Inspection on 09/01/07 for The Gables

This inspection was carried out on 9th January 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Gables 15/12/08

The Gables 19/12/07

The Gables 05/09/05

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 Jane Jewell Key Unannounced Inspection 9th & 10th January 2007 01:00 The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Gables Address 22 Beacon Close Crowborough East Sussex TN6 1DX 01892 655260 01892 660154 pete.langley@yahoo.co.uk www.eastsussex.gov.uk/socialcare East Sussex County Council 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) Peter Langley 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.V325587.R01.S.doc Version 5.2 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 5th September 2005 Brief Description of the Service: The Gables was established in 1991 and is registered to provide residential care for up to five younger adults who have a learning disability. Currently all residents are over the age of 45 years. The home provides long term placements with day care provision provided in the main by the home. The building is owned and maintained by Kelsey Housing Association with the services and staffing supplied by East Sussex County Council Social Services Department. East Sussex County Council Social Services also operate nine further services in the local area in this way. There are close links between the Gables and some of the other homes in the group. The home is a large bungalow situated in a small residential cul-de-sac. The home has a large vehicle, and public transport links are available from the town centre, a short walk away. Residents’ accommodation is provided in five single rooms with one providing ensuite facilities. Communal space consists of a large combined lounge dining room overlooking a garden and patio. There are a number of individual aids and adaptations to the building to assist in the mobility of one resident. The homes literature states that it aims to provide residential service and care support for adults with learning disabilities promoting independence and enabling access to community facilities. Residents contribution towards the fees are currently £62.35 to £94.45 per week, depending on the services and facilities provided. Extras such as: hairdressing, chiropody, transport, toiletries are at an additional cost. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information contained in this report has been comprised from an unannounced inspection undertaken over 7½ hours across two days and information gathered about the home. This includes: residents and relatives survey questionnaires, discussion with stakeholders involved in residents’ care and records submitted to the Commission for Social Care inspection (CSCI) including a Pre-inspection questionnaire. The inspection was facilitated in part by Peter Langley (Registered manager) Lyn Humprey (Resource Officer) and Diane Woodgate (Senior Care officer). It involved a tour of the premises, observations, examination of records and discussion with residents and staff. There were four residents living at the home at the time of the inspection. The focus of the inspection was to look at the experiences of life at the home for people living there. During this summary and report the people who live at the home will be referred to as residents (except in the requirements section), and the people who work at the home as staff or by their job title. In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection reports. The Inspector would like to thank the residents, staff and management for their assistance and hospitality during the visit. What the service does well: Residents live in a comfortable environment, which is clean and reasonably well maintained. The needs of older people who have a learning disability are well catered for by the home. Residents benefit from a well supervised, experienced and enthusiastic staff team that know their needs and who have worked at the home for a number of years. Comments about staff included: “great”; “are kind to me”; “treat him with the utmost care and attention” and “very helpful and cheerful”. Residents are given support in order to have active social and leisure experiences. Integral to the ethos of the home is ensuring and respecting residents’ rights to make decisions about their daily lives. Residents are supported to maintain relationships with their families. Comments made by relatives included: “I can tell by his contact which tells me he is more than happy couldn’t get a better home” and “excellent care seems to get pretty well what he wants within reason” The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 6 The meals are good offering both choice and variety and catering for individual preferences and dietary needs. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 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.V325587.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents would be provided with information about the home although further information should be included in the home’s documents to accurately reflect the range of services provided. Residents’ needs and aspirations are able to be met at the home. Prospective residents would benefit from an admission process that ensures their individual needs and aspirations are assessed prior to moving into the home. EVIDENCE: There is information available about the home, to inform current and prospective residents about the services and facilities, this includes a combined statement of purpose and service user guide. It was previously required that the statement of purpose be updated to include changes in staff and management. Although this had been undertaken these documents still do not include all of the information necessary to inform current and prospective residents about the home. This is with particular reference to the terms and conditions of residency, which much be included into these documents. