined during the inspection and all contained copies of the care management assessment that contained a good level of information of need. Key members of staff from The Gables had also carried out a pre-admission assessment, however these had been completed to differing standards. A number of them contained some detailed information and summarised the individual resident’s care needs however, in others these had been completed as a tick box assessment with no supporting information. The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 The assessment and care plans need some additional detail, which sets out fully resident’s health, personal and social care needs and how these needs are to be met. Whilst the medication systems are in the main robust, the policies and procedures are in need of updating and some additional records need to be in place to support this. EVIDENCE: Six sets of resident’s records were examined and assessments of need and care plans were in place. Some of the assessments were rather scant in detail and did not describe the specific personal need or how this affected the individual. The care plans in place were of a pre written generic nature and in the main had not been individualised and did not contain the information required in regard to meeting care needs. In one of the files examined, the resident had quite complex needs and neither the assessment of need or care plans clearly demonstrated these needs and how to meet them. It was also unclear if there was a great deal of understanding of how the resident’s medical conditions effected her, this particularly related to the resident’s night time routine. The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 10 It was also unclear how up to date personal care records were in respect of bathing and showering, as it looked liked these were rather infrequent for some residents. It was good to see in one of the resident’s files that additional information about their mental health condition had been downloaded from the Internet and supported the written care plan; this would be useful for some of the resident health care needs. Resident’s who were spoken to said, “It’s lovely here, I am well looked after”. Relatives who were talked to informally during the inspection were also pleased with how their loved one’s were being cared for. Another residents said, “I do feel the staff try their best to understand my needs to the best of their ability, they obtain some large handled cutlery for me and I find I can manage much better”. A number of relative survey were received and contained the following comments, “All the staff I have had contact with are very friendly, caring and approachable. Very satisfied of the care my father is receiving”, “We are please with the way mam has settled into the home and with the care she receives”, “Staff are always very helpful and I feel confident that Mum is being cared for very well”. Medication systems were discussed with one of the team leaders who clearly had a very good level of knowledge of the ordering, recording and storage systems. Storage of mediation was appropriate and the records for administering medication contained no gaps and the supporting information about medication administration was detailed and informative. The policy and procedures for administration and ordering were not available for examination, of the procedures that were available, they needed to reviewed and updated. It was also identified that there was the need to include procedures for manager of medication for residents who go out of the home for extended periods. The system for recording what medications have been ordered and what has been received needed some additional development to include quantity received. The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14, 15 Residents are supported where possible to make decision and have a level of control over their lives, however there is the need to increase opportunities for more recreation and activities. Whilst residents are extremely satisfied with the main cooked meals at The Gables, improvements could be made to the presentation of snack type meals and puddings. EVIDENCE: During discussion with resident they spoke of being able to make their own decisions and have a level of control over their individual lives. One resident said, “It’s like home from home, feel like I have my freedom, can go out if I want, can have baths and showers when I want and I am aware of the choices I can have at mealtimes”. During discussion with residents and relatives, it was identified that there continued to be the need to increase and improve on the activities within the home. This was also demonstrated within the a number of relative surveys which stated, “I thinks more could be done in trying to find an interest for the residents. Days are very long when you are just left to sit in a chair”, “More stimulation/activities for residents including outings would be beneficial”. The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 12 Whilst resident’s in the main spoke very highly about the meals provided at The Gables and said, “really good meals here, you get well fed, decent meals like you would get at home”, there was some comments about the presentation of sandwiches, which although there was a choice were presented in a non attractive manner, such as four quarters of sandwiches flat on a plate covered in cling film with no garnish. There were also comments about how some of the puddings/desserts were served, with them being plated or dished up in the kitchen rather that served more freshly in the dining rooms. The Operations Manager agreed with the comments that were made and said this could be improved upon. The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were examined on this occasion. EVIDENCE: The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22 Resident live in a home that is generally clean, homely and comfortable, however additional work needs to be undertaken to improve the environment further. EVIDENCE: On the day of the inspection, the home was observed to be well decorated, clean and in the main well maintained. The carpet in the entrance of the home and the stairs was in need of cleaning or replacement. The actual care units were homely and comfortable. The situation of the services such as the laundry and kitchen did detract a little from the overall homeliness of The Gables. The bathrooms had been improved since the last inspection and the bathrooms on the EMI units now had specialist hoists in place to aid mobility and presented as being homely. The blue flooring to the shower rooms and some of the sealant to the flooring was in need of attention. The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 15 The staff room although not best situated in the home had now been made safe in terms of resident access and ventilation seemed to have improved, although this should continue to be monitored. The door to the staff room was in need of