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 9 It is recommended that the home separate the statement of purpose and service users guide and further develop the service user guide into a format that residents at the home will be able to use. There have not been any new admissions to the home for a number of years. Therefore, this standard could only be assessed in respect of the admission procedure for prospective residents. Any referrals are firstly made to the Resource Officer via an assessment team, who then discuss any suitable referrals with the manager. A social care needs assessment would be completed in order to inform any decisions on whether needs could be met at the home. The Resource Officer said that the admission criteria used takes into account age and compatibility with other residents. It was discussed that the manager should be central to the admission process in order to ensure that their knowledge of staff skills and facilities are incorporated into the assessment process. The manager said that prospective residents would be encouraged to visit the home prior to admission, along with any placing care manager, family or representative. The type and length of visits would depend upon the individual need. Residents who live at the home have done so for a significant number of years and have a wide range of needs including complex physical needs and visual impairment. There is sufficient evidence to confirm that the home is able to meet most needs of residents. However, residents would benefit further from improvements to the care planning system to ensure that all of their needs are identified. This is further identified under standard 6. Staff did demonstrate a clear knowledge and understanding of the needs of each resident and also how those needs are consistently met. All relatives consulted spoke positively about the home, a sample of their comments includes: “I can tell by his contact which tells me he is more than happy couldn’t get a better home” and “excellent care seems to get pretty well what he wants within reason” Residents are aged between 46yrs and 82yrs with services and facilities designed accordingly. The CSCI is currently discussing with the responsible individual the need to change the homes registration categories to accurately reflect this age range of residents. A Licence agreement is available to inform residents and their representatives of their rights and responsibilities whilst staying at the home. This contract is made in conjunction with the East Sussex County Council and Kelsey Housing Association and is in a pictorial format for ease of understanding. However it could not be ascertained that residents had these licence agreements or their contents discussed with them. It was identified that the licence agreement did not accurately reflect the range of additional costs and the total fees payable. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 8 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from support plans which detail information about how to support them safely and appropriately, but would benefit further through their regular review and update. Services are designed to provide appropriate care and support in ways, which maximise independence and choice for residents. The home balances the rights of residents to take reasonable risks against any unacceptable risk to themselves or others. EVIDENCE: Each resident has a comprehensive care plan, which includes background information, communication details, daily routines and personal care support. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 11 Although these provide clear guidance for staff on how to support residents needs, several examples were noted whereby not all of their needs had been identified. There was also little reference to individual goals and aspirations of residents. The standard of daily recording was good with a clear account of actions and events that had occurred, these were written in a style that was respectful and non judgmental. Residents named workers (Keyworkers) are responsible for the review of care plans and the frequency of which varied according to the keyworker. This resulted in some changes in residents needs not being recorded and appropriate guidance provided for staff on how to support those changes. Staff consulted with had worked at the home for a number of years and demonstrated a good understanding of residents’ needs along with any recent changes. However in order to ensure consistent support for residents it is necessary that care plans identify the range of residents’ needs and be reviewed frequently and recorded as having been reviewed. The home has a developed system in place for enabling residents to take responsible risks towards achieving an enhanced lifestyle and where their rights or freedom are limited to ensure their health and safety. Written risk assessments are used to record any risks faced or posed by residents and these identify the control measures needed to help manage or reduce risks. A consistent approach to the regular review of risk assessments is needed to ensure that any changes in risks are promptly identified and any control measure put into place. Staff were able to describe a variety of ways in which they support residents to make decisions about their daily lives who are not able to verbally express their opinions and choices. This included observation of resident’s body language and their reactions to situations. Staff were observed offering choices about food, drinks and activities and their choice was respected. Residents participate in the day to day running of the home in accordance with the range of their strengths and tolerances. For example some residents help to clean their bedrooms once a week and assist in the food shopping. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ lives are enriched by the home providing various opportunities for occupation and leisure and by residents being supported to make decisions about their daily routines. Resident’s benefit by being supported to maintain relationships with their families. The meals are good offering both choice and variety and catering for individual preferences and dietary needs. EVIDENCE: Day care provision is in the main provided by the home and is leisure based. There is a planned programme of activities and events for the week with much flexibility shown depending upon residents’ preferences at the time. Individual activity programmes included: swimming, train rides, church, bowling, aromatherapy, theatre, cinema, sensory and foot spars. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 13 A resident said that he liked staying at home and his favourite occupation was going out for coffee and cakes with staff. The home also has a range of equipment suitable for in-house entertainment, including games, sensory and audio equipment. On the evening of the inspection a regular musical entertainer was visiting which was clearly enjoyed by all of those who attended. Staff spoke of teaming up with other units for some small group outings. Staff consulted with said that very few activities are cancelled due to staffing difficulties but some are limited, as there is not always a male member of staff on duty to go swimming with residents. It was discussed that consideration should be given to this when recruiting new staff. It was previously recommended that the home record where activities are offered to residents, but are declined. Although there is a document to record this, it was not being regularly completed. At the weekend very few outside activities are arranged, staff consulted with said that this was due to lower weekend staffing levels. The manager was aware of this and said that additional staff had been rostered on a Sunday, but due to leave this had not always been adhered to. Staff felt that most residents now needed two staff members on most activities outside of the home, due to decreased mobility. Much use is made of local shops, cafes and the facilities of Crowborough town centre. One staff member said that many of the local facilities are too far for most of the residents to now walk and that having a vehicle suitable for wheelchairs was invaluable. They reported that the vast majority of regular and relief staff are designated drivers. Care plans describe the significant others for each resident and where there is family contact staff support residents to maintain regular contact. This involves weekly visits to parents, phone calls and regular visits from relatives. A relative said that they “felt able to pop in at any time and were always made to feel very welcome”. Where residents do not have any next of kin the manager reported that they have tried to obtain advocates for them but without success. Observation of the daily routines suggests staff accommodate residents’ personal wishes with regard to meal times, going to bed, rising and bathing. During the inspection residents were observed to move around the home freely, choosing which rooms to be in and what level of company they wanted to enjoy. Residents were able to choose when to spend time on their own, and can do so in their own bedrooms. There is a varied traditional menu, offering appetising and nutritious meals. A resident said that the “food is great”. Staff reported that the menus are based on the known likes and dislikes of residents. The meal served at inspection looked appetising with resident’s individual preferences catered for. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 20 and 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive flexible, consistent, dignified and sensitive support to meet their personal, emotional and health care needs and are protected by the systems in place to manage medication. EVIDENCE: Staff were observed providing dignified and sensitive support in a relaxed and friendly manner. The allocation of named workers for each resident (keyworker) helps to support the consistency and continuity of the care and support provided. Staff were very knowledgeable about the individual personal care needs of each residents. As previously stated this knowledge needs to be underpinned by care plans, which record the full range of residents’ needs and provide the guidance for staff on how to meet them. Residents are assisted in choosing their own clothes, hairstyles and to ensure this reflects their individual personalities. Personal care information was displayed in a resident’s bedroom, which was not conducive to promoting their privacy. A staff member said that this was to The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 15 inform relief staff of the residents needs. It was discussed that this information should be included in the care plan. A staff member decided to remove the notice. There was documentary evidence that residents are supported to access a range of health services, to meet their individual needs. This included: opticians, dentists, chiropodists and community health care teams. Residents are registered with local GP’s with prompt medical intervention being sought for any concerns. The medication practices at the home enable a clear audit trail of medication entering the home, being administered or being disposed of. As a matter of good practice, it is however recommended that in order to fully eliminate the associated risk when copying prescribed instructions onto medication administration records (MAR), that hand written MAR charts be checked and countersigned for accuracy by a second member of staff. Written guidance is available on the safe handling and storage of medication. This should include the arrangements for the management of homely remedies /over the counter medicines to ensure their safe administration. Staff explained the current practices for the administration of over the counter medicines, which is based on the agreement with the residents GP. This agreement or any instructions from the GP could not be located. The manager agreed to clarify this. Staff consulted with showed a good understanding of the needs of older people and of age appropriate activities. The manager said that one staff member had recently attended training on aging and that they were planning for more staff to attend. Staff spoke of the support they had received in the past from health care professionals, during the care of a resident who was receiving palliative care. Staff spoke sensitively about the care and support they provided to a resident when they became terminally ill and to the other residents following a recent death at the home. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives felt able to raise any concerns about the service. Residents are largely protected by the home’s practices but further safeguards need to be put into place to reduce the risk of harm or abuse. EVIDENCE: There is a complaints procedure, however this could not be located at inspection. The Resource Officer reported that the copy displayed had recently been taken down during redecoration and could not now be found. It could therefore not be ascertained whether the complaints procedure is in a format suitable for residents to be able to follow. It was discussed with the Resource Officer that the complaints procedure needs to be made available again and should be in a format suitable for residents to follow. The Manager stated in information submitted both before and during the inspection, that there have not been any complaints about the service in the last twelve months. A resident said they “would tell any staff if I was unhappy”. Relatives consulted with said that they all felt able to raise any concerns with staff. Staff demonstrated some understanding of their responsibilities under adult protection guidelines but were not always aware of whom to report suspected concerns to. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 17 Not all staff have undergone training in adult protection guidelines and this has been required to ensure that they are fully aware of the role and responsibilities under adult protection guidelines. Recruitment records are not held at the home, therefore it could not be ascertained that staff have undergone Criminal Records Bureau (CRB) checks in order to safeguard residents. There are policies and procedures on the management of challenging behaviour designed to guide staff on the appropriate techniques in order to safeguard residents. The manager holds the personal finances for all residents, there was a transparent system for the handling of residents money. The system had an easy audit trail from receiving benefit monies to cash transactions. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 26 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. Residents live in a comfortable environment, which is clean and reasonably well maintained, however residents would further benefit from improvements to the overall décor, furniture and a review of the current storage of equipment. Residents have the specialist equipment they require to maximise their independence. EVIDENCE: The maintenance of the building is undertaken by Kelsey Housing Association. The manager said that they were satisfied with the response from Kelsey in the event of urgent maintenance and repairs. There is a maintenance plan in place for 2005 to 2007, which covers basic areas of maintenance but which did not include redecoration. Staff are currently undertaking the redecoration of the home. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 19 To date this includes residents’ bedrooms and some communal areas, with further communal areas in need of an upgrade. Where redecoration had occurred this had been done to a good standard with residents involved in the choosing of the paint for their bedrooms. It was previously required that repairs be made to a down pipe and drain area. The Resource Officer said that this had now been completed to a satisfactory standard. Much effort is made by staff to try and create a homely environment, however the lack of storage space for files, laundry and equipment mean that these are stored in the entrance hall and corridor. This not only creates a potential risk to residents but also does not promote a homely environment. The manager has been required to undertake a risk assessment of these areas to ensure residents’ safety. This is with particular reference to those residents with visual impairment. Two members of staff consulted with said that the worst bit about their job was the environment and the lack of resources to be able to improve it. Communal space consists of a large combined lounge dining room, which is spacious and enables a wheelchair user to use this space with ease. The style and age of the settees in the lounge meant that not all residents could easily use them. A staff member said that the furniture was particularly restrictive for one resident. It has been required that the home provide suitable furniture as is appropriate for the needs of residents. It was discussed with the manager that it is advisable to seek the advice of an occupational therapist to determine what type of furniture would be suitable. There is a garden area that surrounds the premises, which has a patio area and a flowerbed, making this an attractive and accessible area for all residents to enjoy. Staff are currently in the process of cutting back trees in the front garden to allow for more parking. Residents’ bedrooms are highly individualised reflecting their tastes and preferences. One resident had chosen to move into a vacant room and spoke of how much he liked his new room and that he had chosen all of the new furniture and fittings. No locks are provided on resident’s bedroom doors. Staff said that this decision is based on individual risk assessments regarding resident’s safety. There are sufficient number of toilets and bathing facilities located around the building. 