attention, as it would not comply with fire regulations due to breaches in the door and the actual fitting of the door in which smoke could easily spread into the bedroom corridor in the event of a fire. The operations manager agreed to take steps to address these matter urgently. It was noted that there was an overflow area being used for storage of catering goods, this area did not appear very clean and did not seem appropriate for this type of use. It was agreed with the Operations Manager that this situation would be reviewed. During a tour of the home, it was noted that there were two smoking areas for use by residents. The smell of cigarette smoke was however very obvious on entry to the first floor unit and as such the ventilation to this room was inadequate. On the first day of the inspection, it was noted that there were fluctuating temperatures in the building. The ground floor was quite cool, whilst upstairs was really warm. Residents did comment about the heating and one lady in particular on the ground floor said she was frequently cold and could not alter the temperature of the room to suit her own needs. The operations manager said that the heating in several of TL Care’s homes were currently being reviewed with a view to upgrading. There was general discussion about the layout of the home, which really can not be changed however it was agreed by the Operations Manager that this would be looked at with a view to improving what she could, such as taking hand written notices down from outside the laundry. The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30 Whilst training takes place the records do not support this and it could not fully be evidenced that staff were fully competent to do their jobs. EVIDENCE: During discussion with one of the team leaders and the administrator, it was confirmed that there had been a substantial reduction in the use of agency staff and it was confirmed that new permanent care workers had been appointed. The duty rota was looked at and confirmed that although some agency staff were used, this was far less than previous. It was also confirmed by the team leader that when agency staff were used, it was regular agency staff who knew the residents and to ensure consistency of care. Staff training records were made available for examination. The matrix that was looked at did not contain details that mandatory training was up to date and did not contain the information required in regard to induction and foundation training. The home administrator did say that all new employees were underway with their induction and would also be commencing the relevant National Vocational Training. On the second day of inspection, a new matrix had been developed on the computer and the administrator was in the process of updating all of the training records. The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 17 Training was also discussed with the Operation Manager who said that the required training had been taking place however she did acknowledge that there had been a problem with recording training and not having up to date copies of training certificates. She said that the company are in the process of reviewing the training programmes throughout with a view to contracting a dedicated training organiser. The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 38 Effective systems are generally in place to safeguard residents personal allowance. There is the potential for breaches of confidentiality around the nurse’s station. Policies and procedures are in need of review and updating to ensure health, safety and welfare of residents. EVIDENCE: During discussion, it was confirmed that the manager was in the process of completing NVQ Level 4 in care and had registered for the Registered Manager’s Award. A relative survey stated, “The manager is very approachable and understanding, they always contact me on any matters concerning my mum”. Through discussion with the Operations Manager, it was agreed that the policies and procedures of the home were in need of review and updating, and whilst she said that some steps had been taken in regard to this however there was still much to achieve. The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 19 Personal allowance records were examined and in the main contained the required information however there was the need to remember that two signatures was required. Quality assurance records were examined and a residents survey had been completed and it was clear that progress had been made since the last inspection. This should continue as should the other quality assurance arrangements within the home such as unit checks and care plan audits. The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 20 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 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 2 2 X X X 2 3 STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 3 X X 2 The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 21 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 OP3 Regulation 15 Timescale for action The pre admission assessment 01/05/06 must contain sufficient detail to demonstrate that individual residents needs can be met at The Gables. The assessment of need and 01/05/06 care plans must contain sufficient detail to clearly identify the needs and ability of the residents and to inform a plan of care to ensure clear interventions are in place to meet individual needs. The medication procedures must 01/04/06 be reviewed and updated. The door leading into the staff 13/02/06 smoking rooms must be repaired or replace. The entrance and main stairwell 01/05/06 carpet must be cleaned or replaced. The ventilation to the resident’s 01/05/06 smoking room on the first floor must be improved. The heating system must be working effectively and to the comfort of the residents. The additional storage area for DS0000000122.V266327.R01.S.doc Requirement 2. OP7 15 3. 4. 5. 6. OP9 OP19 OP20 OP25 3 23 23 23 7. OP38 16 13/02/06 Page 22 The Gables Version 5.1 8. OP38 12 overflow catering products must be reviewed, as this was not appropriate. Policies and procedures must be reviewed and updated. 01/06/06 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 OP12 Good Practice Recommendations The recreational and activities programmed continue to need further development and steps should be taken to ensure that residents are able to have an increase in these opportunities. The blue flooring in the shower rooms should be refurbished or replaced. Records should be available within home which details staff training, The door leading into the staff smoking rooms must be repaired or replace, which is up to date. The manager should continue to achieve NVQ Level 4 in Care and the Registered Manager’s Award. 2. 3. 4. OP21 OP30 OP32 The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Gables DS0000000122.V266327.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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