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 residents. All areas of the home were observed to be clean with a high standard of hygiene maintained. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 34 35 and 36 Quality in this outcome area is adequate . This judgement has been made using available evidence including a visit to this service. Residents benefit from a well supervised, experienced and enthusiastic staff team that know their needs and who have worked at the home for a number of years. However, improvements to the homes recruitment practices and in the management of training would increase resident’s safety. EVIDENCE: It was observed throughout the inspection that staff understood their roles and had good planning skills. The tasks of the day were organised at handover and the individual staff appeared confident in carrying them out. Staff had a clear understanding of the purpose of the service and how their role contributed to the achievement of this. In information submitted to the CSCI as part of the inspection process, the manager stated that currently two out of eight staff members have completed National Vocational Qualifications (NVQ) to at least NVQ Level 2. To increase the number of staff trained to NVQ level the manager said that further staff are to commence this training shortly. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 21 Staff consulted with spoke respectfully and professionally regarding residents and demonstrated much commitment towards the home and enthusiasm towards supporting residents. Residents’ comments about staff included: “great” “are kind to me”. A sample of comments made by relatives regarding staff includes: “Staff wonderful so friendly its like having another family its lovely to know that he has his own family at the home”: “treat him with the utmost care and attention” and “very helpful and cheerful”. It was previously required that the home reviews the number of staff on each shift. Staff said that additional staff were rostered at the weekend in accordance with the needs of residents at the time. Staff consulted with said that they felt the current weekday staffing levels enabled them to meet resident’s individual needs. The resource manager stated that staffing levels would be reviewed upon the admission of a fourth resident. Nighttime staffing is provided by sleep in staff with additional cover provided by an on call system located at a nearby home. Relief staff are used regularly to cover shifts, the manager said that the same relief staff are used, where possible, in order to promote continuity. The staff team currently does not reflect the gender composition of residents, following the recent departure of male staff. A staff member said that some activities have to be limited as there is not always a male member of staff to assist with swimming. This needs to be taken into consideration when recruiting new staff. There is a core group of staff who have worked at the home for a number of years and who have considerable experience of supporting people who have learning disabilities. However, the staffs’ knowledge of residents must be underpinned by improved management of training to ensure that staff have undertaken the mandatory and specialist training needed to work safely with residents. This includes training in manual handling, first aid, fire safety, food hygiene and health and safety. The manager is currently developing a training and development plan in order to improve the overall management of training. The manager reported that the recruitment of staff is undertaken centrally, with Resource Officers taking primary responsibility for this task. The importance of the manager being involved in this process was stressed. Recruitment files are held outside of the home and it was therefore not possible for these to be inspected on this occasion. It has previously been agreed between the Provider and the CSCI that this was acceptable, providing there is evidence in the home that correct procedures have been followed. This information was not available for inspection and therefore it could not be ascertained that residents are being safeguarded by the homes recruitment practices. Staff said that they receive regular supervision with the manager regarding their performance and conduct. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 38 39 and 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The manager ensures the ethos and values of the home enable staff to provide good quality care to residents. However, improvements in way the manager is enabled to manage and in the home self-assessment of its services would benefit residents further. A range of regular health and safety checks helps to ensure the health and safety of residents and staff. Resident’s safety must be further supported by the risk assessment of the storage arrangements around the home. EVIDENCE: The manager became the registered manager of the home in May 2006 and holds a management qualification. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 23 They also have many years experience in working with adults with learning disabilities. All persons consulted spoke positively about the manager, a sample of comments included: “Pete is really nice, laid back easy going” “No problem pleasant easy to chat to” and “very nice, very approachable”. Staff consulted said that they felt well supported by the manager. It was discussed with the manager that external constraints placed on them by the organisations procedures often appear to inhibit their ability to fully meet their legal requirements as the registered manager. This is with particular reference to the manager having little control in policies and procedures, budgets, expenditure, maintenance, recruitment and admissions to the home. This issue needs to be addressed in order for the manager to be able to meet all of the areas of shortfall noted at this inspection. Relationships between residents, staff and the manager were observed to be friendly and informal and the general atmosphere of the home was relaxed and open. A sense of the homes aims and objectives are reflected in the homes policies and procedures and through the manager working directly with residents and staff. There are some mechanisms in place for the manager to obtain feedback on the services of the home and whether it is achieving its aims and objectives. These include: Residents yearly satisfaction surveys and six monthly reviews of resident’s placements. A monitoring record had been developed to record the level of activities being offered and undertaken by residents, but this was not being regularly completed. The registered provider currently does not carry out the required monthly-unannounced visit to the home. This is in line with their legal obligations for an employee who is not directly involved with the home to report on the conduct of the home. The current system is for the manager to complete a monthly quality audit, which is then signed by the resource officer, this therefore does not provide an impartial assessment on the conduct of the home. Improved management of procedures to self-monitor the services and facilities would ensure that residents who do not use verbal communication as their main method of communication are actively involved in feedback about the quality of the services they receive. Written guidance is available for staff on issues related to health and safety. Records submitted by the manager prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment had been undertaken. As previously noted it has been required that the entrance hall and corridors, currently used as storage areas, be risk assessed to ensure that these areas are safe for use. The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 3 27 3 28 2 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 3 2 x x 3 x The Gables DS0000063870.V325587.R01.S.doc Version 5.2 Page 25 YES 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 YA1 Regulation 4. Sch 1. Requirement The home provides an up to date and accurate statement of purpose (Made at inspection 5/9/05 with timescales of 10/10/05 not met) That the Terms and Conditions of residency is agreed with each service user or their representative, which includes the range of additional fees to be paid and the total fee payable and a copy maintained at the home That care plans provide clear guidance for staff on all aspects of the health, personal and social care needs of service users and which make explicit the actions needed to meet these needs and which are reviewed regularly. That service users individual risk assessments are reviewed frequently and recorded as having been reviewed. That staff undergo training in adult protection and a record of attendance maintained. That a plan of re-decoration and repair be developed, which addresses the al areas DS0000063870.V325587.R01.S.doc Timescale for action 30/03/07 2 YA5 5(1)(bb) & (bc) 30/04/07 3 YA6 15(1) 30/04/07 4 YA9 13(4)(c) 30/03/07 5 6 YA23 YA24 13(6) 23(2)(d) 30/04/07 30/04/07 The Gables Version 5.2 Page 26 7 8 YA28 YA34 23(2)(n) 19 & Sch 2 9 10 YA35 YA39 18(1) 26 redecoration and includes timescales for their completion. That furniture provided by the home is suitable for the need of residents. The information about staff, as listed in Schedules 2 (as amended) & 4 to be available at the home for inspection at all times. That staff are appropriately trained to undertake their roles. That monthly visits by the Registered Individual are in accordance with the National Minimum Standard. That the entrance hall and corridors are risk assessed to ensure that these areas are safe for use. 30/04/07 30/04/07 30/05/07 30/03/07 11 YA42 13(4)(c) 28/02/07 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 3 4 5 Refer to Standard YA2 YA6 YA11 YA20 YA20 Good Practice Recommendations That the home provides a service users guide in a format that service users who are admitted to the home will be able to use. That care plans include clearly identifiable goals and aspirations the targets leading to their achievement. The home records where activities are offered to service users, but are declined. (first made at inspection 5/9/05) That hand written medication administration records be checked and countersigned for accuracy by a second member of staff. That the medication procedures include the arrangements for the management and use of homely remedies or over the counter medication and an approved list of such medication is available. DS0000063870.V325587.R01.S.doc Version 5.2 Page 27 The Gables Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 DS0000063870.V325587.R01.S.doc Version 5.2 Page 28 - 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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